Endoskopi yapılan hastalarda eroziv reflü hastalığının sıklığı,endoskopik, klinik ve histopatolojik özellikleri ve Helicobacter pylori ile ilişkisi

Yıl 2015, Cilt: 25 Sayı: 1, 8 - 13, 01.03.2015

Hüseyin Korkmaz Onur Kerpiç

Öz

Amaç: Gastroözofageal reflü hastalığı, noneroziv reflü hastalığı NERH , eroziv reflü hastalığı ERH ve Barrett özofagus olmak üzere 3 grup olarak tanımlanır. Bu çalışmanın amacı, endoskopi yapılan hastalarda ERH’nin sıklığı, endoskopik, klinik özellikleri ve Helicobacter pylori H. pylori infeksiyonu ile ilişkisini değerlendirmektir. Gereç ve yöntem: Üst gastrointestinal sistem endoskopisi yapılan ve histopatolojik değerlendirme ve H. pylori için antrum-korpusdan biyopsi alınan 1840 hasta geriye dönük olarak değerlendirildi. ERH tanısı Los Angeles sınıflandırmasına göre yapıldı. Bulgular: Endoskopik olarak, 1840 hastanın 531’inde %28.9 ERH tespit edildi. ERH olan hastaların ortalama yaşı 49.4±18.8 yıldı. Hastaların 251’i %47.2 kadın iken, 280’i %52.7 erkek hastaydı. ERH olan hastaların 60’ında %11.2 hiatal herni, 38’inde %7.1 Barrett özofagus ve 233’ünde %43.9 H. pylori pozitif saptandı. ERH hastalarının %66.1’inde evre A, %29.0’unda evre B, %3.9’unda evre C ve %0.9’unda evre D özofajit izlendi. H. pylori varlığı ve özofajit evresi arasında anlamlı bir ilişki yoktu. Sonuç: ERH olan hastaların büyük çoğunluğu düşük evre evre A ve B özofajite sahipti. H. pylori’nin özofajit evresine bir etkisi gözlenmedi. H. pylori’nin varlığından ziyade oluşturduğu histolojik gastrit tipi özofajit ile ilişkili olabilir

Anahtar Kelimeler

Gastroözofageal reflü hastalığı, noneroziv reflü hastalığı, eroziv reflü hastalığı, Barrett özofagus, Helikobacter pylori

The prevelance, endoscopic and histopathological characteristics of erosive reflux disease in endoscopy performed patients and its relationship with Helicobacter pylor

Öz

Objectives: Gastroesophageal reflux disease has been defined into three groups of patients: nonerosive reflux disease, erosive reflux disease ERD , and Barrett’s esophagus. The aim of the study was to evaluate the prevelance, endoscopic and histopathological charac- teristics of ERD in endoscopy performed patients and its relationship with Helicobacter pylori infection. Material and methods: Data of the 1840 patients, whom upper gastrointestinal endoscopy was performed and biopsy specimens were obtained from antrum-cor- pus for H. pylori and histopathological examination, were investigated retrospectively. Diagnosis of esophagitis was done based on Los Angles classification criteria. Results: Endoscopically ERD was detected in 531 28.9% of 1840 patients. The mean age of the ERD patients was 49.4 ±18.8 years. While 251 47.2% of the patients were female, 280 52.7% of the patients were male. In patients with ERD, the sliding hiatal hernia and Barrett’s esophagus was found in 60 11.2% and 38 7.1% patients, respectively. In patients with ERH, grade A, B, C and D esophagitis was present in 66.1%, 29.0%, 3.9% and 0.9%, respectively. H. pylori was positive in 43.9% of ERD patients. There was no significant association between the presence of H. pylori and severity of esophagitis. Conclusion: Most of the patients with ERD had low grade grades A and B esophagitis. No impact of H. pylori on the severity of esophagitis was shown. The types of histological gastritis caused by H. pylori rather than the presence of H. pylori may associate with esophagitis

Anahtar Kelimeler

Gastroesophageal reflux disease, nonerosive reflux disease, erosive reflux disease, Barrett’s esophagus, Helicobacter pylori

Kaynakça

• Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Con- sensus Group. The Montreal definition and classification of gast- roesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-20.
• Richter JE. Gastroesophageal reflux disease and it’s complicati- ons. In: Feldman M, Friedman SL, Brandt JL Ed. Gastrointestinal and Liver Disease 8th Edition. Philadelphia; Saunders Elsevier, 2006;905-36.
• Uyanıkoglu A, Ermiş F, Akyuz F, Mungan Z. Gastroözofageal Ref- lü Hastalığı. Güncel Gastroenteroloji 2013;17:39-45.
• Vardar R. Gastroözofageal reflü hastalığı. Güncel Gastroenteroloji 2012;16:126-32.
• Dent J, Wallander El-Serag HB, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005;54:710-7.
• Dogan İ. Gastroözofageal reflü hastalığı: Epidemiyoloji ve klinik. Güncel Gastroenteroloji 2009:13:77-80.
• Bor S, Mandiracioglu A, Kitapcioglu G, Caymaz-Bor C, Gilbert RJ. Gastroesophageal reflux disease in a low-income region in Turkey. Am J Gastroenterol 2005;100:759-65.
• Bor S, Vardar R, Vardar E, Takmaz S, Mungan Z, GORHEN Study Group. Endoscopic findings of gastroesophageal reflux disease in Turkey: Multicenter prospective study (GORHEN). Gastroentero- logy 2008;134:5;T2014(600).
• Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further valida- tion of the Los Angeles classification. Gut 1999;45:172-80.
• DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200.
• Goh KL. Changing epidemiology of gastroesophageal reflux dise- ase in the Asian-Pacific region: an overview. J Gastroenterol He- patol 2004;19:S22-5.
• Wong WM, Lim P, Wong BC. Clinical practice pattern of gastroen- terologists, primary care physicians, and otolaryngologists for the management of GERD in the Asia-Pacific region: the FAST survey. J Gastroenterol Hepatol 2004;19:S54-60.
• Stanghellini V. Three-month prevalence rates of gastrointestinal symptoms and the influence of demographic factors. Results from The Domestic/ International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol Suppl 1994;34:20-8.
• Tunc N, Şıkgenç MM, Yakut M. Bir bölge hastanesi gastroskopi ünitesinde tanı konulan eroziv reflü hastalığı olgularının endosko- pik ve klinik özellikleri. JCEI 2012;3:260-2.
• Ataseven H, Ödemiş B, Arhan M ve ark. Reflü özofajit ile Heli- kobakter pilori ve gastrit ilişkisi. Akademik Gastroenteroloji Derg 2007;6:115-9.
• Wang PC, Hsu CS, Tseng TC, et al. Male sex, hiatus hernia, and Helicobacter pylori infection associated with asymptomatic erosi- ve esophagitis. J Gastroenterol Hepatol 2012;27:586-91.
• Fixa B, Komárková O, Nozicka Z. Changing prevalence of some selected gastrointestinal diseases vis-à-vis H. pylori infection. He- patogastroenterology. 2011;58:1062-6.
• Werdmuller BF, Loffeld RJ. Helicobacter pylori infection has no role in the pathogenesis of reflux esophagitis. Dig Dis Sci 1997;42:103-5.
• Labenz J, Blum AL, Bayerdörffer E, Meining A, Stolte M, Börs- ch G. Curing Helicobacter pylori infection in patients with du- odenal ulcer may provoke reflux esophagitis. Gastroenterology 1997;112:1442-7.
• O’Connor HJ, McGee C, Ghabash NM, Cunnane K. Prevalence of esophagitis in H. pylori-positive peptic ulcer disease and the impa- ct of eradication therapy. Hepatogastroenterology 2001;48:1064-8.
• Soylu A, Dolapcıoglu C, Yasar N, Sevindir İ, Sever N. Helikobakter 13 pilori eradikasyonu reflü semptomlarını ve endoskopik özofajiti olumlu etkiliyor. Akademik Gastroenteroloji Derg 2009; 8:63-8.
• Dobrucalı A. Özofagus hastalıkları. İç Hastalıkları-Cerrahpaşa. Ed: Hamuryudan V, Sonsuz A. İstanbul Medikal Yayıncılık, İstanbul, 2005,S:742-82.
• Us D, Hascelik G. Seroprevalence of Helicobacter pylori infection in an asymtomatic Turkish population. J Infect 1998;48:148-50.
• Kesli R, Gokturk HS, Erbayrak M, Karabagli P, Terzi Y. Comparison of the diagnostic values of the 3 different stool antigen tests for the noninvasive diagnosis of Helicobacter pylori infection. JInvestig Med 2010;58:982-6.
• Korkmaz H, Kesli R, Karabagli P, Terzi Y. Comparison of the diagnostic accuracy of five different stool antigen tests for the diagnosis of Helicobacter pylori infection. Helicobacter 2013;18:384-91.
• Newton M, Kamm MA, Talbot IC, Bryan R, Burnham WR. Fundal gastritis as a potential cause of reflux oesophagitis. Dis Esophagus 2000;13:56-60.
• Mihara T, Adachi K, Komazawa Y, et al. Characteristics of gastritis in patients with Helicobacter pylori-positive reflux esophagitis. J Gastroenterol Hepatol 2005;20:682-7.