2017年 · 第37卷第03期

Since the 4th NationalH.pyloriConsensus on infection management^[1]Since the convening of the Conference (2012), the international community has successively issued three importantH.pyloriConsensus reports on infection management, respectively, under theH.pyloriKyoto Global Consensus on Gastritis (hereinafter referred to as Kyoto Consensus)^[2]Toronto AdultH.pyloriConsensus on Treatment of Infections (hereinafter referred to as Toronto Consensus)^[3]And "H.pyloriMaastricht-5 Consensus on Infection Management (hereinafter referred to as Maastricht-5 Consensus)^[4]。

First released by the National Institutes of Health (NIH) in 1994H.pyloriSince the consensus on infection treatment, a series of publications have been published at home and abroadH.pyloriConsensus guidelines for the management of infections. With the publication of the Maastricht V Consensus, China has also issued four nationalH.pyloriConsensus report on infection management.H.pyloriThe indication for eradication has been determined byH.pyloriPositive peptic ulcers spread to numerousH.pyloriRelated disease^[1,2]。 Released in 2015H.pyloriGastritis Kyoto Global Consensus^[3]It is proposed to treat allH.pyloriPositive ones. However, does it still need to be eradicatedH.pyloriIndications remain a question worth exploring.

Accurate detectionH.pylroiIs a standardized treatmentH.pyloriThe premise of infection.H.pyloriIt is a gram-negative spiral bacterium, which colonizes the gastric epithelium (stomach and duodenal mucosa with gastric metaplasia) after infection in human body, and can undergo spherical deformation when the environment is not suitable.H.pyloriA relatively specific urease can be produced, which breaks down urea to produce ammonia and carbon dioxide. PartH.pyloriCan lose colonization with gastric epithelial metabolism and excretion from feces.H.pyloriIt can stimulate the body's immune response and produce corresponding antibodies. Aimed atH.pyloriof these biological properties, a variety of applications have been developed forH.pyloriInfection detection methods, each detection method has its own characteristics, reasonable combination of the characteristics of various methods and the individual situation of patients to detect is beneficial to improve the accuracy of diagnosis.

eradicationH.pyloriTreatment can be divided into empirical treatment and drug sensitivity test-based treatment, and whether to choose the former or the latter depends mainly on the eradication rate of the former. Over the past 30 years, in view ofH.pyloriDrug sensitivity testing is time-consuming and laborious, and it is not feasible to carry out it in primary medical institutions. Therefore, according to localH.pyloriThe primary therapeutic methods used by clinicians are the empirical treatment of strain resistance to antibiotics and the results of clinical trials. Empirical treatment has formed a series of consensus and guidelines at home and abroad, which effectively guides clinical work. At present, the empirical use of commonly used clinical treatment programs in China is summarized.

As an infectious disease,H.pyloriThe best eradication protocol for infection is individualized treatment that combines multi-faceted information such as strain, host, and drug, among whichH.pyloriThe susceptibility of antibiotics is the most critical factor affecting the eradication rate. Therefore, if antibiotic resistance information can be obtained before eradication treatment, and targeted drug selection can be carried out based on drug sensitivity results, excellent and satisfactory eradication efficacy can be obtained, and unreasonable use of antibiotics can be effectively avoided, and the occurrence of antibiotic resistance can be reduced.

Gastric cancer is one of the common malignant tumors in China. Statistics from the National Cancer Center show that in 2015, the new incidence rate of gastric cancer in China was 679/100,000, and the mortality rate was 498/100,000^[1], ranking second among all malignant tumors. The occurrence of gastric cancer isH.pyloriAs a result of the combined action of infection, host genetic factors and environmental factors, primary prevention to eliminate the cause of gastric cancer is the fundamental measure to reduce the incidence of gastric cancer. Host genetic factors cannot be changed and should therefore focus onH.pyloriPrevention and control of infections. Recently released Asia-Pacific consensus on gastric cancer prevention and treatment determinesH.pyloriInfection is the most important controllable risk factor for gastric cancer prevention,H.pyloriGastritis Kyoto Global Consensus^[2]AndH.pyloriInfection Management Maastricht V/Florence Consensus^[3]Eradication is also strongly recommendedH.pyloriPrevention of gastric cancer.

Human health is closely related to the microbiota (microbiota) living on the surface or inside of human body. The oral cavity, skin, lung, genitourinary tract, gastrointestinal tract, etc. have unique microbial communities. They interact with the host, depend on each other, and co-evolve to form a dynamic and stable microecosystem (microecosystem). Among them, gastrointestinal tract is the most studied microbial system with the most widespread and powerful functions^[1]。 Gastrointestinal microecological balance plays an important role in digestion, absorption, metabolism, immunity, and inhibition of pathogenic colonization. The disorder of its structure or function can lead to a variety of diseases. As the most studied microorganism in the stomach,H.pyloriCan lead to sustained damage to the gastric mucosa and is associated with various gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric MALT lymphoma and gastric cancer. There is a global consensus that it should be givenH.pyloriEradication treatment for infected persons, unless counterbalancing factors are considered^[2,3]。H.pyloriInfection can alter the composition of gastrointestinal microecology, eradicatingH.pyloriIt may also have an impact on the existing gastrointestinal microecosystem. In the latest onH.pyloriIn the Masstricht V consensus on infection management,H.pyloriThe relationship to the gastric microbiome is discussed in a separate section and 10 related statements are drawn^[3]。 Although most of the statements have a low level of evidence and the conclusions are not clear, they adequately illustrateH.pyloriField experts attach importance to this issue. We will now discuss separatelyH.pyloriThe effects of infection and eradication on gastrointestinal microecology provide some experimental and clinical data, and present a shallow understanding of this problem, hoping to help readers understandH.pyloriThe complex and close relationship between gastrointestinal microecology and human health.

Cultured from human gastric mucosa was first reported by Marshall and Warren in 1983H.pyloriSince then, the worldwide publishedH.pyloriThere are more than 40,000 related documents. Although about 70% of theH.pyloriThe infected person is asymptomatic, butH.pyloriChronic active gastritis will occur in infected people, about 15% ~20% of infected people will have peptic ulcer, and 10% will have dyspepsia (H.pyloriassociated dyspepsia), 1% developed gastric malignancies (gastric cancer, gastric MALT lymphoma). WhereasH.pyloriInfections can cause chronic active gastritis, andH.pyloriInfection can be transmitted from person to person, published in 2015H.pyloriGastritis Kyoto Global Consensus^[1]And the recently published Maastricht-VH．pyloriConsensus on infection management^[2]WillH.pyloriGastritis is defined as an infectious (infectious) disease.

H.pyloriIt is related to the occurrence of upper gastrointestinal diseases, such as gastritis, gastric cancer and MALT lymphoma.H.pyloriIt is also closely related to other malignant tumors and various extraintestinal diseases^[1,2]。 Currently,H.pyloriThe eradication rate is decreasing year by year, and this study intends to analyze the impactH.pyloriThe factors of eradication rate are reported below.

The common manifestation of UC is mucous bloody stool, and mucosal congestion, erosion and ulcer formation can be seen under colonoscopy, but now there are also mucous bloody stool and intestinal mucosal changes caused by other reasons similar to UC. Drug-induced enteritis is a relatively rare intestinal lesion. Drug injury is generally mainly manifested as drug-induced liver injury, but there are also cases with normal liver function and mucus and bloody stool. Especially under the induction of some inducements, it is easy to be misdiagnosed. This patient was diagnosed as suspected UC in an outside hospital. After multidisciplinary discussion, no pathological changes such as typical crypt abscess and crypt structural changes in UC were found, but foreign body deposition and granuloma formation occurred. Further animal experiments were considered as drug-induced enteritis, and its diagnosis and treatment were now comprehensively discussed.

A 39-year-old female was admitted to the hospital 3 days after physical examination revealed gallbladder stones. Han nationality, usually healthy, HBV carrier, no family history of genetic diseases, denied history of abroad residence; No bad habits such as tobacco and alcohol. Height 1.58 m, weight 45 kg. From March 2015, I had yellow watery stool 4 to 5 times/d without other discomfort. On April 1, 2015, hepatobiliary ultrasound showed gallbladder bile salt deposition (full type) and gallbladder solid-like changes? He was admitted to the hepatobiliary surgery department for surgery. After hospitalization, he was positive for HBsAg and negative for hepatitis C antibody, HIV antibody and syphilis antibody. Full set of blood tumor markers, thyroid function, biochemical indexes and urine routine were normal. Fecal routine and occult blood tests were negative. Blood WBC count was 17.9×10⁹/L, the neutrophil ratio was 0.91, Hb was 121 g/L, and the PLT count was 372×10⁹/L; The enhanced CT examination of chest and upper abdomen showed no obvious abnormalities. Colonoscopy showed UC, and biopsy (hereinafter referred to as biopsy) showed chronic active inflammatory reaction of the mucosa.

The upper part of the stomach is connected to the esophagus and the lower part is connected to the small intestine. Bacteria in the mouth, pharynx, esophagus and small intestine can enter the stomach. Although its acidic environment forms an effective protective barrier, a considerable number of acid-resistant bacteria still exist in the stomach, with contents close to 1×10³CFU/mL. In 1982, Marshall and Warren discovered in human gastric mucosaH.pylori。 Currently,H.pyloriInfects about half of the world's population, may be asymptomatic, or may cause host disease, causing gastric ulcers or even gastric cancer, but may have other benefits^[1,2]。

IBD is a group of intestinal nonspecific inflammatory reactive diseases with unknown etiology, including CD and UC. The incidence of IBD is gradually increasing in recent years. The incidence of UC and CD is (120~200) /100,000 and (50~200) /100,000, respectively^[1]。 The course of IBD is chronic, recurrent, the disease is prolonged, and various complications often occur, which seriously affect the emotional and social ability of patients. Many chronic diseases, such as cardiovascular diseases and diabetes, are causally related to psychological factors, and some mental abnormalities may be caused by intestinal diseases. IBD, as a functional disease of intestine, is considered to be closely related to psychological factors. Whether psychological factors affect the occurrence and development of IBD, or long-term physical discomfort brings mental and psychological problems to patients? At present, the role and influence of psychological factors on IBD patients is still controversial. Now, this paper summarizes the relationship between IBD and psychological factors.

In 2010, the guidelines for the diagnosis and treatment of primary sclerosing cholangitis (PSC) published by the American Association for the Study of Liver Diseases (AASLD) emphasized that patients suspected of PSC should be tested for serum IgG4 and screened for IgG4-related sclerosing cholangitis (IgG4-SC)^[1]。 PSC and IgG4-SC are highly similar in clinical manifestations, serology and imaging, and IgG4-SC has only been gradually recognized in recent years, and is often misdiagnosed as PSC clinically. PSC is a chronic cholestatic liver disease involving the intrahepatic and extrahepatic bile duct system, characterized by progressive fibrous lesions that eventually progress to cirrhosis and hepatic failure, for which there is currently no effective treatment. IgG4-SC is sensitive to glucocorticoid (hereinafter referred to as hormone) therapy and the prognosis of patients is good. It is more and more important to master the identification methods and diagnosis and treatment methods between PSC and IgG4-SC. The pathogenesis, clinical symptoms and histological manifestations of the two diseases were compared, so as to provide reference for clinical differentiation.