Bornschein Jan, Pritchard D Mark
Translational Gastroenterology Unit, University of Oxford, Oxford, Oxfordshire, UK.
Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
Frontline Gastroenterol. 2021 Jul 2;13(3):245-253. doi: 10.1136/flgastro-2021-101826. eCollection 2022.
The discovery of infection in 1984 revolutionised the management of several common upper gastrointestinal diseases. However, some of the clinical practices that were adopted following discovery of this organism have become less appropriate over the intervening years. This article discusses five 'myths and misconceptions' that we believe have now emerged and which we argue need re-evaluation. Although the prevalence of infection is decreasing in some developed countries, it remains a huge global problem and the most serious consequence of infection, gastric adenocarcinoma, is still a major cause of mortality. The epidemiology of -related diseases is also changing and careful testing remains crucially important, especially in patients with peptic ulceration. Eradication of infection has also become much more difficult over recent years as a result of the widespread acquisition of antibiotic resistance. Routine assessment of the success of eradication should therefore now be performed. Finally, there has been increased awareness about the role of in the multistep pathway of gastric carcinogenesis, about the opportunities to prevent cancer development by eradicating this infection in some individuals and about detecting high-risk preneoplastic changes via endoscopic surveillance. The discovery of was rightly honoured by the award of the Nobel prize for Physiology and Medicine in 2005. However, unless we re-evaluate and update the ways in which we manage infection, much of the fantastic progress that has been made in this field of medicine may tragically be lost once again.
1984年幽门螺杆菌的发现彻底改变了几种常见上消化道疾病的治疗方式。然而，在发现这种细菌后所采用的一些临床实践在随后的几年里已变得不那么合适。本文讨论了我们认为目前已出现的五个“误区和误解”，并认为需要重新评估。尽管在一些发达国家幽门螺杆菌感染率正在下降，但它仍然是一个巨大的全球性问题，而感染最严重的后果——胃腺癌，仍是主要的死亡原因。与幽门螺杆菌相关疾病的流行病学也在发生变化，仔细检测仍然至关重要，尤其是对于消化性溃疡患者。由于抗生素耐药性的广泛出现，近年来根除幽门螺杆菌感染也变得更加困难。因此，现在应该对根除是否成功进行常规评估。最后，人们越来越意识到幽门螺杆菌在胃癌发生多步骤途径中的作用、通过根除某些个体的这种感染来预防癌症发展的机会以及通过内镜监测检测高危癌前病变的机会。幽门螺杆菌的发现于2005年被授予诺贝尔生理学和医学奖，这是实至名归的。然而，除非我们重新评估并更新管理幽门螺杆菌感染的方式，否则在这个医学领域所取得的许多巨大进展可能会再次悲惨地丧失。
