Helicobacter pylori eradication therapy for gastric ulcer in elderly

Sixty-five-years or older person accounts for 23% of the population in Japan. Hence, Helicobacter pylori (H. pylori) eradication therapy is performed in many elderly patients. Urea breath test and H. pylori stool antigen test for diagnosis of H. pylori infection before and after eradication therapy are recommended from the point of being a noninvasive test and providing accurate diagnosis. H. pylori eradication therapy in Japan consists of the PPI/AMPC/CAM as the first therapy, and PPI/AMPC/MNZ as the second therapy. Eradication therapy rate and adverse effect rate of H. pylori eradication therapy for elderly patients are the same as for young people. It is not necessary to avoid H. pylori eradication therapy merely because of high age in elderly patients. However, it is necessary to be careful regarding drug interactions in patients who are taking multiple drugs.     

Anti-ulcer therapy after eradication of Helicobacter pylori

Helicobacter pylori (H. pylori) infection is the cause of the frequent relapse of peptic ulcer disease. Successful eradication therapy of H. pylori is associated with a decline in the recurrence of peptic ulcer. In this paper, we discussed the significance of anti-ulcer therapy after H. pylori eradication therapy. In patients with duodenal ulcer, maintenance therapy for preventing ulcer recurrence is not necessary because the rate of ulcer recurrence after eradication therapy is very low. However, in patients with gastric ulcer, the rate of ulcer relapse and reflux esophagitis ranges between 5-10% in the Japanese population even after successful eradication therapy; therefore, maintenance therapy for 1 year may be permissible in patients with gastric ulcer even after successful eradication therapy.     

The effect of Helicobacter pylori eradication on duodenal gastric metaplasia

We investigated the incidence of duodenal gastric metaplasia and its response to Helicobacter pylori eradication in patients with duodenal ulcer or erosive duodenitis. Gastric and duodenal biopsies were taken from patients with endoscopically detected H. pylori positive duodenal ulcer or erosive duodenitis, and the presence and extent of duodenal gastric metaplasia was recorded. Patients were given omeprazole 20 mg twice daily for 2 weeks, and amoxicillin 1 g and clarithromycin 500 mg twice daily for 10 days, and then ranitidine for a further 8 weeks. Biopsies were repeated 6 months after the start of treatment. Duodenal gastric metaplasia was initially present in 22 patients (52%) and was more frequent in ulcer patients than in duodenitis patients, but not significantly so (69% versus 45%). After treatment, H. pylori was eradicated in 68% of duodenal gastric metaplasia patients and the duodenum was normal endoscopically in 85% of these patients. Duodenal gastric metaplasia was improved or eliminated in 12/15 H. pylori eradicators (80%) and in 5/7 H. pylori non-eradicators (71%), a non-significant difference. The improvement in duodenal gastric metaplasia appeared to be independent of H. pylori eradication.     

Side effects of Helicobacter pylori eradication therapy

The authors found that antihelicobacter therapy is accompanied by various side-effects, such as allergic reactions, gastrointestinal disturbances, dysbacteriosis, hematological disorders, and sometimes toxic hepatic lesions, depending on what antibiotic and in what doses is applied, as well as on the duration of antibiotic therapy.     

Long-term outcomes of gastric mucosa-associated lymphoid tissue lymphomas after Helicobacter pylori eradication therapy

Mucosa-associated lymphoid tissue (MALT) lymphomas are localized primarily in the gastrointestinal tract and are characterized by an indolent nature and favorable outcome with specific therapy. Gastric MALT lymphomas are closely linked to Helicobacter pylori (H. pylori) infection, for which eradication therapy is recognized as an effective primary treatment for the disease. However, there is little information about long-term outcomes after the therapy. In the present study, we elucidated the long-term outcomes of 74 patients (70 H. pylori-positive and 4 negative cases) followed up by endoscopy at least 12 months after exclusive eradication therapy alone. The median follow-up period was 46 months. When the remission status was estimated at the time point of 12 months post-eradication, the numbers of patients with complete remission (CR), histologically residual disease with macroscopic normalization (hRD), partial remission with more than 50% tumor reduction (PR) or no response (NR) were 56, 12, 2 and 4, respectively. During follow-ups of over 12 months post-eradication, 11 of the 12 hRD cases were belatedly induced to CR but one CR case histologically relapsed into hRD. One of the 2 PR cases eventually turned into hRD 20 months later. Therefore, 66 CR, 3 hRD, 1 PR, and 4 NR cases (including 3 H. pylori-negative) were identified at the last follow-up of the present study. All 74 patients were followed up without any second-line therapies, but none exhibited disease progression. Thus, the long-term outcome of localized gastric MALT lymphoma after H. pylori eradication therapy was favorable. A watch and wait strategy may be a reasonable approach for hRD since the majority might be in the process of turning into delayed CR.     

左克胶囊三联疗法根除幽门螺杆菌感染

目的观察左氧氟沙星短程三联疗法根除幽门螺杆菌（Hp）感染的疗效。方法100例Hp阳性患者[A组，男62例，女38例；年龄（59±11）岁；十二指肠球部溃疡（DU）62例，胃溃疡（GU）38例]给予泮托拉唑40mg，po，bid，左氧氟沙星200mg及阿莫西林1000mg，po，bid。另102例Hp阳性患者[B组，男59例，女43例；年龄（57±9）岁；DU58例，GU44例]给予泮托拉唑40mg，克拉霉素500mg及阿莫西林1000mg，po，bid。疗程均为1周。疗程结束后4～6周复查胃镜及Hp。结果A、B两组抗Hp治疗结束后4—6周停用PPI2周后，Hp根除率各为87％、79％（P〉0．05），均无严重不良反应。结论Hp耐药菌株多见，左旋氧氟沙星联合奥美拉唑和阿莫西林是一种安全、疗效高、耐受性好的治疗Hp感染的方案。     

Helicobacter pylori eradication and associated changes in the gastric mucosa

Persistent Helicobacter pylori infection contributes towards the development of chronic gastritis. To clarify the changes in chronic gastritis as a precursor of gastric cancer secondary to H. pylori eradication is an important issue, as it has significant implications for reducing the risk of gastric cancer. Studies published to date, however, are far from consistent with regard to the morphologic changes reported following H. pylori eradication. Of these, some papers reported improvement in gastric atrophy or intestinal metaplasia, versus others reporting no improvement, with the majority of papers published after 2000 reporting improvement in these end points. The inconsistent results concerning the impact of H. pylori eradication on gastric atrophy could be due to the inconsistency of the diagnostic criteria employed for evaluation of the morphology, confounded by the difficulties involved in evaluating atrophic changes in the gastric mucosa. While adherence to the Updated Sydney System available for evaluation of gastritis is primarily required worldwide to ensure consistency in evaluating gastritis, long-term research into the morphologic changes associated with H. pylori eradication is also required to explore strategies for the prevention of gastric cancer with H. pylori eradication.     

Helicobacter pylori eradication and associated changes in the gastric mucosa

Persistent Helicobacter pylori infection contributes towards the development of chronic gastritis. To clarify the changes in chronic gastritis as a precursor of gastric cancer secondary to H. pylori eradication is an important issue, as it has significant implications for reducing the risk of gastric cancer. Studies published to date, however, are far from consistent with regard to the morphologic changes reported following H. pylori eradication. Of these, some papers reported improvement in gastric atrophy or intestinal metaplasia, versus others reporting no improvement, with the majority of papers published after 2000 reporting improvement in these end points. The inconsistent results concerning the impact of H. pylori eradication on gastric atrophy could be due to the inconsistency of the diagnostic criteria employed for evaluation of the morphology, confounded by the difficulties involved in evaluating atrophic changes in the gastric mucosa. While adherence to the Updated Sydney System available for evaluation of gastritis is primarily required worldwide to ensure consistency in evaluating gastritis, long-term research into the morphologic changes associated with H. pylori eradication is also required to explore strategies for the prevention of gastric cancer with H. pylori eradication.     

Improvement in gastric histology following Helicobacter pylori eradication therapy in Japanese peptic ulcer patients

We aimed to determine if successful or failed eradication of Helicobacter pylori with triple therapy causes any difference in gastric mucosal histology. Japanese H. pylori-positive patients with a healed peptic ulcer received high (n = 112) or low (n = 113) doses of triple therapy (omeprazole, amoxicillin and clarithromycin) for 1 week. Biopsies from the greater curvature of the central antrum and upper corpus were taken 6 weeks and 30 weeks after treatment completion, and gastric mucosal histology compared between successful (n = 171) and failed (n = 34) eradication groups. Morphological variables of gastritis were graded according to the updated Sydney System. Successful eradication therapy was defined as improvement in inflammation, neutrophil activity and atrophy; failed eradication therapy as improvement in inflammation and neutrophil activity only. Gastric mucosal atrophy gradually improved (in addition to improvements in inflammation and neutrophil activity) with successful eradication of H. pylori infection.     

幽门螺杆菌根除后胃黏膜的病理变迁

目的探讨根除幽门螺杆菌(Hp)对胃黏膜萎缩、肠上皮化生等癌前病变的转归,以及胃黏膜上皮细胞增殖指标ki-67表达的影响。方法67例Hp感染且有胃黏膜萎缩和(或)肠上皮化生的慢性胃炎患者,随机分为实验组(37例)和对照组(30例),分别给予Hp根除和对症治疗,1年后复查,比较Hp根除与否对胃黏膜萎缩、肠上皮化生等癌前病变的影响;用免疫组化方法检测治疗前后胃黏膜上皮细胞增殖指标ki-67的表达,比较Hp根除与否对它的影响。结果实验组炎症程度减轻(34/37,91.9%,P<0.01),活动性炎症者减少(P<0.01),萎缩、肠上皮化生等癌前病变减轻或逆转(21/32,65.6%vs15/26,57.7%,均P<0.05);ki-67表达降低(46.5±27.7vs15.4±18.7,P<0.01)。结论根除Hp可使胃黏膜炎症程度减轻,活动性炎症消失,萎缩、肠化等癌前病变减轻或逆转,胃黏膜上皮细胞增殖指标ki-67表达减少,从而有利于预防胃癌的发生。     

Helicobacter pylori eradication: role of individual therapy constituents and therapy duration

Treatment of Helicobacter pylori ( H. pylori ) infection has become a key factor in the management of dyspepsia and is the treatment of choice for peptic ulcer disease. First-line eradication regimens combining a proton pump inhibitor (PPI) with clarithromycin and amoxicillin or metronidazole are considered most effective when given for a minimum period of 1 week. Eradication regimens of shorter duration have shown promising results but clinical experience remains limited. Pharmacological properties such as bioavailability and plasma concentrations of individual PPIs differ between individuals but it remains unclear whether these differences impact on the efficacy of eradication therapy and are influenced by renal or hepatic impairment. Bioavailability of PPIs also differs and is impacted on by factors including intragastric pH, metabolic pathways, potency on an mg-for-mg basis and intrinsic antibacterial activity. Several significant pharmacokinetic differences between the PPIs do not seem to influence overall H. pylori eradication rates for first-line triple therapy. However, comparison of factors including pharmacokinetics and treatment duration may prove important in achieving successful eradication with second- and third-line treatments. Based on the factors which influence therapy outcome, we suggest an algorithm for the use of H. pylori eradication therapies.     

Oral colonization of Helicobacter pylori: risk factors and response to eradication therapy

BACKGROUND: Dental plaque is considered by some to be a secondary reservoir for Helicobacter pylori and thus responsible for gastric reinfection. The aim of this study was to investigate whether testing dental plaque using a rapid urease test (CLOtest) can be used to determine gastric H. pylori status. METHODS: We investigated dental plaque colonization by H. pylori and its correlation with gastric infection in 75 dyspeptic patients. CLOtest was used to determine H. pylori positivity. RESULTS: Tests for H. pylori were positive in dental plaque samples from 68 patients and in stomach samples from 65 patients. The sensitivity of using CLOtest in dental plaque to determine gastric H. pylori status was 89.7%, with a diagnostic accuracy of 86.7%. Gastric eradication was achieved in 83% of patients, but efforts to eradicate dental plaque colonization were unsuccessful in all patients. CONCLUSION: Using CLOtest to detect H. pylori in dental plaque is a reliable first-line diagnostic approach for gastric H. pylori infection. Dental plaque might be a sanctuary for H. pylori, leading to gastric recurrence.     

益生菌联合三联疗法根除幽门螺杆菌疗效研究

目的 评价复方嗜酸乳杆菌片与布拉酵母菌(Saccharomyces boulardii,S.Boulardii)散剂联合三联疗法根除幽门螺杆菌(Helicobacter pylori,H.pylori)的有效性和安全性.方法 H.pylori阳性患者240例随机分为3组,A组:埃索美拉唑20 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,口服每日2次,疗程10天;B组:在A组三联10天基础上,加用复方嗜酸乳杆菌片1 000 mg,口服每日3次,总疗程14天;C组:在A组三联10天基础上,加用S.Boulardii散剂500mg,口服每日2次,总疗程14天.治疗期间观察患者不良反应发生情况,疗程结束4周后观察H.pylori根除率.结果 A、B、C组H.pylori根除率按意向性(ITT)分析分别为62.5％、76.2％、83.8％,按方案(PP)分析分别为64.1％、79.2％、85.9％,B组、C组PP根除率明显高于A组(P＜0.05),C组ITT和PP根除率与B组比较差异无统计学意义(P＞0.05).不良反应发生率方面,B、C组明显低于A组(19.5％、7.7％ vs 34.6％,P＜0.05),C组明显低于B组(P＜0.05).B、C组对药物的耐受程度明显高于A组(P＜0.05),B组与C组差异无统计学意义(P＞0.05).结论 复方嗜酸乳杆菌片或S,Boulardii散剂联合三联疗法均可提高H.pylori根除率,后者安全性优于前者.     

Regression of high-grade gastric B-cell lymphoma after eradication of Helicobacter pylori

Regression of high-grade gastric B-cell lymphoma after eradication of Helicobacter pylori with antibiotic therapy has recently been shown in a very small number of patients. We describe here a patient with a 5-cm polypoid gastric lymphoma, who received a 7-day course of triple therapy when the histopathology was unknown. A second endoscopic examination 4 weeks later showed partial tumor regression without biopsy evidence of malignancy. Endoscopic mucosectomy was performed 8 weeks after the initial diagnosis. Again, in the histological analysis of the specimen, no evidence of B-cell lymphoma could be found. To confirm that the original biopsies were from the same patient, DNA analyses were carried out which gave identical results. This case suggests that a subgroup of primary gastric B-cell lymphomas responds to eradication of H. pylori with antibiotic therapy.     

免疫刺激剂在幽门螺杆菌根除治疗中的疗效评价

目的观察和评价免疫刺激剂联合三联疗法在幽门螺杆菌（Hp）根除治疗中的临床疗效。方法将150例Hp阳性患者随机分为2组,治疗组给予免疫刺激剂（匹多莫德口服液）联合三联疗法（奥美拉唑＋克拉霉素＋阿莫西林）治疗,对照组单纯采用三联疗法治疗,观察2组患者的临床疗效。结果治疗组Hp根除率（92.0%）明显高于对照组（64.0%）,差异有统计学意义（P〈0.01）;治疗组症状缓解率（73.3%）显著高于对照组（56.0%）,差异有统计学意义（P〈0.05）;治疗组不良反应发生率（8.0%）低于对照组（17.3%）,但差异无统计学意义（P〉0.05）。治疗组复发率（21.7%）显著低于对照组（43.8%）,差异有统计学意义（P〈0.05）。结论免疫刺激剂联合三联疗法可提高Hp根除率、临床症状缓解率、Hp复发率,减少抗生素不良反应,可直接用于根除Hp的一线首次治疗。     

Immune response to Helicobacter pylori infection and gastric cancer development

Gastric adenocarcinoma is a global health concern, and Helicobacter pylori (H. pylori) infection is the main risk factor for its occurrence. Of note, the immune response against the pathogen seems to be a determining factor for gastric oncogenesis, and increasing evidence have emphasized several host and bacterium factors that probably influence in this setting. The development of an inflammatory process against H. pylori involves a wide range of mechanisms such as the activation of pattern recognition receptors and intracellular pathways resulting in the production of proinflammatory cytokines by gastric epithelial cells. This process culminates in the establishment of distinct immune response profiles that result from the cytokine-induced differentiation of T naïve cells into specific T helper cells. Cytokines released from each type of T helper cell orchestrate the immune system and interfere in the development of gastric cancer in idiosyncratic ways. Moreover, variants in genes such as single nucleotide polymorphisms have been associated with variable predispositions for the occurrence of gastric malignancy because they influence both the intensity of gene expression and the affinity of the resultant molecule with its receptor. In addition, various repercussions related to some H. pylori virulence factors seem to substantially influence the host immune response against the infection, and many of them have been associated with gastric tumorigenesis.     

术前与术后根除幽门螺杆菌胃癌患者生存率差异的研究

目的研究术前与术后根除幽门螺杆菌(Hp)治疗胃癌患者的生存率差异。方法回顾性选取2014年6月至2016年6月应急总医院收治的胃癌患者60例,所有患者依据根除幽门螺杆菌时间节点不同分为治疗组和对照组,各30例。对照组患者在胃癌切除术前接受根除Hp治疗,治疗组患者胃癌切除术后接受根除Hp治疗。统计分析两组患者的6个月、1年、2年、3年生存情况以及Hp复发情况。结果两组患者术后6个月、1年生存率[100.0%(30/30)、96.7%(29/30)vs.100.0%(30/30)、93.3%(28/30)]比较,差异均无统计学意义(P>0.05)。对照组患者2年、3年生存率[93.3%(28/30)、83.3%(25/30)]均显著高于治疗组[80.0%(24/30)、66.7%(20/30)],差异具有统计学意义(P<0.05)。对照组患者中Hp复发1例,Hp复发率为3.3%(1/30);治疗组患者中复发3例,Hp复发率为10.0%(3/30)。两组患者的Hp复发率比较,差异无统计学意义(P>0.05)。结论胃癌患者术前与术后根除Hp近期疗效相似,但前者更能有效提升胃癌患者2年、3年生存率。