Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
Dig Dis Sci. 2011 Feb;56(2):457-64. doi: 10.1007/s10620-010-1309-z. Epub 2010 Jul 16.
Helicobacter pylori can cause hypochlorhydria in some hosts and predispose to diarrheal infections.
We tested the hypothesis that chronic H. pylori infection increases the risk of diarrheal illness due to an acid-sensitive organism: enteropathogenic Escherichia coli (EPEC).
After testing healthy adult volunteers for H. pylori, 19 infected and 26 uninfected subjects had gastric pH probes placed and were given 5-10 × 10(9) EPEC organisms; six had previously received a proton pump inhibitor. We measured diarrhea and created a composite gastroenteritis severity score based on symptoms in the 48 h following exposure. Outcomes were compared using logistic regression and analysis of covariance.
More H. pylori-infected (36.8%) than H. pylori-uninfected subjects (7.7%) were hypochlorhydric (P = 0.02). Six (31.6%) H. pylori-infected and five H. pylori-uninfected subjects (19.2%) developed diarrhea (P = 0.34). Hypochlorhydria was a strong risk factor for diarrhea [odds ratio (OR) 6.25, confidence interval (CI): 1.29-30.35]. After adjusting for hypochlorhydria and EPEC dose, H. pylori was not associated with diarrhea (OR 0.89, CI: 0.17-4.58). Among those with symptoms, H. pylori-infected subjects had lower gastroenteritis severity score than did H. pylori-uninfected subjects (2.6, CI: 1.9-3.4 versus 1.5, CI: 1.1-1.9, P = 0.01), particularly if they were also hypochlorhydric (3.8, CI: 2.3-5.3 versus 1.9, CI: 1.3-2.5, P = 0.02).
In adults, H. pylori infection was associated with hypochlorhydria but had no detectable effect on occurrence of diarrhea. Among symptomatic subjects, H. pylori infection decreased severity of gastroenteritis.
幽门螺杆菌在某些宿主中可引起低胃酸分泌，并易引发腹泻感染。
我们检验了这样一个假说，即慢性幽门螺杆菌感染会增加因胃酸敏感病原体（如肠致病性大肠杆菌，EPEC）而导致腹泻病的风险。
在检测健康成年志愿者的幽门螺杆菌后，将 19 名感染患者和 26 名未感染患者的胃内 pH 探头放置，并给予 5-10×10(9)个 EPEC 菌；其中 6 名患者之前已接受质子泵抑制剂治疗。我们测量了腹泻，并根据暴露后 48 小时内的症状创建了一个综合胃肠炎严重程度评分。使用逻辑回归和协方差分析比较结果。
与未感染幽门螺杆菌的受试者（7.7%）相比，更多的幽门螺杆菌感染（36.8%）患者表现出低胃酸分泌（P=0.02）。6 名（31.6%）幽门螺杆菌感染患者和 5 名未感染幽门螺杆菌患者（19.2%）发生腹泻（P=0.34）。低胃酸分泌是腹泻的一个强烈危险因素[比值比（OR）6.25，置信区间（CI）：1.29-30.35]。在校正低胃酸分泌和 EPEC 剂量后，幽门螺杆菌与腹泻无关（OR 0.89，CI：0.17-4.58）。在出现症状的患者中，幽门螺杆菌感染患者的胃肠炎严重程度评分低于未感染幽门螺杆菌患者（2.6，CI：1.9-3.4 与 1.5，CI：1.1-1.9，P=0.01），特别是如果他们也有低胃酸分泌（3.8，CI：2.3-5.3 与 1.9，CI：1.3-2.5，P=0.02）。
在成年人中，幽门螺杆菌感染与低胃酸分泌相关，但与腹泻的发生无明显关联。在有症状的患者中，幽门螺杆菌感染降低了胃肠炎的严重程度。
