Gürsel BAYRAM, Bülent ÖDEMİŞ, Bahattin ÇİÇEK, Osman YÜKSEL, Erkan PARLAK, Neslihan İ. ZENGİN, Burhan ŞAHİN

Kolesistektominin alkalen reflü gastrit, antral mukoza histolojisi ve Helikobakter pylori kolonizasyonu üzerine etkisi

Giriş ve amaç: Kolesistektomi semptomatik safra taşları için standart tedavi olmasına rağmen duodenogastrik reflüyü indükleyen anotomik ve fonksiyonel değişikliklere yol açabilir. Bu çalışmanın amacı kolesistektomi ile alkalen reflü, antral mukozal değişiklikler ve H. pylori kolonizasyonu arasındaki ilişkiyi araştırmaktır. Gereç ve yöntem: Bu prospektif çalışmaya 135 kolesistektomili (104 kadın, 31 erkek; 56.25±11.35 yıl) ve 50 kontrol hastası (35 kadın, 15 erkek; 55.48±12.50) alındı. Kolesistektomi geçiren grup kendi içerisinde kolesistektomi yılına göre sınıflandırıldı (≤5 yıl, 6-9 yıl, 10 ≥). Tüm hastalara üst gastrointestinal endoskopi yapılarak alkalen reflü gastrit varlığı değerlendirildi. Antrumdan alınan endoskopik biyopsilerde mukozadaki histopatolojik değişiklikler ve H. pylori varlığı araştırıldı. Bulgular: Alkalen reflü gastrit kolesistektomi grubunda (%58.5) kontrol grubuna (%6) göre anlamlı olarak yüksek saptandı. H. pylori, İntestinal metaplazi, kronik aktif gastrit, ve kronik atrofik gastrit açısından iki grup arasında anlamlı farklılık yoktu. Yıllara göre kolesistektomi grubu snıflandırılarak yapılan değerlendirmede alkalen reflü gastrit kolesistektomi gruplarının tamamında kontrol grubuna göre anlamlı olarak yüksekti, ancak kolesistektomi grupları arasında anlamlı farklılık yoktu. H. pylori, intestinal metaplazi, kronik aktif gastrit ve kronik atrofik gastrit açısından kontrol ile kolesistektomi grupları arasında ve kolesistektomi gruplarının kendi arasında istatistiksel olarak anlamlı bir fark bulunmadı. Sonuç: Kolesistektomi endoskopik alkalen reflü gastrite yol açmakla beraber antrum mukozasında histolojik deği- şiklere yol açmaz ve H. pylori kolonizasyonunu etkilemez.

Anahtar Kelimeler:

Alkalen reflü gastrit, helikobakter pylori, kolesistektomi

Effect on alkalen reflux gastritis, histology of the antral mucosa and Helicobacter pylori colonization of cholecystectomy

Background/aim: Although cholecystectomy is the standard therapy for symptomatic gallbladder stones, it may lead to anatomic and functional changes that induce duodenogastric reflux. The aim of this study was to evaluate the relationship between cholecystectomy and alkaline reflux, antral mucosal changes, and colonization of Helicobacter pylori. Materials and methods: One hundred and thirty-five cases (104 female, 31 male; 56.25±11.35 years old) with cholecystectomy and 50 (35 female, 15 male; 55.48±12.50 years old) control cases were included in this prospective study. Patients with cholecystectomy were subclassified according to the time interval after cholecystectomy (≤5 years, 5-9 years, ≥10 years). All patients were investigated for alkaline reflux gastritis by upper gastrointestinal endoscopy. Mucosal histopathologic changes and Helicobacter pylori existence were evaluated in endoscopic biopsies obtained from the antrum. Results: Alkaline reflux gastritis in the cholecystectomy group (58.5%) was significantly higher than in the control group (6%). There was no significant difference between groups regarding to Helicobacter pylori existence, intestinal metaplasia, chronic active gastritis and chronic atrophic gastritis. Presence of alkaline reflux gastritis was significantly higher in all cholecystectomy subgroups than in the control group, but there were no significant differences between values among cholecystectomy subgroups. Rates of Helicobacter pylori, intestinal metaplasia, chronic active gastritis and chronic atrophic gastritis were similar between the control group and cholecystectomy subgroups and also among cholecystectomy subgroups. Conclusion: Cholecystectomy often leads to endoscopic alkaline reflux gastritis. Nevertheless, it does not influence Helicobacter pylori colonization nor cause antral mucosal histopathological changes.

Keywords:

Alkaline reflux gastritis, helicobacter pylori, cholecystectomy,

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