根除幽门螺杆菌治疗十二指肠溃疡的随机对照研究

通过根除幽门螺杆菌（Ｈｐ）治疗（不加用任何抗酸或抑酸药物）观察十二指肠溃疡（ＤＵ）的愈合率。方法：１１５例Ｈｐ感染的ＤＵ患者随机分为两组，接受７天铋剂三联治疗。Ａ组口服替硝唑５００ｍｇ、克拉霉素２５０ｍｇ和胶体次构橼酸铋２２０ｍｇ各每日２次，疗程７天，Ｂ组在Ａ组基础上加服奥美拉唑每日２０ｍｇ，疗程４周。服药前和停止抗ＨＰ治疗后４周作胃镜检查及~ （１３）Ｃ－尿素呼气试验。结果：１０７例患者完成治疗和复查，８例失访。Ａ、Ｂ两组的ＤＵ愈合率分别为９２．５％（９５％可信区间为８５．４％～９９．６％）和９６．３％（９５％可信区间为９１．３％～１００％）；两组Ｈｐ根除率分别为９４．３％（９５％可信区间为８８．１％～１００％）和９８．１％（９５％可信区间为９４．５％～１００％），统计学上均无显著差异（＞０．０５）。服药１周内上腹痛缓解率Ｂ组明显高于Ａ组（Ｐ＜０．００５）。两组方案均未发现有明显不良反应。结论：Ｈｐ感染的ＤＵ患者经根除ＨＰ治疗，溃疡能自行愈合而不需使用抑酸药物；奥美拉唑能迅速减轻或消除ＤＵ患者的上腹痛症状；本治疗方案具有Ｈｐ根除率高、疗程短、依从性好和不良反应少等优点。

Dose Eradication of Helicobacter pylori Infection with a New Triple Therapy Heal Duodenal Ulcer?

Background/Aims: To test the hypothesis that eradication of Helicobacter pylon (HP) infection without anti acid drug heals the duodenal ulcer. Methods: 115 patients with HP infected duodenal ulcer were recruited randomly to receive either a 1-week course of colloidal bismuth subcitrate 220mg, tinidazole 500mg, and clarithromycin 250mg, twice a day, respectively (Group A); or omeprazole 20mg added daily for 4 weeks with the same regimen of Group A from the first week (Group B). Endoscopy with antral biopsies and ~(13)C-urea breath test were performed before and 4 weeks after a course of 7-day bismuth-based triple therapy. Results: 107 patients completed the trial. Duodenal ulcer healing rates in Group A and Group B were 92.5%(95% CI 85.4%-99.6%) and 96.3%(95% CI 91.3%-100%), respec- tively. The eradication rates of Hp in Group A and B were 94.3%(95% CI 88.1%-100%) and 98.1% (95% CI 94.5%-100%), respectively. There was no significant difference statistically in ulcer healing rates and eradication rates between the two groups (P>0.05). Symptoms improved or disappeared rapidly during the first week of treatment in patients who received omeprazole (P<0.005). Conclusions: Almost all duodenal ulcers heal spontaneously after eradication of HP. Symptoms improved or disappeared more rapidly in patients who received omeprazole. This new treatment regi- men is effective, simple to use, and well tolerated requiring a relatively short treatment duration.