Хеликобактериоз: изменения слизистой оболочки при нарушении двигательных функций (моторики) в гастроэзофагальной и дуоденогастральной зонах желудка

О. О. Янович, Леонид Петрович Титов, М. В. Дорошко, И. Г. Сергеева, С. А. Гузов
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Abstract

The morphological changes in the gastric mucosa in the presence of duodenogastric reflux and refluxesophagitis and their connection with the presence of Helicobacter pylori (HP) infection are studied. The endoscopic and histological examination of the stomach antral part was performed in 1251 patients with different gastroduodenal pathologies. HP was diagnosed by histological and real-time PCR methods. Among patients with different gastroduodenal pathologies the frequency of H. pylori infection was 77.9 %. Duodenogastric reflux was detected in 23.9 % of patients. In the presence of duodenogastric reflux, we have found a decrease in the risk of duodenal ulcer by a factor of 2.5, thus duodenogastric reflux may protect against the development of duodenal ulcer. In patients with duodenogastric reflux in the presence of H. pylori infection, significant differences from the group uninfected of Helicobacter pylori were found in the metaplasia frequency. A significant increase in the frequency of foveolar hyperplasia among patients with duodenogastric reflux was revealed. The prevalence of reflux-esophagitis in the study group was 8.3 %. No increased risk in reflux-esophagitis was observed either in the HP-positive or HP-negative cases. According to our finding, duodenogastric reflux was characterized by foveolar hyperplasia and metaplasia. We suggest that the presence or absence of H. pylori does not affect reflux-esophagitis.
螺旋菌:胃食管和二头肌区域运动功能障碍引起的粘膜变化
研究了十二指肠胃反流和反流性食管炎时胃黏膜的形态学变化及其与幽门螺杆菌感染的关系。本文对1251例不同胃十二指肠病理的患者行胃窦部内镜及组织学检查。采用组织学和实时PCR方法诊断HP。不同胃十二指肠病变患者幽门螺杆菌感染发生率为77.9%。23.9%的患者出现十二指肠胃反流。在存在十二指肠胃反流的情况下,我们发现十二指肠溃疡的风险降低了2.5倍,因此十二指肠胃反流可以防止十二指肠溃疡的发展。在存在幽门螺杆菌感染的十二指肠胃反流患者中,在化生频率上与未感染幽门螺杆菌的组有显著差异。在十二指肠胃反流的病人中,有显著增加的频率出现小凹增生。研究组中反流性食管炎的患病率为8.3%。在hp阳性或hp阴性病例中均未观察到反流性食管炎的风险增加。根据我们的发现,十二指肠胃反流的特征是小窝增生和化生。我们认为幽门螺旋杆菌的存在与否并不影响反流性食管炎。
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