Li Xiao Bo, Lu Hong, Chen Hui Min, Chen Xiao Yu, Ge Zhi Zheng
Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China.
J Dig Dis. 2008 Nov;9(4):208-12. doi: 10.1111/j.1751-2980.2008.00348.x.
The influence of the main pathogenic factors on remnant gastritis is still to be evaluated. The aim of this study was to investigate the role of bile reflux and Helicobacter pylori infection on endoscopic inflammation and histological changes of gastric remnant after distal gastrectomy.
A total of 281 patients with a more than 1-year history of distal gastrectomy were retrospectively involved after excluding those with tumors and ulcers on endoscopy. The severity of endoscopic remnant gastritis and bile reflux were recorded during the endoscopy. The histological changes including chronic inflammation, activity, atrophy, intestinal metaplasia and H. pylori were evaluated independently.
An endoscopic inflammation of remnant gastric mucosae was found in 81.1% (228/281) of the patients. The prevalence of H. pylori infection and bile reflux in patients with endoscopic remnant gastritis was more common than in those without gastritis (21.5%vs 0%, 88.6%vs 24.5%, P < 0.0001). The score of histological chronic inflammation was significantly higher in patients with bile reflux than in those without obvious bile reflux (1.65 vs 1.45, P = 0.02). Chronic inflammation (1.82 vs 1.57), activity (0.78 vs 0.34), atrophy (0.67 vs 0.41) and intestinal metaplasia (0.67 vs 0.27) in H. pylori-positive patients were all significantly more severe than in H. pylori-negative patients.
Bile reflux and H. pylori infection exacerbates the severity of endoscopic remnant gastritis and chronic histological inflammation.
主要致病因素对残胃炎的影响仍有待评估。本研究旨在探讨胆汁反流和幽门螺杆菌感染对远端胃切除术后胃残端内镜下炎症及组织学变化的作用。
回顾性纳入281例远端胃切除术后病史超过1年的患者，排除内镜检查发现有肿瘤和溃疡的患者。在内镜检查期间记录内镜下残胃炎和胆汁反流的严重程度。对包括慢性炎症、活动性、萎缩、肠化生和幽门螺杆菌在内的组织学变化进行独立评估。
81.1%（228/281）的患者存在胃残端黏膜内镜下炎症。内镜下残胃炎患者中幽门螺杆菌感染和胆汁反流的发生率高于无胃炎患者（21.5%对0%，88.6%对24.5%，P<0.0001）。胆汁反流患者的组织学慢性炎症评分显著高于无明显胆汁反流的患者（1.65对1.45，P=0.02）。幽门螺杆菌阳性患者的慢性炎症（1.82对1.57）、活动性（0.78对0.34）、萎缩（0.67对0.41）和肠化生（0.67对0.27）均明显比幽门螺杆菌阴性患者严重。
胆汁反流和幽门螺杆菌感染会加重内镜下残胃炎的严重程度及组织学慢性炎症。
