Bayerdörffer E, Ritter M M, Hatz R, Brooks W, Ruckdeschel G, Stolte M
Medical Department II, Klinikum Grosshadern, University of Munich, Germany.
Gut. 1994 May;35(5):701-4. doi: 10.1136/gut.35.5.701.
Hypertrophic gastropathy--that is, Ménétrier's disease--was found, in a retrospective analysis, to be associated with Helicobacter pylori in more than 90% of patients. It is proposed that hypertrophic gastropathy represents a special form of H pylori gastritis in these patients. A case is described of a 28 year old woman with Ménétrier's disease associated with proved protein loss from the stomach. Treatment with cimetidine for more than three years had little benefit when colonisation by H pylori was detected. Density of H pylori colonisation and activity of gastritis, which was also present in the first biopsy specimens taken five years ago, were more pronounced in the body than in the antrum, which is in agreement with the characteristics of H pylori gastritis found in other cases with Ménétrier's disease. A 14 day antibacterial treatment course with 750 mg amoxicillin three times a day combined with 40 mg omeprazole three times a day was started in April 1991. This resulted in eradication of H pylori and the return to normal of giant folds and the mucosal histology. Serum protein concentrations returned to normal within six weeks and remained normal at two endoscopies during a two year follow up. This case report suggests that a subgroup of the patients with Ménétrier's disease may be healed by the eradication of H pylori.
回顾性分析发现,肥厚性胃病(即门脉高压性胃病)在90%以上的患者中与幽门螺杆菌有关。有人提出,在这些患者中,肥厚性胃病是幽门螺杆菌胃炎的一种特殊形式。本文描述了一例28岁患有门脉高压性胃病的女性病例,该病例伴有经证实的胃蛋白丢失。在检测到幽门螺杆菌定植后,使用西咪替丁治疗三年多效果甚微。幽门螺杆菌定植密度和胃炎活动在胃体部比胃窦部更明显,这与其他门脉高压性胃病病例中幽门螺杆菌胃炎的特征一致,且在五年前采集的首次活检标本中也存在胃炎。1991年4月开始了一个为期14天的抗菌治疗疗程,每天三次服用750毫克阿莫西林并联合每天三次服用40毫克奥美拉唑。这导致幽门螺杆菌被根除,巨大皱襞和黏膜组织学恢复正常。血清蛋白浓度在六周内恢复正常,并在两年随访期间的两次内镜检查中保持正常。该病例报告表明,一部分门脉高压性胃病患者可能通过根除幽门螺杆菌而治愈。