el-Serag H B, Sonnenberg A
Department of Veterans Affairs, Medical Center, Albuquerque, USA.
Gut. 1998 Sep;43(3):327-33. doi: 10.1136/gut.43.3.327.
Gastritis associated hypochlorhydria may be protective against gastro-oesophageal reflux disease. It was hypothesised that the historic decline in Helicobacter pylori infection resulted in a decline in peptic ulcer and a concomitant risk in reflux disease.
To study the time trends of peptic ulcer and reflux disease.
Hospitalisation rates were analysed using the computerised database of the US Department of Veterans Affairs from 1970 until 1995. Death rates were calculated from the Vital Statistics of the United States.
From 1970 to 1995, hospitalisation rates for gastric and duodenal ulcer, as well as gastric cancer fell, while the hospitalisation rates for gastro-oesophageal reflux disease and those for oesophageal adenocarcinoma rose significantly. Similar time trends were observed with respect to the death rates. There were notable ethnic differences. White subjects incurred higher rates of reflux disease and oesophageal adenocarcinoma and lower rates of gastric ulcer or cancer compared with non-whites.
The ethnic variations and the opposing time trends of gastroduodenal versus oesophageal disease are consistent with the hypothesis that the declining infection rates of H pylori in the general population have led to a rise in the occurrence of gastro-oesophageal reflux disease and associated oesophageal adenocarcinoma.
与胃炎相关的胃酸过少可能对胃食管反流病具有保护作用。据推测，幽门螺杆菌感染率的历史性下降导致消化性溃疡发病率下降，同时反流病风险增加。
研究消化性溃疡和反流病的时间趋势。
利用美国退伍军人事务部的计算机数据库分析1970年至1995年的住院率。死亡率根据美国生命统计数据计算得出。
1970年至1995年期间，胃溃疡、十二指肠溃疡以及胃癌的住院率下降，而胃食管反流病和食管腺癌的住院率显著上升。死亡率也呈现出类似的时间趋势。存在显著的种族差异。与非白人相比，白人患反流病和食管腺癌的比率更高，患胃溃疡或胃癌的比率更低。
胃十二指肠疾病与食管疾病的种族差异及相反的时间趋势与以下假设一致，即普通人群中幽门螺杆菌感染率下降导致胃食管反流病及相关食管腺癌的发病率上升。
