Maaroos H I, Kekki M, Vorobjova T, Salupere V, Sipponen P
Dept. of Internal Medicine, Tartu University Hospital, Estonia.
Scand J Gastroenterol. 1994 Jun;29(6):532-6. doi: 10.3109/00365529409092468.
We describe here our observations on colonization of the gastric mucosa by Helicobacter pylori in a long-term follow-up of 25 patients with gastric ulcer (GU).
All patients were followed-up endoscopically for more than 10 years (mean, 16 years) and endoscopically verified to have GU in the angular or corpus area of the stomach. None had received treatment with H2 blockers or omeprazole or had undergone any maintenance therapy or surgery. On the basis of the endoscopic findings on the activity of GU at follow-up endoscopies, the patients were divided into a group of subjects with 'low risk' of recurrence (15 patients who either had no (7 patients) or only a single recurrence (8 patients) at the first follow-up endoscopy but not thereafter) and into those with a 'high risk' of recurrence (10 patients who had at least 2 episodes of recurrence at follow-up endoscopies).
A severe bilateral (antrum and corpus) colonization of the gastric mucosa by H. pylori at the first re-examination (1-6 years after the initial diagnosis of GU) was the most important characteristic feature in the patients with high risk of recurrence as compared with those with low risk. In the course of the follow-up, colonization of the corpus mucosa by H. pylori remained rather unchanged in both high- and low-risk subjects but decreased in grade in antrum particularly in those with low risk (no bacteria at the last endoscopy in 13 of 16 low-risk patients and in 2 of 8 high-risk patients). In both low- and high-risk groups corpus gastritis developed progressively into atrophic gastritis (11 of 25 patients had severe corpus atrophy at the last endoscopy). On the other hand, antral gastritis showed a tendency to heal (13 of 24 patients had normal or only slightly gastric antrum at the last endoscopy).
The observations indicate that the H. pylori plays a role in and associates closely with the long-term course of angular or corpus GU disease and is related to the tendency of these ulcers to recur.
我们在此描述对25例胃溃疡（GU）患者进行长期随访时观察到的幽门螺杆菌在胃黏膜定植的情况。
所有患者接受了超过10年（平均16年）的内镜随访，内镜检查证实胃角或胃体部有GU。所有患者均未接受过H2受体阻滞剂或奥美拉唑治疗，也未接受过任何维持治疗或手术。根据随访内镜检查时GU的活动情况，将患者分为复发“低风险”组（15例患者，其中7例在首次随访内镜检查时无复发，8例仅有单次复发，此后无复发）和复发“高风险”组（10例患者，在随访内镜检查时有至少2次复发）。
首次复查（GU初诊后1 - 6年）时，幽门螺杆菌在胃黏膜严重双侧（胃窦和胃体）定植是复发高风险患者与低风险患者相比最重要的特征。在随访过程中，幽门螺杆菌在胃体黏膜的定植在高风险和低风险患者中均保持相对稳定，但胃窦部定植程度降低，尤其是低风险患者（16例低风险患者中有13例在最后一次内镜检查时无细菌，8例高风险患者中有2例）。在低风险和高风险组中，胃体胃炎均逐渐发展为萎缩性胃炎（25例患者中有11例在最后一次内镜检查时出现严重胃体萎缩）。另一方面，胃窦炎有愈合倾向（24例患者中有13例在最后一次内镜检查时胃窦正常或仅有轻微病变）。
这些观察结果表明，幽门螺杆菌在胃角或胃体GU疾病的长期病程中起作用并与之密切相关，且与这些溃疡的复发倾向有关。
