BACKGROUND AND AIMS Compromise of the gastric acid barrier may facilitate bacterial invasion of the lower intestinal tract and influence the occurrence of inflammatory bowel disease (IBD). Our study tested the associations between histopathologic changes in the upper and lower gastrointestinal tract in patients undergoing bidirectional endoscopy. METHODS The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the entire USA. A case-control study among 302,061 patients, of whom 13,943 harbored IBD, evaluated whether the occurrence of Crohn's disease or ulcerative colitis was influenced by the presence of various upper gastrointestinal diagnoses associated with lowered gastric acid output. The influence of individual risk factors on the occurrence of colonic disease was expressed as odds ratios with their 95% confidence intervals. RESULTS The odds ratio for Crohn's disease being associated with gastric H. pylori was 0.30 (0.24-0.37), with intestinal metaplasia 0.30 (0.24-0.39), with fundic gland polyps 0.42 (0.35-0.50), with gastric hyperplastic polyps 0.35 (0.23-0.51), with Barrett's metaplasia 0.19 (0.14-0.24), and with reflux esophagitis 0.46 (0.42-0.51). The odds ratio for ulcerative colitis being associated with gastric H. pylori was 0.58 (0.50-0.67), with intestinal metaplasia 0.39 (0.32-0.47), with fundic gland polyps 0.61 (0.53-0.71), with gastric hyperplastic polyps 0.64 (0.49-0.84), with Barrett's metaplasia 0.50 (0.43-0.59), and with reflux esophagitis 0.77 (0.71-0.84). CONCLUSIONS A diminished gastric acid barrier function, as evidenced by various upper gastrointestinal diseases associated with lowered gastric acid output, may exert a protective influence against the development of inflammatory bowel disease.

中文翻译：

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上消化道疾病影响炎症性肠病的发生。

背景和目的胃酸屏障的破坏可能促进细菌入侵下肠道并影响炎症性肠病（IBD）的发生。我们的研究测试了接受双向内窥镜检查的患者上消化道和下消化道的组织病理学变化之间的关联。方法Inform Diagnostics数据库是分布在整个美国的患者组织病理学记录的国家电子存储库。一项在302,061例患者中进行的病例对照研究评估了克罗恩氏病或溃疡性结肠炎的发生是否受到胃酸输出量降低相关的各种上消化道诊断的影响，从而影响了克罗恩病或溃疡性结肠炎的发生。各个危险因素对结肠疾病发生的影响以其95％置信区间的比值比表示。结果与胃幽门螺杆菌相关的克罗恩病比值比为0.30（0.24-0.37），肠上皮化生为0.30（0.24-0.39），胃底息肉为0.42（0.35-0.50），胃增生性息肉为0.35（0.23） -0.51），巴雷特化生0.19（0.14-0.24）和反流性食管炎0.46（0.42-0.51）。与胃幽门螺杆菌相关的溃疡性结肠炎的优势比为0.58（0.50-0.67），肠化生为0.39（0.32-0.47），眼底腺息肉为0.61（0.53-0.71），胃增生性息肉为0.64（0.49- 0.84），巴雷特化生为0.50（0.43-0.59），反流性食管炎为0.77（0.71-0.84）。