Duodenal ulcer, CLOtest : positive, biopsy proven H. pylori (+++)
십이지장 궤양과 헬리코박터 파일로리 관련성 증거
1. 헬리코박터 파일로리는 진통소염제 사용과 관련이 없는 십이지장 궤양 환자의 대부분에서 존재
2. 헬리코박터 파이롤리 감염은 십이지장 궤양 발생 이전에 발견되고 이 질환의 위험 요인인 것 같음
3. 헬리코박터 파일로리 제균은 십이지장 궤양 재발을 예방
There are several lines of evidence that implicate H. pylori as a major etiologic factor in duodenal ulcers (DU):
● H. pylori is present in most patients who have a DU that is not related to NSAID use
● H. pylori infection is detectable before the occurrence of DU and appears to be a risk factor for the disorder
● Eradication of H. pylori prevents DU recurrence
Incidence of H. pylori in patients with duodenal ulcer
Early studies noted a high incidence of H. pylori infection (then called Campylobacter pylori) in patients with DU; subsequent reviews confirmed that H. pylori is detectable in 80 to 95 percent of these patients. These data were supported by reports which found that the prevalence of H. pylori is negligible in populations in which ulcer disease is rare.
The prevalence of H. pylori in patients with DU is changing in some parts of the world. While H. pylori infection remains very common in patients from Asia with DU, it is becoming less common in patients from the United States and parts of Europe. In an epidemiologic study from China, 1030 patients underwent endoscopy and 73 percent were found to have H. pylori. Peptic ulcers were present in 17 percent, more than two-thirds of which were duodenal ulcers. Among those with peptic ulcers, the prevalence of H. pylori infection was 93 percent. On the other hand, in the United States and parts of Europe, the prevalence of H. pylori in patients with ulcer disease appears to be falling and is now in the range of 50 to 75 percent.
While the association between H. pylori and DU is strong, it is not specific. As examples, H. pylori infection is also found in patients with gastric ulcers (65 to 95 percent), dyspepsia (20 to 60 percent), gastric cancer (70 to 90 percent), and asymptomatic patients (20 to 45 percent).
H. pylori occurs before manifestations of the disease
Several trials have found that preexisting H. pylori infection is a risk factor for the development of DU. One study, for example, reviewed the cases of more than 5000 native Hawaiians who had stored serum from the late 1960s. Of the 65 patients who developed DU over the next 20 years, 92 percent were H. pylori positive versus 78 percent of controls, producing an odds ratio of 4.0. Similarly, an endoscopic study that included 526 patients with long-term follow-up found that the odds ratio of developing DU was 5.0 for those with preexisting H. pylori infection compared with H. pylori-negative subjects.
Eradication of H. pylori reduces disease recurrence
Treatment of H. pylori infection in patients with DU decreases the incidence of ulcer recurrence. One meta-analysis examined the recurrence rate for DU after at least six months of follow-up. The recurrence rate was 6 percent if H. pylori was eradicated and 67 percent if it was not. A second meta-analysis found recurrence rates of 20 and 56 percent, respectively. The studies in the meta-analyses used endoscopic findings to define ulcer recurrence. It should be noted that the rate of symptomatic recurrence is lower.
REF. UpToDate 2020.01.30
PPI 치료 후 위내시경과 CLOtest : negative
Previous imageNext image
