The correlation between reflux esophagitis and Helicobacter pylori infection based on natural population / 中华内科杂志

Objective:Reflux esophagitis (RE) may be negatively correlated with Helicobacter pylori ( H. pylori) infection, but the conclusion and relevant mechanism is still controversial. This study proposed to explore the correlation between RE and H. pylori infection based on natural population. Methods:From July 2013 to December 2014, 3 940 residents aged 40-69 years were recruited in Linqu County of Shandong Province and Hua County of Henan Province by the whole sampling method. All the subjects underwent gastroscopy, and gastric mucosa biopsy specimens were collected for pathological diagnosis and Warthin-Starry (WS) staining to identify H. pylori infection. Venous blood samples of some subjects were collected for H. pylori immunoglobulin G ( H. pylori-IgG) detection. Also, demographic and sociological data were collected. Chi-square test and logistic regression were used to analyze the correlation between RE and H. pylori infection. Results:A total of 359 cases of RE were detected. Excluding RE and other upper gastrointestinal organic diseases, 3 382 cases were considered as controls. Chi-square test showed that WS staining positive rate in RE group was significantly lower than that in control group ( P=0.023), but there was no significant difference in the positive rate of H. pylori-IgG between the two groups ( P=0.281). There were significant differences between RE group and control group in gender composition, age, body mass index (BMI), smoking, alcohol consumption, education level and mucosal active inflammation. Multivariate regression analysis showed that RE was negatively correlated with gastric mucosa active inflammation [ OR=0.754 (95% CI 0.600-0.949), P=0.016], and positively correlated with male [ OR=4.231 (95% CI 3.263-5.486), P<0.001], age ≥60 years, BMI≥24 kg/m 2 [ OR=1.540 (95% CI 1.220-1.945), P<0.001]. Compared to those aged 40-49 years and 50-59 years, the odds ratio ( OR) of RE in these aged ≥60 years were 1.566 (95% CI 1.144-2.143, P=0.005) and 1.405 (95% CI 1.093-1.805, P=0.008). Conclusion:RE is more closely related to H. pylori present infection. Multivariate analysis showed that RE is negatively correlated with active inflammation of gastric mucosa caused by H. pylori infection, and positively correlated with male, overweight and aged ≥60 years.

Pathological assessment of gastric mucosa using OLGA system / 中华消化内镜杂志

Objective To evaluate the clinical value of OLGA (Operative Link on Gastritis Assessment) system in pathological assessment of gastric mucosa from Chinese patients.Methods Endoscopic and pathological data of patients,who underwent the endoscopic examination of upper gastrointestinal tract from 2007 to 2012,were analyzed.Using the Sydney protocol,we graded atrophy and staged the Helicobacter pylori infection status in gastric biopsies from 108 patients with dyspepsia.We applied the OLGA system to assess the relationship between OLGA staging and grading and dysplasia/cancer,and the relationship between OLGA grading and Helicobacter pylori infection.Results Two cases of early gastric adenocarcinoma were detected at stage Ⅱ and Ⅳ,respectively.The detection rates of precancerous lesions (including intestinal metaplasia and dysplasia) in cases clustered in stages Ⅲ-Ⅳ were significantly higher than those in stages 0-Ⅱ (intestinal metaplasia:100.0％ VS 65.3％,P ＜0.001 ;dysplasia:77.8％ VS 13.9％,P ＜0.001,respectively),and there were significant differences between OLGA staging and the degree of dysplasia (r =0.671,P ＜0.001).In the subjects at stage 0-Ⅱ,we observed only 10 cases (13.9％) of mild dysplasia.The difference in rate of Helicobacter pylori infection was significant at different OLGA grade (P ＜ 0.001),and the correlation between OLGA grading and infection degree of Helicobacter pylori was significant (r =0.586,P ＜ 0.001).Conclusion Precancerous lesions and gastric adenocarcinoma tend to be discovered in patients clustered at high-risk (Ⅲ-Ⅳ) OLGA stages.OLGA staging of dysplasia can effectively differentiate the risks of gastric cancer.The OLGA grading system is consistently associated with the Helicobacter pylori infection.

Helicobacter pylori infection: an overview in 2013, focus on therapy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>This article aimed to review the incidence of Helicobacter pylori (H. pylori) infection and its therapy.</p><p><b>DATA SOURCES</b>Relevant articles published in English were identified by searching in PubMed from 2000 to 2013, with keywords "H. pylori". Important references from selected articles were also retrieved from Elsevier, Wiley, EBSCO, and SPRINGER. The Chinese articles published were searched from China National Knowledge Infrastructure (CNKI).</p><p><b>STUDY SELECTION</b>Articles about "prevalence", "gastric carcinoma", "peptic ulcer", "gastroesophageal reflux disease", "functional dyspepsia", "pathogenic mechanism", "therapy", "eradication rate", "antibiotic resistance", and "gene polymorphisms" were selected.</p><p><b>RESULTS</b>The decreased infection rates of H. pylori could also be linked to the changed disease spectrum, such as the decreased morbidity and recurrence rate of H. pylori-related peptic ulcer, and the increased morbidity of gastroesophageal reflux. Although different treatment regimens have been used for H. pylori infection, the H. pylori eradication rate declined gradually. Due to primary resistance to antibiotics, the gene polymorphism of host and infected strain, and the therapy regimes, H. pylori eradication became even more difficult.</p><p><b>CONCLUSIONS</b>The prevalence of H. pylori infection had been decreasing, but the rate of eradication failure has dramatically risen in many countries due to resistance to antibiotic. H. pylori therapy in clinical practice is becoming progressively more difficult.</p>

Relationship of Helicobacter pylori eradication with gastric cancer and gastric mucosal histological changes: a 10-year follow-up study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Helicobacter pylori (Hp) is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years.</p><p><b>METHODS</b>From an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group (T; n = 276) or a placebo group (P; n = 276). In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination.</p><p><b>RESULTS</b>Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia (IM) had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer (2 in the T group; 7 in the P group; P = 0.176). When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group (n = 6) was much higher than that in the T group (n = 0, P = 0.013).</p><p><b>CONCLUSIONS</b>Hp eradication may significantly diminish and help halt progression of gastric mucosal inflammation and delay the development of IM and atrophy gastritis. Hp eradication is helpful for reducing the risk for gastric cancer, especially in the early stage of Hp infection.</p>

The endoscopic and clinical characteristics of gastrointestinal Behcet's disease / 中华消化内镜杂志

ObjectiveTo investigate the endoscopic and clinical characteristics of gastrointestinal Behcet's disease (BD). MethodsWe analyzed the clinical and follow-up data of 27 patients with gastrointestinal BD retrospectively.Results Most common locations involved were esophagus and ileocecum,74. 1％ (20/27) and 59. 3％ (16/27), respectively. The most common parenteral symptoms were oral ulcers (85.2％), genital ulcers (25.9％), ophthalmitis (7. 4％ ) and skin damage (7. 4％ ). The most common gastrointestinal symptom was chest pain (48. 1％, 13/27). Ulcer was the basic endoscopic feature,most of which were with uneven bottom and peripheral inflammatory response. There was no difference in endoscopic features between typical BD and atypical BD. Pathology showed typical small vasculitis (44. 4％,12/27). ConclusionClinical manifestations of intestinal BD vary. Symptoms are not necessarily consistent with the involved locations. A small number of patients with BD present with gastrointestinal symptoms as the first and only symptom, with serious complications in some patients. Physicians need to be fully aware of the disease.

Microscopic measurement of intercellular space of squamous epithelium in lower part esophagus of patients with gastro-esophageal reflux disease / 中华消化内镜杂志

Objective To evaluate the clinical significance of intercellular space diameters (ISD)of squamous epithelium by light microscopy (LM) in lower esophagus of erosive reflux esophagitis (ERD),non-erosive reflux disease ( NERD), Barrett esophagus (BE) and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens ( × 1000). ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control (P＜0. 05). The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE (P = 0. 000). However, the ISDs of NERD and BE are of no significant difference ( P ＞ 0. 05 ). The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease (GERD) was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE.

A case report of collagenous gastritis in a young Chinese woman and literatures review / 中华内科杂志

Objective Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagen band with an inflammatory infiltrate in the mucosa.This report describes the first case of collagenous gastritis occurring in a young Chinese woman and reviews the literatures.Methods The patient underwent the gastroscopy screening, and the biopsy specimens were treated with HE staining, Masson staining, Congo red staining and Warthin-Starry staining.Patients' clinical data was discussed and followed up.Results A twenty-year-old girl had intermittent epigastric pain for 4 years, abdominal distention, hiccup and weight loss for two months.The gastric endoscopy revealed diffuse white nodular appearance of the mucosa in angular incisure and antrum.Pathologic examination of the gastric biopsies from the antrum and angular showed a subepithelial collagen deposition with moderate infiltrates of lymphoplasma cells and eosinophils of the lamina propria.The collagen band measured up to 120.3 μm (mean 43.8 μm).Prednisone 20 mg/d for 4 weeks led to clinical remission and weight gain.Conclusion There are about 40 cases in literatures to date, and the cause and pathogenesis of collagenous gastritis remain unknown.According to the clinical and pathological characteristics, the patient in this article is the subtype of collagenous gastritis that occurring in children and young adults.Specific therapy has not been established, the gluten-free diet and glucocorticosteroid may be helpful to relieve symptoms in collagenous gastritis patients.

Potential mechanism for epigastric discomfort in patients without Helicobacter pylori infection / 中华消化杂志

Objective To investigate the potential mechanism for symptoms related to epigastric discomfort in patients without Helicobacter pylori (H.pylori) infection.Methods Patients who underwent gastric endoscopy and conformed H.pylori negative by histologic examination were enrolled.Among them,232 adult patients were collected between August 2006 and November 2006 and 31 children were collected between September 2005 and August 2009.All patients showed no apparent abnormality by endoscopic examination.The endoscopic biopsy was examined with HE or Warthin-Starry staining.Results In adult group,arteriole obstruction was found in 16 (8.8%) cases and focal haemorrhage in 82 (45.6%) cases.Both were existed in 82 (45.6%) cases.The histopathologic findings showed that arteriole obstruction in transition zone (65.2 %,P = 0.159) was common,whereas the focal haemorrhage in gastric fundus and corpus (65.6%,P=0.001) was in predominance.The symptom of heartburn was less in patients with arteriole obstruction and/or focal haemorrhage in comparison with those without these changes (x2 =8.564,P=0.003).In adolescent group,arteriole obstruction and/or focal haemorrhage accounted for 96.8% (30/31).Conclusion Gastric mucosa ischemic resulted from arteriole obstruction are commonly seen in both adult and adolescent patients,which is an important reason for epigastric discomfort in H.pylori negative patients.

A study on the light microscopic measurement of intercellular space of squamous epithelium in lower-esophagus to diagnose gastroesophageal reflux disease / 中华内科杂志

Objective To evaluate the significance of dilated intercellular space (DIS) of squamous epithelium in lower-esophagus which was measured at light microscopy (LM) in the diagnosis of gastroesophageal reflux disease (GERD). Methods This study was divided into two parts. The first part consists of 133 GERD patients with typical symptoms, including 75 erosive esophagitis (EE) and 58 non-erosive reflux disease (NERD);the second part consists of 25 healthy volunteers as control; ambulatory 24-hr esophageal pH monitoring, endoscopy and biopsies which were taken in lower esophagus were performed in all individuals. NERD patients with negative ambulatory 24-hr esophageal pH monitoring were undertaken PPI test. We selected 43 individuals randomly (4 control, 11 NERD and 28 EE) to measure the intercellular space diameter with LM and transmission electronic microscopy (TEM) simultaneously. All the samples were observed at immersion objective, taken pictures and make the scale at the same time; all the pictures were measured by the computer-assisted morphometry and in the samples for one ease should be measured 100 points and then calculate the mean intercellular space diameter, while the TEM has the same procedures. Results A total of 158 individuals (90 male, 68 female) were enrolled in this study. The mean intercellular space diameter with LM of the controls, the NERD and the EE patients were (0.61±0.10)μm, (1.12±0.61)μm and (1.30±0.19) μm, respectively, with significant differences between the control and NERD group, the control and EE group, the EE and NERD group (P <0.05); the mean intercellular space diameter with LM of EE subgroup of LA-A, LA-B, LA-C, LA-D were (1.31±0. 23)μm, (1.27±0.17)μm, (1.31±0.14)μm, (1.33±0.11)μm, respectively, without significant differences among every two subgroups (P > 0.05);NERD patients with positive and negative 24-hr ambulatory pH monitoring were 40 and 17 cases, and the mean intercellular space diameter with LM were (1.12±0.16) μm, (1.11±0.31) μm, respectively, without significant differences between them (P >0.05) ;the cut-off value of mean intercellular space diameter with LM was 0. 85 μm, if combination the clinical GERD symptom, endoscopy and 24-hr ambulatory pH monitoring as gold standard, its sensitivity was 95.5% and specificity was 100%;the intercellular space diameter of the controls, the NERD patients and the EE patients with TEM were (0. 30±0.14)μm, (1.33±0.28)μm, (1.40±0. 22)μm, respectively,with significant differences between the control and NERD group, the control and EE group (P < 0.05). It was significant correlation in intercellular space diameter between LM and TEM (r=0.737, P=0.000).Conclusions The intercellular space diameter of squamous epithelium in lower esophagus of GERD patients can make quantitative study with LM. It is significant correlation with TEM. DIS with LM is one of sensitive, specific and objective marker of GERD.

Epidemiology of Helicobacter pylori infection in Shandong and Beijing areas / 中华内科杂志

Objectives To study the current prevalence and recent epidemiological changes of Helicobacter pylori (H. pylori) infection among children and adults residing in regions with high ( Muping, Shandong) and low (Yanqing, Beijing) incidence of gastric cancer in China. Methods A total of 2065 asymptomatic children aged 8-15 years and adults aged 40-79 years in the above two regions were examined from May to July 2006. The data obtained in early 1990s in the same two areas and those of 11 656 patients undergoing endoscopy in our hospital in 1991 and 2006 were also collected and studied. Results The prevalence ofH. pylori infection in Muping was significantly higher than that in Yanqing among both children (37.69% vs25.58%, P<0.001) and adults (50.95% vs41.35%, P < 0. 01 ). From 1991 to 2006 H. pylori prevalence among children aged 8-10 years decreased in Muping (60. 00% vs 32. 07% , P < 0.001), but not in Yanqing (24.06% vs 19.10%, P > 0. 05 ) . A significant decrease in H. pylori prevalence among adults in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping (50.95% vs 73.78% , P < 0. 001 ) and in 1992 inYanqing (41.35% vs 55. 35% , P < 0. 01 ) . The detected rate of H. pylori infection in patients undergoing endoscopy in our hospital decreased from 51. 88% in 1991 to 33. 59% in 2006 (P <0. 001). Conclusions The prevalence of H. pylori infection is significantly higher in areas with a high incidence of gastric cancer in China as compared with that in areas with a low incidence of gastric cancer among both children and adults. H. pylori infection may be a risk factor in gastric carcinogenesis. In the past decade or more, H.pylori infection rates have decreased in Chinese population.

The relationship between Helicobacter pylori and peptic ulcer: A 10-year follow-up study / 中华消化杂志

Objective To investigate the incidence of peptic ulcer (duodenal ulcer and gastric ulcer) and the development of Helicobacter pylori (Hp) infection in the population during 10 years after Hp eradication.Methods Subjects were chosen from general population and performed endoscopy.Among them,the individuals confirmed to be Hp positive were randomly divided into treatment group and placebo group.The patients in treatment group received OAC triple therapy (omeprazole 20 mg,clarithromycin 500 nag and amoxicillin 1000 re.g,twice daily) for one week.After that,both groups continuously followed up by endoscopy during at 1st,5th,8th and 10th year for incidence and relapse of peptic ulcer as well as status of Hp infection.The patients in treatment group were examined by 13C-UBT for Hp eradication one month after the completion of treatment.Results At the 1st year,the incidence of peptic ulcer between the treatment group and placebo group were 3.7% and 12.85% (P=0.0002),respectively.At the 5th year,they were 5.86% and 14.93% (P=0.0017),respectively.At the 8th year,they were 4.4% and 9.39% (P = 0.044),respectively.The incidence of peptic ulcer of the treatment group significantly decreased after the eradication therapy compared to the placebo group.After the eradication,at the 1st year,the recurrence rates were 3.70% and 38.1% between the treatment group and the placebo group (P=0.0027).At the 5th year,they were 14.81% and 42.86% (P=0.03).At 8th year,they were 14.81 and 47.62% (P=0.03),respectively.At the 10th year,they were 25.93% and 57.14% (P=0.028).Then the recurrence rates of the treatment group significantly decreased compared to the placebo group.During the 10-year follow up study,the rate of Hp reinfection after a successful eradication in the treatment group was high,and it was 46.4% at the 10th year.Conclusion Both the incidence and recurrence of peptic ulcer significantly decreased after Hp eradication.It is necessary of Hp eradication in patients with peptic ulcer.Hp reinfection after a successful eradication is more frequent.

The effects of sulindac on the pathology of colorectal remnant polyps of familial adenomatous polyposis (FAP) patients / 北京大学学报(医学版)

Objective: To evaluate the long-term effectiveness of sulindac on the pathology of colorectal adenomas of familial adenomatous polyposis (FAP) patients. Methods: FAP patients were treated with sulindac 400 mg per day. The change of colorectal polyps was assessed every 3 months in the first year. After the significant regression of colorectal polyps was achieved, sulindac was used to maintain the effects. The patients received colonoscopy examination regularly. Biopsies of remnant polyps and other lesions were obtained. The type and dysplasia grade of biopsies were evaluated and compared with baseline. Results: Before the study, 90.8% of adenoma biopsies were tubular, while 9.2% was tubulovillous adenoma. The dysplasia of grades Ⅰ, Ⅱ and Ⅲ were 42.1%, 45.6% and 12.3%, respectively. After sulindac treatment, 99.8% of adenoma biopsies were tubular, while 0.2% tubulovillous adenoma. There was significant difference compared with baseline (P