溃疡分期对幽门螺杆菌根除率的影响

背景:幽门螺杆菌(Hp)感染与多种胃肠道疾病的发生相关。研究表明,Hp根除率可能受疾病种类、疾病进展阶段的影响。目的:探讨内镜下溃疡分期对Hp根除率的影响。方法:收集2015年1月—2016年7月新疆维吾尔自治区人民医院收治的Hp感染消化性溃疡(PU)患者423例,其中胃溃疡(GU)组133例,十二指肠溃疡(DU)组255例,予14 d含铋剂四联疗法根除Hp治疗。比较不同内镜分期溃疡患者Hp根除率的差异,对Hp根除率影响因素进行单因素分析。结果:GU与DU组间Hp根除率差异无统计学意义(82.7%对83.9%,P0.05)。GU组活动期溃疡患者根除率显著高于非活动期(89.0%对75.0%,P0.05),而DU组两亚组间根除率无明显差异(85.6%对83.0%,P0.05)。单因素分析显示,溃疡分期与是否能成功根除Hp相关,活动期PU患者根除率显著高于非活动期(87.8%对80.3%,P0.05)。结论:内镜下溃疡分期与PU尤其是GU患者的Hp根除率有关,在溃疡活动期进行Hp根除治疗能显著提高根除率。     

中西医结合治疗消化性溃疡与溃疡复发

目的探讨中西医结合治疗对消化性溃疡(PUR)的临床疗效并非明确PU患者幽门螺杆菌(HP)根除后再感染和溃疡复发情况。方法以标准HP三联根除疗法加中药“胃宝”煎剂的中西医结合两周治疗PU患者80例(治疗组)与中医辩证施治汤药14日疗法的PU患者70例(对照组)进行比较,并以胃镜检查(尿素酶、组织学及细菌培养j对两组PU患者HP根除后共121例2年定期随访,对两组PU患者及两组不同类型溃疡患者(胃溃疡GU和十二指肠溃疡DU)的HP再感染和溃疡复发情况进行比较。结果总有效率治疗组为98．75％,对照组为88．57％;HP根除率治疗组为90％,对照组为70％;HP根除后第1、2年HP阳转率和溃疡复发率,治疗组分别为0、1．43％和1．39％。2．86％,对照组分别为4．17％、12．．SO％和16．67％、50％;不同类型溃疡Hp根除后第1、2年HP再感染率和溃疡复发率,治疗组GU为0、0和5．00％、5．26％,DU为0,1．96％和0、I．96％;对照组GU为5．56％。II．II％和16．6“／％,44．45％,DU为3．34％、13．33％和16．67％,53．33％。结论中西医结合治疗PU具有疗程短,临床疗效高,HP根除率高,HP再感染率和溃疡复发率均低,对GU和DU同样有效。     

胃上皮化生、幽门螺杆菌感染和十二指肠溃疡的关系

近年来大量研究资料表明幽门螺杆菌(Hp)是引起消化性溃疡的重要致病因素,十二指肠溃疡(DU)患者Hp的感染率为90％。正常情况下Hp主要定植于胃型上皮,也有DU患者十二指肠可见胃上皮化生,可供Hp定植引起溃疡形成。我们对79例DU患者的十二指肠胃上皮化生、Hp感染与DU发病及愈合的关系进行分析,并与胃溃疡(GU)、功能性消化不良(FD)患者资料进行对照,分析如下。     

消化性溃疡的流行病学特点（附10955例胃镜检查结果分析）

一、消化性溃疡的胃镜检出率 选自我院1987-1997年期间门诊和住院病人中胃镜检查10955例，共检出消化性溃疡(PU)2444例，检出率22．31％，胃溃疡(GU)335例(占消化性溃疡13．7％)，十二指肠溃疡(DU)2109例(占86．29％)，DU：GU比为6．3：1。     

维持抑酸治疗幽门螺杆菌相关性溃疡

幽门螺杆菌(Hp)是消化性溃疡(PU)的重要病因,胃溃疡(GU)Hp感染率为85%～90%,十二指肠溃疡(DU)Hp感染率为95%～100%[1].根除Hp提高了溃疡愈合率,而进一步维持抑酸治疗,可使溃疡持久愈合率提高.本文就106例PU根除Hp后维持抑酸治疗的临床观察报告如下.     

根除幽门螺杆菌在消化性溃疡治疗中的作用

现有充分的证据表明,有效的抗幽门螺杆菌(Helicobacter pylori,Hp)治疗可促进溃疡愈合,根除Hp可减少溃疡的复发。本文就根除Hp在消化性溃疡治疗中的作用作一综述和评价。1 根除Hp对消化性溃疡复发的影响 消化性溃疡是多因素疾病,有自然缓解和反复发作的倾向。其发病过程主要是攻击因子与防御因子之间不平衡的结果。近20年来,H_2受体拮抗剂如西米替丁、雷尼替丁、法莫替丁和质子泵抑制剂奥美拉唑相继开发应用,无疑是消化性溃疡治疗的重大突破。然而,其远期疗效却不尽人意,一已停上抗酸治疗,1年内溃疡复发率为80％,2年复发率则高达100％。1983年Warren等从入胃粘膜活检组织中成功地分离出Hp,随后大量的调查资料表明,约70％的胃溃疡(GU)患者可检测到Hp,几乎100％十二指肠溃疡(DU)的胃内有Hp定植。于是,一些学者提出“无Hp,无溃疡”的观点,根除Hp已成为当前的研究热点。实验证明胶态次枸橼酸铋(CBS)在体内外均有抗Hp活性。如果该药与抗菌药物合用,Hp根除率可从20％提高到80％,溃疡则获得更长时间的缓解。近年许多研究进一步证实,Hp持续阳性者,1年     

维敏四联治疗Hp相关的消化性溃疡

目的应用维敏胶囊（胶态果胶铋）四联药物疗法治疗Hp相关的消化性溃疡（PU）2wk，停药4wk后经内镜、14C-UBT等方法观察溃疡的愈合及Hp根除的疗效方法经内镜确诊为PU，其中十二指肠溃疡（DU）169例；胃溃疡（GU）89例．受检前2wk内未服抗生素、铋剂及质子泵阻断剂，排除孕妇和溃疡出血者，并镜下活检病理排除恶性溃疡Hp检测：先行快速尿素酶检测（RUT），阳性者再行14C-UBT检测，其中DU的Hp阳性率为95．5％；GU的Hp阳性率为81．0％．四联治疗方法：对Hp阳性PU，给予维敏胶囊100mg，4次／d；兰索拉唑30mg，2次／d；阿莫西林0．5g，4次／d；甲硝唑0．4g，2次／d，疗程为2wk．停药后4wk，同时复查内镜及14G-UBT．结果DU愈合率91．2％，Hp根除率93．0％；GU愈合率86．0％，Hp根除率92．0％．DU和GU愈合率及Hp根除率差异不明显（P＞0．05）；四联疗法后肝肾功能无异常结论Hp与PU关系密切．采用四联治疗Hp相关的PU，有良好效果．14GUBT检测Hp感染具有很高的敏感性和特异性，无创伤性，是治疗后复查Hp的首选方法     

维吾尔族消化性溃疡383例临床分析

目的了解本地区维吾尔族(简称维族)消化性溃疡的临床特点,并发症及幽门螺杆菌(Hp)感染情况。方法对2002年1月～2009年12月在我院住院检查确诊为消化性溃疡维族患者的病历资料结果进行回顾性分析。结果 (1)本组资料消化性溃疡患者中十二指肠球部溃疡332例(占86.68%),胃溃疡36例(占9.4%),男女之比为3.16:1,男性明显多于女性。(2)消化性溃疡的高发年龄段为中年,共215例(占56.14%),十二指肠球部溃疡多见于中青年,共302例(占90.96%),胃溃疡见于中老年,共32例(占88.89%)。(3)消化性溃疡的主要并发症是出血69例(95.83%),其中十二指肠球部溃疡出血49例(占71.01%)。(4)消化性溃疡Hp检出356例(占93.47%),其中十二指肠球部溃疡中Hp检出318例(95.78%),胃溃疡中的Hp检出30例(占83.33%)。结论本组消化性溃疡患者男性明显多于女性,十二指肠球部溃疡多见于中青年,胃溃疡多见于中老年,消化性溃疡的常见并发症主要是出血,消化性溃疡Hp感染检出率高,患者无种族差异。     

幽门螺杆菌与消化性溃疡关系的10年随访研究

目的 探讨根除幽门螺杆菌(Helicobacter pylori,Hp)后10年间十二指肠球部溃疡(DU)、胃溃疡(GU)发病情况.方法 选择胃癌高发区山东烟台高陵镇随机抽样自然人群进行内镜普查,其中Hp阳性者552例均分为治疗组和安慰剂组,治疗组276例予以奥美拉唑20 mg、克拉霉素0.5 g和阿莫西林1.0 g,每日2次口服,疗程7 d.停药1个月后治疗组行13C-尿素呼气试验(13C-UBT)证实根除成功.此后对两组在10年期间进行内镜随访(第1、5、8和10年),观察两组患者消化性溃疡发病率的变化及复发情况,同时观察两组Hp感染状态的变迁.结果 治疗组消化性溃疡第1、5和8年的发病率分别为3.70%、5.86%和4.40%,均明显低于安慰剂组(12.85%、14.93%和9.39%,P值分别=0.0002、0.0017和0.0440).随访10年间,治疗组消化性溃疡新发病例数及复发病例数均低于安慰剂组,两组间差异均有统计学意义(P值均<0.05).治疗组Hp再感染率较高,第10年时Hp阳性率达46.4%.根据Hp感染状态重新进行分组,结果显示随访10年间Hp阴性组消化性溃疡的发病率均低于Hp阳性组(P值均<0.05).结论 根除Hp治疗后消化性溃疡的发病率和复发率均明显降低,消化性溃疡患者根除Hp是必要的.成功根除Hp后再感染率仍较高.     

幽门螺杆菌与消化性溃疡关系的10年随访研究

目的 探讨根除幽门螺杆菌(Helicobacter pylori,Hp)后10年间十二指肠球部溃疡(DU)、胃溃疡(GU)发病情况.方法 选择胃癌高发区山东烟台高陵镇随机抽样自然人群进行内镜普查,其中Hp阳性者552例均分为治疗组和安慰剂组,治疗组276例予以奥美拉唑20 mg、克拉霉素0.5 g和阿莫西林1.0 g,每日2次口服,疗程7 d.停药1个月后治疗组行13C-尿素呼气试验(13C-UBT)证实根除成功.此后对两组在10年期间进行内镜随访(第1、5、8和10年),观察两组患者消化性溃疡发病率的变化及复发情况,同时观察两组Hp感染状态的变迁.结果 治疗组消化性溃疡第1、5和8年的发病率分别为3.70%、5.86%和4.40%,均明显低于安慰剂组(12.85%、14.93%和9.39%,P值分别=0.0002、0.0017和0.0440).随访10年间,治疗组消化性溃疡新发病例数及复发病例数均低于安慰剂组,两组间差异均有统计学意义(P值均<0.05).治疗组Hp再感染率较高,第10年时Hp阳性率达46.4%.根据Hp感染状态重新进行分组,结果显示随访10年间Hp阴性组消化性溃疡的发病率均低于Hp阳性组(P值均<0.05).结论 根除Hp治疗后消化性溃疡的发病率和复发率均明显降低,消化性溃疡患者根除Hp是必要的.成功根除Hp后再感染率仍较高.     

Role of anti-secretory treatment in addition to Helicobacter pylori eradication triple therapy in the treatment of peptic ulcer]

BACKGROUND/AIMS: It is not clear whether the anti-secretory therapy should be continued for symptomatic relief and ulcer healing before or after the eradication of H. pylori in patients with peptic ulcer disease. The aim of this study was to evaluate the effectiveness of additional anti-secretory therapy before or after H. pylori eradication in peptic ulcer disease. METHODS: Thirty eight patients with H. pylori-positive active peptic ulcer were included. Patients were randomly allocated into 3 groups; standard 1-week triple therapy followed by omeprazole (20 mg, qd) for 3 weeks (group A), standard 1-week triple therapy only (group B), and omeprazole (20 mg, qd) for 3 weeks followed by 1-week triple therapy (group C). Endoscopy with the rapid urease test and histology for H. pylori was performed 4-8 weeks after the completion of treatment. The symptom was scored by a visual analog scale. RESULTS: Of the 38 patients, 10 were excluded from the per-protocol analysis of this study. The H. pylori eradication rates were 87.5% (group A), 80.0% (group B) and 90.0% (group C) respectively. The peptic ulcer healing rates were 100% in group A, 70.0% in group B, and 90.0% in group C. There was no difference in H. pylori eradication rates and ulcer healing rates among three groups (p>0.05). Symptom score differences between pre-treatment and post-treatment group were not significantly different (p>0.05). CONCLUSIONS: The standard one week triple therapy with or without 3-weeks anti-secretory treatment with omeprazole before or after the therapy does not affect H. pylori eradication rates, peptic ulcer healing rates, and symptom score improvement.     

Effectiveness of triple therapy and quadruple therapy for Helicobacter pylori eradication]

BACKGROUND/AIMS: Quadruple therapy can be considered as a first-line therapy in areas where the resistance rate to clarithromycin is high. Comparison study of triple therapy and quadruple therapy for Helicobacter pylori (H. pylori) eradication is still lacking in Korea despite the increasing prevalence of antibiotic resistance. This study was conducted to compare the efficacy of triple and quadruple therapy as a first-line treatment in H. pylori infected patients with peptic ulcer. METHODS: Consecutive 149 cases of peptic ulcer disease associated with H. pylori infection were randomized either to proton pump inhibitor (PPI, bid), amoxicillin (1,000 mg, bid), and clarithromycin (500 mg, bid) (PAC group) or to PPI (bid), bismuth subcitrate (300 mg, qid), metronidazole (500 mg, tid), and tetracycline (500 mg, qid) (PBMT group) eradication treatments for 7 days. Outcome of eradication therapy was assessed by 13C-urea breath test performed 4-6 weeks after eradication. RESULTS: Eradication rates in PAC and PBMT group were 78.7% (59/75) and 71.6% (53/74) by intention to treat analysis, respectively (p=0.424). By per protocol analysis, eradication rates of PAC and PBMT group were 85.5% (59/69) and 85.5% (53/62), respectively (p=1.012). Adverse reactions occurred in 5 (6.6%) and 7 (9.5%) patients in PAC and PBMT group, respectively (p=0.346). CONCLUSIONS: One week-quadruple therapy as a first-line treatment for H. pylori infection does not offer any advantage over PPI-based triple therapy in Korean patients.     

Therapy and Diagnostic Tests Used for Helicobacter pylori Infection in the Scandinavian Countries in 1998

Background: We wanted to ascertain how Helicobacter pylori infection is managed in Scandinavia. Methods: A one-page questionnaire with seven questions was mailed in April 1998 to 1718 gastro-enterologists in Finland, Denmark, Norway, and Sweden (excluding Swedish surgeons). Results: The questionnaire was returned by 36%. Antimicrobials were used by 99% for peptic ulcer associated with H. pylori, by 67% for mucosa-associated lymphoid tissue lymphoma, by 27% before long-term therapy with a proton-pump inhibitor (PPI), by 16% for non-ulcer dyspepsia, by 11% for reflux disease, and by 11% for other indications. In Finland several conditions other than ulcer were treated more frequently than in the other countries. The commonest primary therapy is PPI triple therapy (94%), followed by bismuth-based (11%), 'other' (2%), and PPI dual therapy (0.2%). Primary bismuth-based therapy was almost completely limited to Norway. The commonest secondary therapy for failures was also PPI triple therapy (71%), followed by bismuth-based (41%), 'other' (10%), and PPI dual therapy (1%). Clarithromycin for primary therapy was used much less frequently in Finland than in the other countries. Follow-up to ascertain whether eradication is successful was done always or often by 90% in Finland, 63% in Norway, 62% in Sweden, and 21% in Denmark and by 61% of the internists and 42% of the surgeons. The commonest method to confirm eradication was gastroscopy (69%), followed by the breath test (52%) and serology (11%). Conclusions: In Scandinavia H. pylori associated with peptic ulcer disease is treated with antimicrobials by virtually all gastroenterologists. PPI triple therapy is the commonest regimen for primary and secondary eradication. PPI dual therapy has essentially disappeared. Fifty-four per cent confirm eradication always or often, with gastroscopy being the commonest method.     

Therapy and diagnostic tests used for Helicobacter pylori infection in the Scandinavian countries in 1998.

BACKGROUND: We wanted to ascertain how Helicobacter pylori infection is managed in Scandinavia. METHODS: A one-page questionnaire with seven questions was mailed in April 1998 to 1718 gastroenterologists in Finland, Denmark, Norway, and Sweden (excluding Swedish surgeons). RESULTS: The questionnaire was returned by 36%. Antimicrobials were used by 99% for peptic ulcer associated with H. pylori, by 67% for mucosa-associated lymphoid tissue lymphoma, by 27% before long-term therapy with a proton-pump inhibitor (PPI), by 16% for non-ulcer dyspepsia, by 11% for reflux disease, and by 11% for other indications. In Finland several conditions other than ulcer were treated more frequently than in the other countries. The commonest primary therapy is PPI triple therapy (94%), followed by bismuth-based (11%), 'other' (2%), and PPI dual therapy (0.2%). Primary bismuth-based therapy was almost completely limited to Norway. The commonest secondary therapy for failures was also PPI triple therapy (71%), followed by bismuth-based (41%), 'other' (10%), and PPI dual therapy (1%). Clarithromycin for primary therapy was used much less frequently in Finland than in the other countries. Follow-up to ascertain whether eradication is successful was done always or often by 90% in Finland, 63% in Norway, 62% in Sweden, and 21% in Denmark and by 61% of the internists and 42% of the surgeons. The commonest method to confirm eradication was gastroscopy (69%), followed by the breath test (52%) and serology (11%). CONCLUSIONS: In Scandinavia H. pylori associated with peptic ulcer disease is treated with antimicrobials by virtually all gastroenterologists. PPI triple therapy is the commonest regimen for primary and secondary eradication. PPI dual therapy has essentially disappeared. Fifty-four per cent confirm eradication always or often, with gastroscopy being the commonest method.     

Maintenance treatment is not necessary after Helicobacter pylori eradication and healing of bleeding peptic ulcer: a 5-year prospective, randomized, controlled study

BACKGROUND: It is well accepted that in patients with uncomplicated peptic ulcers, Helicobacter pylori eradication therapy does not need to be followed by further antisecretory treatment. However, it is uncertain whether patients with bleeding peptic ulcers should receive maintenance antiulcer therapy after successful H pylori eradication and ulcer healing. The aim of this 5-year, prospective, randomized, controlled study was to investigate the role of long-term maintenance therapy after successful H pylori eradication and healing of bleeding ulcers. METHODS: A total of 82 consecutive patients with H pylori-associated bleeding peptic ulcers were enrolled in the study. After successful H pylori eradication with the 1-week proton pump inhibitor-based triple therapy and an additional 3-week treatment with 20 mg of omeprazole daily for ulcer healing, the patients were assigned to one of four 16-week maintenance treatment groups as follows: group A received 15 mL of an antacid suspension 4 times daily; group B received 300 mg of colloidal bismuth subcitrate 4 times daily; group C received 20 mg of famotidine twice daily; and group D, the control group, received placebo twice daily. Follow-up included an urea breath test labeled with carbon 13, biopsy-based tests, and repeated endoscopic examination. RESULTS: An analysis of variance revealed no difference in mean age and mean follow-up time among the groups. During a mean follow-up of 56 months, there was no peptic ulcer recurrence among the 3 treatment groups, and all of the patients remained free of H pylori infection during the study period. CONCLUSIONS: In patients with bleeding peptic ulcers, antiulcer maintenance treatment was not necessary to prevent ulcer recurrence after successful H pylori eradication and ulcer healing. In addition, the 1-week proton pump inhibitor-based triple therapy had the efficacy to ensure long-term eradication of H pylori in a region of high prevalence.     

根除老年人消化性溃疡合并幽门螺旋杆菌感染的治疗策略

目的对质子泵抑制剂（PPI）或铋剂三联疗法作为初治方案以及序贯疗法或四联疗法作为补救方案根除老年人消化性溃疡（PUA）合并幽门螺旋杆菌（Hp）感染的疗效进行比较。方法2009年7月至2010年7月间261例胃镜下尿素酶法诊断的PUA合并Hp感染患者,随机采用PPI三联疗法、铋剂三联1周疗法进行根除,观察治疗过程中不良反应发生率。PUA患者经上述抗Hp治疗后继续4周抗溃疡治疗,停药1月后复查胃镜并比较两种方法对Hp根除率及溃疡愈合率的疗效差异。对于首次三联疗法根除Hp失败者,随机应用10日序贯疗法和PPI、铋剂四联1周疗法再次行Hp根除。观察疗程中不良反应发生率,停药1个月后采用”C呼气试验观察Hp根除率。统计分析采用符合方案（PP）群组分析和意向治疗（ITT）群组分析。结果相比于铋剂三联疗法,PPI三联疗法Hp根除率（ITT：77．7％vs62．6％;PP：79．5％v564．1％;P〈0．05）及溃疡愈合率（ITT：78．5％vs64．9％;PP：80．3％vs66．4％;P〈0．05）高,不良反应发生率无明显差异（1TT：10．8％vs16．8％：PP：11．0％vs17．2％;P〉0．05）。对于首次三联疗法失败者以10日序贯疗法补救,Hp根除率较高（ITT：84．6％vJ61．5％;PP：86．8％v563．2％;P〈0．05）,且不良反应发生率较四联疗法低（ITT：12．8％VS35．9％;PP：13．2％VS36．8％;P〈0．05）。结论PPI三联1周疗法进行Hp感染根除可作为PUA患者首选,有较高的溃疡愈合率和Hp根除率;首次根除失败者可优先改用10日序贯疗法进行补救。     

A comparative study on Helicobacter pylori infection in peptic ulcer disease patients with or without previous eradication therapy

BACKGROUND/AIMS: Although H. pyloric eradication therapy is indicated for peptic ulcer patients, the prevalence of H. pylori infection may be different between patients with active or chronic (scarred) peptic ulcers. This study aimed to compare the prevalence of H. pylori infection in active and chronic peptic ulcer patients with or without previous H. pyloric eradication therapy. METHODOLOGY: Both non-invasive (13C or 14C urea breath test) and invasive methods (rapid urease test and histology) were used to detect H. pylori. From Dec. 2002 to Jan. 2003, 153 patients with 63% male were enrolled in this study. Fifty-six patients who previously received H. pyloric eradication therapy were enrolled as treated patients, and 97 patients who did not receive therapy were enrolled as untreated patients. RESULTS: H. pylori infection rate was still high in untreated patients even when duodenal ulcer had been scarred (96% in active duodenal ulcer and 63% in scarred duodenal ulcer). In treated patients, H. pyloric infected rates were very low when peptic ulcers were scarred (0% in scarred gastric ulcer, 4% in scarred duodenal ulcer and 0% in both scarred ulcers). CONCLUSIONS: H. pyloric eradication therapy is indicated for untreated patients even when endoscopic examination revealed chronic scarred duodenal ulcer.     

Efficacy of omeprazole and amoxicillin with either clarithromycin or metronidazole on eradication of Helicobacter pylori in Chinese peptic ulcer patients

AIM: One-week triple therapy with proton pump inhibitors, clarithromycin and amoxicillin has recently been proposed as the first-line treatment for Helicobacter pylori (H pylori) infection; however, data regarding the effects of this regimen in China are scarce. The aim of this prospective and randomized study was to compare the efficacy of clarithromycin and metronidazole when they were combined with omeprazole and amoxicillin on eradication of H pylori and ulcer healing in Chinese peptic ulcer patients. METHODS: A total of 103 subjects with Hpylori-positive peptic ulcer were randomly divided into two groups, and accepted triple therapy with omeprazole 20 mg, amoxicillin 1 000 mg and either clarithromycin 500 mg (OAC group, n = 58) or metronidazole 400 mg (0AM group, n - 45). All drugs were given twice daily for 7 d. Patients with active peptic ulcer were treated with omeprazole 20 mg daily for 2-4 wk after anti-H pylori therapy. Six to eight weeks after omeprazole therapy, all patients underwent endoscopies and four biopsies (two from the antrum and two others from the corpus of stomach) were taken for rapid urease test and histological analysis (with modified Giemsa staining) to examine H pylori. Successful eradication was defined as negative results from both examination methods. RESULTS: One hundred patients completed the entire course of therapy and returned for follow-up. The eradication rate of H pylori for the per-protocol analysis was 89.3% (50/56) in OAC group and 84.1% (37/44) in 0AM group. Based on the intention-to-treat analysis, the eradication rate of H pylori was 86.2% (50/58) in OAC group and 82.2% (37/45) in 0AM group. There were no significant differences in eradication rates between the two groups on either analysis. The active ulcer-healing rate was 96.7% (29/30) in OAC group and 100% (21/21) in 0AM group (per-protocol analysis, P>0.05). Six patients in OAC group (10.3%) and five in OAM group (11.1%) reported adverse events (P>0.05). CONCLUSION: One-week triple therapy with omeprazole and amoxicillin in combination with either clarithromycin or metronidazole is effective for the eradication of H pylori. The therapeutic regimen comprising metronidazole with low cost, good compliance and mild adverse events may offer a good choice for the treatment of peptic ulcers associated with H pylori infection in China.     

Secondary and primary prophylaxis of gastropathy associated with nonsteroidal antiinflammatory drugs or low-dose-aspirin: a review based on four clinical scenarios

Based on current references four clinical scenarios were discussed and different management strategies were compared for secondary and primary prophylaxis of ulcer or peptic ulcer bleeding under continuous therapy with non-steroidal antiinflammatory drugs (NSAID) or low-dose-aspirin, for H.pylori-positive and H.pylori-negative patients. Used as secondary prophylaxis eradication alone is insufficient in preventing recurrent peptic ulcer or recurrent ulcer bleeding for H.pylori-positive patients who continue to take unselective NSAIDs. Maintenance therapy with PPIs or switching from nonselective NSAID to COX-2-inhibitors is required after eradication of H.pylori or primary H.pylori-negative patients. Further evaluation is needed of what kind of secondary prophylaxis - maintenance therapy with PPI or switching to COX-2-inhibitor - is more (cost-)effective. It is sufficient to use eradication of H.pylori alone as secondary prophylaxis in preventing recurrent peptic ulcer or recurrent ulcer bleeding for H.pylori-positive patients, who continue to take low-dose-aspirin. Maintenance therapy with PPI is not generally required. However it can be considered for patients with increased risk for gastrointestinal complications (previous history of peptic ulcer, age over 65 years, concomitant use of corticosteroids, anticoagulants or individual NSAID with higher risk for gastrointestinal complications, serious cardiovascular disease). Switching from low-dose-aspirin to clopidogrel is not required. Used as primary prophylaxis in preventing peptic ulcer or ulcer bleeding before starting long-term therapy with NSAIDs, COX-2-inhibitors or unselective NSAIDs concomitant with PPIs are recommended for patients with increased risk for gastrointestinal complications. Patients starting long-term therapy with unselective NSAIDs should be screened for H.pylori and eradicated. There are no valid data supporting screening for H.pylori and eradication for patients starting long-term therapy with low-dose-aspirin. Further studies are needed to evaluate a possible benefit for patients with increased risk for gastrointestinal complications.     

10d序贯疗法对根除幽门螺杆菌疗效的随访研究

背景:幽门螺杆菌(H.pylori)与慢性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织(MALT)淋巴瘤密切相关,但标准三联疗法的根除率逐年下降。目的:比较10 d序贯疗法和三联疗法根除H.pylori的疗效。方法:将经快速尿素酶试验(RUT)和~(14)C-尿素呼气试验(UBT)证实为H.pylori阳性的106例消化性溃疡、慢性糜烂性胃炎和萎缩性胃炎患者随机分为以雷贝拉唑为基础的10 d序贯疗法组(n=56)和三联疗法组(n=50)。治疗结束4周后复查RUT和,~(14)C-UBT,评估H.pylori根除情况;随访1年后再复查~(14)C-UBT评估H.pylori复发情况。结果:共93例患者按方案完成治疗。10 d序贯疗法组H.pylori根除率按意向治疗(ITT)和按方案(PP)分析均显著高于三联疗法组(ITF:89.3%对62.0%,P0.01;PP:94.3%对77.5%,P0.05);10 d序贯疗法组不良反应发生率(7.1%对30.0%,P0.01)和随访1年后的H.pylori复发率(6.0%对25.8%,P0.01)均显著低于三联疗法组。结论:以雷贝拉唑为基础的10 d序贯疗法可明显提高H.pylori根除率,提高患者的依从性,减少不良反应的发生。