Jonkers D, Houben G, de Bruine A, Arends J W, Stobberingh E, Stockbrügger R
Department of Gastroenterology, University Hospital Maastricht, The Netherlands.
Ital J Gastroenterol Hepatol. 1998 Oct;30(5):481-3.
Consecutive untreated patients with duodenal ulcer (n = 49) or gastric ulcer (n = 47) were compared with regard to the presence of gastric metaplasia in the duodenal bulb, gastric distribution of Helicobacter pylori and histopathological findings to assess differences which may contribute to either duodenal ulcer or gastric ulcer development.
Serial sections of corpus, antral and duodenal mucosal biopsies were stained by haematoxylin-eosin stain for histopathological evaluation, immunohistochemistry for the detection of Helicobacter pylori, and duodenal biopsies alone by the PAS/Alcian blue stain to assess the presence of gastric metaplasia in the duodenal bulb.
Helicobacter pylori was found in 81.6% of duodenal ulcer and in 83.0% of gastric ulcer patients. In duodenal ulcer and gastric ulcer patients, Helicobacter pylori was found in 79.6% and 79.5% of corpus, 77.6% and 72.3% of antral, and 16.7% and 20.0% of duodenal bulb biopsies, respectively. In duodenal ulcer patients, the density of Helicobacter pylori was significantly lower in corpus compared to antrum biopsies (p < 0.001). Furthermore, the Helicobacter pylori density was higher in corpus of gastric ulcer than of duodenal ulcer patients. Inflammatory scores followed the density of Helicobacter pylori infection. In the duodenal bulb of both duodenal ulcer and gastric ulcer patients, the occurrence and extent of gastric metaplasia were comparable. Gastric metaplasia was present in 5 out of 8 Helicobacter pylori positive duodenal biopsies of duodenal ulcer patients and in 3 out of 9 Helicobacter pylori positive duodenal biopsies of gastric ulcer patients.
No evidence was found for a role of gastric metaplasia in the differential pathogenesis of duodenal ulcer or gastric ulcer. Differences in the gastric topography of Helicobacter pylori density and inflammatory scores between duodenal ulcer and gastric ulcer may contribute to differences in development and presentation of both peptic ulcer conditions.
对49例十二指肠溃疡患者和47例胃溃疡患者进行连续观察，比较十二指肠球部胃化生情况、幽门螺杆菌在胃内的分布及组织病理学表现，以评估可能导致十二指肠溃疡或胃溃疡发生的差异。
对胃体、胃窦和十二指肠黏膜活检标本进行连续切片，用苏木精-伊红染色进行组织病理学评估，用免疫组织化学检测幽门螺杆菌，仅对十二指肠活检标本用PAS/阿尔辛蓝染色评估十二指肠球部胃化生情况。
81.6%的十二指肠溃疡患者和83.0%的胃溃疡患者检出幽门螺杆菌。在十二指肠溃疡和胃溃疡患者中，分别有79.6%和79.5%的胃体活检标本、77.6%和72.3%的胃窦活检标本以及16.7%和20.0%的十二指肠球部活检标本中检出幽门螺杆菌。十二指肠溃疡患者胃体部幽门螺杆菌密度显著低于胃窦活检标本（p<0.001）。此外，胃溃疡患者胃体部幽门螺杆菌密度高于十二指肠溃疡患者。炎症评分与幽门螺杆菌感染密度相关。十二指肠溃疡和胃溃疡患者十二指肠球部胃化生的发生率和范围相当。十二指肠溃疡患者8例幽门螺杆菌阳性十二指肠活检标本中有5例存在胃化生，胃溃疡患者9例幽门螺杆菌阳性十二指肠活检标本中有3例存在胃化生。
未发现胃化生在十二指肠溃疡或胃溃疡的发病机制差异中起作用。十二指肠溃疡和胃溃疡患者幽门螺杆菌密度和炎症评分在胃内分布的差异可能导致两种消化性溃疡疾病在发生和表现上的差异。
