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Background. A possible association of esophageal reflux disease with peptic ulcer, Helicobacter pylori infection or the results of eradication, has not been elucidated. It is an alarming fact that in developed countries the incidence of esophageal adenocarcinoma, which is associated with reflux disease, is increasing. Aim. The aim of the study was to establish the prevalence of esophageal reflux disease after eradication of H. pylori infection in patients with hemorrhaging and nonhemorrhaging peptic ulcer of stomach or duodenum. Patients and methods. Study was approved in 1998 by the Slovenian Medical Ethics Committee (No. 90/09/98). Prospective, controlled and randomized, carried out between 1998-2000. The study included 80 patients (50 male and 30 female, av. age 57.5 years, SD +/- 17.1, range 22-80 years) in which endoscopy confirmed hemorrhage from peptic ulcer of stomach or duodenum and HP infection. The control group was made up of 80 patients (50 male and 30 female, av. age 56.8 years, SD +/- 16.8, range 19-80 years) with peptic ulcer of stomach or duodenum and H. pylori infection in the same period of time. In all cases the recommended drug combination were used in the treatment of the infection: a proton pump inhibitor, omeprazol (4 weeks), and combination of antibiotics , claritromycin and metronidazole or with regard to the antibiogram (1 week). The therapeutic success was ascertained endoscopically four weeks after inclusion in the study. Infection eradication was confirmed by the rapid urease test and histologic investigation of the gastric mucosa. One year after, in the course of follow-up, in patients with endoscopic investigations, 24-hour pH-metry or fiberoptic spectrophotometric bilirubin determination, bilimetry, we tried to establih signs of esophageal reflux disease. Results. Four weeks after inclusion in the study the success of infection eradication was 92.5% in the study group while in the control group reached 91.25%, p>0.05. Endoscopic investigation performed one year after inclusion in the study revealed a recurrence of H. pylori infection in 4 patients (5%, 4/80) from the study group and in 5 (6.25%, 5/80) from the control group, p>0.05. During endoscopy we confirmed esophagitis in 8 patients from the study group (8/76, 10.5%) and in 9 patients (9/75, 12%) from the control group, p>0.05. The findings of the 24-hour pH-metry confirmed acid reflux in 11 patients (11/76, 14.4%) from the study group and in 10 patients (10/76, 13.1%) from the control group, p>0.05. Fiberoptic spectrophotometric bilirubin determination showed alkaline reflux in 3 patients (3/76, 3.9%) from the study group and in one patient (1/75, 1.3%) from the control group, p>0.05. Conclusions. The results confirm that after eradication of H. pylori infection, esophageal reflux disease occurs significantly more often in patients with peptic ulcer of the duodenum as compared to those with peptic ulcer of the stomach. The development complications is not affected by whether the peptic ulcer had manifested itself with complications or not. Izhodišča. Morebitna povezanost refluksne bolezni požiralnika s peptično razjedo, okužbo s Helicobacter pylori ali s posledicami izkoreninjenja okužbe ni pojasnjena. Skrb zbujajoče je dejstvo, da v razvitih deželah narašča pojavnost adenokarcinoma požiralnika, ki ga povezujejo z refluksno boleznijo. Namen raziskave. Ugotoviti pogostost pojava refluksne bolezni požiralnika po izkoreninjenju okužbe s H. pylori pri bolnikih s krvavečo in nekrvavečo peptično razjedo želodca ali dvanajstnika. Boliki in metode. Raziskavo je odobrila Republiška strokovna komisija za medicinsko etična vprašanja leta 1998 (številka sklepa 90/09/98). Prospektivna, kontrolirana in randomizirana, potekala je v obdobju 1998-2000. V študijsko skupino smo vključili 80 bolnikov (50 moških in 30 žensk, povprečne starosti 57,5 leta, SD +/- 17,1 leta, v razponu od 22 do 80 let), pri katerih smo endoskopsko potrdili krvavečo peptično razjedo želodca ali dvanajstnika in okužbo s H. pylori. V kontrolno skupino smo vključili 80 bolnikov (50 moških in 30 žensk, povprečne starosti 56,8 leta, SD +/- 16,8, v razponu od 19-80) s peptično razjedo želodca ali dvanajstnika, okuženih z bakterijo, v istem časovnem obdobju. Pri vseh bolnikih smo zdravili okužbo s priporočenimi kombinacijami zdravil: zaviralcem protonske črpalke, omeprazolom (štiri tedne) in kombinacijo antibiotikov: klaritromicinom in metronidazolom ali glede na antibiogram (en teden). Uspešnost zdravljenja smo ugotavljali endoskopsko štiri tedne po vključitvi v raziskavo, izkoreninjenje okužbe smo potrdili s hitrim ureaznim testom in histološkim pregledom sluznice želodca. V poteku spremljanja, po enem letu, smo pri bolnikih z endoskopskimi preiskavami, s 24-urno pH-metrijo ali fiberoptičnim spektrometričnim določanjem bilirubina in bilimetrijo skušali ugotoviti znake refluksne bolezni požiralnika.Rezultati: Uspešnost izkoreninjenja okužbe štiri tedne po vključitvi v raziskavo, je bila pri študijski skupini 92,5%, pri kontrolni skupini pa 91,25%, p>0,005. Ob endoskopskem pregledu, opravljenem leto dni po vključitvi v študijo, smo ugotovili ponovitev okužbe pri štirih bolnikih (4/80,5%) študijske skupine in pri petih bolnikih (5/80, 6,25%) kontrolne skupine, p>0,05. Endoskopske znake ezofagitisa na sluznici požiralnika smo ugotovili pri osmih bolnikih študijske skupine (8/76, 10,5%) in devetih bolnikih kontrolne skupine (9/75, 12%), p>0,05. Izvid 24-urne pH-metrije je potrdil kisli refluks pri 11 bolnikih študijske skupine (11/76, 14,4%) in desetih bolnikih (10/75, 13,1%) kontrolne skupine, p>0,05. S fiberoptičnim spektrofotometričnim določanjem bilirubina smo ugotovili refluks žolča pri treh bolnikih študijske skupine (3/76, 3,9%) in enem bolniku kontrolne skupine (1/75, 1,3%), p>0,05. Zaključki. Po izkoreninjenju okužbe s H. pylori se pojavi refluksna bolezen požiralnika značilno pogosteje pri bolnikih s peptično razjedo želodca. Na razvoj refluksne bolezni ne vpliva dejstvo, ali je peptična razjeda potekala zzapleti ali ne. |
