HP根除影响胃食管反流病患者预后的临床及病理分析

Clinical and Histopathological Evaluation on the Effect of Helscobacter Pylori Eradication on the Prognosis of Patients with Gastro-esophageal Reflux Disease

目的:探讨根除幽门螺杆菌(Helicobacter pylori, HP)对胃食管反流病(gastro esophageal reflux disease, GERD)疗效及预后的影响。方法:98例GERD患者,均为HP阳性,试验前均行胃镜检查评估食管炎程度及胃粘膜组织病理学改变,然后所有患者随机分为2组:HP根除组49例,接受HP清除三联疗法;对照组49例,仅服用奥美拉唑(20 mg,每日2次)。1周后所有患者开始连续8周的奥美拉唑(20 mg/d)初始治疗阶段,8周后症状缓解及糜烂性食管炎愈合患者开始奥美拉唑10 mgd的维持治疗阶段,直至试验第12个月。初始治疗后症状未完全缓解或内镜下食管炎未完全愈合、维持阶段症状或内镜下食管炎复发为失效病例。试验结束时所有患者均行胃镜复查及14 C呼气试验。结果:试验前共有33 例患者(33.7%)内镜检查发现糜烂性食管炎;试验结束后HP根除组47例患者HP转阴(95.9%),HP阳性组3 例转阴(6.1%),两组HP根除率差异显著(P<0.01);HP根除组16例失效,HP阳性组有7例失效,两者相比差异显著(P<0.05);然而,HP阳性组患者胃体萎缩及胃体肠化较HP根除组明显增多。结论:HP根除可降低质子泵抑制剂(PPI)治疗GERD的疗效,同时HP根除对患者胃体萎缩及胃体肠化有预防作用。

Objective: To investigate the effect of Helicobacler pylori eradication on gastro-esophageal reflux disease(GERD) patients receiving long term acid suppressants. Methods: Ninety-eight patients with gastro-esophageal reflux disease(GERD) and H pylori positive were prospectively recruited for endoscope and symptom evaluation. Then Eligible patients were randomly assigned to omeprazole triple therapy(HpE group) or omeprazole(20mg, twice per day) single(Hp+group) for one week. Then omeprazole 20mg daily was given for 8 weeks for healing of esophagitis and symptom relief. Which was followed by a maintenance dose of 10mg daily for up to 12 months. Treatment failure was defined as either incomplete resolution of symptoms or esophagitis at the initial treatment phase, or relapse of symptoms and oesophagitis during the maintenance phase. Endoscopic examination, including biopsies for histological evaluation and biopsy urease test, was offered when reflux symptom recurred or at the end of 12 months. Patients underwent a 14C urea breath test 4 weeks after cessation of omeprazole to determine H pylori status.Results: 98 GERD patients with H pylori positive were included in the study(49 in the HpE group and 49 in the Hp+group),thirty three patients(33.7%) had erosive esophagitis at baseline. H pylori was eradicated in 95.9% of the HpE group and in 6.1% of the Hp+group. Overall, 16 patients(32.7%) in the HpE group and 7 (14.3%) in the Hp+group had treatment failure(P<0.05). However, the onset of corpus atrophy and intestinal metaplasia was more prevalent in the Hp+group when compared with the HpE group.Conclusion:H pylori eradication may lead to more resilient GERD, Whereas, H pylori eradication had the Prophylactic effect for corpus atrophy and intestinal metaplasia in the long run.