The Relation Between H.pylori, Reflux Esophagitis And Barrett Esophagus

Objectiver 1.To investigate the incidence of reflux esophagitis(RE) and Barrett esophagus(BE) patients with in endoscopic examination in FuJian provincial hospital. 2.To study esophaguseal motor functions in RE and BE. 3.To study esophaguseal motor functions in H.pylori (+), H.pylori (-) RE and BE groups. 4.To compare the expression of EGFr, P53, Ki-67, C-erbB2 between esophageal adenocarcinoma(EA), BE and RE groups for possible biomarker. 5. To compare the expression of EGFr, P53, Ki-67, C-erbB2 between H.pylori (+) and H.pylori (-).Methods: 1.Patients with reflux esophagitis and Barrett esophagus were recruited prospectively for accessment of four symptoms(heartburn, acid regurgitation, pain behind breastbone and dysphagia)by age, sex, height and weight. 2.Thirty patients with RE, 25 patients with BE and 12 non-reflux patient controls were recruited prospectively for stationary esophageal manometry, 24-h ambulatory esophageal pH monitoring and 24-h ambulatory esophageal bile monitoring. 3.A piece of endoscopic biopsy specime from gastric antrum was got to biopsy urease test The serum of the same patient was used to detect the antibody of H.pylori. 4. Immunohistochemical methods were used to detect expression of EGFr, P53, Ki-67 and C-erbB2 in 12 samples of EA, 18 samples of BE with intestinal metaplasia, 24samples of BE without intestinal metaplasia and 15 samples of RE.Results: 1 .There were no differences in age, sex, body index, symptom score in BE groups and RE groups. 2.There were no differences in esophaguseal motor functions between RE, BE groups and controls. 3.There was more esophageal acid exposure in RE, BE groups than controls, but there was no difference between RE and BE groups. 4.There was no differences in esophaguseal motor functions andesophageal acid exposure between H.pylori (+), H.pylori (-) RE and BE groups. 5.The expression of EGFr, P53, Ki-67 and C-erbB2 was significantly higher in EA than BE with intestinal metaplasia and BE with intestinal metaplasia was higher than BE without intestinal metaplasia. 6. The expression of EGFr , P53, Ki-67, C-erbB2 were no differences between H.pylori (+) and H.pylori (-)BE.Conclusions: 1.The incidence of reflux esophagitis and Barrett esophagus under endoscopy was 3.96%, 1.5% respectively. 2.There was no correlation between reflux symptom, esophageal mucous lesion in endoscopy and the outcome of esophageal motor functions. 3.Acid reflux was the main cause for mucous lesion of RE and BE, however, duodenogastroesophageal reflux(DGER)can not be neglected. 4.The infection rate of H.pylori in RE and BE was 34.6%. which was no significantly difference with the infection rate of H.pylori in all patients with endoscopic examination. 5. From the esophageal acid exposure between H.pylori (+), H.pylori (-) RE and BE groups we suggested that H.pylori infection in stomach had no correlation with acid exposure in inferior esophagus, H.pylori was not protective factor for RE, BE and acidity in inferior esophagus can not represent the acidity in stomach. 6. The lower degree of tissue differentiation degree, the higher expression of EGFr, P53, Ki-67, C-erbB2. P53 will a possible marker for BE diagnosis. 7. The expression of EGFr, P53, Ki-67 and C-erbB2 were no differences between H.pylori (+) and H.pylori (-)BE.