胃底腺息肉临床内镜特征及合并疾病分析

Clinical and endoscopic characteristics of fundic gland polyps and associated conditions

目的总结胃底腺息肉(FGPs)临床内镜特征,并探讨其与质子泵抑制剂(PPI)、幽门螺旋杆菌(Hp)感染及胆汁反流性胃炎、萎缩性胃炎、结直肠肿瘤等合并疾病的关系。方法收集2012—2018年于宜昌市第一人民医院初诊为胃息肉的患者1249例,其中FGPs组981例,对照组(非FGPs患者)268例,回顾总结两组患者的临床内镜特征,对比分析两组患者超4周PPI使用率、Hp感染率,胆汁反流性胃炎、消化性溃疡、萎缩性胃炎、胃异性增生及结直肠肿瘤发病率差异。结果FGPs患者中男女比例为1∶2.3,平均年龄56.02±10.38(24~79)岁,病变多位于胃体和胃底,单发息肉占43.4%,直径多在0.2~0.5 cm,山田Ⅱ型为主;FGPs组Hp感染率为22.8%,明显低于非FGPs组52.2%,组间差异有统计学意义(P<0.001),472例(48.1%)FGPs患者有超过4周质子泵抑制剂使用史,非FGPs组为99例(36.9%),两者差异有统计学意义(P<0.01);同时FGPs组胃溃疡或十二指肠球部溃疡、萎缩性胃炎、胃异性增生及胃癌发生率较非FGPs组低(P<0.01);FGPs组中胆汁反流性胃炎发生率更高(P<0.05);FGPs组与非FGPs组的结直肠肿瘤检出率分别为32.7%和22.2%,两者差异无统计学意义(P>0.05)。结论FGPs的发生与PPI使用存在关联,且和Hp感染呈负相关,FGPs患者胃溃疡或十二指肠球部溃疡、萎缩性胃炎发生率较低,但可能更易出现胆汁反流性胃炎,FGPs与结直肠肿瘤的关系尚需进一步探究。

Objective To investigate the clinical and endoscopic characteristics of fundic gland polyps(FGPs),and assess the correlation between FGPs and Associated Conditions.Methods This retrospective study included patients with 1249 gastric polyps for lesions found on esophagogastroscopy with polyp on biopsy or endoscopic resection at People’s Hospital of China Three Gorges University between 2012 and 2018,then,we evaluated the clinical and endoscopic characteristics,history of proton pump inhibitors(PPIs)use,and prevalence of H.pylori infection,associated Conditions,colonic carcinomas in subjects with and without FGPs.Results The mean age was(56.02±10.38)years,the ratio of male to female was 1∶2.3,the size of the polyps was 0.2-0.5 cm,single polyp was determined in 426(43.4%)patients,the most common localizations of polyps were the fundus and corpus,mostly in YamadaⅡ.Helicobacter infection was present in 22.8%patients with FGPs and 52.2%of those without FGPs(P<0.01).A total of 472 patients with FGPs(472/981,48.1%)was significantly more than 99 patients without FGPs(99/268,36.9%)received PPIs therapy(P<0.01).The prevalence of atrophic gastritis,above digestive ulcer and gastric neoplasms in patients with FGPs was significantly lower than in those without FGPs(P<0.01),Reflux gastritis was significantly more than non-FGPs(P<0.05).Colorectal neoplasms was present in 32.7%patients with FGPs and 22.2%of those without FGPs(P>0.05).Conclusions FGPs may be induced by PPIs therapy,or negatively correlate with H.pylori infection.FGPs in patients may have a low prevalence of above digestive ulcer,atrophic gastritis,and the prevalence of bile reflux gastritis were beyond others,The relationship between FGPs and colorectal neoplasms needs further investigation.