三联疗法治疗HP相关性出血性十二指肠溃疡的远期疗效观察

目的;观察三联疗法根除幽门螺杆菌,预防溃疡复发与再出血的远期疗效。方法：选择有ＨＰ感染的出血性十二指肠溃疡患者５８例,随机分为两组。治疗组３６例,用丽珠得乐冲剂,呋喃唑酮片剂,泰胃美片治疗２周;对照组２２例,单用泰胃美片治疗２周,疗程结束后,两组患者均再用泰胃美治疗２周。总疗程结束后４周及每半年复查胃镜和ＨＰ,定期随访２年。     

埃索美拉唑三联疗法治疗十二指肠球部溃疡疗效分析

将90例胃幽门螺杆菌(Hp)阳性的十二指肠球部溃疡患者随机分成两组,分别给予埃索美拉唑(治疗组)和奥美拉唑(对照组)为主的三联疗法。于用药1、2、3、7d观察临床症状的改善情况;疗程结束4周后,观察两组溃疡愈合率Hp根除率。结果治疗组溃疡愈合率为91.8%(45/49),Hp根除率为83.7%(41/49),对照组分别为87.8%(36/41)、80.5%(33/41),两组溃疡愈合率和Hp根除率比较无显著差异(P>0.05);治疗组第1、2天临床症状缓解率分别为38.8%、63.3%,高于对照组的14.6%、36.6%(P<0.05);不良反应发生率分别为6.1%和7.3%。表明埃索美拉唑能有效清除Hp,缓解症状,促使溃疡愈合。     

三联疗法治疗老年幽门螺杆菌阳性消化性溃疡患者的最佳时效

目的探讨三联疗法治疗老年幽门螺杆菌阳性消化性溃疡患者的最佳时效。方法选取100例老年幽门螺杆菌阳性消化性溃疡患者作为研究对象,采用随机数字表法将100例患者分为三组,患者均采用奥硝唑、雷贝拉唑和铝碳酸镁标准三联方案,每日用药两次。组1患者服药7 d,组2患者服药10 d,组3患者服药14 d。观察并比较三组患者的幽门螺杆菌根除率、溃疡愈合率以及不良反应发生情况。结果三组患者幽门螺杆菌根除率比较有统计学差异(均P0.05),组1显著低于组2和组3(均P0.05),组2和组3比较无统计学差异(P0.05)。三组患者的溃疡愈合率比较无统计学差异(P0.05)。组1、2不良反应发生率明显低于组3(均P0.05);组1和组2比较无统计学差异(P0.05)。结论三联疗法10 d疗程是治疗老年幽门螺杆菌阳性消化性溃疡的较好实验方案。     

三联治疗幽门螺杆菌阳性十二指肠球部溃疡34例

我院从１９９７年１０月～１９９８年７月采用盐酸雷尼替丁加黄连素和维酶素治疗幽门螺杆菌（ＨＰ）阳性十二指肠球部溃疡（ＤＵ）３４例,疗效满意,现报告如下。１　对象与方法１．１　对象：经内窥镜检查和ＨＰ检测确诊的ＨＰ阳性ＤＵ患者３４例中,男１８例,女１６例;年龄２０～４０岁２０例,４０～６０岁１４例;Ａ期２０例,Ｈ期１３例,Ｓ期１例。１．２　治疗方法：给予口服黄连素６８０ｍｇ／次,每天３次;维酶素１～１．２ｇ／次,每天３次;雷尼替丁０．１５ｇ／次,早晚各１次,均３周为１疗程,治疗结束后４５ｄ复查内窥镜…     

奥美拉唑三联疗法治疗幽门螺杆菌相关性消化性溃疡的疗效观察

目的探讨奥美拉唑三联疗法治疗幽门螺杆菌(Hp)相关性消化性溃疡(PU)的疗效。方法选取60例Hp阳性的消化性溃疡患者,随机分为治疗组与对照组,每组30例。治疗组予以奥美拉唑胶囊、阿莫西林胶囊和甲硝唑三联治疗,对照组予以雷贝拉唑钠、阿莫西林和甲硝唑片三联治疗。均为饭前口服,连续服用2周。治疗结束后4周,观察两组临床症状改善情况,并通过胃镜检查,观察溃疡愈合率及Hp根除率。结果治疗组溃疡愈合率为80.0%,有效率为13.3%,总有效率为93.3%;对照组溃疡愈合率为73.3%,有效率为16.7%,总有效率为90.0%,两组比较差异无统计学意义(P0.05)。治疗组Hp根除率为90.0%,对照组Hp根除率为93.3%,两组比较差异无统计学意义(P0.05)。结论奥美拉唑、阿莫西林、甲硝唑三联疗法治疗Hp相关性消化性溃疡具有疗效好、疗程短、依从性好、费用低的优点,适合基层医院推广应用。     

雷尼替丁三联疗法治疗HP相关性消化性溃疡56例报告

近年来 ,我们联合应用雷尼替丁、羟氨苄西林、甲硝唑治疗幽门螺杆菌 (HP)阳性的 5 6例上消化道溃疡患者。现报告如下 ,并观察其对 HP的根除效果及十二指肠溃疡的愈合情况。一般资料 :本组 5 6例均为内镜检查确诊为上消化道溃疡且 HP阳性者 ,男 4 2例 ,女 14例 ;平均年龄 39± 4     

三联疗法治疗幽门螺杆菌阳性溃疡病疗效观察

三联疗法治疗幽门螺杆菌阳性溃疡病疗效观察李紫禾笔者１９９１年１０月至１９９４年１２月对幽门螺杆菌（Ｈｅ－ｌｉｃｏｂａｃｔｅｒ，Ｈｐ）阳性的消化性溃疡（ｐｅｐｔｉｃｕｌｅｅｒ，ＰＵ）患者用羟氨苄青霉素、甲硝唑和法莫替丁治疗，近期效果满意。现将观察结果报...     

三联短程疗法治疗幽门螺杆菌相关性十二指肠溃疡

目的探讨奥美拉唑(Omeprazole)、羟氨苄青霉素(Amoxycillinum)和甲硝唑(Metronidazole)1wk短程疗法根除幽门螺杆菌(Hp)的疗效,对Hp相关性活动期十二指肠溃疡(DU)治疗效果和复发的影响,并与2wk疗法相比较.方法将128例Hp阳性的活动期DU患者随机分成两组.A组奥美拉唑20mg、羟氨苄青霉素1000mg、甲硝唑400mg、均为2次/d,治疗1wk.B组奥美拉唑20mg,羟氨苄青霉素1000mg,甲硝唑400mg,均为2次/d,治疗2wk.两组均继续给奥美拉唑20mg,满4wk停药.治疗前和治疗后1mo,1a各做一次电子内镜检查,并取活组织做快速尿素酶检测和组织学Silver-Staining银染色法检测Hp.结果A,B两组Hp根除率分别为92.19%(59/64),95.31%(61/64)(P>0.05);DU治愈率为93.75%(60/64),96.88%(62/64)(P>0.05);副作用发生率为4.69%(3/64),12.50%(8/64)(P<0.01).Hp根除和未根除者1a后DU复发率分别为3.33%(4/120),75.00%(6/8)(P<0.01).结论以奥美拉唑为主,合并羟氨苄青霉素和甲硝唑治疗Hp相关性DU,Hp清除率和DU治愈率高,并能有效预防DU复发.1wk短程疗法即可达到治疗目的,副作用小、顺应性好,可以取代2wk疗法,是目前治疗Hp相关性DU较好的治疗方案.     

雷尼替丁三联疗法对幽门螺杆菌阳性十二指肠溃疡的近期及远期疗效

对82例幽门螺杆菌(HP)阳性的十二指肠溃疡用雷尼替丁、羟氨苄青霉素和甲硝唑三联疗法2周,追踪1年,并与145例铋剂三联疗法病例对照。结果治疗组溃疡愈合率87.8%,HP根除率89.0%;对照组两参数为92.4%和85.7%(P均＞0.05)。治疗组副反应显著少。追踪1年,治疗组HP感染再燃9例(12.3%),重感染2例(2.7%),溃疡复发率HP阴转组1/61(1.6%),HP阳性组7/11(63.6%)(P＜0.01)。因再燃率高且在停药后4~8周发生,建议修定HP根除的标准时间,应从4周末延到8周末。     

十二指肠球部溃疡患者高胃泌素血症与幽门螺杆菌相关性的研究

本文报告我院１９９０年４月～１９９２年１０月期间经胃镜确诊的２６４例十二指肠球部溃疡患者胃窦部幽门螺杆菌检测和血清胃泌素测定结果。结果显示ＨＰ检出率球溃组高达８０．３％（２１２／２６４），与对照组２９．６３％（１６／５４）有显著差异（Ｐ＜０．００５）。ＨＰ阳性球溃组血清胃泌素水平１０３．０３±７２．４３（ｎｇ／Ｌ），较对照组６３．３３±３９．０４（ｎｇ／Ｌ）和ＨＰ阴性球溃组７４．３２±４９．７２（ｎｇ／Ｌ）明显增高（Ｐ均＜０．００５）。随访３８例治疗后ＨＰ阳性球溃患者，２６例溃疡愈合且ＨＰ转阴者血清胃泌素为７８．３２±４２５６（ｎｇ／Ｌ），较前明显下降（Ｐ＜０．０１）。表明球溃患者高胃泌素血症与ＨＰ感染有一定相关性。     

血浆胃动素水平与十二指肠球部溃疡发生与愈合的关系

本文用放免法测定了３３例十二指肠球部溃疡及３５例慢性胃炎患者血浆胃动素水平，同时检测胃粘膜ＨＰ感染情况及胃液ｐＨ值，并对其中１９例十二指肠球部溃疡患者进行抗ＨＰ二联治疗（得乐冲剂＋甲硝唑片）共６周，观察ＨＰ转阴后胃动素变化，结果表明十二指肠球部溃疡患者血浆胃动素显著高于慢性胃炎患者，分别为４４７．２３±９８．４ｎｇ／Ｌ及３５３．５±１００．２ｎｇ／Ｌ（Ｐ＜０．０１），１７例溃疡愈合者血浆胃动素显著下降，与慢性胃炎愈合者无显著性差异（Ｐ＞０．０５），而２例溃疡未愈者血浆胃动素仍持续升高，相关分析显示十二指肠球部溃疡患者血浆胃动素升高与ＨＰ感染及胃液ｐＨ值无关。本文认为十二指肠球部溃疡患者血浆胃动素升高可能是一种继发性改变，其临床意义尚有待进一步阐明。     

三联疗法治疗幽门螺杆菌相关性消化性溃疡疗效观察

目的：研究不含甲硝唑的短程低剂量质子泵抑制剂（ＰＰＩ）三联疗法对幽门螺杆菌（ＨＰ）根除消化性溃疡愈合的疗效。方法：采用随机双盲对照研究。将４７ 例ＨＰ阳性的消化性溃疡患者随机分为２ 组,即Ａ组（低剂量三联）采用达克普隆３０ ｍ ｇ １次／ｄ 加克拉霉素２５０ ｍ ｇ ２ 次／ｄ 加阿莫西林５００ ｍ ｇ ２ 次／ｄ,连服１０ ｄ;Ｂ组（安慰剂）采用胃舒平３片,２ 次／ｄ,连用４ 周,双盲双模拟用药。疗程结束后４ 周复查胃镜。结果：Ａ组ＨＰ根治率和溃疡愈合率分别为９３．３％ 和８６．７％ ,明显高于Ｂ组的０ 和２３．５％ （均Ｐ＜ ０．０５）。前者对症状缓解作用好、速度快,无明显副作用,患者依从性好。结论：短程低剂量ＰＰＩ三联疗法是治疗ＨＰ相关性消化性溃疡较为理想的治疗方案,尤其对甲硝唑耐药者更值得试用     

改良果胶铋四联疗法治疗幽门螺杆菌阳性十二指肠溃疡

目的：探讨果胶铋、雷尼替丁、痢特灵和四环素每日服２次,２周疗法对确诊为幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒ ｐｙｌｏｒｉ,ＨＰ）阳性的十二指肠溃疡的疗效及费用分析。方法：６０例农村患者随机分成四联疗法组（３０例）和新三联（由奥美拉唑、克拉霉素、甲硝唑组成）疗法组（３０例）,服药前及停药４周行胃镜检查和组织活检。结果：改良果胶铋四联疗法的溃疡愈合率、ＨＰ根除率和不良反应出现率分别为９３．３％、８６．７％和２０．０％,而新三联组则分别为９６．６％、９０．０％和１６．６％,２组比较均无显著差异（Ｐ〉０．０５）。结论：由雷尼替丁、果胶铋、痢特灵和四环素组成的每日服药２次,连服２周的四联疗法,对ＨＰ阳性十二指肠溃疡疗效好,价格便宜,适合山区农村医院推广。     

Risk Factors For Duodenal Ulcer Recurrence: Three-year Follow-up during Famotidine Maintenance Therapy

The recurrence-free rate and factors related to recurrence after healing were investigated in duodenal ulcer patients on H₂-blocker maintenance therapy with famotidine. Famotidine maintenance therapy (20 or 40 mg once a day before bedtime) was performed in 488 evaluable patients after endoscopically-proven healing of ulcers (S₁ or S₂). The cumulative recurrence-free rates were 81.1%, 65.1% and 58.2%, respectively, after one, two and three years of maintenance therapy. Among various background factors, those which have been suggested to be closely associated with ulcer recurrence were compared on the basis of their relation to the recurrence-free rate. These factors included a past history of duodenal ulcer, smoking, alcohol use, bulbar deformation, the endoscopic stage of ulcer healing, concomitant drugs and compliance with famotidine therapy. Recurrence correlated most significantly with a past history of duodenal ulcer and with compliance. Compliance was categorized as excellent, good, fair or poor. The recurrence-free rate was significantly lower in patients with excellent compliance than in any other compliance group. A famotidine dose of 40 mg/day (the standard dose), versus the half dose of 20 mg/day, produced no significant difference in the cumulative recurrence-free rate and it was therefore suggested that 20 mg/day of famotidine is comparable to 40 mg/day in its preventive effect on duodenal ulcer recurrence. In addition, because recurrence was more common in patients who had previously experienced recurrence, a past history of ulcer was suggested to be a significant risk factor for ulcer recurrence.     

止溃灭幽汤治疗幽门螺杆菌阳性活动期十二指肠溃疡的临床观察

目的探讨止溃灭幽汤治疗幽门螺杆菌(HP)阳性活动期十二指肠溃疡的近期疗效。方法自拟止溃灭幽汤治疗HP阳性活动性十二指肠溃疡64例,并与雷尼替丁、丽珠得乐组对照．治疗6周结束时进行胃镜复查。结果两组6周溃疡愈合率分别为87．2％和92．9％。两组的溃疡愈合率、HP转阴率和疼痛缓解率均无显著性差异,未发现严重的副作用。结论止溃灭幽疡是治疗HP阳性活动期十二指肠溃疡较为理想的方药。     

Effects of Omeprazole and Eradication of Helicobacter pylori on Gastric and Duodenal Mucosal Enzyme Activities and DNA in Duodenal Ulcer Patients

Vetvik K, Schrumpf E, Mowinckel P, Aase S, Andersen K-J. Effects of omeprazole and eradication of Helicobacter pylori on gastric and duodenal mucosal enzyme activities and DNA in duodenal ulcer patients. Scand J Gastroenterol 1994;29:995-1000.

Background: Duodenal and gastric content of mucosal enzymes in duodenal ulcer (DU) patients differs from that of controls. The purpose of this study has been to examine the effect of omeprazole and eradication of Helicobacter pylori on mucosal enzymes in DU patients

Methods: The enzyme activities of seven gastric and duodenal mucosal marker enzymes from the brush border, lysosomes, and mitochondria have been studied. In study I the measurements were made in 29 patients with an active DU before and after 14 days of omeprazole treatment. In study II 22 duodenal ulcer patients were given bismuth subnitrate, oxytetracycline, and metronidazole (triple therapy) for 2 weeks to eradicate H. pylori. Biopsy specimens were taken from the duodenum and the stomach for enzyme measurements and histologic assessment. In study II additional specimens were obtained from the prepyloric region for urease tests and culture of H. pylori.

Results: The ulcer healing rates were more than 90% after both omeprazole and triple therapy. H. pylori was eradicated in 86% after triple therapy. The activities of the brush-border enzymes lactase, neutral-α-glucosidase, alkaline phosphatase, leucyl-β-naphthylami-dase, and γ-glutamyltransferase (γ-GT) increased significantly in the duodenal bulb and the descending duodenum during treatment with omeprazole. No changes in duodenal enzyme activity were detected after triple therapy, whereas a significant fall in γ-GT and acid phosphatase activities was seen in the stomach. The mucosal DNA in the gastric antrum decreased both after treatment with omeprazole and after triple therapy.

Conclusions: A similar decrease in mucosal DNA of the gastric antrum was demonstrated after both omeprazole and triple therapy with bismuth subnitrate, oxytetracycline, and metronidazole. Omeprazole also affects the content of duodenal mucosal enzymes, whereas triple therapy particularly affects the gastric mucosal enzyme activity.     

Prevention of Duodenal Ulcer Recurrence with Penicillin: A Double-Blind,Placebo-Controlled Trial

Eradication of Helicobacter pylori is associated with a reduced recurrence of duodenal ulcer (DU). The relationship between H. pylori and DU has been interpreted as causal, but the evidence has been criticized for methodologic reasons. To ascertain whether an antibiotic with no effect on epithelial-cell integrity prevents DU recurrence, we conducted a randomized double-blind trial of phenoxy-methylpenicillin (PEN), 2.4 twice daily, and placebo (PLA). Patients with an active DU and positive H. pylori culture from antral biopsy specimens were treated with 40 mg omeprazole daily for 4 weeks, but at week 2 they were allocated at random to PEN (85 patients) or PLA (85 patients) for up to 14 weeks. Those without recurrence during this treatment were followed up for another 6 months. Endoscopy and H. pylori culture were performed at the end of the treatment period and at the end of follow-up, and in between if ulcer symptoms recurred. During the treatment period the ulcer relapse rate was 5 of 58 (9%) in the PEN group and 34 of 68 (50%) in the PLA group (p < 0.0001, log-rank test), with 53% and 14%, respectively, of the patients in the two groups being H, pylori-negative. The relapse rate in the PEN group did not differ between H. pylori-negative and H. pylori-positive patients. The recurrence rate in the PEN group remained low for another 5 months but then approached the rate in the PLA group. The prevalence of H. pylori-negative patients at the end of follow-up was 20% in the PEN group and 10% in the PLA group. These data provide strong evidence that DU has a bacterial cause, with H. pylori as the likely agent.     

Review: Myths and misconceptions in the management of Helicobacter pylori infection

The discovery of Helicobacter pylori infection in 1984 revolutionised the management of several common upper gastrointestinal diseases. However, some of the clinical practices that were adopted following discovery of this organism have become less appropriate over the intervening years. This article discusses five ‘myths and misconceptions’ that we believe have now emerged and which we argue need re-evaluation. Although the prevalence of H. pylori infection is decreasing in some developed countries, it remains a huge global problem and the most serious consequence of infection, gastric adenocarcinoma, is still a major cause of mortality. The epidemiology of H. pylori-related diseases is also changing and careful testing remains crucially important, especially in patients with peptic ulceration. Eradication of H. pylori infection has also become much more difficult over recent years as a result of the widespread acquisition of antibiotic resistance. Routine assessment of the success of eradication should therefore now be performed. Finally, there has been increased awareness about the role of H. pylori in the multistep pathway of gastric carcinogenesis, about the opportunities to prevent cancer development by eradicating this infection in some individuals and about detecting high-risk preneoplastic changes via endoscopic surveillance. The discovery of H. pylori was rightly honoured by the award of the Nobel prize for Physiology and Medicine in 2005. However, unless we re-evaluate and update the ways in which we manage H. pylori infection, much of the fantastic progress that has been made in this field of medicine may tragically be lost once again.