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非溃疡性消化不良患者的临床特征、幽门螺杆菌感染率、IgA-Ttg 及十二指肠异常谱。

Clinical Profile and Prevalence of H Pylori, Iga-Ttg, and Spectrum of Duodenal Abnormalities in Non Ulcer Dyspepsia.

机构信息

Army Hospital (R&R), Delhi.

出版信息

J Assoc Physicians India. 2022 Apr;70(4):11-12.


DOI:
PMID:35443497
Abstract

UNLABELLED: The Rome IV criterion for a diagnosis of NUD is chronic or recurrent epigastric pain within the last 3 months and an onset of symptoms at least 6 months prior to presentation. The term functional Dyspepsia and idiopathic dyspepsia are often used as well. Symptoms include ulcer-like dyspepsia; gastroparetic-like (nausea, early satiety, and post-prandial pain), and undifferentiated. Pathogenesis of NUD is not completely known yet. Several mechanisms have been proposed to be responsible for these symptoms. Although there is strong evidence of an association between H. pylori infection and NUD, Celiac Disease and NUD. Being a tropical country, the prevalence of infections is parasitic cause. Dyspepsia is likely to be more in India. However, the present data from India as scares in literature. Hence the present study was planned to decipher the clinical profile, prevalence of H. pylori, IgA tTG, spectrum of duodenal biopsy abnormalities in NUD patients. MATERIAL: This Descriptive Observational study was carried out in the Gastro Enterology center in GOI research institute from August 2020 to March 2021. Initially, 200 dyspepsia patients were selected. 50 patients were excluded due to various reasons. Finally, 150 patients who met the Rome 4 criteria for NUD/Functional Dyspepsia were recruited. The inclusion criteria were patients above 18 years of age, dyspepsia for >/- 6 months, and no evidence of underlying malignancy, pan gastritis, previous gastric ulcers, and pancreatitis. The patients underwent routine blood investigations like haemogram and biochemistry, Rapid Urease Test (RUT), Upper Gastro-Intestinal Endoscopy, Duodenal Biopsy, and Serum IgA-tTG antibody. OBSERVATION: The mean age was 46.3 yrs. +/- 14.12 yrs, of which 49.3% were females and 50.70% were males. The prevalence of Epigastric Pain Syndrome (EPS) was found in 37.3%, Post Prandial Distress Syndrome (PDS) in 30.7%, and 32% had both EPS+PDS. 38% of the NUD patients were positive on Rapid Urease Test (RUT) suggesting H. pylori infection. 88.7% of NUD patients were IgA-tTG antibody negative and 11.3% serologically positive. The Duodenal biopsy was normal in 48% of patients, 21.3% had mild inflammation/duodenitis, 8% chronic duodenitis and 22.7% had various grades of Celiac Disease (as per Marsh Grading). These 22.7% showing evidence of Celiac Disease on histopathological examination showed Marsh Grade 1 in 12.7%, Grade-2 in 2%, Grade 3A in 6.7%, and Grade 3B in 1.3%. Only 17.6% of biopsy positive had IgA-tTG antibody positivity but only 4% of total cases were positive for both biopsy and IgA-tTG antibody (p-value 0.05). Eosinophilic infiltration in duodenum common in NUD patients. It was observed that 17.33% (26/150) NUD patients had duodenal eosinophilia. Further, look for the association of duodenal eosinophilia with various diseases. 33.33% (19/57) H. pylori patients had duodenal eosinophilia with p-value < 0.001. It was also observed that 7.52% (7/93) others like normal individual, Chronic duodenitis, mild inflammation/ duodenitis had Duodenal eosinophilia. CONCLUSION: The prevalence of H. pylori and IgA-tTG antibodies in non-ulcer dyspepsia patients was 38% and 11.3% respectively. The spectrum of Duodenum biopsy abnormalities in NUD patients included mild inflammation/ duodenitis, Chronic duodenitis, and Celiac Disease. 22.7% of NUD patients had various degrees of celiac disease morphology on D2 biopsy and only 17.6% of these biopsy positive patients were positive for IgA-tTG. Only 4% of total NUD patients were positive for both biopsy and IgA-tTG antibody labeled as Celiac Disease (CeD). There is a significant association between H. pylori and duodenal eosinophilia.

摘要

背景:罗马 IV 标准用于诊断非溃疡性消化不良(NUD)为慢性或复发性上腹痛,且症状至少在就诊前 6 个月开始。功能性消化不良和特发性消化不良这两个术语也经常被使用。症状包括溃疡样消化不良;胃轻瘫样(恶心、早饱和餐后疼痛)和未分化型。NUD 的发病机制尚未完全清楚。已经提出了几种机制来解释这些症状。尽管幽门螺杆菌感染与 NUD、乳糜泻和 NUD 之间存在很强的关联,但在热带国家,寄生虫感染的患病率更高。在印度,消化不良可能更为普遍。然而,目前来自印度的相关数据在文献中很少。因此,本研究旨在阐明 NUD 患者的临床特征、幽门螺杆菌感染率、IgA 组织转谷氨酰胺酶(tTG)、十二指肠活检异常的谱。

材料和方法:本描述性观察研究于 2020 年 8 月至 2021 年 3 月在 GOI 研究所的胃肠病学中心进行。最初选择了 200 名消化不良患者。由于各种原因,50 名患者被排除在外。最后,招募了符合罗马 4 标准的 150 名 NUD/功能性消化不良患者。纳入标准为年龄大于 18 岁、消化不良大于/等于 6 个月、无恶性肿瘤、全胃炎、既往胃溃疡和胰腺炎的证据。患者接受了常规血液检查,如血常规和生化检查、快速尿素酶试验(RUT)、上消化道内镜检查、十二指肠活检和血清 IgA-tTG 抗体检查。

结果:平均年龄为 46.3 岁 +/- 14.12 岁,其中女性占 49.3%,男性占 50.70%。上腹痛综合征(EPS)的患病率为 37.3%,餐后不适综合征(PDS)为 30.7%,32%的患者同时存在 EPS+PDS。38%的 NUD 患者快速尿素酶试验(RUT)阳性提示幽门螺杆菌感染。88.7%的 NUD 患者 IgA-tTG 抗体阴性,11.3%血清学阳性。48%的 NUD 患者十二指肠活检正常,21.3%有轻度炎症/十二指肠炎,8%有慢性十二指肠炎,22.7%有不同程度的乳糜泻(根据 Marsh 分级)。这 22.7%在组织病理学检查中显示乳糜泻证据的患者中,12.7%为 Marsh 分级 1,2%为 Marsh 分级 2,6.7%为慢性 3A 级,1.3%为慢性 3B 级。仅 17.6%的活检阳性患者 IgA-tTG 抗体阳性,但只有 4%的总病例同时活检和 IgA-tTG 抗体阳性(p 值 0.05)。十二指肠嗜酸性粒细胞浸润在 NUD 患者中很常见。观察到 17.33%(26/150)的 NUD 患者有十二指肠嗜酸性粒细胞浸润。进一步研究了十二指肠嗜酸性粒细胞浸润与各种疾病的相关性。33.33%(19/57)的幽门螺杆菌患者有十二指肠嗜酸性粒细胞浸润,p 值 < 0.001。还观察到,7.52%(7/93)的其他患者,如正常个体、慢性十二指肠炎、轻度炎症/十二指肠炎,也有十二指肠嗜酸性粒细胞浸润。

结论:非溃疡性消化不良患者的幽门螺杆菌和 IgA-tTG 抗体感染率分别为 38%和 11.3%。NUD 患者十二指肠活检异常的谱包括轻度炎症/十二指肠炎、慢性十二指肠炎和乳糜泻。22.7%的 NUD 患者在 D2 活检中有不同程度的乳糜泻形态,只有 17.6%的活检阳性患者 IgA-tTG 阳性。只有 4%的总 NUD 患者同时活检和 IgA-tTG 抗体阳性,被标记为乳糜泻(CeD)。幽门螺杆菌和十二指肠嗜酸性粒细胞浸润之间存在显著关联。

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[1]
Clinical Profile and Prevalence of H Pylori, Iga-Ttg, and Spectrum of Duodenal Abnormalities in Non Ulcer Dyspepsia.

J Assoc Physicians India. 2022-4

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