功能性消化不良患者中以铋剂为基础的治疗方案根除幽门螺杆菌疗效和安全性研究

背景在功能性消化不良(FD)患者中,以铋剂为基础的治疗方案根除幽门螺杆菌(H.pylori)的疗效优于以质子泵抑制剂(PPI)为基础的治疗方案.目的观察在常规1周三联疗法结束后继续单独应用胶体次枸橼酸铋(CBS)3周对H.pylori根除率的影响,评估以铋剂为基础的治疗方案在FD患者中根除H.pylori的疗效和安全性.方法165例H.pylori阳性FD患者随机分为3组,治疗方案分别为A组CBS 220 mg bid 7天、克拉霉素250 mg bid 7天和呋喃唑酮100mg bid 7天;B组CBS 220 mg bid 28天、克拉霉素250 mg bid 7天和呋喃唑酮100mg bid 7天;C组法莫替丁20 mg bid 7天、CBS 220 mg bid 7天、克拉霉素250 mg bid 7天和呋喃唑酮100mg bid 7天.H.pylori阳性由快速尿素酶试验结合组织学检查证实.疗程结束后4～6周行13C-尿素呼气试验以判断H.pylori是否已根除.结果3种治疗方案均获得较好的疗效,按意图治疗(ITT)[方案(PP)]分析,H.pylori总根除率达87.3%(90.0%),B组和C组的根除率分别为89.1%(94.2%)和92.7%(94.4%),均较A组的80.0%(81.5%)提高约10%(P＜0.05).3组总的副反应发生情况无显著差异.结论3种以铋剂为基础的治疗方案在FD患者中均能有效根除H.pylori,且安全性较高.在常规以铋剂为基础的1周三联疗法结束后继续单独应用铋剂3周,或在三联疗法的基础上加用H2受体拮抗剂的四联方案,均能进一步提高H.pylori的根除率.     

比较以阿莫西林和呋喃唑酮为基础的抗幽门螺杆菌四联和三联方案

目的比较以阿莫西林和呋喃唑酮为基础的四联、三联疗法根除幽门螺杆菌(H.pylori)的临床疗效。方法对符合条件的816例H.pylori阳性的慢性胃炎、十二指肠球部炎及消化性溃疡患者,根据治疗方案的随机选择分组如下:(1)质子泵抑制剂(PPI)+枸橼酸铋钾+阿莫西林+呋喃唑酮(含PPI四联组);(2)枸橼酸铋雷尼替丁(RBC)+阿莫西林+呋喃唑酮(含RBC三联组);(3)PPI+阿莫西林+呋喃唑酮(含PPI三联组);(4)枸橼酸铋钾+阿莫西林+呋喃唑酮(含枸橼酸铋钾三联组)。疗程结束4周后,复查快速尿素酶试验或13C呼气试验评判H.pylori根除情况。结果 (1)含PPI四联组与其他各组的H.pylori根除率比较均有显著性差异(P<0.05);(2)将上述每组患者按照接受H.pylori根除治疗的时间(2004年-2006年、2007年-2009年、2010年-2012年)分为3个时间段,在相同治疗方案下比较H.pylori根除率。结果显示同一治疗组的H.pylori根除率在不同时间段无显著差异(P>0.05)。结论含PPI四联疗法H.pylori根除率高,无与治疗相关的严重不良反应,在传统的一线含PPI三联疗法根除率H.pylori逐年下降的状况下,为克服原发耐药和避免继发耐药产生,值得进一步探讨作为根除H.pylori一线治疗选择方案的可能性。     

益生菌提高幽门螺杆菌根除率的临床研究

目的观察益生菌(复方嗜酸乳杆菌片)与抑酸抗菌药物联合治疗幽门螺杆菌的临床疗效。方法经内镜检查发现快速尿素酶试验阳性的患者,随机纳入不同的治疗方案组:A组(埃索美拉唑镁+丽珠胃三联,疗程2周);B组(埃索美拉唑镁+丽珠胃三联+益生菌,疗程1周);C组(埃索美拉唑镁+枸橼酸铋+克拉霉素+益生菌,疗程2周);D组(埃索美拉唑镁+枸橼酸铋+克拉霉素+益生菌,疗程1周),停药后4周再次内镜快速尿素酶试验,同时14C-H.pylori呼气实验检测幽门螺杆菌,比较各组的幽门螺杆菌根除率。结果 A组H.pylori根除率75.0%,B组H.pylori根除率88.9%,C组H.pylori根除率90.0%,D组H.pylori根除率93.7%,其中各组慢性胃炎患者的H.pylori根除率分别为70.9%、88.5%、89.8%、95.7%,十二指肠球部溃疡患者的H.pylori根除率分别为83.3%、87.5%、87.0%、95.3%,胃溃疡患者的H.pylori根除率分别为85.7%、100%、100%、83.3%,H.pylori的总根除率为86.9%,无益生菌的H.pylori根除率为75.0%,加用益生菌的H.pylori根除率为90.8%。结论益生菌联合抗幽门螺杆菌治疗可显著提高H.pylori根除率,并且在去除替硝唑和缩短疗程后,H.pylori根除率依然较高。由于缺乏统一认识,益生菌对幽门螺杆菌的治疗作用尚未广泛采用。     

提高幽门螺杆菌根除率的当代观点

幽门螺杆菌(H.pylori)对克拉霉素和甲硝唑耐药率进行性上升降低了标准三联疗法的疗效,目前我国多数地区标准三联疗法根除率已降低到不可接受的水平[按意向治疗(ITT)分析H.pylori根除率80%]。本文讨论了有可能达到可接受根除率的初次治疗的当代方案,包括含铋剂四联疗法、序贯疗法、质子泵抑制剂(PPI)加3种抗生素(不含铋剂四联疗法)和高剂量PPI方案,对治疗失败后补救治疗问题也提出了讨论和建议。     

评估以雷贝拉唑为基础的三联和四联方案根除幽门螺杆菌的疗效

背景：在标准三联方案对幽门螺杆菌（H.pylori）感染根除率有所下降的情况下，首选含铋剂的四联方案是否较标准三联方案更具优势？目的：比较以雷贝拉唑为基础的标准三联方案和再加铋剂的四联方案对H.pylori感染者进行初次根除治疗的疗效。方法：65例内镜诊断为非溃疡性消化不良的H.pylori感染者随机分配至三联组（雷贝拉唑10mg bid＋克拉霉素500mg bid＋阿莫西林1．0g bid）和四联组（上述三联药物加胶体次枸橼酸铋220mg bid），连服7天。治疗结束后至少间隔4周复查^13C-尿素呼气试验检测H.pylori，评估治疗结果。结果：60例患者按方案完成治疗。三联组和四联组H．prlori根除率按意图治疗（ITT）分析分别为71．9％和75．8％，按方案（PP）分析分别为76．7％和83．3％，两组间根除率无显著差异（P〉0．05）。除四联组中有2例分别因头晕和上腹痛而未完成治疗外，两组其余患者的不良反应相似，且能耐受，停药后不良反应自行消失。结论：含雷贝拉唑、克拉霉素和阿莫西林的一周三联治疗方案与再加铋剂的四联方案均能有效根除H.pylori，加用铋剂并未显著提高H.pylori的根除率，提示首次根除H.pylori治疗时仍应选择含质子泵抑制剂和两种抗生素的三联方案。     

边疆少数民族地区含铋剂四联疗法根除幽门螺杆菌疗效分析

目的比较边疆少数民族地区含铋剂四联疗法与不含铋剂三联疗法根除幽门螺杆菌(H.pylori)阳性慢性胃病的疗效。方法因上消化道不适接受胃镜检查确诊为慢性胃炎或消化性溃疡伴H.pylori感染的患者100例,随机分为治疗组:奥美拉唑20 mg Bid,阿莫西林1 000 mg Bid,克拉霉素500 mg Bid,枸橼酸铋钾220 mg Bid,口服,疗程14 d;对照组,疗程相同,不用铋剂。两组H.pylori根除治疗2周后停用抗生素,继续治疗4~6周,疗程结束4周后,采用14C-呼气试验检测H.pylori,检测结果阴性者判断为H.pylori根除。并对两组的总疗效及不良反应进行比较。结果治疗组总有效率为88%(44/50),对照组总有效率为64%(32/50),含铋剂四联方案的总有效率明显优于传统的三联方案(Z=-3.093,P=0.002);治疗组H.pylori根除率96%(48/50),对照组H.pylori根除率70%(35/50),含铋剂四联方案的H.pylori根除率明显优于传统的三联方案(χ~2=11.977,P=0.001);两组均无明显不良反应。结论含铋剂四联疗法疗效优于不含铋剂的三联疗法。     

左氧氟沙星联合雷贝拉唑及果胶铋治疗幽门螺杆菌的疗效

目的:讨论含左氧氟沙星、雷贝拉唑的三联方案及加入果胶铋的四联方案对根除幽门螺杆菌(H.pylori )的效果及不良反应.方法:将门诊确诊H.pylori 感染者196例, 随机分为左氧氟沙星、雷贝拉唑组、克拉霉素三联组及加入果胶铋的四联组;以替硝唑代替左氧氟沙星作为对照三、四联组, 四种不同方案治疗7 d, 1 mo后进行H.pylori 检测.结果:无论是三联方案还是四联方案, 含左氧氟沙星组的H.pylori 根除率要高于替硝唑组,且均有显著性差异(82.8% vs 70.6%, 86.9% vs73.2%, 均P <0.05);加入果胶铋的四联方案较之相应的三联方案H.pylori 根除率要高, 但无显著性差异(P >0.05).结论:含有左氧氟沙星的三联方案及加入果胶铋的四联方案H.pylori 的根除率效果较好,安全性高, 值得在临床上推广应用.     

含替硝唑序贯疗法根除幽门螺杆菌62例

目的: 观察由泮托拉唑、替硝唑、阿莫西林、克拉霉素组成的10日序贯疗法根除幽门螺杆菌( H pylori)的疗效.方法: 将经胃镜检查确诊为慢性胃炎和消化性溃疡且H pylori阳性的患者120例随机分为两组, 治疗组(62例)方案为前5 d给予泮托拉唑+阿莫西林, 后5 d给予泮托拉唑+克拉霉素+替硝唑;对照组(58例)三联疗法为泮托拉唑+阿莫西林+克拉霉素, 疗程7 d. 比较治疗后两组患者H pylori根除率.结果: 治疗组和对照组H pylori ITT根除率分别为83.87%和67.24%, PP根除率分别为89.66%和72.22%, 两组分别有统计学意义( P<0.05).结论: 含替硝唑的10日序贯疗法治疗H pylori感染具有较高的根除率.     

以泮托拉唑为基础的三联和四联疗法根除幽门螺杆菌疗效比较——一项单中心、随机、开放、平行对照研究

背景：近年质子泵抑制剂（PPI）＋阿莫西林＋克拉霉素标准三联疗法对幽门螺杆菌（H.pylori）的根除率有所降低,PPI＋铋剂＋甲硝唑＋四环素的四联疗法能否成为一线治疗的首选以及适当延长疗程能否提高根除率尚有待明确。目的：比较以泮托拉唑为基础的7d标准三联疗法与7d、10d四联疗法根除H.pylori的疗效。方法：133例非溃疡性消化不良的H.pylori感染患者随机分配至7d三联组（45例,泮托拉唑40mgbid＋阿莫西林1.0gbid＋克拉霉素500mgbid,PAC方案）以及7d、10d四联组（43例和45例,泮托拉唑40mgbid＋枸橼酸铋钾220mgbid＋甲硝唑400mgtid＋四环素750mgbid,PBMT方案）。治疗结束后至少间隔4周行13C-尿素呼气试验复查H.pylori,评估治疗结果。结果：共129例患者按方案完成治疗。三组H.pylori根除率按意图治疗（ITT）分析分别为73.3%、79.1%和88.9%,按方案（PP）分析分别为75.0%、82.9%和90.9%。7dPAC方案的PP根除率显著低于10dPBMT方案（P〈0.05）。除四联组中有2例患者分别因头晕和腹泻而未完成治疗外,其余患者的不良反应相似且均能耐受。结论：在7d标准三联疗法H.pylori根除疗效降低的情况下,含泮托拉唑、铋剂、甲硝唑和四环素的10d四联疗法可考虑作为根除治疗的首选方案。     

根除幽门螺杆菌对功能性消化不良疗效的研究

背景:功能性消化不良(FD)的患病率始终居高不下,目前就幽门螺杆菌(H.pylori)阳性的FD患者是否需根除H.pylori尚存在争议。目的:探讨根除H.pylori对H.pylori阳性FD患者的疗效。方法:200例H.pylori阳性FD患者随机分为治疗组(100例.予以枸橼酸铋雷尼替丁400mg+阿莫西林1000mg+克拉霉素250mg,2次/d,疗程1周)和对照组(100例,予以铝碳酸镁1000mg,3次/d,疗程1周)。随访结束后评估H.pylori根除率和FD症状改善情况。结果:治疗组的H.pylori根除率分别为87.5%(PP分析)和84.0%(ITT分析),对照组H.pylori根除率为0%。H.pylori根除亚组FD症状改善的总有效率显著高于H.pylori未根除亚组和对照组(90.5%对41.7%和45.9%,P0.01)。结论:部分H.pylori阳性FD患者根除H.pylori后,其症状可长期缓解,因此对部分H.pylori阳性FD患者根除H.pylori是一种值得推广的有效治疗手段。     

Efficacy of Different Helicobacter pylori Eradication Regimens in Patients Affected by Insulin-Dependent Diabetes Mellitus

Background: Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; antibiotic absorption, however, may be influenced by the disease. H. pylori eradication appears to be reduced in IDDM patients. The aim of the study was to evaluate the efficacy of the most common H. pylori eradication regimens in a population of IDDM-infected patients. Methods: One hundred and seventy-two IDDM patients were evaluated. H. pylori infection was assessed through the 13C-urea breath test. Infected patients were randomly assigned to three different standard 7-day eradication regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole, clarithromycin, pantoprazole. Patients in whom eradication was not successful in the first cycle were subsequently submitted to a 7-day therapy with tinidazole, tetracycline, bismuth, and pantoprazole. Results: Thirty-seven per cent of IDDM patients were infected. None of the triple therapies used provided an eradication higher than 62%. Conversely, the quadruple regimen was successful in 88% of the patients. Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P &lt; 0.05). Conclusions: IDDM patients show a low H. pylori eradication rate with a standard triple therapy regardless of the regimen utilized, the dosage and/or the duration of the therapy used appearing not to be sufficient to eradicate the infection efficiently. The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, although it is accompanied by a greater incidence of minor side effects.     

含铋剂和克拉霉素的四联根除方案在幽门螺杆菌一线治疗中的作用

背景：近年经典三联方案对幽门螺杆菌（H.pylori）感染的根除疗效明显下降,建立新型、安全和高效的一线标准治疗方案是临床工作的当务之急。目的：评估含铋剂和克拉霉素的四联方案作为H.pylori一线治疗方案的疗效和安全性。方法：120例胃镜诊断为非溃疡性消化不良的H.pylori感染患者随机分为3组：7 d三联组（奥美拉唑20 mgbid＋阿莫西林1000 mg bid＋克拉霉素500 mg bid,疗程7 d）、7 d四联组（7 d三联方案＋枸橼酸铋钾220 mg bid,疗程7 d）和2周四联组（方案同7 d四联组,疗程2周）。治疗结束后至少4周行13C-尿素呼气试验以评估根除疗效。H.pylori分离菌株行克拉霉素、甲硝唑和阿莫西林药敏试验。结果：115例患者按方案完成治疗。7 d三联组、7 d四联组和2周四联组按意向治疗（ITT）分析H.pylori根除率分别为70.0%、75.0%和90.0%,按方案（PP）分析分别为73.7%、76.9%和94.7%。2周四联组ITT和PP根除率均显著高于7 d三联组（P〈0.05）,PP根除率显著高于7 d四联组（P=0.026）,而7 d三联组ITT和PP根除率与7 d四联组相比均无明显差异。H.pylori对克拉霉素、甲硝唑和阿莫西林的耐药率分别为24.2%、48.3%和0%,7 d三联组、7 d四联组和2周四联组对克拉霉素耐药菌株的根除率逐渐升高（37.5%、55.6%、80.0%）,但差异无统计学意义。除2周四联组中1例患者因皮肤过敏而未完成治疗外,其余患者的不良反应相似且轻微,耐受性良好。结论：含铋剂和克拉霉素的2周四联方案可明显提高H.pylori根除疗效,且安全性较高,可作为H.pylori一线治疗的标准方案。     

Efficacy of different Helicobacter pylori eradication regimens in patients affected by insulin-dependent diabetes mellitus

BACKGROUND: Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; antibiotic absorption, however, may be influenced by the disease. H. pylori eradication appears to be reduced in IDDM patients. The aim of the study was to evaluate the efficacy of the most common H. pylori eradication regimens in a population of IDDM-infected patients. METHODS: One hundred and seventy-two IDDM patients were evaluated. H. pylori infection was assessed through the 13C-urea breath test. Infected patients were randomly assigned to three different standard 7-day eradication regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole, clarithromycin, pantoprazole. Patients in whom eradication was not successful in the first cycle were subsequently submitted to a 7-day therapy with tinidazole, tetracycline, bismuth, and pantoprazole. RESULTS: Thirty-seven per cent of IDDM patients were infected. None of the triple therapies used provided an eradication higher than 62%. Conversely, the quadruple regimen was successful in 88% of the patients. Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P < 0.05). CONCLUSIONS: IDDM patients show a low H. pylori eradication rate with a standard triple therapy regardless of the regimen utilized, the dosage and/or the duration of the therapy used appearing not to be sufficient to eradicate the infection efficiently. The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, although it is accompanied by a greater incidence of minor side effects.     

Use of bovine lactoferrin for Helicobacter pylori eradication

BACKGROUND: One-week triple therapy is the most frequently recommended treatment for Helicobacter pylori infection. Eradication rate is satisfactory, nevertheless is advisable to look for more effective therapies. AIM: To test the efficacy of a standard triple therapy plus bovine lactoferrin in the eradication of H. pylori infection. PATIENTS AND METHODS: One hundred and fifty consecutive H. pylori positive patients, suffering from dyspeptic symptoms were recruited in a 7-day triple therapy open randomised single centre study with rabeprazole, clarithromycin, tinidazole, bovine lactoferrin (group A) or rabeprazole, clarithromycin, tinidazole (group B), or a 10-day therapy with rabeprazole, clarithromycin, tinidazole (group C). H. pylori status was assessed 8 weeks after the end of the treatment by means of a 13C-urea breath test or a H. pylori stool antigen-test. RESULTS: Eradication rates (intention to treat/per protocol) were: group A (92.2/95.9%), group B (71.2/72.5%) and group C (70.2/75%). The efficacy of triple therapy added with lactoferrin was significantly higher than other two regimens (p=0.01, intention to treat analysis; p=0.005, per protocol analysis). CONCLUSION: These results suggest that lactoferrin tested in the present study was effective in curing H. pylori and could be a new agent to assist the antimicrobials in the eradication of the bacterium.     

Sofalcone, a mucoprotective agent, increases the cure rate of Helicobacter pylori infection when combined with rabeprazole, amoxicillin and clarithromycin

AIM: The mucoprotective agents, sofalcone and polaprezinc have anti-Helicobacter pylori (H pylori) activities. We determined the therapeutic effects of sofalcone and polaprezinc when combined with rabeprazole, amoxicillin and clarithromycin for Helicobacter pylori infection. METHODS: One hundred and sixty-five consecutive outpatients with peptic ulcer and H pylori infection were randomly assigned to one of the following three groups and medicated for 7 d. Group A: triple therapy with rabeprazole (10 mg twice daily), clarithromycin (200 mg twice daily) and amoxicillin (750 mg twice daily). Group B: sofalcone (100 mg thrice daily) plus the triple therapy. Group C: polaprezinc (150 mg twice daily) plus the triple therapy. Eradication was considered successful if 13C-urea breath test was negative at least 4 wk after cessation of eradication regimens or successive famotidine in the cases of active peptic ulcer. RESULTS: On intention-to-treat basis, H pylori cure was achieved in 43 of 55 (78.2%) patients, 47 of 54 (87.0%) and 45 of 56 (80.4%) for the groups A, B and C respectively. Using per protocol analysis, the eradication rates were 81.1% (43/53), 94.0% (47/50) and 84.9% (45/53) respectively. There was a significant difference in the cure rates between group A and B. Adverse events occurred in 10, 12 and 11 patients, from groups A, B and C respectively, but the events were generally mild. CONCLUSION: The addition of sofalcone, but not polaprezinc, significantly increased the cure rate of H pylori infection when combined with the rabeprazole-amoxicillin-clarithromycin regimen.     

Comparison of short- and long-term treatment protocols and the results of second-line quadruple therapy in children with <Emphasis Type="Italic">Helicobacter pylori</Emphasis> infection

BACKGROUND: Research regarding the optimal therapeutic approach to Helicobacter pylori infection in children is ongoing. There is no consensus as to duration of treatment or second-line therapy. The purpose of this study was compare the efficacy of 7-day and 14-day triple therapies and report the results of second-line quadruple therapy in children. METHODS: A total of 275 consecutive H. pylori-infected patients were enrolled into two groups. Group 1 (n = 180) received triple therapy with 14 days of amoxicillin and clarithromycin and 21 days of proton pump inhibitor. Group 2 (n = 95) received triple therapy including 7 days of amoxicillin and clarithromycin with 21 days of proton pump inhibitor. Subsequently, 89 patients not responding to the triple therapies received quadruple therapy comprising omeprazole (14 days), bismuth subcitrate (7 days), doxycycline (7 days), and metronidazole (7 days). Eradication was evaluated by 13C-urea breath test. RESULTS: The per-protocol eradication rates in groups 1 and 2 were 60.5% and 55.8%, respectively (P = 0.44). In the second interview with 227 patients, severe symptoms were reported to have disappeared in 59% and decreased notably in 34.8%. Helicobacter pylori was eradicated in 66.7% of patients at the end of the quadruple therapy. In the third interview with 75 patients, severe symptoms had decreased in 38.6% and disappeared in 56%. CONCLUSIONS: The different duration of the two treatment regimens had no impact on eradication rates. Furthermore, quadruple therapy was necessary to achieve H. pylori eradication after triple therapy. However, the eradication rate with quadruple therapy was still insufficient. Consequently, a new therapeutic approach to H. pylori infection in children is needed.     

The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori

BACKGROUND: Helicobacter pylori eradication rates have tended to decrease recently, mostly due to increasing antibiotic-resistance. The present study aimed to compare the efficacy of bismuth-based quadruple regimen with proton pump inhibitor-based triple regimen for eradication of H. pylori. METHODS: Consecutive H. pylori-positive patients with non-ulcer dyspepsia were randomized into one of two regimens: (i) bismuth subsalicylate 300 mg q.i.d., lansoprazole 30 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. (BLTM group) for 14 days; (ii) lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d and clarithromycin 500 mg b.i.d. (LAC) for 14 days. Gastroscopy and (14)C-Urea breath test (UBT) were performed before enrollment, and UBT only was repeated for 6 weeks after treatment. RESULTS: A total of 240 patients were randomized into groups and 212 of them completed the protocols. The 'intention-to-treat' (ITT) and 'per protocol' (PP) H. pylori eradication rates were 70% (95%CI 61-78) and 82.3% (95%CI 74-89) in the BLTM group, and 57.5% (95%CI 48-66) and 62.7% (95%CI 53-71) in the LAC group. The BLTM treatment achieved a significantly better eradication rate compared with LAC treatment in PP analysis (82.3% vs. 62.7%, P = 0.002). Mild to severe side-effects, which were more frequent in the BLTM group, were reported in 18.2% of the patients. CONCLUSION: The bismuth-based quadruple regimen achieved a better eradication rate compared with proton pump inhibitor-based triple regimens as a first-line eradication option for H. pylori in our population.     

Eradication rates of helicobacter pylori infection with second-line treatment: non-ulcer dyspepsia compared to peptic ulcer disease

BACKGROUND/AIMS: Initial proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) infection is less effective in patients with nonulcer dyspepsia (NUD) than those with peptic ulcer disease (PUD). To date, there have been no studies on the difference in eradication rates in NUD compared to PUD with regard to second-line therapy. Therefore, we retrospectively analyzed the difference in eradication rates of a second-line quadruple therapy for NUD and PUD patients. METHODOLOGY: Between June 2003 and December 2005, patients who failed to respond to initial PPI-based triple therapy, received 7 days of quadruple therapy (PPI b.i.d., bismuth 300mg q.i.d., metronidazole 500mg t.i.d., tetracycline 500mg q.i.d.) as a second-line treatment regimen. Four weeks after the completion of the course of medication, a 13C-urea breath test was performed for detection of H. pylori. RESULTS: A total of 87 patients received second-line quadruple therapy. Of these, 43 patients had NUD and 44 patients had PUD (19 gastric ulcers, 23 duodenal ulcers, 2 both ulcers). The eradication rates were 76.7% (33/43) in the NUD group and 90.9% (40/44) in the PUD group by per-protocol analysis. Therefore, the eradication rates in the NUD group were significantly lower than those in the PUD group (p = 0.034). CONCLUSIONS: A 7-day bismuth-based second-line quadruple therapy for H. pylori infection was less effective in patients with NUD than those with PUD. Therefore, a more potent second-line treatment regimen or extension of treatment duration of quadruple therapy should be considered for the eradication of H. pylori in patients with NUD.     

Quadruple therapy with lactoferrin for Helicobacter pylori eradication: A randomised, multicentre study

BACKGROUND: Helicobacter pylori eradication rate with standard triple therapies is decreasing. Recently, lactoferrin administration has been shown to significantly increase the cure rate of 7-day rabeprazole, clarithromycin and tinidazole triple therapy. We assessed whether lactoferrin also increases the eradication rate of 7-day esomeprazole, clarithromycin and amoxycillin triple therapy as first-line treatment. METHODS: Overall, 133 consecutive patients with non-ulcer dyspepsia and H. pylori infection were randomised to receive either a standard 7-day triple therapy with esomeprazole 20mg b.i.d., clarithromycin 500 mg b.i.d. and amoxycillin 1g b.i.d. (68 patients) or a quadruple therapy comprising of the same regimen plus lactoferrin 200mg b.i.d. (65 patients). H. pylori at entry was assessed by endoscopy, while bacterial eradication was checked by (13)C urea breath test 4-6 weeks after treatment. RESULTS: H. pylori eradication following standard triple therapy was achieved in 53/68 (77.9%; 95% CI = 68-88) and in 53/66 (80.3%; 95% CI = 71-89) patients at ITT and PP analyses, respectively. Following the quadruple regimen, the infection was cured in 50/65 (76.9%; 95% CI = 67-87) and 50/64 (78.1%; 95% CI = 68-88) patients at ITT and PP analyses, respectively. No statistically significant difference emerged between the two therapeutic regimens, both at ITT (p = 0.9) and PP analyses (p = 0.9). Side effects were complained by seven (10.3%) patients and six (9.2%) patients following the triple and quadruple regimens, respectively (p = 0.9), with only one patient in the quadruple group interrupting the treatment due to side effects. CONCLUSIONS: Quadruple therapy with lactoferrin did not significantly increase the H. pylori cure rate of standard 7-day clarithromycin-amoxycillin based triple therapy in non-ulcer dyspepsia patients.     

序贯疗法与标准四联疗法对幽门螺杆菌根除失败后补救治疗的疗效分析

近年经典三联疗法的幽门螺杆菌（11．pylori）根除疗效明显降低,选择有效补救疗法对Hpylori根除失败者有重要意义。目的：比较序贯疗法与标准四联疗法对且pylori根除失败者的疗效。方法：将98例Hpylori根除失败者随机分为序贯疗法组（前5d予奥美拉唑20mg＋阿莫西林1000mgbid,后5d予奥美拉唑20mg＋左氧氟沙星200mg＋克拉霉素500mgbid）和标准四联疗法组（予奥美拉唑20mg＋胶体次枸橼酸铋钾220mg＋阿莫西林1000mg＋克拉霉素500mgbid,疗程7d）。停药4周后复查”C一尿素呼气试验,评估Hpylori根除疗效。结果：共95例患者完成方案,序贯疗法组11Tr和PP分析的Hpylori根除率均显著高于标准四联疗法组（ITF：89．8％对71,4％,PP：91．7％对74。5％,P〈0．05）,序贯疗法组临床症状改善的总有效率亦显著高于标准四联疗法组（95．8％对80．9％,P〈0．05）,两组不良反应发生率无明显差异（P〉0．05）。结论：对Hpylori根除治疗失败的患者,序贯疗法和标准四联疗法均可作为有效的补救治疗方案,但10d序贯疗法的疗效优于7d标准四联疗法。