Varanasi R V, Fantry G T, Wilson K T
Department of Medicine, University of Maryland School of Medicine, and Baltimore Veterans Affairs Medical Center, 21201, USA.
Helicobacter. 1998 Sep;3(3):188-94. doi: 10.1046/j.1523-5378.1998.08001.x.
An increased incidence of reflux esophagitis has been reported after eradication of H. pylori in patients with duodenal ulcer. To determine if H. pylori is associated with lower rates of esophagitis, we studied the prevalence of H. pylori infection in patients with and without reflux esophagitis and a subgroup of patients with concomitant peptic ulcer disease.
Patients who underwent esophagogastroduodenoscopy and had diagnostic testing for H. pylori over a 30-month period were studied. H. pylori infection was determined by rapid urease testing, gastric histopathology, or serology. Reflux esophagitis was determined by endoscopic and/or histologic criteria.
Of 514 patients, 39.5% had H. pylori infection and 22.2% had reflux esophagitis. The prevalence of H. pylori infection in patients with reflux esophagitis was 30.7%, compared with 42.0% in patients without esophagitis (p = 0.039). The odds ratio for esophagitis risk with H. pylori infection was 0.61 (95% CI, 0.39-0.95). Neither patient age nor gender affected H. pylori prevalence. In patients with duodenal ulcer, H. pylori was present in 36.4% of patients with esophagitis and in 69.2% of patients without esophagitis (p = 0.018). The odds ratio for esophagitis with H. pylori infection in these patients was 0.25 (95% CI, 0.09-0.73).
Our study demonstrates that H. pylori infection is significantly less prevalent in patients with reflux esophagitis and may protect against its development. In duodenal ulcer patients, this effect was more dramatic. Further study is required to confirm these findings and elucidate mechanisms underlying possible beneficial effects of H. pylori.
据报道，十二指肠溃疡患者根除幽门螺杆菌后反流性食管炎的发病率增加。为了确定幽门螺杆菌是否与食管炎发生率较低有关，我们研究了有反流性食管炎和无反流性食管炎患者以及伴有消化性溃疡疾病患者亚组中幽门螺杆菌感染的患病率。
对在30个月期间接受食管胃十二指肠镜检查并进行幽门螺杆菌诊断检测的患者进行研究。通过快速尿素酶试验、胃组织病理学或血清学确定幽门螺杆菌感染情况。根据内镜和/或组织学标准确定反流性食管炎。
514例患者中，39.5%有幽门螺杆菌感染，22.2%有反流性食管炎。反流性食管炎患者中幽门螺杆菌感染的患病率为30.7%，无食管炎患者为42.0%（p = 0.039）。幽门螺杆菌感染导致食管炎风险的比值比为0.61（95%可信区间，0.39 - 0.95）。患者年龄和性别均不影响幽门螺杆菌患病率。在十二指肠溃疡患者中，食管炎患者中有36.4%存在幽门螺杆菌，无食管炎患者中有69.2%存在幽门螺杆菌（p = 0.018）。这些患者中幽门螺杆菌感染导致食管炎的比值比为0.25（95%可信区间，0.09 - 0.73）。
我们的研究表明，反流性食管炎患者中幽门螺杆菌感染的患病率显著较低，且可能预防其发生。在十二指肠溃疡患者中，这种作用更为显著。需要进一步研究来证实这些发现并阐明幽门螺杆菌可能有益作用的潜在机制。
