Grossi Laurino, Ciccaglione Antonio Francesco, Marzio Leonardo
Laurino Grossi, Antonio Francesco Ciccaglione, Leonardo Marzio, c/o Digestive Sciences Unit, School of Gastroenterology, G. d'Annunzio University Chieti-Pescara, Ospedale Spirito Santo, 65124 Pescara, Italy.
World J Gastrointest Pharmacol Ther. 2015 Nov 6;6(4):238-43. doi: 10.4292/wjgpt.v6.i4.238.
To analyze whether the presence of Helicobacter pylori (H. pylori) infection could affect the quality of symptoms in gastro-esophageal reflux disease (GERD) patients.
one hundred and forty-four consecutive patients referred to our Unit for suspected GERD were recruited for the study. All patients underwent esophageal pH-metric recording. For those with a positive test, C13 urea breath test was then performed to assess the H. pylori status. GERD patients were stratified according to the quality of their symptoms and classified as typical, if affected by heartburn and regurgitation, and atypical if complaining of chest pain, respiratory and ears, nose, and throat features. H. pylori-negative patients were also asked whether they had a previous diagnosis of H. pylori infection. If a positive response was given, on the basis of the time period after successful eradication, patients were considered as "eradicated" (E) if H. pylori eradication occurred more than six months earlier or "recently eradicated" if the therapy had been administered within the last six months. Patients without history of infection were identified as "negative" (N). χ (2) test was performed by combining the clinical aspects with the H. pylori status.
one hundred and twenty-nine of the 144 patients, including 44 H. pylori-positive and 85 H. pylori-negative (41 negative, 21 recently eradicated, 23 eradicated more than 6 mo before), were eligible for the analysis. No difference has been found between H. pylori status and either the number of reflux episodes (138 ± 23 vs 146 ± 36, respectively, P = 0.2, not significant) or the percentage of time with pH values < 4 (6.8 ± 1.2 vs 7.4 ± 2.1, respectively, P = 0.3, not significant). The distribution of symptoms was as follows: 13 typical (30%) and 31 atypical (70%) among the 44 H. pylori-positive cases; 44 typical (52%) and 41 atypical (48%) among the 85 H. pylori-negative cases, (P = 0.017 vs H. pylori+; OR = 2.55, 95%CI: 1.17-5.55). Furthermore, clinical signs in patients with recent H. pylori eradication were similar to those of H. pylori-positive (P = 0.49; OR = 1.46, 95%CI: 0.49-4.37); on the other hand, patients with ancient H. pylori eradication showed a clinical behavior similar to that of H. pylori-negative subjects (P = 0.13; OR = 0.89, 95%CI: 0.77-6.51) but different as compared to the H. pylori-positive group (P < 0.05; OR = 3.71, 95%CI: 0.83-16.47).
Atypical symptoms of GERD occur more frequently in H. pylori-positive patients than in H. pylori-negative subjects. In addition, atypical symptoms tend to decrease after H. pylori eradication.
分析幽门螺杆菌（H. pylori）感染是否会影响胃食管反流病（GERD）患者的症状特点。
本研究纳入了连续144例因疑似GERD前来我科就诊的患者。所有患者均接受了食管pH值监测。对于检测结果呈阳性的患者，随后进行碳-13尿素呼气试验以评估幽门螺杆菌感染状况。GERD患者根据症状特点进行分层，若出现烧心和反流症状则归类为典型症状患者，若主诉胸痛、呼吸及耳鼻喉相关症状则归类为非典型症状患者。幽门螺杆菌阴性的患者还被询问是否曾有过幽门螺杆菌感染的诊断。若回答为是，则根据成功根除幽门螺杆菌后的时间间隔，若幽门螺杆菌根除发生在六个月之前，则患者被视为“已根除”（E），若治疗在过去六个月内进行，则患者被视为“近期已根除”。无感染史的患者被确定为“阴性”（N）。通过将临床特征与幽门螺杆菌感染状况相结合进行χ²检验。
144例患者中的129例符合分析条件，其中包括44例幽门螺杆菌阳性患者和85例幽门螺杆菌阴性患者（41例阴性、21例近期已根除、23例六个月前已根除）。在幽门螺杆菌感染状况与反流发作次数（分别为138±23次和146±36次，P = 0.2，无统计学意义）或pH值<4的时间百分比（分别为6.8±1.2和7.4±2.1，P = 0.3，无统计学意义）之间未发现差异。症状分布如下：44例幽门螺杆菌阳性病例中，13例为典型症状（30%），31例为非典型症状（70%）；85例幽门螺杆菌阴性病例中，44例为典型症状（52%），41例为非典型症状（48%），（与幽门螺杆菌阳性组相比，P = 0.017；OR = 2.55，95%CI：1.17 - 5.55）。此外，近期根除幽门螺杆菌的患者的临床体征与幽门螺杆菌阳性患者相似（P = 0.49；OR = 1.46，95%CI：0.49 - 4.37）；另一方面，既往根除幽门螺杆菌的患者表现出与幽门螺杆菌阴性患者相似的临床特征（P = 0.13；OR = 0.89，95%CI：0.77 - 6.51），但与幽门螺杆菌阳性组相比存在差异（P < 0.05；OR = 3.71，95%CI：0.83 - 16.47）。
GERD的非典型症状在幽门螺杆菌阳性患者中比在幽门螺杆菌阴性患者中更频繁出现。此外，幽门螺杆菌根除后非典型症状倾向于减少。
