Effect of Helicobacter pylori eradication on reflux esophagitis therapy: a multi-center randomized control study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Helicobacter pylori (H. pylori) frequently colonizes the stomach. Gastroesophageal reflux disease (GERD) is a common and costly disease. But the relationship of H. pylori and GERD is still unclear. This study aimed to explore the effect of H. pylori and its eradication on reflux esophagitis therapy.</p><p><b>METHODS</b>Patients diagnosed with reflux esophagitis by endoscopy were enrolled; based on rapid urease test and Warth-Starry stain, they were divided into H. pylori positive and negative groups. H. pylori positive patients were randomly given H. pylori eradication treatment for 10 days, then esomeprazole 20 mg bid for 46 days. The other patients received esomeprazole 20 mg bid therapy for 8 weeks. After treatment, three patient groups were obtained: H. pylori positive eradicated, H. pylori positive uneradicated, and H. pylori negative. Before and after therapy, reflux symptoms were scored and compared. Healing rates were compared among groups. The χ2 test and t-test were used, respectively, for enumeration and measurement data.</p><p><b>RESULTS</b>There were 176 H. pylori positive (with 92 eradication cases) and 180 negative cases. Healing rates in the H. pylori positive eradicated and H. pylori positive uneradicated groups reached 80.4% and 79.8% (P = 0.911), with reflux symptom scores of 0.22 and 0.14 (P = 0.588). Healing rates of esophagitis in the H. pylori positive uneradicated and H. pylori negative groups were, respectively, 79.8% and 82.2% (P = 0.848); reflux symptom scores were 0.14 and 0.21 (P = 0.546).</p><p><b>CONCLUSIONS</b>Based on esomeprazole therapy, H. pylori infection and eradication have no significant effect on reflux esophagitis therapy.</p>

Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prevalence of Helicobacter pylori (H. pylori) infection varies by geographic locations. Studies indicate that the infection rate of H. pylori was previously high in China but that rates had been declining worldwide over recent decades.</p><p><b>THE AIMS OF OUR STUDY WERE</b>(1) to determine the current prevalence of H. pylori infection among children and adults residing in areas with high (Muping County, Shandong) and low (Yanqing County, Beijing) incidences of gastric cancer in China, and (2) to compare the prevalence for 2006 with the prevalence for the early 1990s.</p><p><b>METHODS</b>Using Warthin-Starry silver staining of gastric mucosal biopsy specimens and H. pylori stool antigen tests (HpSA), we tested a total of 2065 asymptomatic children aged 8 - 15 years and adults aged 40 - 79 years in the above two regions from May to July 2006. We evaluated 520 children and 526 adults from Muping, and 516 children and 503 adults from Yanqing. Subjects were selected randomly and H. pylori status was determined by HpSA in children and either HpSA or histology of gastric biopsies in adults. Data obtained in the early 1990s in the same two areas of China were also collected and studied.</p><p><b>RESULTS</b>For children, the prevalence of H. pylori infection was significantly higher in Muping (37.69%) than it was in Yanqing (25.58%, P < 0.001). In both regions, the prevalence of H. pylori increased with age but was not related to gender. A significant difference was observed between 8 - 9-years old and 10 - 11-years old (P < 0.05), but not between other adjoining age groups (P > 0.05). From 1991 to 2006 H. pylori prevalence among 8 - 10-year-old children decreased in Muping (60.00% vs 32.07%, P < 0.001), but not Yanqing (24.06% vs 19.10%, P > 0.05). In the adult group, H. pylori prevalence was 50.95% in Muping, which was significantly higher than the 41.35% positive rate in Yanqing (P < 0.01). But there were no statistically significant differences between different age groups of 40 - 49, 50 - 59, and 60 - 79 years, or between males and females. A significant decrease in H. pylori prevalence 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 in Yanqing (41.35% vs 55.35%, P < 0.01).</p><p><b>CONCLUSIONS</b>After fifteen years, the prevalence of H. pylori infection among both children and adults remained significantly higher in areas with a high incidence of gastric cancer in China compared with that in areas with a low incidence of gastric cancer. H. pylori infection rates have decreased in the general Chinese population during recent years.</p>

Dilated intercellular spaces in gastroesophageal reflux disease patients and the changes of intercellular spaces after omeprazole treatment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastroesophageal reflux disease (GERD) is a common disorder. Dilation of intercellular spaces of esophageal epithelium has been revealed at transmission electron microscopy both in the rabbit acid-perfused esophagus and in esophageal biopsies from GERD patients. This study aimed to observe the changes of the intercellular spaces of squamous epithelium of lower esophagus in patients with GERD and the changes of intercellular spaces of patients with erosive esophagitis (EE) before and after omeprazole treatment.</p><p><b>METHODS</b>Outpatients having GERD symptoms for more than 3 months and volunteers were collected. All of them underwent gastroendoscopy and 24-hour ambulatory pH monitoring. Biopsies were taken from the lower esophagus (2 cm above Z-line) for electron microscope examination. Five healthy volunteers, six non-erosive reflux disease (NERD) patients, and five EE patients were enrolled. Intercellular spaces of GERD patients and controls were calculated. Then we selected 20 patients with EE diagnosed by gastroendoscopy. All of them were treated with omeprazole (Losec, 20 mg bid) for 4 weeks then underwent gastroendoscopy again. Biopsies were taken from 2 cm above Z-line for electron microscope examination. All the patients completed the questionnaire about reflux symptoms before and after treatment.</p><p><b>RESULTS</b>Intercellular spaces of esophageal epithelial cell in volunteers, NERD patients and EE patients were (0.37 +/- 0.07) microm, (1.31 +/- 0.08) microm, and (1.33 +/- 0.14) microm, respectively, with significant differences between the control group and the NERD group (P = 0.000). In the 20 EE patients, the mean intercellular space before treatment was (1.14 +/- 0.15) microm. After treatment the intercellular space was (0.51 +/- 0.18) microm, a significant difference compared with pre-treatment measurements (P = 0.000).</p><p><b>CONCLUSIONS</b>Dilated intercellular spaces (DIS) were seen in both NERD and EE cases. The dilated intercellular spaces of esophageal epithelium in EE patients could be recovered after a short time of treatment with omeprazole.</p>

The changes of the intercellular spaces of squamous epithelium of lower esophagus in gastroesophageal reflux disease / 中华消化杂志

Objective To observe the changes of the intercellular spaces of squamous epithelium of lower esophagus in gastroesophageal reflux disease(GERD).Methods Eleven outpatients with GERD symptoms more than 3 months [6 with nonerosive reflex disease(NERD)and 5 with erosive esophagitis(EE)]and 5 healthy volunteers were recruited.All of them underwent endoscopy and 24-hr ambulatory pH monitoring.Biopsies were taken in lower esophagus(2 cm above Z-line)for electron microscope examination.Results Intercellular spaces of esophageal epithelial cell in volun teers,NERD patients and EE patients were (0.374?0.073)?m,(1.308?0.079)?m and (1.332?0.144)?m respectively,with significant differences between the control group and the NERD or EE group.There was no difference between NERD group and EE group.Conclusions Dilated intercellular spaces were seen in both NERD and EE cases,which was significantly different from the control cases.