Cleghorn G
University of Queensland, Australia.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 May-Jun;38(3):178-82.
Since the initial report by Warren and Marshall in 1984, Helicobacter pylori has assumed an increasingly important role in the pathogenesis of peptic ulcer disease and gastric carcinoma in all ages. A recent National Institutes of Health Consensus Development conference acknowledges the relationship between H. pylori infection and peptic ulcer disease and recommends that the medical community treat H. pylori infection in all patients with Helicobacter pylori and peptic ulcer. Although the same organism, the response to Helicobacter pylori infection in childhood differs somewhat from that seen in adults. The paediatric patient mounts a different inflammatory response, has different macroscopic appearances and has a markedly diminished peptic ulcer disease frequency compared with their adult counterparts. The appearances of antral nodularity appear to be characteristic of Helicobacter pylori infections. The appearances, however, are unrelated to symptoms and the underlying cause for this nodularity remains obscure. Younger children with peptic ulcer diseases are more likely to be Helicobacter pylori negative. This may suggest an increased susceptibility to gastric acid or possibly a very transient Helicobacter pylori infection rather than the well described lifelong infection without treatment. It is well known that the epidemiology of Helicobacter pylori would suggest that the incidence of infection increases with age. There is also geographical variations with the incidence being higher in countries of a third world background. These epidemiological observations fly in the face of all other infections where the major period of acquisition is in childhood. There has been recent evidence to suggest that in fact the incidence in childhood is decreasing in developed countries which could support the observation that there is a decreasing positive serology with successive decades in some countries. It is felt that the most likely mode of transmission to Helicobacter pylori is faecal to oral or oral to oral route. These are similar modes of transmission to Hepatitis A infections. It is obvious that most infections in childhood remain asymptomatic. It is also clear that there is no relationship between chronic recurrent abdominal pain of childhood syndrome and the presence of Helicobacter pylori infections. It remains to be seen as to who should be treated, what with and when. All of these issues will be discussed in the paper.
自1984年沃伦和马歇尔的初步报告以来，幽门螺杆菌在各年龄段消化性溃疡病和胃癌的发病机制中发挥着越来越重要的作用。美国国立卫生研究院最近召开的共识发展会议承认幽门螺杆菌感染与消化性溃疡病之间的关系，并建议医学界对所有幽门螺杆菌感染且患有消化性溃疡的患者进行治疗。虽然是同一种病原体，但儿童对幽门螺杆菌感染的反应与成人有所不同。与成人相比，儿科患者会产生不同的炎症反应，有不同的宏观表现，且消化性溃疡病的发病率明显降低。胃窦结节状外观似乎是幽门螺杆菌感染的特征。然而，这些外观与症状无关，这种结节状的潜在原因仍不清楚。患有消化性溃疡病的年幼儿童幽门螺杆菌检测呈阴性的可能性更大。这可能表明其对胃酸的易感性增加，或者可能是幽门螺杆菌感染非常短暂，而不是未经治疗就会出现的那种众所周知的终身感染。众所周知，幽门螺杆菌感染的流行病学表明，感染率随年龄增长而增加。此外，存在地域差异，第三世界背景国家的感染率更高。这些流行病学观察结果与所有其他感染情况相悖，在其他感染中，主要感染期是在儿童时期。最近有证据表明，事实上在发达国家，儿童时期的感染率正在下降，这可以支持一些国家连续几十年血清学阳性率下降的观察结果。人们认为，幽门螺杆菌最可能的传播途径是粪口途径或口口途径。这些传播途径与甲型肝炎感染相似。显然，大多数儿童感染仍无症状。同样明显得是，儿童综合征的慢性复发性腹痛与幽门螺杆菌感染的存在之间没有关系。至于谁应该接受治疗、用什么治疗以及何时治疗，还有待观察。本文将讨论所有这些问题。
