D'Amico G, Montalbano L, Traina M, Pisa R, Menozzi M, Spanò C, Pagliaro L
Divisione di Medicina, Università di Palermo, Italy.
Gastroenterology. 1990 Dec;99(6):1558-64. doi: 10.1016/0016-5085(90)90458-d.
In a prospective study of the natural history of congestive gastropathy, 212 consecutive cirrhotic patients (75 treated with sclerotherapy) were included. Mean follow-up was 46 months. Mild gastropathy (mosaiclike pattern) was found in 110 patients and severe gastropathy (granular mucosa with cherry spots) was found in 20. Prevalence of Helicobacter pylori, formerly Campylobacter pylori, was 50% in patients without, 43% in those with mild, and 28% in those with severe gastropathy. Congestive gastropathy was significantly more frequent in patients treated with sclerotherapy (83% vs. 50%, P less than 10(-5)). Sixty-month actuarial proportions of patients free of anemia (in the absence of hematemesis or melena), were 17% with severe, 62% with mild, and 93% without gastropathy (P less than 10(-8]. Corresponding figures for overt bleeding were 25%, 73%, and 87% (P less than 10(-7], whereas those for survival were 46%, 72%, and 85% (P = 0.0005), respectively. A multivariate regression analysis supported the following conclusions: (a) sclerotherapy and the presence of large esophageal varices significantly increase the risk of congestive gastropathy, which (b) is a significant risk indicator of both chronic and overt bleeding but does not independently affect survival.
在一项关于充血性胃病自然史的前瞻性研究中，纳入了212例连续的肝硬化患者（75例接受了硬化疗法治疗）。平均随访时间为46个月。110例患者发现有轻度胃病（马赛克样图案），20例发现有重度胃病（颗粒状黏膜伴樱桃红点）。幽门螺杆菌（原称幽门弯曲菌）的感染率在无胃病患者中为50%，轻度胃病患者中为43%，重度胃病患者中为28%。接受硬化疗法治疗的患者中充血性胃病明显更为常见（83%对50%，P<10⁻⁵）。无贫血（无呕血或黑便）患者的60个月精算比例，重度胃病患者为17%，轻度胃病患者为62%，无胃病患者为93%（P<10⁻⁸）。显性出血的相应数字分别为25%、73%和87%（P<10⁻⁷），而生存的相应数字分别为46%、72%和85%（P = 0.0005）。多变量回归分析支持以下结论：（a）硬化疗法和大的食管静脉曲张的存在显著增加充血性胃病的风险，（b）充血性胃病是慢性出血和显性出血的重要风险指标，但不独立影响生存。
