Szőke Andreea, Mocan Simona, Negovan Anca
Department of Pathology, Mureș County Clinical Hospital, 540061 Târgu Mureș, Romania.
Department of Pathology, Emergency County Hospital, 540136 Târgu Mureș, Romania.
Exp Ther Med. 2021 Jul;22(1):766. doi: 10.3892/etm.2021.10198. Epub 2021 May 14.
infection and duodenogastric reflux (DGR) are both linked to endoscopic and premalignant gastric lesion development, but it is still unclear whether they are independent or have a causal relationship. This study investigated the histologic gastric changes in patients with primary DGR and infection, as well as their endoscopic findings, symptoms, drug consumption, and social behavior in comparison with patients presenting only DGR. The study included 560 patients with primary DGR on endoscopy divided into two groups, according to the presence/absence of infection on biopsy (utilizing usual stainings and immunohistochemical methods). There was no significant difference in terms of age and sex, nor in the frequency of diabetes or esophagitis between the studied groups. Epigastric pain was associated with -positive biopsies in multivariate logistic regression analysis (P=0.005). Although without statistical significance, severe endoscopic lesions and premalignant gastric lesions were more frequent in the group (45.1 vs. 28.4% and 37.4 vs. 32.3%, respectively). In patients with DGR, the final multivariate model revealed a positive association between smoking and immunohistochemically confirmed infection (P=0.02, OR=1.88, 95% confidence intervals (CI)=1.10 to 3.21), but a negative effect of proton pump inhibitor consumption (P<0.001, OR=0.50, 95% CI=0.35 to 0.73). In conclusion, in patients with infection and DGR, epigastric pain was the main reason for the endoscopic investigation. infection over DGR did not influence the severity of endoscopic or premalignant gastric lesion development. Furthermore, smoking is directly related to immunohistochemically assessed active infection in patients with bile reflux.
感染和十二指肠胃反流（DGR）均与内镜下及癌前胃病变的发展相关，但它们是独立的还是存在因果关系仍不清楚。本研究调查了原发性DGR和感染患者的胃组织学变化，以及与仅表现为DGR的患者相比，他们的内镜检查结果、症状、药物使用情况和社会行为。该研究纳入了560例经内镜检查诊断为原发性DGR的患者，根据活检时是否存在感染（采用常规染色和免疫组化方法）分为两组。研究组之间在年龄、性别、糖尿病或食管炎的发生率方面没有显著差异。在多因素逻辑回归分析中，上腹部疼痛与活检阳性相关（P = 0.005）。虽然无统计学意义，但感染组中严重内镜病变和癌前胃病变更为常见（分别为45.1%对28.4%和37.4%对32.3%）。在DGR患者中，最终的多因素模型显示吸烟与免疫组化证实的感染呈正相关（P = 0.02，OR = 1.88，95%置信区间（CI）= 1.10至3.21），但质子泵抑制剂的使用有负面影响（P < 0.001，OR = 0.50，95% CI = 0.35至0.73）。总之，在感染和DGR患者中，上腹部疼痛是进行内镜检查的主要原因。感染相对于DGR并未影响内镜下或癌前胃病变发展的严重程度。此外，吸烟与胆汁反流患者免疫组化评估的活动性感染直接相关。
