Iijima Katsunori, Koike Tomoyuki, Sekine Hitoshi, Abe Yasuhiko, Asanuma Kiyotaka, Ara Nobuyuki, Uno Kaname, Imatani Akira, Ohara Shuichi, Shimosegawa Tooru
Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
J Gastroenterol. 2009;44(1):47-55. doi: 10.1007/s00535-008-2270-x. Epub 2009 Jan 22.
We recently reported the expansion of the acid-secreting mucosa following Helicobacter pylori eradication with Congo red chromoendoscopy for a short-term follow-up of up to 7 months. We aimed to extend the observation period and to clarify the characteristic features of acid-secreting and non-acid-secreting mucosa.
In 24 H. pylori-positive patients with fundic atrophy, Congo red chromoendoscopy was performed prior to, 1 month, 7 months, and finally more than 2 years after the eradication. The areas of the acid-secreting mucosa were evaluated semiquantitatively. Two gastric biopsy specimens were taken from the acid-secreting and non-acid-secreting areas at the final chromoendoscopy and were subjected to histologic evaluation and immunohistochemistry for Ki-67 as a proliferation index.
After a gradual increase in acid-secreting areas for up to 7 months after eradication, they further increased in 79% subjects between 7 months and the final observation at a mean follow-up of 62 months. However, there still existed non-acid-secreting mucosa in the fundic area in all subjects, indicating that the expansion of acid-secreting mucosa remained partial. Compared with the neighboring acid-secreting area, the non-acid-secreting area was characterized histologically by higher degrees of residual inflammation, mucosal atrophy, and intestinal metaplasia, and by sustained hyperproliferation as well.
Functionally irreversible (non-acid-secreting) gastric mucosa after eradication was associated with extensive intestinal metaplasia and sustained hyperproliferation, suggesting that such mucosa still possesses malignant potential. Congo red chromoendoscopy may be useful for estimating the risk of subsequent development of gastric cancer following successful H. pylori eradication by determining the distribution of functionally irreversible mucosa.
我们最近报道了采用刚果红染色内镜检查法对幽门螺杆菌根除后胃酸分泌黏膜进行短期随访（长达7个月）的情况，发现胃酸分泌黏膜有所扩张。我们旨在延长观察期，并阐明胃酸分泌和非胃酸分泌黏膜的特征。
对24例幽门螺杆菌阳性的胃底萎缩患者，在根除治疗前、治疗后1个月、7个月以及最终超过2年后进行刚果红染色内镜检查。对胃酸分泌黏膜的面积进行半定量评估。在最后一次内镜检查时，从胃酸分泌和非胃酸分泌区域各取两份胃活检标本，进行组织学评估和Ki-67免疫组化检测，以作为增殖指数。
根除治疗后，胃酸分泌区域在7个月内逐渐增加，之后在79%的受试者中，从7个月到最终观察（平均随访62个月）期间进一步增加。然而，所有受试者的胃底区域仍存在非胃酸分泌黏膜，这表明胃酸分泌黏膜的扩张仍然是局部的。与相邻的胃酸分泌区域相比，非胃酸分泌区域在组织学上的特征是残留炎症、黏膜萎缩和肠化生程度更高，并且持续存在高增殖现象。
根除治疗后功能上不可逆（非胃酸分泌）的胃黏膜与广泛的肠化生和持续的高增殖有关，这表明这种黏膜仍具有恶性潜能。刚果红染色内镜检查可能有助于通过确定功能上不可逆黏膜的分布来评估幽门螺杆菌成功根除后胃癌后续发生的风险。
