Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease
Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease
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DOI：
10.1111/j.1572-0241.1999.01513.x
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发表时间：
1999-11-01
影响因子：
9.8
通讯作者：
Sipponen, P
中科院分区：
文献类型：
--
作者：
Voutilainen, M;Färkkilä, M;Sipponen, P
目的：胃食管交界处慢性炎症（心脏炎）的临床意义尚不清楚：它可能与幽门螺杆菌（H。pylori）胃炎或胃食管反流病（GERD）。我们的目的是研究心脏炎和H。方法：1053例接受胃镜检查的患者入选本研究。活检标本从胃窦和胃体，立即远端正常出现鳞状柱状交界处和远端esophageal.Results：慢性炎症在胃食管交界处粘膜（心脏炎）检测到790（75%）的1053例。心脏炎组的男女比例为1：1.5，非心脏炎组为1：1.6（Gn = 0.6）。心脏炎组的平均年龄为58.7岁（95%可信区间[CI]，57.6-59.9），非心脏炎组的平均年龄为52.6岁（95% CI，50.7-54.6，p < 0.001）。在心脏炎组（N = 790）中，549例（69%）患有慢性胃炎（70% H。pylori阳性）和241例（31%）胃组织学正常。在多变量分析中，慢性胃炎患者心脏炎的唯一危险因素是H。幽门螺杆菌感染（优势比[ORI，2.9; 95%CI，1.6-5.0），而胃组织学正常受试者的心脏炎的独立危险因素是内镜下糜烂性食管炎（OR，1.8; 95%CI，1.1-3.1）。贲门粘膜完全肠上皮化生（IM）的患病率在非心脏炎组中为7%，在慢性胃炎的心脏炎组中为19%（p < 0.001），在正常胃的心脏炎组中为10%（p = 0.3）。不完全LM的患病率分别为3%、12%（p < 0.001）和12%（Gn < 0.001）。在胃组织学正常的心脏炎患者（N = 241）中，完全和/或不完全IM患者（N = 49）的年龄高于单纯心脏炎患者（63.6年[95% CI，59.9-67.2] vs 51.4年[95% CI，48.9-53.9]; p < 0.001）。两种不同类型的慢性炎症的胃贲门粘膜似乎发生，一个存在与慢性H。pylori胃炎和胃正常糜烂性GERD。慢性贲门炎和肠上皮化生多见于慢性H。幽门胃炎。(C)1999年，我Cell.胃肠病学
OBJECTIVE: The clinical significance of chronic inflammation at the gastroesophageal junction (carditis) is unknown: it may be associated with Helicobacter pylori (H. pylori) gastritis or with gastroesophageal reflux disease (GERD). We aimed to examine the association between carditis and H. pylori gastritis and endoscopic erosive esophagitis.METHODS: One thousand and fifty-three patients undergoing gastroscopy were enrolled in the study. Biopsy specimens were obtained from gastric antrum and corpus, immediately distal to normal-appearing squamocolumnar junction and distal esophagus.RESULTS: Chronic inflammation at the gastroesophageal junctional mucosa (carditis) was detected in 790 (75%) of 1053 patients. The male:female ratio of the carditis group was 1:1.5 and of the noncarditis group 1:1.6 Gn = 0.6). The mean age of the carditis group was 58.7 yr (95% confidence interval [CI], 57.6-59.9) and of the noncarditis group, 52.6 yr (95% CI, 50.7-54.6, p < 0.001). Of the carditis group (N = 790), 549 (69%) had chronic gastritis (70% H. pylori positive) and 241 (31%) had normal gastric histology. In multivariate analyses, the only risk factor for carditis in subjects with chronic gastritis was H. pylori infection (odds ratio [ORI, 2.9; 95% CI, 1.6-5.0), whereas the independent risk factor for carditis in subjects with histologically normal stomach was endoscopic erosive esophagitis (OR, 1.8; 95% CI, 1.1-3.1). The prevalence of complete intestinal metaplasia (IM) in the gastric cardia mucosa was 7% in the noncarditis group, 19% (p < 0.001) in the carditis group with chronic gastritis, and 10% (p = 0.3) in the carditis group with normal stomach. The respective prevalences of incomplete LM were 3%, 12% (p < 0.001), and 12% Gn < 0.001). Among carditis patients with normal stomach histologically (N = 241), those with complete and/or incomplete IM (N = 49) were older than those with carditis only (63.6 yr [95% CI, 59.9-67.2] vs 51.4 yr [95% CI, 48.9-53.9]; p < 0.001).CONCLUSIONS: Two dissimilar types of chronic inflammation of the gastric cardia mucosa seem to occur, one existing in conjunction with chronic H. pylori gastritis and the other with normal stomach and erosive GERD. Most cases of chronic gastric cardia inflammation and intestinal metaplasia are detected in patients with chronic H. pylori gastritis. (C) 1999 by Am. Cell. of Gastroenterology.