Non-Helicobacter pylori bacterial flora during acid-suppressive therapy:: differential findings in gastric juice and gastric mucosa
Non-Helicobacter pylori bacterial flora during acid-suppressive therapy:: differential findings in gastric juice and gastric mucosa
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DOI：
10.1046/j.1365-2036.2001.00888.x
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发表时间：
2001-03-01
影响因子：
7.6
通讯作者：
Stockbr端gger, RW
中科院分区：
文献类型：
--
作者：
Sanduleanu, S;Jonkers, D;Stockbr端gger, RW
背景：在抑酸治疗过程中，非幽门螺杆菌的胃内生长是常见的。长期的临床后果尚不清楚。目的：研究胃酸抑制期间胃腔和粘膜细菌的生长，与抑酸治疗的类型和持续时间以及伴随的H。方法：共纳入145例使用质子泵抑制剂（n = 109）或组胺（2）受体拮抗剂（H2 RAs，n = 36）持续抑酸治疗胃食管反流病的患者，以及75例未使用抑酸治疗的消化不良患者（对照组）。在内镜检查时，采集空腹胃液进行pH测量和细菌学培养。胃活检标本进行H。pylori（免疫组化）和非H. pylori细菌（改良Giemsa染色阳性，同一部位细菌化学染色阴性）。92例（41.8%）患者胃液中检出幽门植物群，109例（49.6%）患者胃粘膜中检出幽门。胃液中非H。服用质子泵抑制剂的患者的幽门螺杆菌高于对照组和服用H2 RAs的患者（分别为58.7%和22.6%和30.6%，P < 0.0001和P < 0.003），但H2 RAs与对照组之间无统计学差异。在胃粘膜中，非H。在服用质子泵抑制剂和H2 RA的患者中，幽门细菌高于对照组（胃窦：46.9%和48.6% vs. 25%，P < 0.05;体部：52.2%和56.8% vs. 23.7%，P < 0.001），但质子泵抑制剂和H2 RA之间没有差异。非H. pylori细菌在H.服用质子泵抑制剂的幽门螺杆菌阳性患者明显高于幽门螺杆菌阴性患者（P < 0.05）。非H的管腔生长。pylori植物群随胃内pH值升高而增加，而粘膜细菌生长随抑酸时间延长而增加。幽门螺杆菌植物群不仅污染胃液，而且还定植在大部分长期用酸抑制治疗的患者的胃粘膜上。H. pylori和non-H.幽门螺杆菌在萎缩性胃炎和胃癌发病中的作用有待进一步阐明。
Background: Intragastric growth of non-Helicobacter pylori bacteria commonly occurs during acid-suppressive therapy. The long-term clinical consequences are still unclear.Aim: To investigate the luminal and mucosal bacterial growth during gastric acid inhibition, in relation to the type and duration of acid-inhibitory treatment, as well as to concomitant H. pylori infection.Methods: A total of 145 patients on continuous acid inhibition with either proton pump inhibitors (n = 109) or histamine(2)-receptor antagonists (H2RAs, n = 36) for gastro-oesophageal reflux disease, and 75 dyspeptic patients without acid inhibition (control group) were included. At endoscopy, fasting gastric juice was obtained for pH measurement and bacteriological culture. Gastric biopsy specimens were examined for detection of H. pylori (immunohistochemistry) and of non-H. pylori bacteria (modified Giemsa stain-positive and immunohistochemistry-negative at the same location).Results: Non-H. pylori flora was detected in the gastric juice of 92 (41.8%) patients and in the gastric mucosa of 109 (49.6%) patients. In gastric juice, prevalence rate for non-H. pylori bacteria was higher in patients taking proton pump inhibitors than controls and those taking H2RAs (58.7% vs. 22.6% and vs. 30.6%, P < 0.0001 and P < 0.003, respectively), but did not differ statistically between H2RAs and controls. In gastric mucosa, prevalence rates for non-H. pylori bacteria were higher in patients taking proton pump inhibitors and H2RAs than in the controls (antrum: 46.9% and 48.6% vs. 25%, P < 0.05 for both; corpus: 52.2% and 56.8% vs. 23.7%, P < 0.001 for both), but did not differ between proton pump inhibitors and H2RAs. Both luminal and mucosal growth of non-H. pylori bacteria were significantly greater in H. pylori-positive than -negative patients taking proton pump inhibitors (P < 0.05 for both). Luminal growth of non-H. pylori flora increased with the intragastric pH level, whilst mucosal bacterial growth increased with the duration of acid inhibition.Conclusions: Non-H. pylori flora not only contaminates the gastric juice but also colonizes the gastric mucosa of a large proportion of patients treated long-term with acid inhibition. The relationship between H. pylori and non-H. pylori bacteria in the pathogenesis of atrophic gastritis and gastric cancer needs further elucidation.