Hall Mats, Wenner Jörgen, Scherman Peter, Öberg Stefan
a Department of Gastroenterology, Skåne University Hospital , Clinical Sciences Lund, Lund University , Lund , Sweden.
b Department of Surgery & Urology , Division of Surgery, Helsingborg Hospital , Helsingborg , Sweden.
Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1179-1185. doi: 10.1080/00365521.2018.1526967. Epub 2018 Dec 5.
Studies of the etiology of intestinal metaplasia (IM) at a normal appearing gastroesophageal junction (GEJ) are conflicting as associations with both H. Pylori (HP) infection and gastroesophageal reflux has been reported. The aim of this study was to investigate whether IM at the GEJ is associated with gastroesophageal reflux or HP infection.
Fifty asymptomatic volunteers and 149 patients with reflux symptoms underwent endoscopy with biopsies obtained from the gastric antrum and the squamocolumnar junction (SCJ). All subjects underwent wireless 48 h pH monitoring with the electrode placed immediately above the SCJ and a fecal antigen test for HP infection. Clinical characteristics and the pattern of reflux were compared in subjects with and without IM.
Three asymptomatic volunteers and 35 patients who had clearly irregular SCJs with short extensions of columnar mucosa were excluded from the study. In the remaining 47 asymptomatic volunteers and 114 patients, variables that reached a significance level of 0.1 or less on univariate analyses were used in a binomial regression analysis to assess their relative importance for the finding of IM. IM at the GEJ was significantly associated with abnormal distal esophageal acid exposure (5.5 (1.2-24.6), p = .026), the frequency of reflux episodes/hour (1.5 (1.1-2.2), p = .031), and an endoscopic appearance of the SCJ corresponding to ZAP grade I (4.6 (1.4-15.6), p = .013). There was no association with HP infection.
The finding of IM at an endoscopically normal-appearing GEJ is associated with gastroesophageal reflux but not with HP infection.
关于正常外观的胃食管交界处（GEJ）肠化生（IM）病因的研究结果相互矛盾，因为已有报道称其与幽门螺杆菌（HP）感染和胃食管反流均有关联。本研究的目的是调查GEJ处的IM是否与胃食管反流或HP感染相关。
50名无症状志愿者和149名有反流症状的患者接受了内镜检查，并从胃窦和鳞柱状交界处（SCJ）获取活检样本。所有受试者均接受了无线48小时pH监测，电极置于SCJ正上方，同时进行了HP感染的粪便抗原检测。对有和没有IM的受试者的临床特征和反流模式进行了比较。
3名无症状志愿者和35名SCJ明显不规则且柱状黏膜延伸较短的患者被排除在研究之外。在其余47名无症状志愿者和114名患者中，单因素分析中显著性水平达到0.1或更低的变量被用于二项回归分析，以评估它们对于发现IM的相对重要性。GEJ处的IM与食管远端异常酸暴露（5.5（1.2 - 24.6），p = .026）、每小时反流发作频率（1.5（1.1 - 2.2），p = .031）以及与ZAP I级相对应的SCJ内镜表现（4.6（1.4 - 15.6），p = .013）显著相关。与HP感染无关。
在内镜检查外观正常的GEJ处发现IM与胃食管反流有关，但与HP感染无关。
