| Aims: To study on the relation among Helicobacter pylon (Hp) infection, gastric metaplasia in the duodenum (DGM) and gastrin (GAS), for elucidating the pathogenesis of duodenal ulcer (DU). Methods: One hundred and twenty-one patients were enrolled into this study and divided into DU(36), gastric ulcer(GU, 31), compound ulcer(CU, 16) and chronic gastritis(CG, 38) by endoscopic or pathologic findings. Under endoscopy, biopsy specimens were obtained from the duodenal bulb, the antral mucosa, the angular mucosa and the corpus mucosa. Biopsy sections were stained with Giemsa for Hp detection, alcian blue(pH2.5)/periodic acid Schiff for DGM, and hematoxylin and eosin for gastroduodenal inflammation. Serum gastnin concentration was also measured by radioimmunoassay in 66 of 121 patients. Results: 1. The rates of Hp detection: The rates of Lip detection in stomach and in duodenal bulb were 86.1% and 36.1% in DU, 100% and 50% in CU, 77.4% and 3.2% in GU, 47.4% and 2.6% in CG, and much higher in patients with DU and CU(90.4%,40.4%) than in patients with GU and CG(60.9%,2.9% P < 0.00 1); However, the positive rates of Hp in duodenal bulb showed no significance between DU and CU, or GU and CG(P>O,05). 2. The prevalence and extent of DGM: The prevalence of DGM was 91.7%(DU), 93.8%(CU), 32.2%(GU) and 50%(CG), and much higher in patients with DU and CU(92.3%) than in patients with GU and CG(42.0%, P<0.001); The extent of DGM was much greater in the former than in the latter(P<0.001) also, but no significance between DU and CU, or CU and CG(P>0.05). DGM was identified in 73.0% of patients with Hp in stomach, and 37.5% of patients without Hp(P< 0.001). The extent of DGM was significantly greater in those patients with lip positive in stomach, in 47.2% of Hp positive patients having more than DGM(+, compared with 21.9% of the Hp negative patients(P<0.05). In duodenum, Hp was mostly detected on areas of DGM, and Hp prevalence showed an increasing trend with the extent of DGM increasing. The prevalence of DGM in the moderate and severe antral gastnitis (67.6%), and in the moderate and severe duodenitis (89.8%) were much higher than that in the mild antral gastnitis (42.1%, P<0.05), and that in the mild duodenitis (45.8%, P<0.00l), respectively; and the extent of DGM were much greater in the former than in the latter(P<0.0b---0.00l). 3. Serum gastrin concentrations: Serum gastrin concentrations were much higher in the i-ip positive patients(139.40 2.86pg/ml) than in the Hp negative patients(115.46 22.64pg/ml, P<0..01), but no difference among DU(137.2 ? 24.8pg/ml), CU(156.7 28.Opg/ml), GU(137.6 44.2pg/ml) and CG(135.3 32.2pg/ml) with Hp positive(P>0.05); Serum gastrin concentrations in the patients with DGM(143.26 3.89pg/ml) were much higher than that in the patients without DGM (118.73 3.OSpg/ml, P<0.01); A significantly positive association was found between the serum gastnin concentrations and the extent of DGM (r~=0.42, P<0.01). Gonc(usions: I. The positive rate of Hp in duodenal bulb and the prevalence and extent of DGM in those patients with DU (including CU) are much higher than that in those patients with GU or CC. This suggests that Hp infection in duodenum and DGM are two major risk factors influencing appearance and development of DU. 2. The prevalence of DGM in the patients with Hp in stomach are much higher than that in the patients without Hp, and the... |
PDF Full Text Request