Valle J, Kekki M, Sipponen P, Ihamäki T, Siurala M
Dept. of Pathology, University of Helsinki, Finland.
Scand J Gastroenterol. 1996 Jun;31(6):546-50. doi: 10.3109/00365529609009126.
The long-term course of Helicobacter pylori gastritis is not well known because there are few follow-up studies available, and the follow-up time has been short.
The progression of H. pylori infection and chronic gastritis was retrospectively examined in 102 patients followed up for 32 years. In all patients a blind suction biopsy from the corpus mucosa was taken in 1952, and an endoscopic re-examination with biopsy specimens from the antrum and corpus was performed in 1983.
In the first examination 85 patients (83%) were H. pylori-positive as assessed from Giemsa-stained corpus mucosa specimens as compared with 70 H. pylori-positive patients (69%) at the end of the follow-up (1983). Two of the 17 patients who were initially H. pylori-negative became positive in 1983, implying an infection rate of 0.4% per patient-year. On the other hand, 17 of the 85 patients who were initially H. pylori-positive became negative in 1983, representing a disappearance rate of 0.6%. However, the stomach became completely normal in only eight cases, which represents a healing rate of 0.3% per patient-year. All patients with duodenal ulcer disease were H. pylori-positive at the first examination and remained so during the follow-up. In these patients chronic gastritis affected predominantly the antral mucosa, and corpus atrophy did not develop. Parietal cell antibodies appeared during the follow-up in six cases, and five of them were H. pylori-positive at the first examination. In most of these cases gastritis progressed into severe grades of corpus atrophy accompanied by the disappearance of H. pylori infection and normalization of the antral mucosa.
New H. pylori infection and complete healing of infected mucosa may occur in adult life, but this is rare. Duodenal ulcer disease is associated with persistent H. pylori infection and absence of corpus atrophy. The appearance of parietal cell antibodies leads to progression of corpus atrophy and disappearance of H. pylori.
幽门螺杆菌胃炎的长期病程尚不明确，因为可用的随访研究较少，且随访时间较短。
对102例随访32年的患者进行回顾性研究，观察幽门螺杆菌感染及慢性胃炎的进展情况。所有患者于1952年进行了胃体黏膜盲吸活检，1983年进行了内镜复查，并取胃窦和胃体活检标本。
首次检查时，根据吉姆萨染色的胃体黏膜标本评估，85例患者（83%）幽门螺杆菌阳性，而随访结束时（1983年）为70例幽门螺杆菌阳性患者（69%）。17例最初幽门螺杆菌阴性的患者中有2例在1983年转为阳性，意味着每年的感染率为0.4%。另一方面，85例最初幽门螺杆菌阳性的患者中有17例在1983年转为阴性，消失率为0.6%。然而，只有8例患者的胃完全恢复正常，每年的愈合率为0.3%。所有十二指肠溃疡患者在首次检查时幽门螺杆菌均为阳性，随访期间一直如此。在这些患者中，慢性胃炎主要累及胃窦黏膜，未出现胃体萎缩。随访期间有6例出现壁细胞抗体，其中5例在首次检查时幽门螺杆菌阳性。在大多数这些病例中，胃炎进展为重度胃体萎缩，同时幽门螺杆菌感染消失，胃窦黏膜恢复正常。
在成年期可能会发生新的幽门螺杆菌感染和感染黏膜的完全愈合，但这种情况很少见。十二指肠溃疡疾病与幽门螺杆菌持续感染及胃体萎缩缺失有关。壁细胞抗体的出现会导致胃体萎缩进展和幽门螺杆菌消失。
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