Is there any relationship between functional dyspepsia and chronic gastritis associated with Helicobacter pylori infection?
Is there any relationship between functional dyspepsia and chronic gastritis associated with Helicobacter pylori infection?
复制标题
幽门螺杆菌感染引起的功能性消化不良与慢性胃炎有关系吗？
作者：
J. Kyzekové;J. Arlt;M. Arltová
背景/目的
功能性消化不良与H。pylori感染与慢性胃炎的关系存在争议。本研究的目的是：1）确定功能性消化不良和H. pylori感染; 2）确定根除治疗对功能性消化不良症状的影响。
方法
前瞻性随机研究。251例连续的消化不良患者（141例女性和110例男性），平均年龄48.08岁，SD 16.68（经内镜检查确定无溃疡、胃恶性肿瘤或反流性食管疾病），幽门螺杆菌感染，在基线、治疗后3个月和6个月进行上消化道内窥镜检查，并获得6份活检（贲门、胃体、胃窦）（泮托拉唑40 mg，每日一次，阿莫西林100 mg b.i.d.，克拉霉素500 mg b.i.d.）。炎症、活动、H.在治疗前和治疗后6个月，根据悉尼系统半定量地评估幽门螺杆菌的存在和其他粘膜变化。在治疗前和治疗后6个月进行了一次访谈，确定了7种症状（评分为0-3）;上腹部烧灼感和压迫感、餐后疼痛、恶心、呕吐、腹胀和打嗝、空腹疼痛和厌食。计算症状和组织学结果平均值的95%置信区间。通过Kendall tau-b（K tau-b）确定症状与组织学结果之间的相关性。在5%的显著性水平上使用t检验，我们检验了零假设，即症状和组织学结果是自变量。
结果
3个月后根除有效率为87.3%，6个月后根除有效率为92.0%。6个月后再感染率为6.4%，根除失败率为1.6%。慢性炎症、活动性和H.幽门螺杆菌在贲门、胃体、胃窦的分布差异有统计学意义（P = 0.001）。胃体和胃窦腺体萎缩程度较低（P = 0.001），而贲门腺体萎缩程度较低（P = 0.001），肠上皮化生在所有胃区域均保持不变，而胃小凹增生程度较高，以胃体和胃窦最为明显（P = 0.01）。贲门和胃窦淋巴滤泡明显消退（P = 0.001）。与治疗后6个月访视相比，首次访视时症状与组织学结果之间的平均显著相关性较高，K tau值的变异性较低（K tau-b 0.171，SD 0.05，变异系数30.5% vs. K tau-b 0.167，SD 0.07，变异系数41.5%）。根据首次访视时胃炎的地形分布，发现症状和结果之间的平均显著关联在胃窦和胃体中最高，而在治疗后6个月的访视中，发现贲门变量的关联值最高，胃体变量的关联值最低。6个月后，主诉症状的患者数量和消化不良评分均较低（Wilcoxon P = 0.000）。
结论
胃粘膜的高级形态学改变被发现与动力障碍症状显著相关。空腹时疼痛预示胃窦炎。治疗后6个月，贲门癌与症状的平均相关性较高。根除治疗导致炎症变化和症状的改善。在一些患者中，持续性动力障碍症状与贲门持续性炎症相关，胃窦也是如此，但程度较轻。
BACKGROUND/AIMS
The relationship between functional dyspepsia, H. pylori infection and chronic gastritis is controversial. Our aims were 1) To determine the prevalence of symptoms and the degree of association between symptoms and histopathological findings in different topographical gastric regions in patients with functional dyspepsia and H. pylori infection; 2) To determine the effect of eradication treatment on functional dyspepsia symptoms.
METHODOLOGY
Prospective randomized study. 251 consecutive patients with dyspepsia (141 women and 110 men), mean age 48.08, SD 16.68 (without ulcer, gastric malignancy or reflux esophageal disease as determined by endoscopy), and with H. pylori infection, underwent upper endoscopy accompanied by the obtaining of 6 biopsies (cardia, corpus, antrum) at baseline, 3 and 6 months after treatment (pantoprazole 40 mg, once daily, amoxycillin 100 mg b.i.d., clarithromycine 500 mg b.i.d.). Inflammation, activity, H. pylori presence and other mucosal alterations were evaluated semi-quantitatively according to the Sydney system, before treatment and 6 months following treatment. An interview that was carried out before, and 6 months following the treatment, determined seven symptoms (scored as 0-3); epigastric burning and pressure, pain after meal, nausea, vomiting, bloating and belching, pain on empty stomach and anorexia. 95% confidence intervals were calculated for mean values of the symptoms and histological findings. The association between symptoms and histological findings was determined by the Kendall tau-b (K tau-b). Using the t test on a 5% level of significance we tested the null hypothesis that symptoms and histological findings were independent variables.
RESULTS
The effectiveness of eradication after 3 months was 87.3% and after 6 months 92.0%. Reinfection rate after 6 months was 6.4% and the overall failure of eradication was 1.6%. Significant decline of chronic inflammation, activity and H. pylori was found in cardia, corpus and antrum (P = 0.001). Glandular atrophy was found to be lower in corpus and antrum (P = 0.001), whereas in cardia an increase was found. Intestinal metaplasia remained unchanged in all gastric regions, whereas a higher degree of foveolar hyperplasia was found, which was most pronounced in corpus and antrum (P = 0.01). There was a significant regression of lymphoid follicles in cardia and antrum (P = 0.001). On the first visit, the mean significant association between symptoms and histological findings was higher, with lower variation of K tau values as compared with the visit 6 months after treatment (K tau-b 0.171, SD 0.05, variation coefficient 30.5% vs. K tau-b 0.167, SD 0.07, variation coefficient 41.5%). According to the topographic distribution of gastritis at the time of the first visit, the mean significant association between symptoms and findings was found to be highest in antrum and corpus as opposed to the visit 6 months after treatment, where the values of association were found to be highest for variables from cardia and lowest for those in gastric corpus. After 6 months both the number of patients complaining of symptoms and dyspepsia score were lower (Wilcoxon P = 0.000).
CONCLUSIONS
Advanced morphological changes of gastric mucosa were found to be significantly associated with symptoms of dysmotility. Pain on an empty stomach is predictive of antral inflammation. Cardia showed higher values of mean association with symptoms 6 months after therapy. Eradication treatment results in an improvement of both inflammatory changes and symptoms. In some patients persisting dysmotility symptoms were associated with persistent inflammation in cardia, which was also true for antrum, however to a lesser degree.