Vicari J J, Peek R M, Falk G W, Goldblum J R, Easley K A, Schnell J, Perez-Perez G I, Halter S A, Rice T W, Blaser M J, Richter J E
Department of Gastroenterology, Cleveland Clinic Foundation, Ohio, USA.
Gastroenterology. 1998 Jul;115(1):50-7. doi: 10.1016/s0016-5085(98)70364-6.
BACKGROUND & AIMS: The role of Helicobacter pylori in the pathogenesis of gastroesophageal reflux disease (GERD) is unknown. We determined the prevalence of cagA-positive (cagA+) H. pylori strains in patients with GERD or its complications compared with controls of similar age.
A total of 153 consecutive patients with GERD, Barrett's esophagus, and Barrett's esophagus complicated by dysplasia or adenocarcinoma were compared with 57 controls who underwent upper endoscopy for reasons other than GERD. H. pylori infection and CagA antibody status were determined by histology and enzyme-linked immunosorbent assay.
H. pylori prevalence was lower (34%) in patients with GERD and its sequelae than in the control group (45.6%)(P = 0.15). Regardless of the group, increasing age was associated with higher prevalence of H. pylori (P = 0.003). When compared with controls (42.3%), the prevalence of cagA+ H. pylori strains decreased (P = 0.008) in patients with more severe complications of GERD (GERD, 36.7% [nonerosive GERD, 41.2%; erosive GERD, 30.8%]; Barrett's esophagus, 13.3%; and Barrett's with adenocarcinoma/dysplasia, 0%).
Prevalence of H. pylori in patients with GERD and its sequelae was lower but not significantly different than that of a control group. However, patients carrying cagA+ strains of H. pylori may be protected against the complications of GERD, especially Barrett's esophagus and its associated dysplasia and adenocarcinoma.
幽门螺杆菌在胃食管反流病（GERD）发病机制中的作用尚不清楚。我们测定了GERD患者或其并发症患者中细胞毒素相关基因A阳性（cagA+）幽门螺杆菌菌株的流行率，并与年龄相仿的对照组进行比较。
连续纳入153例GERD、巴雷特食管以及并发发育异常或腺癌的巴雷特食管患者，并与57例因GERD以外原因接受上消化道内镜检查的对照组进行比较。通过组织学和酶联免疫吸附测定法确定幽门螺杆菌感染及CagA抗体状态。
GERD及其后遗症患者中幽门螺杆菌的流行率（34%）低于对照组（45.6%）（P = 0.15）。无论在哪一组，年龄增加均与幽门螺杆菌流行率升高相关（P = 0.003）。与对照组（42.3%）相比，GERD更严重并发症患者（GERD，36.7%[非糜烂性GERD，41.2%；糜烂性GERD，30.8%]；巴雷特食管，13.3%；伴有腺癌/发育异常的巴雷特食管，0%）中cagA+幽门螺杆菌菌株的流行率降低（P = 0.008）。
GERD及其后遗症患者中幽门螺杆菌的流行率较低，但与对照组相比无显著差异。然而，携带cagA+幽门螺杆菌菌株的患者可能对GERD的并发症具有保护作用，尤其是巴雷特食管及其相关的发育异常和腺癌。
