胆汁反流性胃炎临床分析

Clinical Analysis of Bile-regurgitational Gastritis

目的:进一步提高对胆汁反流性胃炎(BRG)的病因、诊断及治疗有关问题的认识。方法:从一般资料、临床表现、内镜及病理所见、幽门螺杆菌(Hp)检测、治疗与转归几方面对84例BRG病例进行回顾分析。结果:男性多于女性,20-40岁发病率最高(82.1%,69/84),全部病例均有上腹痛,但无特异性,内镜检查全部病例黏液湖呈黄绿色,黏膜明显充血、水肿,以窦部或远端胃为甚,部分病例见胆汁反流,黏膜糜烂,质脆易出血,附有胆汁斑;病理检查,慢性胃窦炎为14例(16.7%),伴轻度萎缩8例(9.5%),中度萎缩7例(8.3%),肠化生3例(3.6%),非典型增生2例(2.4%),反应性胃炎50例(59.5%);Hp阳性36例(42.8%);全部病例治疗4周后症状明显减轻或消失。结论:BRG病因原发病例(85.7%)多于继发性(14.3%),而Hp可能为BRG的病因之一;诊断主要根据胃镜所见及病理组织学胃小凹增生性改变,结合临床症状及既往病史诊断较为可靠;治疗选用胆酸络合剂、胃肠动力剂、黏膜保护剂、抑酸剂能收到较好疗效。

Objective： The clinic data of 84 cases bile regurgitation gastritis （BRG） were reviewed. Among these cases, males are more than females and 82. 14% （69/84） patients were in 20-40 years group. All the cases had upper abdomen pain, which is not special for the diagnosis. Endoscopic examinations revealed yellow-green mucus, mucosal hyperemia and edema in all cases, especially in the sinus and distal stomach. Pathological examination found chronic antral gastritis （16.67%） in 14 cases, 8 cases of low-grade atrophy（9. 52%）, 7 cases of moderate atrophy （8.33%）, 3 cases of intestinal metaplasia（3.57%）, 2 cases of atypical（2.38%） and 50 cases of reactive gastritis（59. 52 %）. 36 （42. 8%） cases had positive helicobacter pylori （Hp） assay. Symptoms of all cases clearly reduced or disappeared after 4 weeks of treatment. This paper revealed that Hp infection could be one of the causes of BRG. Diagnosis is mainly based on endoscopy and histopathology combined with clinical symptoms and history. Cholic acid complexing agent, gastrointestinal dynamic agent, mucosal protective agent and acid inhibitor were effective for the treatment.