Chosun University College of Medicine Internal Medicine, Gwangju, Korea.
Helicobacter. 2017 Dec;22(6). doi: 10.1111/hel.12427. Epub 2017 Aug 18.
Aside from Helicobacter pylori, another cause for the development or worsening of gastrointestinal ulcers is scrub typhus, an acute febrile disease caused by Orientia tsutsugamushi. We aimed to compare the endoscopic characteristics of peptic ulcers caused by these infectious agents.
This retrospective case-control study involved patients who underwent upper gastrointestinal endoscopy at Chosun University Hospital in Korea. We compared endoscopic features and demographic characteristics between patients with H. pylori infection and those with O. tsutsugamushi infection.
A total of 141 patients with peptic ulcer were included in the study. Compared to patients with O. tsutsugamushi infection (n = 62; age, 63.8 ± 12.1 years; male sex, 42%), those with H. pylori infection (n = 79; age, 53.0 ± 14.8 years; male sex, 81%) were younger and more likely to be male (P < .001 for both). Patients with O. tsutsugamushi infection were more likely to have multiple lesions (40/62, 64.5% vs 37/79, 46.8%; P = .042) and irregular-shaped lesions (27/62, 43.6% vs 20/79, 25.3%; P = .031). Patients with H. pylori infection had higher incidence of hemorrhagic ulcers (26/79, 32.9% vs 8/62, 12.9%; P = .007), and lesions occurred most often in the duodenum (43.0%), followed by the antrum (36.7%), body (34.2%), and angle (12.7%) of the stomach. In patients with O. tsutsugamushi infection, lesions occurred most often in the antrum (70.97%), followed by the duodenum (35.5%), body (22.6%), and angle (14.5%) of the stomach. In both groups, gastric ulcer lesions occurred most often in the antrum, followed by the body and angle of the stomach (36.7% vs 70.97%, 34.2% vs 22.6%, and 12.7% vs 14.5% for gastric ulcers associated with H. pylori and O. tsutsugamushi infection, respectively). Patients with O. tsutsugamushi infection had significantly higher incidence of ulcers on the antrum (70.97% vs 36.7%, P < .001) and the greater curvature (45.2% vs 24.0%, P = .012). Finally, 35.5% of patients with gastric ulcer caused by scrub typhus also had duodenal ulcer.
This is the first study to compare endoscopic features of peptic ulcers caused by H. pylori and O. tsutsugamushi. Peptic ulcers in patients with H. pylori infection occurred predominantly in the antrum/body/lesser curvature and presented with single, round/oval lesions, while ulcers in patients with scrub typhus occurred predominantly in the antrum/greater curvature and presented with multiple, irregular lesions. Scrub typhus should be considered as a cause of duodenal ulcer in scrub typhus-endemic areas.
除了幽门螺杆菌，另一个导致胃肠道溃疡发展或恶化的原因是恙虫病，这是一种由恙虫东方体引起的急性发热性疾病。我们旨在比较这些感染因子引起的消化性溃疡的内镜特征。
本回顾性病例对照研究纳入了在韩国全州大学医院接受上消化道内镜检查的患者。我们比较了幽门螺杆菌感染患者和恙虫病东方体感染患者的内镜特征和人口统计学特征。
共有 141 例消化性溃疡患者纳入研究。与恙虫病东方体感染患者（n=62；年龄 63.8±12.1 岁；男性 42%）相比，幽门螺杆菌感染患者（n=79；年龄 53.0±14.8 岁；男性 81%）年龄更小，更可能为男性（均 P<.001）。恙虫病东方体感染患者更可能有多处病变（40/62，64.5% vs 37/79，46.8%；P=.042）和不规则形状的病变（27/62，43.6% vs 20/79，25.3%；P=.031）。幽门螺杆菌感染患者发生出血性溃疡的比例更高（26/79，32.9% vs 8/62，12.9%；P=.007），病变最常发生在十二指肠（43.0%），其次是胃窦（36.7%）、胃体（34.2%）和胃角（12.7%）。在恙虫病东方体感染患者中，病变最常发生在胃窦（70.97%），其次是十二指肠（35.5%）、胃体（22.6%）和胃角（14.5%）。在两组患者中，胃窦是幽门螺杆菌和恙虫病东方体感染相关胃溃疡最常发生的部位，其次是胃体和胃角（36.7% vs 70.97%，34.2% vs 22.6%，12.7% vs 14.5%）。恙虫病东方体感染患者胃窦和胃大弯的溃疡发生率显著更高（70.97% vs 36.7%，P<.001；45.2% vs 24.0%，P=.012）。最后，35.5%的恙虫病导致的胃溃疡患者同时患有十二指肠溃疡。
这是第一项比较幽门螺杆菌和恙虫病东方体引起的消化性溃疡内镜特征的研究。幽门螺杆菌感染患者的消化性溃疡主要发生在胃窦/体/小弯侧，表现为单个、圆形/椭圆形病变，而恙虫病患者的溃疡主要发生在胃窦/大弯侧，表现为多个、不规则病变。在恙虫病流行地区，应考虑恙虫病为十二指肠溃疡的病因。
