784例胃内胆汁返流现象相关因素分析

Analysis of relevant factors of biliary regurgitation to the stomach

目的 分析胃内胆汁返流现象的相关因素 ,提供有助于胆汁返流性胃炎诊断的临床依据。方法 对 784例近 2年胃镜检查时见黏液湖黄染和黏膜有胆汁斑块附着、且无胃手术史的患者进行临床表现、内镜诊断和病理组织学改变及快速尿素酶试验结果进行总结 ,分析其相关因素及临床表现特点。结果 黏液湖黄染和黏膜黄染者多见于 3 0～ 60岁的慢性胃炎患者 ,其它多见球部溃疡 ,快速尿素酶试验阳性者占 5 1% ,病理组织学改变见胃小凹增生者极少。临床表现以上腹饱胀、进食胀痛多见 ,但无特异性表现。结论 胆汁返流是慢性胃炎时内镜下多见的一种表现 ,也是慢性胃炎和消化性溃疡发病机制中重要的损害因素。Hp感染和胆汁返流对慢性胃炎和消化性溃疡是互相独立的致病因素。胆汁返流现象多数不够条件诊断胆汁返流性胃炎。内镜见黏液湖黄染和胃窦、胃体均广泛充血 ,散在糜烂可临床诊断胆汁返流性胃炎。胆汁返流性胃炎时病理组织学改变并不以胃小凹增生具特异性 ,其并不多见。

Objective To analyze the related factors of biliary regurgitation to the stomach and provide a useful guide for diagnosis of bile reflux gastritis.Methods The clinical manifestation,endoscopic diagnosis,pathologic histology change and rapid urease test were retrospectively investigated in 784 patients who had no history of stomach operation,and had yellow mucus and yellow bile spot attached to the gastric mucosa under endoscopes in the past two years.Results Yellow mucus and yellow bile spot attached to gastric mucosa were the most frequent in patients with chronic gastritis in age of 30～60 years old,followed by from duodenal bulb ulcer.Rapid urease tests were positive in 51% cases.Gastric foveola hyperplasia was rare.Many patients showed glutted midsection,swollen and stomachache after taking food,but no special manifestation appeared.Conclusions Biliary regurgitation is common in patients with chronic gastritis and is a critical pathogenesis of chronic gastritis and peptic ulcer.HP infection and biliary regurgitation are two independent pathogenic factors to chronic gastritis and peptic ulcer.Biliary regurgitation type of gastritis can be diagnosed according to yellow mucus,extensive congestion in the gastric antrum and body and scattered erosion.Gastric foveola hyperplasia is not the specific pathologic change of biliary regurgitation type of gastritis.