Intestinal metaplasia at the gastro-oesophageal junction:: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?
Intestinal metaplasia at the gastro-oesophageal junction:: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?
复制标题
DOI：
10.1136/gut.43.1.17
复制
发表时间：
1998-07-01
期刊：
影响因子：
24.5
通讯作者：
Malfertheiner, P
中科院分区：
文献类型：
--
作者：
Hackelsberger, A;Günther, T;Malfertheiner, P
背景-无论是在贲门还是在食道远端，肠化生都被统一定义为特化的柱状上皮，提示与Barrett‘s食道有关。然而，尚不清楚这两个部位与肠化生相关的危险因素是否相同。目的-调查鳞状结肠交界处(SCJ)下的活检标本与内窥镜、胃组织学和临床表现的关系。患者和方法-在调查的423名患者中，SCJ的内窥镜方面被归类为不显著(I组，315例)或提示Barrett‘s食道(II组，n=108)。结果：在I组患者中，13.4%的患者在SCJ处检测到肠化生，其与胃肠化生(优势比(OR)6.96；可信区间(CI)2.48~19.54)和幽门螺杆菌(OR 7.85；CI 2.82~21.85)显著相关，在34.3%的II组患者中，其与反流症状显著相关(OR 19.98；CI 6.12~65.19)，糜烂性食管炎(OR 12.16；CI 3.86~38.24)，男性(OR 6.25，CI 2.16~18.14)，但与幽门螺杆菌或胃肠上皮化生无关。结论：本研究提示幽门螺杆菌肠化生的发病机制并不一致：在胃镜下不明显的鳞癌中，肠化生是幽门螺杆菌胃炎的后遗症，但与Barrett‘s食道的内窥镜特征并存，与男性和胃食道反流病有关。
Background-Intestinal metaplasia, whether in the cardia or the distal oesophagus, has been uniformly defined as specialised columnar epithelium, suggesting a relation with Barrett's oesophagus. It is, however, not clear whether the risk factors associated with intestinal metaplasia are identical at both sites.Aims-To investigate biopsy specimens obtained below the squamocolumnar junction (SCJ) in relation to endoscopic aspect, gastric histology, and clinical presentation.Patients and methods-In 423 patients investigated the endoscopic aspect of the SCJ was classified as unremarkable (group I, n=315) or suggestive of Barrett's oesophagus (group II, n=108). Standardised biopsy specimens from the antrum, corpus, and directly below the SCJ were investigated.Results-Intestinal metaplasia was detected at the SCJ in 13.4% of group I patients, where it was significantly associated with gastric intestinal metaplasia (odds ratio (OR) 6.96; confidence interval (CI) 2.48 to 19.54) and H. pylori (OR 7.85; CI 2.82 to 21.85), and in 34.3% of group II patients where it was significantly associated with reflux symptoms (OR 19.98; CI 6.12 to 65.19), erosive oesophagitis (OR 12.16; CI 3.86 to 38.24), and male sex (OR 6.25, CI 2.16 to 18.14), but not with H pylori or gastric intestinal metaplasia.Conclusion-This study suggests that the pathogenesis of intestinal metaplasia at the SCJ is not uniform: at an endoscopically unremarkable SCJ it is a sequela of H pylori gastritis, but coexisting with endoscopic features of Barrett's oesophagus it is associated with male sex and gastrooesophageal reflux disease.