Robles-Campos R, Lujan-Mompean J A, Parrilla-Paricio P, Bermejo-Lopez J, Liron-Ruiz R, Torralba-Martinez J A, Morales-Cuenca G, Molina-Martinzez J A
Department of General Surgery, Virgen de la Arrixaca, University Hospital, Murcia, Spain.
Surg Gynecol Obstet. 1993 Jun;176(6):594-8.
In patients undergoing gastric operations, we studied the relationship between data suggesting alkaline reflux gastritis (symptoms, endoscopic alterations and histologic lesions) and two factors that produce chronic gastritis (helicobacter pylori and duodenogastric reflux). Of 225 patients who underwent operations for gastroduodenal gastric ulcer at our General Surgery Unit between 1980 and 1982, 63 agreed to undergo endoscopy and biopsies. Of these 63 patients, 38 agreed to a test to quantify duodenogastric reflux (24 hour gastric pH monitoring associated with the determination of bile acids in gastric juice). According to the clinical questionnaire, patients were classified as symptomatic and asymptomatic. Endoscopy was considered either normal with mucosal lesions or mucosal lesions plus bile. In the histologic study, we considered normal mucosa, superficial chronic gastritis and atrophic chronic gastritis. Furthermore, the presence of atrophy, metaplasia, foveolar hyperplasia and helicobacter pylori was studied. Symptoms, endoscopic alterations and histologic lesions were not significantly related to helicobacter pylori, but were significantly related to the quantity of duodenogastric reflux. The symptomatic patients presented with a greater quantity of reflux than the asymptomatic patients (p < 0.05). The patients with mucosal lesions plus bile who had endoscopy showed a greater quantity of reflux than those with normal endoscopy (p < 0.001) and those with mucosal lesions without bile (p < 0.02 for pH values and p < 0.001 for bile acids). The patients with atrophic chronic gastritis presented with a greater quantity of reflux than those with normal mucosa and superficial chronic gastritis (p < 0.05, respectively), and the patients with atrophy and metaplasia and foveolar hyperplasia had more reflux than those without (p < 0.001, respectively). The patients who were helicobacter positive and negative presented with similar quantities of reflux.
在接受胃部手术的患者中，我们研究了提示碱性反流性胃炎的数据（症状、内镜改变和组织学病变）与导致慢性胃炎的两个因素（幽门螺杆菌和十二指肠胃反流）之间的关系。1980年至1982年间，在我们普通外科接受胃十二指肠溃疡手术的225例患者中，63例同意接受内镜检查和活检。在这63例患者中，38例同意进行一项量化十二指肠胃反流的检测（24小时胃pH监测并测定胃液中的胆汁酸）。根据临床问卷，患者被分为有症状和无症状两类。内镜检查结果分为黏膜正常、有黏膜病变或有黏膜病变伴胆汁反流。在组织学研究中，我们观察了正常黏膜、浅表性慢性胃炎和萎缩性慢性胃炎。此外，还研究了萎缩、化生、小凹增生和幽门螺杆菌的存在情况。症状、内镜改变和组织学病变与幽门螺杆菌无显著相关性，但与十二指肠胃反流的量显著相关。有症状的患者反流量比无症状的患者多（p<0.05）。内镜检查显示有黏膜病变伴胆汁反流的患者反流量比内镜正常的患者多（p<0.001），也比有黏膜病变但无胆汁反流的患者多（pH值p<0.02，胆汁酸p<0.001）。萎缩性慢性胃炎患者的反流量比正常黏膜和浅表性慢性胃炎患者多（分别为p<0.05），有萎缩、化生和小凹增生的患者反流比没有这些情况的患者多（分别为p<0.001）。幽门螺杆菌阳性和阴性的患者反流量相似。
