Increasing trend of reflux esophagitis and decreasing trend of Helicobacter pylori infection in patients from a multiethnic Asian country
Increasing trend of reflux esophagitis and decreasing trend of Helicobacter pylori infection in patients from a multiethnic Asian country
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DOI：
10.1111/j.1572-0241.2005.50138.x
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发表时间：
2005-09-01
影响因子：
9.8
通讯作者：
Kang, JY
中科院分区：
文献类型：
--
作者：
Ho, KY;Chan, YH;Kang, JY
目的：本研究旨在确定新加坡一家大型教学医院 10 年间内镜下食管炎和幽门螺杆菌 (H. pylori) 感染频率的时间趋势。方法：我们对 1992 年至 2001 年间新转诊进行诊断性食管胃十二指肠镜检查的 16,375 名患者进行了连续系列研究。所有内镜检查结果均进行前瞻性记录。从 1995 年起，对 6,185 名未经选择的患者进行了胃窦活检，用于内部活检尿素酶测试。内镜下食管炎定义为存在糜烂和/或溃疡。分析糜烂性食管炎与各相关因素的关系。结果：内镜下食管炎的总患病率为6.9%（95% Cl，6.5~7.3）。尿素酶试验呈阳性的患者的这一比例为 7.3% (95% Cl, 6.2-8.4)，而脲酶试验阴性的患者的这一比例为 9.0% (95% Cl, 8.1-9.9) (p < 0.001)。从1992年到2001年，内镜下食管炎的发生率有所增加（趋势p < 0.001），而从1995年到2001年，尿素酶试验阳性的发生率有所下降（趋势p < 0.001）。即使在调整了年龄、性别、种族分布和食管裂孔后，内镜下食管炎患病率的增加（RR 1.99，95% CI 1.18-3.36，p = 0.0098）及其与脲酶测试结果阳性的负相关关系（RR 0.991，95% CI 0.983-0.999，p = 0.049）仍然显着结论：从1992年到2001年，新加坡内镜下食管炎的发病率有所增加。这种短时间内的增加表明，环境因素（幽门螺杆菌感染率下降可能是其中之一）在胃食管反流病的发病机制中发挥着重要作用。
OBJECTIVES: This study aimed to determine time trends in the frequency of endoscopic esophagitis, and Helicobacter pylori (H. pylori) infection in a large Singaporean teaching hospital over a 10-yr period.METHODS: We studied a consecutive series of 16,375 patients who had been newly referred for diagnostic esophagogastroduodenoscopy from 1992 to 2001. All endoscopic findings were prospectively recorded. From 1995, an antral biopsy was taken from 6,185 unselected patients for an in-house biopsy urease test. Endoscopic esophagitis was defined as the presence of erosions and/or ulceration. The relationship between erosive esophagitis and various relevant factors was analyzed.RESULTS: The overall prevalence of endoscopic esophagitis was 6.9% (95% Cl, 6.5-7.3). It was 7.3% (95% Cl, 6.2-8.4) in patients with a positive urease test, and 9.0% (95% Cl, 8.1-9.9) in those in whom the urease test was negative (p < 0.001). From 1992 to 2001, the frequency of endoscopic esophagitis increased (p < 0.001 for trend) while that of positive urease test decreased from 1995 to 2001 (p < 0.001 for trend). The increase in the prevalence of endoscopic esophagitis (RR 1.99, 95% Cl 1.18-3.36, p = 0.0098), and its inverse relationship with positive urease test results (RR 0.991, 95% CI 0.983-0.999, p = 0.049) remained significant even after adjusting for age, gender, ethnic distribution, and hiatal hernia.CONCLUSIONS: The frequency of endoscopic esophagitis increased in Singapore from 1992 to 2001. This increase within a short period of time suggests that environmental factors, of which the decreasing rate of H. pylori infection may be one, are important in the pathogenesis of gastroesophageal reflux disease.