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Sjúkdómar í efri meltingarvegi : er Helicobacter pylori orsökin?

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Authors
Bergþór Björnsson
Kjartan Örvar
Ásgeir Theodórs
Issue Date
2000-03-01

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Other Titles
Diseases in the esophagus, stomach and duodenum: is Helicobacter pylori to blame?
Citation
Læknablaðið 2000, 86(3):168-73
Abstract
Objective: To evaluate a) how many of symptomatic patients referred for upper endoscopy have active H. pylori infection, b) the correlation between the indications for upper endoscopy and endoscopic diagnosis and c) the association between H. pylori and organic disease in the upper gastrointestinal tract. Material and methods: This is a prospective study on 562 symptomatic patients referred for upper gastrointestinal endoscopy. The criteria for inclusion were symptoms from the upper gastrointestinal tract but patients taking anticoagulation medication were excluded. All patients who had received H. pylori eradication therapy were excluded from the final analysis. Biopsies were obtained from both the antrum and body of the stomach for CLO testing as well as for histological evaluation for H. pylori. Results: For final analysis 458 patients (81.5%) were evaluable, 76 patients (13.5%) were excluded who came for evaluation after H. pylori eradication and 28 patients (5%) were also excluded due to inadequate information. Of 458 patients, 220 (48%) tested CLO positive, there of 122 women (46%) and 98 men (50.5%). The correlation between indication for referral for upper endoscopy and final endoscopic diagnosis was poor, where peptic ulcer disease was clearly overrated. Active H. pylori infection was most often diagnosed among patients with peptic ulcer disease, particularly duodenal ulcer (82%) and less often gastric ulcer (60%). Patients with gastritis and duodenitis had H. pylori diagnosed in 57% of the cases. Conclusions: H. pylori was diagnosed in 48% of patients with symptoms from the upper gastrointestinal tract. Of all patients with peptic ulcer disease H. pylori was diagnosed in only 69% of the cases, which is lower than previous studies have indicated. The correlation between indication for endoscopy and the endoscopic diagnoses is rather poor. It is important to perform diagnostic endoscopy early in order to select the best initial treatment for the patient.
Tilgangur: Tilgangur rannsóknarinnar var að kanna algengi virkra H. pylori sýkinga hjá sjúklingum með einkenni frá efri meltingarvegi, kanna tengsl H. pylori við sjúkdóma í vélinda, maga og skeifugörn og bera saman klínískar greiningar og niðurstöður holsjárskoðana. Efniviður og aðferðir: Rannsóknin var með framskyggnu sniði og fór fram á árunum 1996 og 1997. Holsjárskoðanir á efri meltingarvegi voru framkvæmdar hjá 562 sjúklingum á speglunareiningu meltingarsjúkdómadeildar St. Jósefsspítala í Hafnarfirði. Skilyrði fyrir þátttöku var að sjúklingur hefði einkenni frá efri meltingarvegi en frábending var blæðingarhætta hjá sjúklingum. Sjúklingar sem fengið höfðu H. pylori upprætingarmeðferð voru útilokaðir við úrvinnslu gagna. Tekin voru sýni úr magahelli (antrum ventriculi) og magabol (corpus ventriculi) til CLO (Camphylobacter Like Organism) rannsókna og til vefjarannsókna í þeim tilfellum sem það átti við. Niðurstöður: Unnt var að meta niðurstöður rannsókna hjá 458 sjúklingum (81,5%) en 76 (13,5%) voru útilokaðir þar sem þeir höfðu gengist undir upprætingarmeðferð vegna H. pylori sýkingar og 28 (5%) voru útilokaðir vegna þess að fullnægjandi gögn skorti. Alls reyndust 220 (48%) sjúklingar vera H. pylori jákvæðir. Þar af voru 122 konur (55,5%) og 98 karlar (44,5%). Samsvörun milli klínískra sjúkdómsgreininga og niðurstaðna holsjárskoðana var ekki góð og virðast ætisár ofgreind klínískt. H. pylori sýkingar tengjast mest ætisárum (ulcus pepticum) og þá fremur skeifugarnarsárum (ulcus duodeni) en magasárum (ulcus ventriculi). Þannig reyndust 82% sjúklinga með skeifugarnarsár H. pylori jákvæðir en 60% sjúklinga með magasár. Sjúklingar með magabólgur og skeifugarnarbólgur voru H. pylori jákvæðir í 57% tilvika. Ályktanir: Einungis 48% sjúklinga með einkenni frá efri meltingarvegi hafa jafnframt virka H. pylori sýkingu í magaslímhúð. Hlutfall H. pylori sýktra meðal sjúklinga með ætisár (maga- og skeifugarnarsár) er 69% sem er lægra en fyrri rannsóknir hafa gefið til kynna. Samsvörun milli klínískrar sjúkdómsgreiningar og niðurstöðu holsjárskoðunar á efri meltingarvegi er ekki góð. Holsjárskoðun er mikilvæg til að tryggja rétta sjúkdómsgreiningu og gerir meðferð markvissari.
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