奥美拉唑和法莫替丁治疗球部溃疡愈合率和复发率的对比研究

目的 对比研究奥美拉唑和法莫替丁治疗十二指肠球部溃疡的愈合率和复发率。方法 60例经内镜检查证实为活动性十二指肠球部溃疡患者，随机分成奥美拉唑组和法莫替丁组，先行短程治疗。奥美拉唑每日1次，每次20mg，治疗4周；法莫替丁每次40mg，每晚睡前服，治疗4周。结果 奥美拉唑组和法莫替丁组4周溃疡愈合率分别为90．0％(27/30)、66．7％(20/30)，对溃疡愈合的47例进行长程治疗，奥美拉唑组用量20mg，每周2次；法莫替丁组20mg，睡前服一次；各用药一年，观察一年内溃疡累积复发率：奥美拉唑组为7．4％(2/27)，法莫替丁组为30．0％(6/20)。奥美拉唑组短程治疗时溃疡愈合率高于法莫替丁组，而长程治疗时一年累积复发率明显低于法莫替丁组。结论 奥美拉唑对酸抑制程度强且抑制持续时间长。     

奥美拉唑三联疗法对老年人HP感染消化性溃疡疗效观察

目的 观察奥美拉唑三联疗法根除幽门螺杆菌（HP）感染的临床应用价值。方法 对33例胃溃疡、30例十二指肠球部溃疡病人用奥美拉唑、阿莫西林、灭滴灵三联疗法，并与33例胃溃疡30例十二指肠球部溃疡病人行雷尼替丁、阿莫西林、灭滴灵三联疗法分别治疗4周和2周对照。结果 治疗组与对照组停药2个月后复查，胃溃疡HP根治率分别为86．1％（31／36）及68．9％（20／33），溃疡愈合率分别为88．9％（32／36）及3．6％（21／33），十二指肠球部溃疡HP根治率分别为86．1％（26／30）及63．3％（19／30），溃疡愈合率分别为90％（27／30）及20／30（66．7％）（P〈0．05），治疗不良反应少。结论 奥美拉唑三联疗法能有效根除老年人消化性溃疡HP感染，不良反应少。     

奥美拉唑四联法治疗及预防消化性溃疡病复发的研究

目的 观察奥美拉唑四联法对消化性溃疡病的疗效.方法 随机分奥美拉唑四联法(治疗组) 与奥美拉唑三联法(对照组)对比观察, 两组均经6周治疗, 内镜复查溃疡愈合情况.每年复检1～2次, 连续观察1～3年.结果 两组对比溃疡愈合率差异无统计学意义(P＞0.05),而幽门螺旋菌根除率和3年内溃疡复发率与对照组相比差异有统计学意义(P＜0.05).结论 应用奥美拉唑四联法可有效治疗和降低消化性溃疡病的复发.     

清创术治疗复发性十二指肠溃疡的临床研究

目的：探讨治疗复发性十二指肠 溃疡的新方法，观察清创术治疗十二指肠溃疡的愈合率及其复发率。方法：选择反复发作的十二指肠溃疡100例,随机分为两组，治疗组采用胃镜下清创术后服用雷尼替丁、得乐冲剂、甲消唑治疗，对照组只服药物治疗。治疗后4周复查胃镜。观察病人十二指肠溃疡的愈合率及其半年内、一年内的复发率。结果：治疗组4周溃疡愈合率为94％（47／50），对照组为78％（39／50）；半年内复发率：治疗组为8．5％（4／47），对照组为30％（13／19）；1年内复发：治疗组为13．2％（6／47），对照组为43．7％（16／39）。结论：胃镜下清创术配合药物治疗复发性十二指肠溃疡不仅能提高治愈率，而且能明显降低复发率,值得临床进一步推广。     

枸橼酸铋雷尼替丁、阿莫西林二联疗法对幽门螺杆菌阳性的消化性溃疡的疗效观察

目的 观察枸橼酸铋雷尼替丁二联疗法根除幽门螺杆菌（Hp）的临床应用价值。方法 对120例Hp阳性的消化性溃疡病人用枸橼酸铋雷尼替丁、阿莫西林二联疗法治疗2周，并与100例行奥美拉唑、阿莫西林、替硝唑三联疗法的病人进行对照。结果治疗组与对照组停药4周后Hp根除率分别为86．7％（104／120）及86．0％（86／100）（P〉0．05）；溃疡愈合率分别为95．0％（114／120）及94．0％（94／100）（P〉0．05）。治疗组不良反应少。结论 以枸橼酸铋雷尼替丁为中心的二联疗法能有效根除Hp，不良反应少，值得进一步推广和应用。     

雷尼替丁与庆大霉素合剂联用治疗幽门螺杆菌阳性消化性溃疡

目的观察雷尼替丁与庆大霉素合剂联用治疗幽门螺杆菌（Hp）阳性消化性溃疡的疗效。方法62例幽门螺杆菌（Hp）阳性消化性溃疡患者随机分成两组。治疗组：庆大霉素合剂10ml,口服,3次／d,雷尼替丁150mg,口服,2R／d。对照组：雷尼替丁150mg,口服,2次／d。两组均连服4周为1个疗程,治疗期间两组全部停用其它药物。结果两组溃疡愈合率,治疗组为90．3％,对照组为83．9％,近期疗效差异显著（P〈0．05）。幽门螺杆菌清除率治疗组为80．6％,对照组为29．6％,治疗组明显高于对照组（P〈0．01）。溃疡复发率半年、1年后治疗组明显低于对照组（P〈0．01）,远期疗效显示治疗组明显高于对照组。结论雷尼替丁与庆大霉素合剂联用治疗幽门螺杆菌阳性消化性溃疡,在症状缓解、溃疡愈合率、Hp根除上均明显优于单独使用雷尼替丁,且溃疡复发率明显降低,无明显不良反应,是治疗消化性溃疡较为满意的方法。     

雷尼替丁加甲硝唑治疗十二指肠球部溃疡疗效观察

我院1995年2月～1997年3月,应用雷尼替丁加甲硝叹治疗十二指肠球部溃疡,观察其治疗愈合率及复发率。回资料与方法将有上腹部症状并经内镜确诊的活动性十二指肠球部溃疡病患者,随机分成两组。治疗组39例,服用国产雷尼替丁olsg,每天2次,国产甲硝少0．4g,每天3次;对照组37例,单取国产雷尼替丁0．15g,每天2次。疗程均为1个月。疗程结束后复查胃镜了解溃疡愈合情况并检测HP,对清病愈合者进行随访观察。（编者注：甲硝吐长期使用对心脏、肝功能及凝血酶元有一定影响,一定要注意监测）2结果2．l愈合率治疗组溃疡愈合率821％（32／39）…     

三联疗法根除幽门螺杆菌临床观察

目的：探讨枸橼酸铋雷尼替丁加左氧氟沙星加呋喃唑酮三联1周疗法根除幽门螺杆菌的疗效及安全性。方法：选择110例符合条件的幽门螺杆菌阳性慢性胃炎和消化性溃疡患者，随机分为两组。治疗组采用枸橼酸铋雷尼替丁（350mg，2次／d）加左氧氟沙星（200mg，2次／d）加呋喃唑酮（100mg，2次／d），治疗7d；溃疡患者继用枸橼酸铋雷尼替丁350mg，2次／d，3周。对照组采用奥美拉唑（20mg，2次／d）加阿莫西林（1．0g，2次／d）加甲硝唑（400mg，2次／d），治疗7d；溃疡患者继用奥美拉唑20mg，1次／d，3周。疗程结束后4周及8周复查Hp，观察幽门螺杆菌根除率、症状缓解率、溃疡愈合率及不良反应等。结果：治疗组和对照组的症状缓解率、幽门螺杆菌根除率、溃疡治愈率、不良反应发生率分别为91．8％、81．6％、90，5％、32．7％和94．0％、86．0％、95．0％、28．0％，差异无统计学意义（P〉0．05）。治疗组与对照组每例根除幽门螺杆菌费用分别为100．10元、274．68元，治疗组根除幽门螺杆菌期望成本比对照组低196．77元。结论：幽门螺杆菌加左氧氟沙星加呋喃唑酮三联1周疗法是根除幽门螺杆菌的理想方案，可作为根除幽门螺杆菌一线治疗的选择。     

丽珠胃三联、奥美拉唑联合治疗幽门螺杆菌阳性的消化性溃疡疗效观察

目的对照观察丽珠胃三联、奥美拉唑联合治疗方案对幽门螺杆菌（Hp）阳性消化性溃疡的治愈率、复发率及Hp根除率的影响。方法将130例Hp阳性消化性溃疡患者随机分为治疗组（70例）和对照组（60例）,治疗组给予丽珠胃三联口服1周;奥美拉唑20rag／次、2次／d,1周后改为20mg、1次／d,连服3周,共治疗4周。对照组给予阿莫西林0．5g／次、3次／d,连服1周;甲硝唑0．4g／次、3次／d,连服1周,同时给予奥美拉唑口服,剂量和方法同治疗组。结果治疗组和对照组比较,4周后溃疡治疗总有效率差异有显著性（分别为98．6％和88．3％,P〈0．05）;Hp根除率治疗组高于对照组（94．3％VS86．7％,P〈0．05）。不良反应2组差异无显著性意义（P〉0．05）;1年后随访,治疗组溃疡复发率（6．3％）和Hp复发率（12．7％）均明显低于对照组溃疡复发率（16．7％）和Hp复发率（31．5％）（P均〈0．01）。结论丽珠胃三联、奥美拉唑联合治疗Hp阳性消化性溃疡的有效率和Hp根除率高,复发率较低,不良反应少,是治疗消化性溃疡的有效方法。     

幽门螺杆菌与非甾体消炎药相关消化性溃疡的临床研究——附69例报告

目的： 研究幽门螺杆菌（Ｈｐ） 根除对长期服用非甾体消炎药（ＮＳＡＩＤ） 的消化性溃疡愈合和复发的影响。方法：将６９ 例长期服用ＮＳＡＩＤ的消化性溃疡患者分为Ｈｐ 阳性雷尼替丁组２５ 例,Ｈｐ 阳性雷尼替丁加阿莫西林组２３ 例, Ｈｐ 阴性雷尼替丁组２１例, 三组的用药时间均为６周。结果： 三组溃疡愈合率依次为６４％ 、７４％ 、７１％（Ｐ＞ ０．０５）。追踪溃疡愈合者４３ 例, 并分为Ｈｐ 根除组１３ 例, Ｈｐ 持续阳性组１６ 例, Ｈｐ 持续阴性组１４ 例。均停用抗溃疡药物, 继续服用ＮＳＡＩＤ６ 个月后复查。累计溃疡复发率三组分别为３１％ 、４４％ 、２９％ （Ｐ＞ ０．０５）。结论： 根除Ｈｐ 不能提高ＮＳＡＩＤ相关消化性溃疡的愈合率, 亦不能降低其复发率, 且Ｈｐ 持续阳性者其溃疡复发率有升高趋势     

Is ranitidine therapy sufficient for healing peptic ulcers associated with non‐steroidal anti‐inflammatory drug use?

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of serious gastroduodenal events. To minimise these risks, patients often require concomitant acid-suppressive therapy. We conducted a literature review of clinical trials examining use of ranitidine 150 mg twice daily to heal gastroduodenal ulcers (GU) in NSAID recipients. Seven studies were identified. After 8 weeks' treatment with ranitidine, GU healing rates ranged from 50% to 74% and rates of duodenal ulcer (DU) healing ranged from 81% to 84%. Ranitidine was more effective when NSAIDs were discontinued (healing rates reaching 95% and 100%, respectively). The ulcer healing rate with sucralfate was similar to that of ranitidine. However, proton pump inhibitor (PPI) therapy was associated with significantly greater rates of both GU and DU healing than ranitidine; 8-week GU rates were 92% and 88% with esomeprazole 40 mg and 20 mg, respectively (vs. 74% with ranitidine, p < 0.01). For omeprazole, 8-week healing rates were 87% with omeprazole 40 mg and 84% with omeprazole 20 mg (vs. 64% for ranitidine, p < 0.001), and for lansoprazole the corresponding values were 73-74% and 66-69% for the 30 mg and 15 mg doses, respectively (vs. 50-53% for ranitidine, p < 0.05). In the PPI study reporting DU healing the values were 92% for omeprazole 20 mg (vs. 81% for ranitidine, p < 0.05) and 88% for omeprazole 40 mg (p = 0.17 vs. ranitidine). NSAID-associated GU are more likely to heal when patients receive concomitant treatment with a PPI rather than ranitidine.     

Healing and relapse rates in gastroesophageal reflux disease treated with the newer proton-pump inhibitors lansoprazole, rabeprazole, and pantoprazole compared with omeprazole, ranitidine, and placebo: evidence from randomized clinical trials

BACKGROUND: The older proton pump inhibitor (PPI) omeprazole and the newer PPIs lansoprazole, rabeprazole, and pantoprazole are approved for the acute and maintenance treatment of gastroesophageal reflux disease (GERD). OBJECTIVE: On the basis of the results of randomized clinical trials, this study sought to estimate healing and relapse rates in acute and maintenance treatment of GERD with the newer PPIs compared with omeprazole, the histamine2-receptor antagonist ranitidine (the most frequent non-PPI comparator in studies of PPIs), and placebo. METHODS: A search of MEDLINE was conducted to identify randomized, controlled clinical trials that included a PPI in > or =1 treatment arm and assessed the healing of erosive esophagitis endoscopically. The primary outcome for studies of acute therapy was healing rate, and the primary outcome for studies of maintenance therapy was relapse rate. RESULTS: Fifty-three studies were identified, of which 38 involved acute therapy (12 excluded) and 15 maintenance therapy. None of the studies of pantoprazole met the inclusion criteria for maintenance therapy. The 8-week overall healing rate ratios in the comparison of newer PPIs with omeprazole 20 mg/d were as follows: lansoprazole 30 mg/d, 1.02 (95% CI, 0.98-1.06): rabeprazole 20 mg/d, 0.93 (95% CI, 0.87-1.00); and pantoprazole 40 mg/d, 0.98 (95% CI, 0.90-1.07). In the comparison of any PPI with ranitidine 300 mg/d, the ratios were as follows: lansoprazole, 1.62 (95% CI, 1.46-1.76); rabeprazole, 1.36 (95% CI, 1.20-1.54); pantoprazole, 1.60 (95% CI, 1.33-1.96); and omeprazole, 1.58 (95% CI, 1.41-1.78). Relapse rates over 1 year of treatment were similar between lansoprazole and rabeprazole. Compared with ranitidine, there were statistically significant differences in the rates of resolution of heartburn symptoms (P < 0.002), ulcer healing (P < 0.05), and relapse (P < 0.01). Similar results were seen in the comparison of PPIs with placebo in terms of rates of resolution of heartburn symptoms (P < 0.01), ulcer healing (P < 0.001), and relapse (P < 0.006). CONCLUSIONS: In this study, the newer PPIs were of similar efficacy to omeprazole in terms of heartburn control, healing rates, and relapse rates. All the PPIs were superior to ranitidine and placebo in healing erosive esophagitis and decreasing relapse rates.     

Combined ranitidine and pirenzepine in the treatment of duodenal ulcer: a multicentre double-blind study using endoscopy

The efficacy of a combination of ranitidine and pirenzepine in the short-term treatment of duodenal ulcer was evaluated in a double-blind trial. In a multicentre study, 352 patients with active duodenal ulcers were randomly allocated to be treated with 300 mg/day ranitidine plus placebo (group I), 300 mg/day ranitidine plus 50 mg/day pirenzepine (group II), or 300 mg/day ranitidine plus 100 mg/day pirenzepine (group III) for 4 weeks. The respective healing rates assessed using endoscopic examination after 2 and 4 weeks' treatment were 40% and 70% in group 1, 44% and 82% in group II, and 37% and 77% in group III. The differences between the treatment groups were not significant, although 300 mg/day ranitidine plus 50 mg/day pirenzepine tended to be superior to the other treatments. Analgesic activity was the same in the three groups with 33%, 34% and 33% reductions, respectively, in the numbers of patients experiencing pain after 2 weeks. Side-effects (mainly dry mouth and blurred vision) were significantly more frequent in group III patients.     

Colloid bismuth versus famotidine in the treatment and prevention of duodenal ulcer relapse: results of a double-blind, double dummy randomized study

Summary— Fifty-three consecutive patients with active duodenal ulcer (DU) were randomly included in a double-blind, double-dummy study to test the healing and relapsing rate of two treatment regimens: famotidine 40 mg nocte for 4–8 weeks, followed by 20 mg for 12 months after healing of the ulcer and colloidal bismuth (CBS) (240 mg bid) for 4–8 weeks, followed by placebo maintenance treatment. The results of the short term period confirmed the efficacy of CBS in healing DU (24/25 in CBS group and 19/23 in famotidine group). However, the relapse rate in the CBS-treated group was higher (77.8% at 12 months) than in the famotidine group (35.7%) ( p = 0.041). Only 7 patients (41.2%) were cleared from Helicobacter pylori (HP) after CBS treatment. In conclusion, the high relapse rate observed in CBS treated patients may be related to the high percentage of patients with HP infection in the tested group and support the hypothesis that lack of efficacy of CBS in preventing DU recurrence is related to its poor eradication of HP.     

两种方案治疗十二指肠溃疡幽门螺杆菌感染的临床分析

目的分析小剂量奥关拉唑、左氧氟沙星及呋喃唑酮新三联与小剂量奥关拉唑、阿莫西林及甲硝唑标准三联疗法治疗十二指肠溃疡幽门螺杆菌(Helicobacter pylori,Hp)感染的临床疗效对比。方法98例符合条件的患者随机分成两组,其中47例为新三联疗法,即口服小剂量奥美拉唑20mg,1次／d,连服6周,左氧氟沙星200mg及呋喃唑酮200mg,均为2次／d,连服2周。另一组51例为标准三联疗法,即口服小剂量奥关拉唑20mg,1次／d,连服6周,阿莫西林1000mg及甲硝唑400mg,均为2次／d,连服2周,疗程结束后1个月复查胃镜。结果96例患者完成治疗及随访,小剂量奥美拉唑新三联组与小剂量奥关拉唑标准三联组疗法Hp根除率分别为84．8％、82．0％,差异无统计学意义(P=0．715);溃疡愈合率分别为95．7％、92．0％,差异无统计学意义(P=0．752)。两组患者不良反应发生率分别为12．8％、15．7％,差异无统计学意义(P=0．680)。HP根除组溃疡愈合率(100．0％)明显高于HP未根除组(62．5％),差异有统计学意义(P=0．001)。结论小剂量奥关拉唑新三联组与标准三联组疗法均有较理想的Hp根除率及溃疡愈合率,新三联组疗法不良反应发生率与标准三联组疗法相当;同时发现Hp根除有利于溃疡愈合。因此,在当今面临Hp对常规抗生素耐药率上升的情况下,推荐新三联疗法在阿莫西林及甲硝唑耐药地区可作为根除十二指肠溃疡HP感染的一线治疗或失败后的补救治疗方案。     

A randomized comparison of triple therapy Helicobacter pylori eradication regimens in children with peptic ulcers

An open, randomized trial was performed to compare the efficacy of three Helicobacter pylori eradication regimens in children with peptic ulcer disease. A total of 106 children (5 - 15 years) were treated for 1 week with metronidazole, 30 - 40 mg/kg per day depending on age, amoxycillin, 750 mg/day, and one of three anti-secretory agents: proprietary omeprazole, 20 - 40 mg/day depending on age; generic omeprazole, 20 - 40 mg/day; or ranitidine, 150 mg twice daily. The H. pylori eradication rate was significantly higher in patients receiving proprietary omeprazole (88.9%) than in those receiving generic omeprazole (80.0%) or ranitidine (74.3%), and this was associated with a trend towards faster ulcer healing. It is concluded that triple therapy consisting of an anti-secretory agent and two antimicrobials produces effective eradication of H. pylori and ulcer healing in children with peptic ulcer disease, and that proprietary omeprazole is more effective than both ranitidine and the generic formulation used in this study.     

雷尼替丁、呋喃唑酮、克拉霉素、果胶铋四联疗法治疗幽门螺杆菌阳性消化性溃疡

根除幽门螺杆菌是防治消化性溃疡的重要措施,以质子泵抑制剂(PPI)为基础的三联疗法是近年来国内外较常用的根除幽门螺杆菌方案,获得了较高的根除率,但是随着该方案广泛应用,耐药率逐年上升,且费用较高,影响了此方案的疗效。我院应用雷尼替丁、呋喃唑酮、克拉霉素、果胶铋四联疗     

Treatment of peptic ulcer in general practice and in hospital: a comparison of omeprazole and cimetidine

The aim of this study was to compare duodenal ulcer healing and symptom relief after two and four weeks treatment with omeprazole or cimetidine in groups of patients treated in general practice and as hospital out-patients. It was a randomised, double-blind, parallel group study with stratification for trial centre (hospital or GP). Endoscopy was performed at entry, after two weeks and, if unhealed at two weeks, after four weeks. All endoscopies were carried out in hospitals. In all, 189 patients were randomised (98 omeprazole, 91 cimetidine), 79 (42 per cent) of which by GPs, to either omeprazole 20 mg om (n = 41) or cimetidine 800 mg nocte (n = 38) for two to four weeks. After two weeks, ulcer healing occurred in 56 per cent (omeprazole) and 29 per cent (cimetidine) (p less than 0.05) of patients treated by GPs, and 67 per cent (omeprazole) and 36 per cent (cimetidine) (p less than 0.005) of those treated as hospital out-patients. Similar differences in healing rates were seen after four weeks. Omeprazole produces faster duodenal ulcer healing than cimetidine whether patients are treated as hospital out-patients or by GPs.     

不同剂量奥美拉唑和羟氨苄青霉素联用根除幽门螺杆菌感染的对比研究

本研究旨在探明不同剂量的奥美拉唑和羟氨苄青霉素联用对幽门螺杆菌（Ｈｐ）的根除率、溃疡愈合率和疼痛缓解时间，并对其进行比较。作者将７０例经尿素酶试验和胃粘膜组织学证明有Ｈｐ感染的活动性十二指肠溃疡病员，随机分为２组，分别予奥美拉唑２０ｍｇ每日２次与每日１次，同时加服羟氨苄青霉素０．５克每日４次共２周，继以国产雷尼替丁０．１５克每晚１次计４周。然后复查胃镜和尿毒酶试验检测Ｈｐ，内２例失访。Ｈｐ根除率分别为９０．９％和８８．６％（Ｐ＞０．０５）．溃疡愈合率分别为９３．９％及９１．４％（Ｐ＞０．０５）。疼痛消失时间平均为１天，副反应差异不显著。本研究表明Ｈｐ根除率与奥美拉唑剂量大小无相关性。