瑞巴派特可提高胃溃疡的组织学愈合质量

背景：质子泵抑制剂的广泛应用，以及将根除幽门螺杆菌（H．pytori）感染作为治疗胃溃疡的主要手段，极大地提高了消化性溃疡的临床愈合率，但溃疡易复发的难题仍亟待解决。溃疡愈合质量，尤其是组织学愈合质量正日益受到关注。目的：观察活动性胃溃疡患者应用瑞巴派特联合法莫替丁与单用奥美拉唑治疗前后的胃黏膜组织学变化，比较两组溃疡的组织学愈合质量。方法：将110例经胃镜检查证实伴有H．pylori感染的活动性胃溃疡患者随机分为治疗组和对照组。治疗组口服瑞巴派特片和法莫替丁片，对照组口服奥美拉唑胶囊，疗程均为6周。治疗结束后。两组复查胃镜。内镜下取胃溃疡周围黏膜（相当于原取材点处）组织2～4块，观察两组治疗前后的胃黏膜组织学变化，着重从炎性细胞浸润程度、黏膜形态结构和上皮细胞内中性黏液含量三个方面观察胃黏膜组织学恢复情况。结果：治疗6周后，两组胃黏膜组织形态好转程度相似，但治疗组胃黏膜上皮细胞内中性黏液含量恢复程度较对照组显著（p=0．0039），腺体密度较治疗前显著增加（P=0．0485）。结论：无论H．pylori感染根除与否，瑞巴派特均可使胃黏膜上皮细胞内中性黏液含量和腺体密度较快恢复，增强胃黏膜上皮细胞成熟程度，提高胃黏膜防御功能，从而提高溃疡的组织学愈合质量。     

铝碳酸镁联合奥美拉唑治疗活动期胃溃疡的随机、平行对照、多中心临床研究

目的比较铝碳酸镁咀嚼片（商品名：达喜）联用奥美拉唑或单用奥美拉唑治疗成人活动期胃溃疡患者的临床症状改善情况、内镜下溃疡愈合率以及组织学溃疡愈合质量。方法采用多中心、随机、平行对照研究、将88例经胃镜证实伴幽门螺卡下菌感染的成人活动期胃溃疡患者，随机分为试验组（45例）和对照组（43例）。治疗第1周．两组均予幽门螺杆菌根除三联疗法．试验组同时给予铝碳酸镁咀嚼片每次1000mg．每日4次嚼服。第2～6周，试验组给予铝碳酸镁（剂量服法同前）联合奥美拉唑胶囊20mg．每晨1次口服。对照组仅给予奥美拉唑胶囊20mg．每晨1次口服。第7～8周．试验组继续给予铝碳酸镁咀嚼片（剂量服法同前），对照组停药。结果首次服药后上腹痛消失时间对照组为2d．试验组仅0．5d．两组间差异有统计学意义（P〈0．001）。治疗第1周末，试验组改善腹痛、腹胀、反酸、暖气、呕吐的发生频率显著优于对照组（P〈0．05）．试验组改善腹痛程度亦显著优于对照组（P〈0．01）。治疗8周后，两组内镜下溃疡愈合总有效率差异无统计学意义（P〉0．05）。病理组织学检查显示试验组腺体密度和腺管形念恢复显著优于对照组（P〈0．05）。结论治疗活动期胃溃疡，在质子泵抑制剂有效抑酸基础上．联合应用兼有抗酸、抗胆汁作用的胃黏膜保护剂铝碳酸镁，能更快缓解多种临床症状，尤其是迅速缓解胃痛。加用铝碳酸镁能显著促进胃黏膜组织形态结构的恢复，提高溃疡愈合质量。     

幽门螺杆菌感染对胃黏膜病理变化的影响

背景：幽门螺杆菌(H．pylori)感染已被公认为慢性胃炎和消化性溃疡的重要危险因素，根除H．pylori能加速消化性溃疡的愈合，但其对胃黏膜病理变化的影响尚有待进一步探索。目的：了解根除H．pylori对慢性胃炎胃黏膜病理变化和癌前状态的影响。方法：采用多中心随机对照临床试验和回顾性队列研究，样本选自胃癌高发区：上海郊区的金山区和奉贤区。共纳入360例经内镜检查证实有H．pylori感染的慢性胃炎伴或不伴十二指肠溃疡患者，随机分为两组。治疗组用三联疗法(质子泵抑制剂或Hz受体阻滞剂加两种抗生素)治疗，对照组单纯慢性胃炎患者予西沙必利、十二指肠溃疡患者予西米替丁治疗。在第1年和第4年末随访胃镜，根据H．pylori是否根除将患者分为两组：H．pylori阳性组和H．pylori阴性组。所有胃黏膜活检标本由两位病理科医师统一复读。结果：至第4年末，有120例患者完成全部随访，其中H．pylori持续根除组54例，阳转组5例；H．pylori持续未根除组45例，阴转组16例。持续根除组第1年随访时，活动性炎症比例减少(P＜O．05)；第4年随访时，慢性炎症和肠化程度以及活动性炎症比例减少(P＜O．05)。持续未根除组第1年随访时，慢性炎症程度增加(P＜O．05)；第4年随访时，慢性炎症和肠化程度以及活动性炎症比例增加(P＜O．05)，萎缩程度较第1年随访时增加(P＜O．05)。结论：根除H．pylori可以减轻慢性胃炎的炎症程度，防止肠化的发生和发展。     

铝碳酸镁治疗幽门螺杆菌相关性胃溃疡及ESD术后人造溃疡有效性的Meta分析

目的系统评价铝碳酸镁联合幽门螺杆菌(H. pylori)根除治疗H. pylori相关性胃溃疡及铝碳酸镁联合质子泵抑制剂(PPI)治疗内镜黏膜下剥离术(ESD)后人造溃疡的有效性。方法计算机检索CBM、CNKI、Wanfang Data、VIP、Pub Med、Embase、Web of Science、Scopus及The Cochrane Library数据库,纳入联用铝碳酸镁治疗H. pylori相关性胃溃疡及联用铝碳酸镁治疗ESD术后人造溃疡的随机对照试验(RCTs),筛选文献、提取数据并评价偏倚风险后,采用Rev Man 5. 3统计软件进行Meta分析。结果①H. pylori相关性胃溃疡:与单独应用H. pylori根除相比,铝碳酸镁联合H. pylori根除治疗能降低溃疡的1年后复发率(ITT分析:RR=0. 48,95%CI:0. 36～0. 65,P 0. 001)。②ESD术后人造溃疡:与单独应用PPI相比,铝碳酸镁联合PPI治疗能提高术后4周的溃疡愈合率(ITT分析,WMD=12. 92,95%CI:10. 15～15. 69,P 0. 001)。结论目前证据表明,在H. pylori根除治疗的基础上联用铝碳酸镁有助于降低H. pylori相关性胃溃疡的1年后复发率;在PPI基础上联用铝碳酸镁有助于加快ESD术后人造溃疡的愈合。     

奥美拉唑与法莫替丁治疗儿童消化性溃疡的随机对照研究

目的研究奥美拉唑与法莫替丁治疗儿童幽门螺杆菌(H.pylori)阳性消化性溃疡的疗效对比分析。方法选取2014年3月至2015年5月在我院门诊及住院就诊的60例H.pylori(+)消化性溃疡儿童患者,随机分为两组,对照组先用传统三联疗法根除H.pylori两周,再用法莫替丁30 d促溃疡愈合;观察组先用四联疗法根除H.pylori两周,再用奥美拉唑30 d促溃疡愈合。比较两组总有效率、不良反应发生率及H.pylori根除情况。结果治疗后,观察组临床疗效、不良反应发生率(16.6%)均优于对照组(P0.05),观察组、H.pylori根除率高于对照组,但差异无统计学意义(P0.05)。结论采用两组药物虽均能达到疗效,但儿童消化性溃疡使用奥美拉唑口服药物治疗后,疗效较高、副作用较小且安全性高,值得临床进一步进行推广。     

2型糖尿病伴发消化性溃疡愈合质量及其复发的临床评析

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)伴发消化性溃疡(peptic ulcer,PU)愈合质量及复发的临床特点。方法随访观察72例T2DM伴发PU患者和74例同期诊断明确的非糖尿病PU患者,并进行对照分析。所有患者均为活动期溃疡合并幽门螺杆菌(Helicobacter pylori,H.pylori)感染,胃溃疡(gastric ulcer,GU)和复合性溃疡共96例患者接受8周奥美拉唑治疗,十二指肠球部溃疡(duodenal ulcer,DU)50例患者接受6周奥美拉唑治疗;同时加用克拉霉素、阿莫西林或甲硝唑抗H.pylori治疗2周。治疗结束后1个月和12个月分别进行胃镜检查和H.pylori检测。结果治疗结束后1个月随访,T2DM组Sc期溃疡愈合率低于非T2DM组(P0.01);H.pylori根除者溃疡高质量愈合率明显高于H.pylori未根除者(P0.01)。治疗结束后12个月随访,T2DM组的溃疡年复发率高于非T2DM组(P0.05);H.pylori根除者溃疡年复发率低于H.pylori未根除者(P0.01)。结论虽然H.pylori根除后溃疡可获得高质量愈合,且溃疡复发率显著降低,但T2DM伴发PU溃疡愈合质量差,溃疡年复发率高。应重视对T2DM伴发PU患者H.pylori和胃镜的随访和复查。     

兰索拉唑联合铝碳酸镁治疗消化性溃疡的长期疗效分析

目的：探讨溃疡愈合质量对消化性溃疡复发的影响。方法：将68例十二指肠球部溃疡合并幽门螺杆菌(H．Pylori)感染患者随机分为：试验组38例,对照组30例。2组均先给予标准3联疗法根除H．Pylori,1周后试验组,兰索拉唑30mg每日2次,联合铝碳酸镁(商品名,达喜)1000mg每日3次；对照组,兰索拉唑30mg每日2次；继续治疗4周。停药4周后观察内镜下溃疡愈合率、胃粘膜组织学改变；随访1年内溃疡复发情况。结果：停药4周后内镜下溃疡愈合率分别为,试验组94．7%,对照组80．0%,两者比较无显著性差异(P＞0．05)。组织学观察显示粘膜层厚度、腺体密度和腺管形态恢复,试验组显著优于对照组(P＜0．05)；1年内溃疡复发率,试验组2．8%,对照组25．0%,两者比较有显著性差异(P＜0．05)。结论：兰索拉唑联用铝碳酸镁能提高溃疡愈合质量,减少溃疡复发,显著优于单用兰索拉唑。     

泮托拉唑联合铝碳酸镁治疗消化性溃疡的疗效观察

目的探讨溃疡愈合质量对消化性溃疡复发的影响。方法将124例十二指肠球部溃疡合并幽门螺杆菌（Hp）感染患者随机分为观察组68例、对照组56例,两组均先给予标准三联疗法根除Hp。1周后观察组给予泮托拉唑40 mg、1次/d,铝碳酸镁1000 mg、3次/d;对照组给予泮托拉唑40 mg、1次/d;继续治疗4周。停药4周后观察内镜下溃疡愈合率、胃黏膜组织学改变;随访1 a内溃疡复发情况。结果内镜下溃疡愈合率观察组94.1%、对照组87.5%,两组比较无统计学差异（P＆gt;0.05）。组织学观察显示黏膜层厚度、腺体密度和腺管形态恢复观察组显著优于对照组（P〈0.05）;1 a内溃疡复发率观察组2.9%、对照组17.8%,两者比较有统计学差异（P〈0.05）。结论泮托拉唑联用铝碳酸镁能提高溃疡愈合质量,减少溃疡复发。     

铝碳酸镁联合兰索拉唑与单用兰索拉唑治疗幽门螺杆菌相关性胃溃疡的疗效对比

目的探讨铝碳酸镁联合兰索拉唑与单用兰索拉唑治疗幽门螺杆菌(Helicobacter pylori,H.pylori)相关性胃溃疡的疗效。方法选取我院2013年6月至2016年7月收治的H.pylori阳性胃溃疡患者150例,随机分为对照组和观察组,各75例。两组患者经常规四联疗法(即兰索拉唑片,30mg/次,2次/d;克拉霉素缓释片,0.5 g/次,2次/d;阿莫西林胶囊,1 g/次,2次/d;胶体果胶铋胶囊,200 mg/次,2次/d)杀菌治疗2周后,对照组继续使用兰索拉唑治疗,观察组在对照组的基础上联合铝碳酸镁治疗。比较两组临床疗效、H.pylori根除率、不良反应的发生情况及1年后胃溃疡的复发率。结果观察组临床总有效率90.67%,显著高于对照组的73.33%(P0.05)。观察组H.pylori根除率为86.67%,显著高于对照组的70.67%(P0.05)。观察组不良反应的发生率为4.00%,显著低于对照组的13.33%(P0.05)。治疗后1年,观察组H.pylori相关性胃溃疡的复发率为6.67%,显著低于对照组的25.33%(P0.05)。结论铝碳酸镁联合兰索拉唑能促进胃溃疡的愈合,减少不良反应的发生并降低胃溃疡的复发及提高H.pylori根除率,值得临床应用和推广。     

铝碳酸镁咀嚼片联合奥美拉唑治疗胃溃疡的疗效观察

[目的]观察铝碳酸镁咀嚼片联合奥美拉唑治疗胃溃疡(GU)的临床疗效.[方法]选取我院2009年1月～2012年1月收治的GU患者92例,随机分为2组,每组46例.所有患者在药物治疗前先抗幽门螺杆菌(Hp)治疗,对照组患者采用奥美拉唑治疗;观察组患者采用铝碳酸镁咀嚼片联合奥美拉唑治疗.观察2组患者治疗后的临床疗效.[结果]经治疗后,观察组患者的溃疡直径较对照组小,治愈人数及总有效率均明显高于对照组(P＜0.05).[结论]铝碳酸镁咀嚼片联合奥美拉唑治疗效果显著,较单用奥美拉唑用药好,值得临床推广应用.     

不同抗溃疡药物对应激性溃疡发生、发展过程中细胞凋亡的影响

背景：研究不同抗溃疡药物在防治应激性溃疡(SU)时，其对胃黏膜细胞学行为的作用是否有助于SU的防治。目的：观察抗溃疡药物奥美拉陛、米索前列醇和铝碳酸镁对SU的疗效，及其对细胞凋亡和与凋亡相关的细胞因子一氧化氮合酶(NOS)表达的影响。方法：水浸—束缚应激(WRS)结束后2h，计算胃黏膜损伤的溃疡指数(UI)；原位末端标记(TUNEL)法检测胃黏膜细胞凋亡；免疫组化法检测神经型NOS(nNOS)和诱导型NOS(iNOS)表达的变化。结果：奥美拉陛(0)组、米索前列醇(M)组和铝碳酸镁(H)组胃黏膜损伤均较生理盐水组显著减轻(P＜0．01)，胃黏膜细胞凋亡发生率均显著降低(P＜0．01)，但0组和M组的效果优于H组。与生理盐水组比较，3组用药组的nNOS表达均显著增加(P＜0．01)，iNOS表达均显著降低(P＜0．01)，M组和H组的nNOS表达升高较0组更为显著(P＜0．05)。结论：奥美拉唑、米索前列醇和铝碳酸镁作用于SU发生的不同环节，可显著抑制细胞凋亡的发生，对SU均有明显防治作用。寻找对细胞有直接保护作用的药物以提高细胞的抗应激能力可能是防治SU的最终途径。     

Low Incidence of Helicobacter pylori Infection in Patients with Duodenal Ulcer and Chronic Liver Disease

Background: Duodenal ulcer (DU) is a common problem in patients with chronic liver disease (CLD) and with inadequate response to H2 receptor antagonists. Omeprazole might be more effective. In DU-CLD patients, Helicobacter pylori prevalence is low. Nitric oxide is increased in gastric mucosa in cirrhosis. Oxygen-free radicals have a role in gastric inflammation and are abnormal in CLD. Nitrotyrosine is a marker of nitric oxide and oxygen-free radical toxic mucosal reaction. Methods: Sixtynine patients were divided into 2 groups: control (26 patients with DU) and CLD groups (43 patients, DUCLD). Omeprazole was given (40 mg/day) for 2 or 4 weeks. Symptoms and endoscopy findings were recorded before and after treatment. Antral biopsy specimens were stained for H. pylori and nitrotyrosine. Results: Clinical features of DU are similar in patients with and without CLD. The main presentation was epigastric pain (70%) and bleeding (23%). Healing rate with omeprazole was higher in DU-CLD patients (90.7%) than in controls (80.8%). H. pylori was much lower in DU-CLD patients (51.2%) than controls (96.2%). Nitrotyrosine staining was negative in normal controls (0%) and positive in control-DU (100%), CLD- H. pylori positive (81%), and CLD-H. pylori negative (91%) cases. Conclusions: DU in patients with CLD is not different clinically from those without CLD. Omeprazole effectively and safely treats DU in CLD. Nitric oxide and free oxygen radicals may result in gastric mucosal changes in CLD similar to that caused by H. pylori.     

乳香提取物对大鼠乙酸胃溃疡愈合质量的影响

目的:研究乳香提取物对大鼠乙酸胃溃疡愈合质量的影响.方法:用冰醋酸制备大鼠慢性胃溃疡模型,随机分为6组,分别灌服0.85%氯化钠溶液、乳香提取物、雷尼替丁等.用苏木精-伊红染色、粘液组织化学染色和苦味酸-酸性品红染色对大鼠愈合性胃溃疡再生粘膜厚度、再生粘膜粘液含量、囊状扩张腺体数量、炎症细胞浸润数量等进行定量观察.结果:乳香提取物组再生粘膜厚度增加、囊状扩张腺体数量减少和粘液高碘酸无色品红(PAS)含量增加;肉芽组织胶原含量增加,炎症细胞浸润数量减少.结论:乳香提取物能提高溃疡再生粘膜结构和功能成熟度,提高溃疡愈合质量.     

Gastric Metaplasia in the Duodenal Bulb Shows Increased Mucosal Interleukin-8 Activity in Helicobacter pylori-Positive Duodenal Ulcer Patients

Background: Although increased levels of interleukin (IL)-8 are known to be associated with infiltration of neutrophils in the gastric mucosa with Helicobacter pylori infection, no study has investigated the relationship between local IL-8 levels and neutrophil infiltration in the duodenal mucosa of patients with duodenal ulcer (DU). Methods: Duodenal mucosal biopsy specimens with and without gastric metaplasia (GM) were obtained from patients with DU and controls with an endoscopic methylene blue (MB) staining method. Levels of IL-8 secreted in the organ cultures of biopsy specimens were measured with an enzyme-linked immunosorbent assay. The number of myeloperoxidase-positive neutrophils infiltrating the lamina propria was determined in immunohistochemically stained tissue sections. Results: Histologic assessment showed that there was a strong correlation between the absence of endoscopic MB staining and the extent of GM. The levels of IL-8 in both duodenal and antral mucosal tissues were significantly higher in patients with H. pylori infection than in those without infection. In patients with DU the duodenal mucosal tissues with GM (MB-unstained mucosa) showed significantly higher levels of IL-8 than those without GM (MB-stained mucosa) or the antral mucosa. The number of neutrophils showed similar variations among DU and control patients with a positive correlation with IL-8 activity. The levels of IL-8 and the number of neutrophils decreased after H. pylori eradication in both duodenal and antral mucosal tissues, and these changes were more remarkable in the duodenal mucosal tissues with GM. Conclusions: Increased IL-8 activity in the duodenal mucosa with GM may be important for ulcerogenesis in H. pylori-positive DU patients.     

不同饮食对大鼠十二指肠溃疡愈合的影响及胃粘膜的保护作用

目的:观察小米。大米。面粉和全脂奶饮食对实验性十二指肠溃疡(DU愈合的影响及胃粘膜的保护作用,寻求DU患者更为合理的饮食种类。方法:应用5%半胱胺盐酸盐建立实验性大鼠DU模型,给予不同饮食后测定胃粘膜电位差(PD。前列腺素E2(PGE2)含量。计算溃疡指数(UI)及判定溃疡愈合程度。结果:小米组和大米组的UI分别为2.60±1.71和3.00±1.77,低于面粉组4.70±1.77(P<0.05);全脂奶组UI与以上三组相比无显著差异(P>0.05)。胃粘膜组织中PGE2含量亦以小米组和大米组为高,分别为1802.40 pg/mg±567.26pg/mg和1706.86pg/mg±429.08 pg/mg,与面粉组和全脂奶组相比差异显著(P<0.01,P<0.05)。胃粘膜PD检测:小米组为-22.32±10.59;面粉组为-11.76±8.08,两组相比差异显著(P<0.05)。结论:通过胃粘膜PD的检测,反映小米饮食可提高胃粘膜屏障的完整性;小米和大米饮食可增加胃粘膜组织中PGE2含量,对实验性大鼠DU愈合作用优于面粉饮食。     

Effects of Omeprazole and Eradication of Helicobacter pylori on Gastric and Duodenal Mucosal Enzyme Activities and DNA in Duodenal Ulcer Patients

Vetvik K, Schrumpf E, Mowinckel P, Aase S, Andersen K-J. Effects of omeprazole and eradication of Helicobacter pylori on gastric and duodenal mucosal enzyme activities and DNA in duodenal ulcer patients. Scand J Gastroenterol 1994;29:995-1000.

Background: Duodenal and gastric content of mucosal enzymes in duodenal ulcer (DU) patients differs from that of controls. The purpose of this study has been to examine the effect of omeprazole and eradication of Helicobacter pylori on mucosal enzymes in DU patients

Methods: The enzyme activities of seven gastric and duodenal mucosal marker enzymes from the brush border, lysosomes, and mitochondria have been studied. In study I the measurements were made in 29 patients with an active DU before and after 14 days of omeprazole treatment. In study II 22 duodenal ulcer patients were given bismuth subnitrate, oxytetracycline, and metronidazole (triple therapy) for 2 weeks to eradicate H. pylori. Biopsy specimens were taken from the duodenum and the stomach for enzyme measurements and histologic assessment. In study II additional specimens were obtained from the prepyloric region for urease tests and culture of H. pylori.

Results: The ulcer healing rates were more than 90% after both omeprazole and triple therapy. H. pylori was eradicated in 86% after triple therapy. The activities of the brush-border enzymes lactase, neutral-α-glucosidase, alkaline phosphatase, leucyl-β-naphthylami-dase, and γ-glutamyltransferase (γ-GT) increased significantly in the duodenal bulb and the descending duodenum during treatment with omeprazole. No changes in duodenal enzyme activity were detected after triple therapy, whereas a significant fall in γ-GT and acid phosphatase activities was seen in the stomach. The mucosal DNA in the gastric antrum decreased both after treatment with omeprazole and after triple therapy.

Conclusions: A similar decrease in mucosal DNA of the gastric antrum was demonstrated after both omeprazole and triple therapy with bismuth subnitrate, oxytetracycline, and metronidazole. Omeprazole also affects the content of duodenal mucosal enzymes, whereas triple therapy particularly affects the gastric mucosal enzyme activity.     

Epidermal Growth Factor in Gastric Ulcer Healing by Nocloprost,a Stable Prostaglandin E2 Derivative

Background: The gastroprotective and ulcer-healing properties of prostaglandins, especially in gastric ulcers induced by non-steroidal anti-inflammatory drugs, are well established. Ulcer healing is an active process of filling the mucosal defect with migrating and proliferating epithelial cells combined with angiogenesis in granulation tissue at the ulcer bed. Growth factors, especially epidermal growth factor (EGF) and transforming growth factor alpha (TGFa) are crucial in the regulation of the reconstruction of damaged mucosal structures. Methods: In this double-blind, randomized, prospective study 40 patients with gastric ulcer were treated with nocloprost, a stable prostaglandin E₂ derivative, or with ranitidine. All subjects underwent endoscopy before and after 4 and 8 weeks of anti-ulcer therapy. During endoscopy mucosal biopsies were performed for determination of EGF content in gastric mucosa at the ulcer margin and in the intact mucosa. Additionally, EGF output in saliva and its plasma concentrations were determined in all subjects before and during the treatment. Results: The gastric ulcer healing rate after 4 weeks was significantly higher in patients treated with nocloprost than in those treated with ranitidine (63% versus 39%, respectively). At initial examination the EGF content in the gastric mucosa obtained from the ulcer edge was significantly higher than that in the intact mucosa. There was a significant increase in the EGF content in both the ulcer margin and the intact mucosa in subjects treated with nocloprost but not in patients under treatment with ranitidine. Similarly, patients treated with nocloprost had significantly higher EGF output in saliva and higher EGF concentration in plasma throughout the anti-ulcer therapy. Conclusion: Nocloprost is superior to ranitidine in the treatment of chronic gastric ulcers, and these effects could be due, at least in part, to higher expression and mucosal content of EGF in the ulcer area.     

Medium-or High-Dose Omeprazole Plus Amoxicillin Eradicates Helicobacter pylori in Gastric Ulcer Disease

Objective: To compare the efficacy of two omeprazole/amoxicillin regimens concerning Helicobacter pylori eradication, ulcer healing, pain relief, and safety in patients with gastric ulcer disease. Methods: In a prospective, single-blind, single-center study, 70 patients with active, H. Pylori -positive (histology and/or culture) gastric ulcers were randomly treated with either omeprazole 20 mg b.i.d . plus amoxicillin 1 g b.i.d . (group I; n = 35) or with omeprazole 40 mg b.i.d . plus amoxicillin 1 g b.i.d . over 2 wk, followed by full dose ranitidine for another 4 wk. Patients were investigated clinically and endoscopicaily prior to treatment and after 6 wk, including the assessment of H. pylori status by means of urease test, specific culture, and histology. Results: Patients of group I and II had similar demographic and clinical characteristics. Three patients were lost to follow-up. The overall proportion of H. pylori eradication was 88.1% (group I, 91.2%; group II, 84.8%, p = NS). The ulcer healing rate was 79.1% after 6 wk, 92.5% after 10 wk, and 100% after 6 months, without a statistically significant difference between the study groups. Complete pain relief occurred after a median of 2 days (group I) and 1.5 days (group II, p = NS), respectively. Six patients (9.0%) complained of side effects that led to discontinuation of amoxicillin treatment in three patients (4.5%). Conclusions: Omeprazole plus amoxicillin is a highly effective and well-tolerated therapy regimen to eradicate H. pylori from the gastric mucosa of patients with gastric ulcer disease. In addition, the results clearly suggest that medium- and highdose omeprazole schedules are equally effective with regard to bacterial eradication, ulcer healing, pain relief, and safety in gastric ulcers. Thus, medium- and not high-dose omeprazole plus amoxicillin should be the treatment regimen of first choice to eradicate H. pylori in gastric ulcer disease.