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    ×èòàòåëü Íåäóã.Ðó
    Î ÐÎËÈ ÕÅËÈÊÎÁÀÊÒÅÐÍÎÉ ÈÍÔÅÊÖÈÈ È ÄÓÎÄÅÍÎÃÀÑÒÐÎÝÇÎÔÀÃÅÀËÜÍÎÃÎ ÐÅÔËÞÊÑÀ  ÏÀÒÎÃÅÍÅÇÅ ßÇÂÅÍÍÎÉ ÁÎËÅÇÍÈ È ÏÈÙÅÂÎÄÀ ÁÀÐÐÅÒÀ

    Î.Þ. Êóøíèðåíêî

    Óðàëüñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ äîïîëíèòåëüíîãî îáðàçîâàíèÿ



    ßçâåííàÿ áîëåçíü (ßÁ) ýòî õðîíè÷åñêîå ðåöèäèâèðóþùåå çàáîëåâàíèå, ñêëîííîå ê ïðîãðåññèðîâàíèþ è õàðàêòåðèçóþùååñÿ îáùåé ìîðôîëîãè÷åñêîé îñîáåííîñòüþ â âèäå õðîíè÷åñêîé ÿçâû æåëóäêà (ßÆ) èëè ÿçâû äâåíàäöàòèïåðñòíîé êèøêè (ßÄÏÊ).

    Íå ñòîèò ìíîãî ãîâîðèòü î áîëüøîé çíà÷èìîñòè ýòîãî çàáîëåâàíèÿ.  ðàçíûõ ñòðàíàõ ìèðà ßÁ áîëåþò ïðèìåðíî 5-10% íàñåëåíèÿ. ßÄÏÊ âñòðå÷àåòñÿ â 4-13 ðàç ÷àùå ßÆ.  ÑØÀ åæåãîäíî ðåãèñòðèðóåòñÿ äî 500 000 íîâûõ ñëó÷àåâ çàáîëåâàíèÿ, à ó 4 ìëí. ÷åëîâåê êàæäûé ãîä îòìå÷àþòñÿ ðåöèäèâû ÿçâû ñ åæåãîäíûì ýêîíîìè÷åñêèì óùåðáîì â 5,65 ìëðä. äîëëàðîâ (C. Ell et all., 1998).

    Ýòèîëîãèÿ ßÁ äî ñèõ ïîð îñòàåòñÿ íåÿñíîé. Áûëî ïðåäëîæåíî ìíîæåñòâî òåîðèé îá ýòèîëîãèè è ïàòîãåíåçå ýòîãî çàáîëåâàíèÿ, ìíîãèå èç êîòîðûõ ïðåäñòàâëÿþò ëèøü èñòîðè÷åñêèé èíòåðåñ.  òå÷åíèå äëèòåëüíîãî âðåìåíè ñóùåñòâîâàëà óíèâåðñàëüíàÿ êîíöåïöèÿ ïàòîãåíåçà çàáîëåâàíèÿ, â êîòîðîé ó÷èòûâàëèñü ôàêòîðû àãðåññèè, äåéñòâóþùèå íà ñëèçèñòóþ îáîëî÷êó æåëóäêà (êèñëîòà, ïåïñèí, æåë÷íûå êèñëîòû, ëèçîëåöèòèí, èøåìèÿ) è ôàêòîðû çàùèòû (âûäåëåíèå ñëèçè è ïðîñòàãëàíäèíîâ, à òàêæå áèêàðáîíàòîâ è ñóðôàêòàíò-ïîäîáíûõ âåùåñòâ, êîòîðûå íåéòðàëèçóþò ðÍ äî 7 îêîëî ïîâåðõíîñòè ñëèçèñòîé îáîëî÷êè è ïîêðûâàþò åå ãèäðîôîáíûì áàðüåðîì è äð.). Íåñîîòâåòñòâèå ôàêòîðîâ êèñëîòíî-ïåïòè÷åñêîé àãðåññèè æåëóäî÷íîãî ñîêà ñ çàùèòíûìè âîçìîæíîñòÿìè ñëèçèñòûõ îáîëî÷åê æåëóäêà è äâåíàäöàòèïåðñòíîé êèøêè (ÄÏÊ) ïðèâîäÿò ê âîçíèêíîâåíèþ ßÁ ñ ïîñëåäóþùèìè åå îáîñòðåíèÿìè (Ñ.È. Ïèìàíîâ, 2000). Îòêðûòèå â 1983 ãîäó Á. Ìàðøàëëîì è Ð. Óîððåíîì â æåëóäêå áîëüíûõ ßÁ ìèêðîáà Íelicobacter Ðylori (Í.Ð.) ïðîèçâåëî íàñòîÿùèé ïåðåâîðîò â ñîâðåìåííîé ãàñòðîýíòåðîëîãèè, òàê êàê íà ñåãîäíÿøíèé äåíü óñòàíîâëåíî, ÷òî ðàçâèòèå Í.Ð.- àññîöèèðîâàííîãî ãàñòðèòà ÿâëÿåòñÿ âàæíåéøèì ôàêòîðîì ïàòîãåíåçà ßÁ æåëóäêà è ÄÏÊ, à òàêæå ëèìôîìû æåëóäêà íèçêîé ñòåïåíè çëîêà÷åñòâåííîñòè è ðàêà æåëóäêà.

    Í.Ð. ñàìàÿ ðàñïðîñòðàíåííàÿ èíôåêöèÿ ó ÷åëîâåêà. Îáñåìåíåííîñòü ýòèì ìèêðîáîì äîñòèãàåò 85% íàñåëåíèÿ Ðîññèéñêîé Ôåäåðàöèè.  ñòðàíàõ Âîñòî÷íîé Åâðîïû èíôèöèðîâàííîñòü Í.Ð. íåñêîëüêî ìåíüøå - 40-70% â ÑØÀ – 30%. Ïîñëåäíèå óòî÷íåííûå ðåçóëüòàòû èññëåäîâàíèé â ðàçíûõ ñòðàíàõ ïîêàçàëè, ÷òî íà äîëþ ßÆ è ßÄÏÊ, àññîöèèðîâàííûõ ñ Í.Ð. ïðèõîäèòñÿ 50-60% ÿçâ æåëóäêà è 70-80% ÿçâ ÄÏÊ ((Å.Ê. Áàðàíñêàÿ, 1999).

    Í.Ð. âûçûâàåò ðàçâèòèå âîñïàëåíèå ñëèçèñòîé îáîëî÷êè æåëóäêà, èçìåíÿåò åå çàùèòíûå ñâîéñòâà, ïîâûøàåò æåëóäî÷íóþ ñåêðåöèþ è ñïîñîáñòâóåò ðàçâèòèþ ýðîçèâíî-ÿçâåííîãî ïîðàæåíèÿ ñòåíêè æåëóäêà. Ïðè ßÄÏÊ Í.Ð. ñóùåñòâóåò â ó÷àñòêàõ æåëóäî÷íîé ìåòàïëàçèè ñëèçèñòîé îáîëî÷êè ÄÏÊ è âñåãäà ñîïðîâîæäàåòñÿ âûñîêîé æåëóäî÷íîé êèñëîòïðîäóêöèåé. Ïðè ßÆ íàèáîëüøàÿ îáñåìåíåííîñòü Í.Ð. íàáëþäàåòñÿ â ó÷àñòêàõ êèøå÷íîé ìåòàïëàçèè ñëèçèñòîé îáîëî÷êè æåëóäêà. Ýðàäèêàöèÿ Í.Ð. èçëå÷èâàåò õðîíè÷åñêèé Í.Ð. – àññîöèèðîâàííûé ãàñòðèò è ïðèâîäèò ê äëèòåëüíîé ðåìèññèè ßÁ.

    Òàêèì îáðàçîì, äîêàçàíî, ÷òî Í.Ð. èíôåêöèÿ ÿâëÿåòñÿ îäíèì èç îñíîâíûõ ýòèîïàòîãåíåòè÷åñêèõ ôàêòîðîâ ßÁ. Ïî ïîñëåäíèì ëèòåðàòóðíûì äàííûì îòìå÷àåòñÿ òîò ôàêò, ÷òî íàèáîëüøåå êîëè÷åñòâî êîëîíèé ìèêðîáà è áîëåå ãëóáîêèå ïîâðåæäåíèÿ ñòåíîê æåëóäêà è ÄÏÊ íàáëþäàþòñÿ â ó÷àñòêàõ ìåòàïëàçèè: êèøå÷íîé - â ñëèçèñòîé îáîëî÷êå æåëóäêå è æåëóäî÷íîé - â ñëèçèñòîé îáîëî÷êå ÄÏÊ, ïðè÷åì ßÆ âîçíèêàåò íà ãðàíèöå íîðìàëüíîé è ýíòåðîëèçîâàííîé ñëèçèñòîé. Ñàì ôàêò æåëóäî÷íîé è êèøå÷íîé ìåòàïëàçèè ñëèçèñòûõ îáîëî÷åê æåëóäêà è ÄÏÊ èçâåñòåí äàâíî.  ìíîãî÷èñëåííûõ òðóäàõ ß.Ä. Âèòåáñêîãî ïèñàëîñü ìíîãî î òîì, ÷òî ýíòåðîëèçàöèÿ ñëèçèñòîé îáîëî÷êè æåëóäêà ïðîèñõîäèò ïîä âîçäåéñòâèåì äóîäåíî-ãàñòðàëüíîãî ðåôëþêñà (ÄÃÐ). Íàìè áûëî îòìå÷åíî, ÷òî ó ìíîãèõ áîëüíûõ ñ âûðàæåííûì ÄÃÐ è âèäèìîé ìàêðîñêîïè÷åñêè îáøèðíûõ ó÷àñòêîâ êèøå÷íîé ìåòàïëàçèè íèêàêèõ ýðîçèâíî-ÿçâåííûõ ïîðàæåíèé æåëóäêà íå îáíàðóæèâàëîñü. Ñ äðóãîé ñòîðîíû èçáûòî÷íîå âûäåëåíèå æåëóäî÷íîãî ñîêà ó ðÿäà ïàöèåíòîâ (òàê íàçûâàåìûõ «ãèïåðñåêðåòîðîâ») ñ î÷åíü âûñîêèì óðîâíåì ðÍ íå ïðèâîäèëî ê ßÄÏÊ. Àíàëèçèðóÿ äàííûå ýíäîñêîïèè è ñâîè èçó÷åíèÿ õåëèêîáàêòåðíîé èíôåêöèè ó áîëüíûõ, ïðèâåëî ê ìûñëè î òîì, ÷òî ßÁ èìååò äâà ýòèîëîãè÷åñêèõ ôàêòîðà, âîçíèêàþùèõ àáñîëþòíî íåçàâèñèìî äðóã îò äðóãà è òîëüêî èõ ñî÷åòàíèå ïðèâîäèò ê ðàçâèòèþ êëàññè÷åñêîé êàðòèíû ßÁ. Îäíàêî ïàòîãåíåç ýòèõ çàáîëåâàíèé ðàçëè÷åí. Äàííîå ïðåäïîëîæåíèå ïðèåìëåìî òîëüêî äëÿ êëàññè÷åñêîé ßÁ è íå âêëþ÷àåò ðàçâèòèå ÿçâ æåëóäêà è ÄÏÊ ïðè ñòðåññàõ, ãîðìîíàëüíûõ íàðóøåíèÿõ, îáðàçîâàíèÿ èçúÿçâëåíèé â ðåçóëüòàòå ïðèåìà ëåêàðñòâ è äð.

    Ïîÿâëåíèå ó÷àñòêîâ ýíòåðîëèçàöèè ñëèçèñòîé îáîëî÷êè æåëóäêà ïðè ÄÃÐ îáúÿñíÿåòñÿ ñëåäóþùèì îáðàçîì. Íà ëþáîì îòðåçêå ïèùåâàðèòåëüíîãî òðàêòà ïðè ðåôëþêñå ïîÿâëÿþòñÿ â ðåçóëüòàòå ìåòàïëàçèè ýïèòåëèàëüíûå êëåòêè òîãî îðãàíà, èç êîòîðîãî íàáëþäàëñÿ îáðàòíûé çàáðîñ ñîäåðæèìîãî. Ýòîò ôåíîìåí íîñèò óíèâåðñàëüíûé õàðàêòåð. Òàê ïðè ðåôëþêñ-ýçîôàãèòå íàáëþäàåòñÿ æåëóäî÷íàÿ ìåòàïëàçèÿ ñëèçèñòîé îáîëî÷êè ïèùåâîäà. Ïðè ðåôëþêñ-ãàñòðèòå-ýçîôàãèòå â ðåçóëüòàòå çàáðîñà æåë÷è â æåëóäîê, à çàòåì â ïèùåâîä ìîæíî íàáëþäàòü ìåòàïëàçèþ ñëèçèñòîé îðãàíà ïî êèøå÷íîìó òèïó. ß.Ä. Âèòåáñêèì áûëî îòìå÷åíî, ÷òî ïðè ðåôëþêñ-ýíòåðèòå â òåðìèíàëüíîì îòäåëå òîíêîé êèøêè íàáëþäàåòñÿ òèïè÷íûå î÷àãè òîëñòîêèøå÷íîé ìåòàïëàçèè ñëèçèñòîé îáîëî÷êè.

    Òàêèì îáðàçîì, ìîæíî ñäåëàòü âûâîä î òîì, ÷òî ñîäåðæèìîå â ïîëîñòè ëþáîãî îðãàíà æåëóäî÷íî-êèøå÷íîãî òðàêòà îïðåäåëÿåò ñòðîåíèå åãî ñëèçèñòîé îáîëî÷êè. Ïðè ðåôëþêñå ïîÿâëåíèå ýïèòåëèàëüíûõ êëåòîê íåõàðàêòåðíûõ äëÿ äàííîãî îðãàíà âðÿä ëè íîñèò àäàïòàöèîííûé õàðàêòåð. Òàê ó áîëüíûõ ñ ßÄÏÊ â ðåçóëüòàòå óñêîðåííîé ýâàêóàöèè êèñëîãî æåëóäî÷íîãî ñîäåðæèìîãî, êîòîðîå íå óñïåâàåò îùåëà÷èâàòüñÿ â ÄÏÊ, íàáëþäàåòñÿ ìåòàïëàçèÿ ñëèçèñòîé îáîëî÷êè êèøêè ïî æåëóäî÷íîìó òèïó.  ýòèõ ó÷àñòêàõ ïðàêòè÷åñêè âñåãäà ìîæíî íàéòè Í.Ð.  ëàáîðàòîðèè ãàñòðîýíòåðîëîãèè ã. Êóðãàíà ïðè ìîðôîëîãè÷åñêîì èçó÷åíèè ñëèçèñòîé îáîëî÷êè æåëóäêà â çîíå ÿçâû îðãàíà áûëî âûÿâëåíî, ÷òî îíà âîçíèêàåò íà ãðàíèöå ýíòåðîëèçîâàííîé è íîðìàëüíîé ñëèçèñòîé îáîëî÷êè ïðè âûðàæåííîì ÄÃÐ (ß.Ä. Âèòåáñêèé ñ ñîàâò., 1989). Ïî äàííûì ëèòåðàòóðû â î÷àãàõ êèøå÷íîé ìåòàïëàçèè ñëèçèñòîé îáîëî÷êè æåëóäêà îïðåäåëÿåòñÿ íàèáîëüøàÿ êîíöåíòðàöèÿ Í.Ð. è òàì æå íàáëþäàåòñÿ íàèáîëåå âûðàæåííûå äåñòðóêòèâíûå åå ïîâðåæäåíèÿ. Âïîëíå âåðîÿòíî, ÷òî ÿçâåííûé äåôåêò ñòåíêè æåëóäêà (ÄÏÊ) ïîÿâëÿåòñÿ âñëåäñòâèå ðåçêî âûðàæåííîé ìåñòíîé àëëåðãè÷åñêîé ðåàêöèè â ðåçóëüòàòå æèçíåäåÿòåëüíîñòè Í.Ð., êîãäà êîíöåíòðàöèÿ áàêòåðèé ïðåâûñèò îïðåäåëåííóþ êðèòè÷åñêóþ âåëè÷èíó, à ñàìà ðåàêöèÿ ïðîòåêàåò ïî òèïó ôåíîìåíà Àðòþñà.

    Òàêèì îáðàçîì, ïðåäñòàâëåííàÿ ñõåìà ýòèîëîãèè è ïàòîãåíåçà ßÁ, â êîòîðîé çàáîëåâàíèå âîçíèêàåò ïðè ñî÷åòàíèè äâóõ ôàêòîðîâ (ìåòàïëàçèè ñëèçèñòûõ îáîëî÷åê æåëóäêà è ÄÏÊ ïðè óñëîâèÿõ íàëè÷èÿ ó áîëüíûõ Í.Ð.-èíôåêöèè). Äàííàÿ ìîäåëü ðàçâèòèÿ ßÁ îáúÿñíÿåò íåêîòîðûå «áåëûå ïÿòíà» õåëèêîáàêòåðèîëîãèè, îäíàêî äëÿ îêîí÷àòåëüíîãî âûÿñíåíèÿ ðîëè Í.Ð.-èíôåêöèè â ýòèîïàòîãåíåçå ßÆ è ßÄÏÊ òðåáóþòñÿ áîëåå óãëóáëåííûå íàó÷íûå èññëåäîâàíèÿ áàêòåðèîëîãîâ, èììóíîëîãîâ, áèîõèìèêîâ è ìîðôîëîãîâ.

    Ïèùåâîä Áàððåòà îáîçíà÷àåò íàëè÷èå î÷àãîâ ìåòàïëàçèè – ñïåöèàëèçèðîâàííîãî êèøå÷íîãî öèëèíäðè÷åñêîãî ýïèòåëèÿ – â ñëèçèñòîé îáîëî÷êå ïèùåâîäà äàæå ïðè îòñóòñòâèè ÿçâ (Ñ.È. Ïèìàíîâ, 2000). Ñïåöèàëèçèðîâàííûé öèëèíäðè÷åñêèé ýïèòåëèé – ýòî íåïîëíàÿ òîíêîêèøå÷íàÿ ìåòàïëàçèÿ ñ íàëè÷èåì áîêàëîâèäíûõ êëåòîê. Ïèùåâîä Áàððåòà âñòðå÷àåòñÿ ó 10-20% áîëüíûõ ñ ðåôëþêñ-ýçîôàãèòîì è ðèñê ðàçâèòèÿ ðàêà ïèùåâîäà âîçðàñòàåò â 30-40 ðàç, ò.å. 7-8% áîëüíûõ çàáîëåâàåò ýòèì îíêîëîãè÷åñêèì çàáîëåâàíèåì. Òîíêîêèøå÷íàÿ ìåòàïëàçèÿ ñëèçèñòîé îáîëî÷êè ïèùåâîäà îòíîñÿò ê V ñòåïåíè òÿæåñòè ðåôëþêñ-ýçîôàòèòà ïî êëàññèôèêàöèè Savari-Miller¢à (À.À. Øåïòóëèí, 2000). Ðîëü õåëèêîáàêòåðíîé èíôåêöèè ó áîëüíûõ ñ ðåôëþêñ-ýçîôàãèòîì è ïèùåâîäîì Áàððåòà äî êîíöà íå èçó÷åíà, à ó÷àñòèå åå â ïàòîãåíåçå ýòèõ çàáîëåâàíèé ïîäâåðãàåòñÿ ñîìíåíèþ (Â.Ò. Èâàøêèí ñ ñîàâò., 1999; S.J. Spechler, 1998). Îäíàêî îòäåëüíûå àâòîðû îòìå÷àþò, ÷òî ýçîôàãèò ïðè ãàñòðîýçîôàãåàëüíîé ðåôëþêñíîé áîëåçíè ïðîòåêàåò òÿæåëåå ó áîëüíûõ èíôèöèðîâàííûõ H. ðylori ïîñëå ýðàäèêàöèè è ñâÿçàííî ýòî ñ ïîâûøåíèåì ñåêðåöèè ñîëÿíîé êèñëîòû â æåëóäî÷íîì ñîêå (Ñ.È. Ïèìàíîâ, 2000).  ó÷àñòêàõ ìåòàïëàçèè ñëèçèñòîé îáîëî÷êè æåëóäêà â âèäå ýíòåðîëèçàöèè è â äâåíàäöàòèïåðñòíîé êèøêå â âèäå ïèëîðèçàöèè ïðàêòè÷åñêè âñåãäà ìîæíî íàéòè õåëèêîáàêòåðíóþ èíôåêöèþ.

    Ìû ðàçëè÷àåì ðåôëþêñ-ýçîôàãèò íà êèñëûé è ùåëî÷íîé â çàâèñèìîñòè îò õàðàêòåðà ðåôëþêòàòà. Âïîëíå âåðîÿòíî, ÷òî ïðè çàáðîñå ÷èñòîãî æåëóäî÷íîãî ñîêà â ñëèçèñòîé îáîëî÷êè ïèùåâîäà îáðàçóþòñÿ î÷àãè æåëóäî÷íîé ìåòàïëàçèè, à ïðè ðåôëþêñ-ãàñòðèòå-ýçîôàãèòå, ò.å. êîãäà çàáðàñûâàåòñÿ ñîäåðæèìîå äâåíàäöàòèïåðñòíîé êèøêè, íàáëþäàåòñÿ ýíòåðîëèçàöèÿ ñëèçèñòîé îáîëî÷êè îðãàíà. Ïî äàííûì ëèòåðàòóðû èìåííî â ýòèõ ó÷àñòêàõ îáíàðóæèâàåòñÿ íàèáîëüøàÿ êîíöåíòðàöèÿ Í. ðylori. è òàì æå íàèáîëåå âûðàæåíû äåñòðóêòèâíûå ïîâðåæäåíèÿ ñëèçèñòîé îáîëî÷êè ïèùåâîäà Áàððåòà. Âïîëíå âåðîÿòíî, ÷òî ïîä âëèÿíèåì ýòîé èíôåêöèè ìåòàïëàñòè÷åñêèå ïðîöåññû ïåðåõîäÿò â äèñïëàñòè÷åñêèå è â ñëèçèñòîé îáîëî÷êå ïèùåâîäà ïîÿâëÿþòñÿ êëåòêè òîëñòîêèøå÷íîãî ýïèòåëèÿ, êîòîðûå ÿâëÿþòñÿ îáëèãàòíûì ïðåäðàêîì îðãàíà.

    Ïðèâåäåííàÿ ñõåìà ïàòîãåíåçà ðàêà ïðè ïèùåâîäå Áàððåòà íå ÿâëÿåòñÿ îêîí÷àòåëüíîé è òðåáóåò áîëåå óãëóáëåííîãî ìîðôîëîãè÷åñêîãî, ìèêðîáèîëîãè÷åñêîãî è áèîõèìè÷åñêîãî ìåòîäîâ èññëåäîâàíèé ñëèçèñòîé îáîëî÷êè îðãàíà ïðè ýòîì çàáîëåâàíèè. Ñ äðóãîé ñòîðîíû, íàì ïðåäñòàâëÿåòñÿ àáñîëþòíî áåññïîðíî, ÷òî ïðè âûÿâëåíèè õåëèêîáàêòåðíîãî àññîöèèðîâàííîãî ýçîôàãèòà ïðè ïèùåâîäå Áàððåòà, òðåáóåòñÿ àíòèáàêòåðèàëüíàÿ òåðàïèÿ ñ öåëüþ ïîëíîé ýðàäèêàöèè ìèêðîáíîãî îáñåìåíåíèÿ îðãàíà, êàê ïðè ëþáîé äðóãîé ïàòîãåííîé èíôåêöèè æåëóäî÷íî-êèøå÷íîãî òðàêòà ÷åëîâåêà.

  2. Dr. Vad
    #2
    ×èòàòåëü Íåäóã.Ðó
    Helicobacter 2002 Apr;7(2):71-5

    Helicobacter pylori-related iron deficiency anemia: a review.

    Barabino A.

    Pediatric Gastroenterology, G. Gaslini Institute, Genoa, Italy.

    Several clinical reports have demonstrated that Helicobacter pylori gastric infection has emerged as a new cause of refractory iron deficiency anemia, unresponsive to iron therapy, and not attributable to usual causes such as intestinal losses or poor intake, malabsorption or diversion of iron in the reticulo-endothelial system. Although the interaction between infection and iron metabolism is now well consolidated, our understanding of the pathogenetic mechanism underlying the anemia is still wanting. Microbiological and ferrokinetic studies seem to suggest that Helicobacter pylori infected antrum could act as a sequestering focus for serum iron by means of outer membrane receptors of the bacterium, that in vitro are able to capture and utilize for growth iron from human lactoferrin. The proposed hypothesis does not answer why this complication is such a rare disease outcome in a common human infection but it may be used as a template for further controlled studies to determine the mechanisms of this atypical, medically important putative sequelae of H. pylori infection.



    Gut 2003 Apr;52(4):496-501

    Concomitant alterations in intragastric pH and ascorbic acid concentration in patients with Helicobacter pylori gastritis and associated iron deficiency anaemia.

    Annibale B, Capurso G, Lahner E, Passi S, Ricci R, Maggio F, Delle Fave G.

    Digestive and Liver Disease Unit, II Medical School, University La Sapienza, Roma, Italy. Cellular Ageing Centre, IDI, Roma, Italy.

    BACKGROUND: Seroepidemiological and clinical studies suggest that Helicobacter pylori may cause iron deficiency anaemia (IDA) in the absence of peptic lesions by undefined mechanisms, which still remain to be fully elucidated. Gastric acidity and ascorbic acid (AA) promote iron absorption. AA is lowered in the presence of H pylori infection. H pylori can cause atrophic body gastritis with achlorhydria, decreased iron absorption, and consequent IDA. Whether alterations in intragastric acidity and AA concentrations play a role in IDA developing in patients with H pylori gastritis remains to be determined. Aim: To evaluate gastric juice pH and gastric juice and plasma AA in patients with H pylori infection and unexplained IDA, compared with controls with IDA and a healthy stomach or with controls with H pylori infection and no IDA. RESULTS: Patients with IDA and H pylori gastritis were characterised by concomitant increased intragastric pH (median value 7) and decreased intragastric AA (median value 4.4 micro g/ml) compared with controls with a healthy stomach (median pH 2; median intragastric AA 17.5 micro g/ml) and with H pylori positive controls without IDA (median pH 2.1; median intragastric AA 7.06 micro g/ml). Intragastric AA was inversely related to pH (r=-0.40, p=0.0059) and corporal degree of gastritis (r=-0.53, p=0.0039). Plasma AA concentrations were lower in all infected groups than in healthy controls. CONCLUSIONS: Patients with unexplained IDA and H pylori gastritis present concomitant changes in intragastric pH and AA that may justify impaired alimentary iron absorption and consequent IDA.

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