Effect of drug treatment on hyperplastic gastric polyps infected with Helicobacter pylori： A randomized, controlled trial

AIM: To study the effects of drug treatment on hyperplastic gastric polyps infected with Helicobacter pylori (H pylori). METHODS: Forty-eight patients with hyperplastic gastric polyps (3-10 mm in diameter) infected with H pylori were randomly assigned to a treatment group (n = 24) which received proton-pump inhibitor (omeprazole or lansoprazole), clarithromycin, bismuth citrate and tinidazole, and a control group (n = 24) which received protective agent of gastric mucosa (tepretone). Patients underwent endoscopy and H pylori examination regularly before enrollment and 1-12 mo after treatment. RESULTS: Twenty-two patients in the treatment group and 21 in the control group completed the entire test protocol. In the treatment group, polyps disappeared 1-12 mo (average, 6.5+/-1.1 mo) after the treatment in 15 of 22 patients (68.2%) and H pylori infection was eradicated in 19 of the 22 patients (86.4%). However, 12 months after the study, no change in polyps or H pylori status was seen in any controls ((b)P<0.01). CONCLUSION: Most hyperplastic gastric polyps disappear after eradication of H pylori.     

H pylori eradication：A randomized prospective study of triple therapy with or without ecabet sodium

AIM： To investigate whether adding ecabet sodium to the standard triple therapy for H pylori infection improve eradication rate. METHODS： Two hundred and fifty-seven H pylori-infected patients were randomly assigned to standard triple therapy （group A, n = 129） or triple therapy plus ecabet sodium （group B, n = 128）. Successful eradication was defined as a negative 13C-urea breath test 6-8 wk after completion of treatment. RESULTS： After completion of therapy, 194/257 patients showed negative 13C-urea breath test results. According to intention-to-treat analysis, the infection was eradicated in 93/129 （72.1%） patients in group A and 101/128 （78.9%） in group B （P = 0.204）. Per-protocol analysis showed successful eradication in 93/118 （78.8%） patients from group A and 101/114 （88.6%） from group B （P = 0.044）. There were no significant differences in the side effects experienced by the patients in the two treatment groups. CONCLUSION： Our results suggest that the addition of ecabet sodium improves the efficacy of the standard triple therapy for H pylori.     

Treatment of Helicobacter pylori in surgical practice： A randomised trial of triple versus quadruple therapy in a rural district general hospital

AIM： To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori （H pylori） eradication with emphasis on side effect profile, patient compliance and eradication rate at a rural district general hospital in Wales, United Kingdom. METHODS： One hundred one patients with H pylori infection were included in the study. Patients were randomised to receive triple therapy comprising of lansoprazole 30 mg, amoxycillin 1 g, clarithromycin 500 mg, all b.d. （LAC）, or quadruple therapy comprising of lansoprazole 30 mg b.d., metronidazole 500 mg t.d.s., bismuth subcitrate 240 mg b.d., and tetracycline chloride 500 mg q.d.s. （LMBT）. Cure was defined as a negative 13C urea breath test 2 mo after treatment. RESULTS： Seven patients were withdrawn after randomisation. Fifty patients were assigned to LAC group and 44 to LMBT group. The intention-to-treat cure rates were 92% and 91%, whereas the perprotocol cure rates were 92% and 97%, respectively. Side effects were common, with 56% experiencingmoderate to severe symptoms in the LAC group and 59% in the LMBT group. Symptoms of vomiting, diarrhoea and black stools were significantly more common in the LMBT group. Patient compliance was 100% for triple therapy and 86% for quadruple therapy （P 〈 0.01）. One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up. CONCLUSION： One-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy, which can compromise patient compliance. Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen.     

Does Helicobacter pylori infection eradication modify peptic ulcer prevalence？ A 10 years＇ endoscopical survey

AIM: To compare peptic ulcer prevalence in patients referred for upper gastrointestinal endoscopy in two Italian hospitals in pre-Helicobacter era and ten years after the progressive diffusion of eradication therapy. METHODS: We checked all the endoscopic examinations consecutively performed in the Gastroenterology Unit of Padova during 1986-87 and 1995-96, and in the Gastroenterology Unit of Parma during 1992 and 2002. Chi Square test was used for statistic analysis. RESULTS: Data from both the endoscopic centers showed a statistically significant decrease in the prevalence of ulcers: from 12.7% to 6.3% (P< 0.001) in Padova and from 15.6% to 12% (P< 0.001) in Parma. The decrease was significant both for duodenal (from 8.8% to 4.8%, P< 0.001) and gastric ulcer (3.9% to 1.5%, P< 0.001) in Padova, and only for duodenal ulcer in Parma (9.2% to 6.1%, P< 0.001; gastric ulcer: 6.3% to 5.8%, NS). CONCLUSION: Ten years of extensive Helicobacter pylori (H pylori) eradication in symptomatic patients led to a significant reduction in peptic ulcer prevalence. This reduction was particularly evident in Padova, where a project for the sensibilization of H pylori eradication among general practioners was carried out between 1990 and 1992. Should our hypothesis be true, H pylori eradication might in the future lead to peptic ulcer as a rare endoscopic finding.     

Do patients with non-ulcer dyspepsia respond differently to Melicobacter pylorieradication treatments from those with peptic ulcer disease？ A systematic review

AIM: It is controversial whether patients with non-ulcer dyspepsia (NUD) respond differently to Helicobacter pylori (H pylori) eradication treatment than those with peptic ulcer disease (PUD). To review the evidence for any difference in H pylorieradication rates between PUD and NUD patients. METHODS: A literature search for full articles and meeting abstracts to July 2004 was conducted. We included studies evaluating the efficacy of a proton pump inhibitor (P) or ranitidine bismuth citrate (RBC) plus two antibiotics of clarithromycin (C), amoxicillin (A), metronidazole (M), or P-based quadruple therapies for eradicating the infection. RESULTS: Twenty-two studies met the criteria. No significant difference in eradication rates was found between PUD and NUD patients when treated with 7-d RBCCA, 10-d PCA or P-based quadruple therapies. When the 7-d PCA was used, the pooled H pylori eradication rate was 82.1% (431/525) and 72.6% (448/617) for PUD and NUD patients, respectively, yielding a RR of 1.15 (95%CI 1.01-1.29). However, the statistically significant difference was seen only in meeting abstracts, but not in full publications. CONCLUSION: There is no convincing evidence to suggest that NUD patients respond to H pylori eradication treatments differently from those with PUD, although a trend exists with the 7-d PCA therapy.     

Polymerase chain reaction： A sensitive method for detecting Helicobacterpyloriinfection in bleeding peptic ulcers

AIM: To assess the sensitivity and specificity of polymerase chain reaction (PCR) in detecting Helicobacter pylori(H pylon) infection in patients with bleeding peptic ulcers, and to compare its diagnostic efficacy with other invasive and non-invasive tests. METHODS: From April to September 2002, H pylori status in 60 patients who consecutively presented with gastroduodenal ulcer bleeding was examined by rapid urease tests (RUT), histology, culture, PCR, serology and urea breath tests (UBT). RESULTS: The sensitivity of PCR was significantly higher than that of RUT, histology and culture (91% vs 66%, 43% and 37%, respectively; P = 0.01, <0.001, <0.001, respectively), but similar to that of serology (94%) and UBT (94%). Additionally, PCR exhibited a greater specificity than serology (100% vs 65%, P<0.01). However, the specificity of PCR did not differ from that of other tests. Further analysis revealed significant differences in the sensitivities of RUT, culture, histology and PCR between the patients with and those without blood in the stomach (P<0.01, P= 0.09, P<0.05, and P<0.05, respectively). CONCLUSION: PCR is the most accurate method among the biopsy-based tests to detect H pylori infection in patients with bleeding peptic ulcers. Blood may reduce the sensitivities of all biopsy-based tests.     

Triple, standard quadruple and ampicillin-sulbactam-based quadruple therapies for H pylori eradication： A comparative three-armed randomized clinical trial

AIM: To compare the effectiveness of triple, standard quadruple and ampicillin-sulbactam-based quadruple therapies for H pylori eradication in a comparative threearmed randomized clinical trial. METHODS: A total of 360 H pylori-positive patients suffering from dyspepsia and aging 24-79 years with a median age of 42 years were enrolled in the study and randomly allocated into the following three groups: group A (n = 120) received a standard 1-wk triple therapy (20 mg omeprazole b.i.d., 1000 mg amoxicillin b.i.d., 500 mg clarithromycin b.i.d.); group B (n = 120) received a 10-d standard quadruple therapy (20 mg omeprazole b.i.d., 1000 mg amoxicillin b.i.d., 240 mg colloidal bismuth subcitrate b.i.d., and 500 mg metronidazole b.i.d.); group C (n = 120) received the new protocol, i.e. 375 mg sultamicillin (225 mg ampicillin plus 150 mg sulbactam) b.i.d. (before breakfast and dinner), instead of amoxicillin in the standard quadruple therapy for the same duration. Chi-square test with the consideration of P < 0.05 as significant was used to compare the eradication rates by intention-to-treat and per-protocol analyses in the three groups. RESULTS: The per-protocol eradication rate was 91.81% (101 patients from a total of 110) in group A, 85.84% (97 patients from a total of 113) in group B, and 92.85% (104 patients from a total of 112) in group C. The intentionto-treat eradication rate was 84.17% in group A, 80.83% in group B, and 86.67% in group C. The new protocol yielded the highest eradication rates by both per-protocol and intention-to-treat analyses followed by the standard triple and quadruple regimens, respectively. However, the differences were not statistically significant between the three groups. CONCLUSION: The results of this study provide further support for the equivalence of triple and quadruple therapies in terms of effectiveness, compliance and side-effect profile when administered as first-line treatment for H pylori infection. Moreover, the new protocol using ampicillin-sulbactam instead of amoxicillin in the quadruple regimen is a suitable first-line alternative to be used in regions with amoxicillin-resistant H pylori strains.     

Gastrin and antral G cells in course of Helicobacter pylori eradication： Six months follow up study

ABM: To assess long-term effects of Helicobacter pylori (H pylori) eradication on antral G cell morphology and function in patients with and without duodenal ulcer (DU). METHODS: Consecutive dyspeptic patients referred to the endoscopy entered the study. Out of 39 H pylori positive patients, 8 had DU (Hpylori+DU) and 31 gastritis (Hpylori +G). Control groups consisted of 11 uninfected dyspeptic patients (CG1) and 7 healthy volunteers (CG2). Basal plasma gastrin (PGL), antral tissue gastrin concentrations (ATGC), immunohistochemical and electron microscopic characteristics of G cells were determined, prior to and 6 mo after therapy. RESULTS: We demonstrated elevated PGL in infected patients compared to uninfected controls prior to therapy. Elevated PGL were registered in all H pylori+patients (H pylori +DU: 106.78±22.72 pg/mL, H pylori+G: 74.95±15.63, CG1: 68.59±17.97, CG2: 39.24±5.59 pg/mL, P<0.01). Successful eradication (e) therapy in H pylori+patients lead to significant decrease in PGL (H pylori+DU:59.93±9.40 and H pylori+Ge: 42.36±10.28 pg/mL, P<0.001). ATGC at the beginning of the study were similar in infected and uninfected patients and eradication therapy lead to significant decrease in ATGC in H pylori+gastritis, but not in DU patients. In the H pylori+DU patients, the mean number of antral G cells was significantly lower in comparison with all other groups (P<0.01), but after successful eradication was close to normal values found in controls. By contrast, G cell number and volume density were significantly decreased (P<0.01) in H pylori+Ge group after successful eradication therapy (294±32 and 0.31±0.02, respectively), in comparison to values before eradication (416±40 and 0.48±0.09). No significant change of the G cell/total endocrine cell ratio was observed during the 6 mo of follow up in any of the groups. A reversible increase in G cell secretory function was seen in all infected individuals, demonstrated by a more prominent secretory apparatus. However, differences between DU and gastritis group were identified. CONCLUSION: H pylori infection induces antral G cell hyperfunction resulting in increased gastrin synthesis and secretion. After eradication therapy complete morphological and functional recovery is observed in patients with gastritis. In the DU patients some other factors unrelated to the H pylori infection influence antral G cell morphology and function.     

Comparison of esomeprazole enteric-coated capsules vs esomeprazole magnesium in the treatment of active duodenal ulcer： A randomized, double-blind, controlled study

AIM： To evaluate the efficacy and tolerability of two different preparations of esomeprazole in healing duodenal ulcers. METHODS： A total of 60 patients with active duodenal ulcers were enrolled and randomized to receive esomeprazole enteric-coated capsules （40 mg） or esomeprazole magnesium （40 mg）, once daily, for 4 consecutive wk, with ulcer healing being monitored by endoscopy. Safety and tolerability were also assessed. RESULTS： Fifty seven patients completed the whole trial. The ulcer healing rates at the end of wk 2 were 86.7% and 85.2% in the esomeprazole enteric-coated capsules and esomeprazole magnesium groups, respectively （P = 0.8410）, and reached 100% at the end of wk 4 in beth groups. Symptom relief at the end of wk 2 was 90.8% in the esomeprazole enteric-coated capsules group and 86.7% in the esomeprazole magnesium group （P = 0.5406）; at the end of wk 4 symptom relief was 95.2% and 93.2%, respectively （P = 0.5786）. Adverse events occurred in 16.7% of the esomeprazole entericcoated capsules group and 14.8% of the esomeprazole magnesium group （P = 1.0000）. CONCLUSION： The efficacies of esomeprazole entericcoated capsules and esomeprazole magnesium in healing duodenal ulcer lesions and relieving gastrointestinal symptoms are equivalent. The tolerability and safety of beth drugs were comparable.     

Furazolidone therapy for Helicobacter pylori： Is it effective and safe？

Some aspects related with the use of furazolidone as a rescue therapy for Helicobacter pylori （H pylorl） infection should be remarked, especially regarding its potential oncologic risk. The inclusion of furazolidone in a treatment regimen for H pylori infection is, at least, controversial, and it does not appear to be safe.     

以复方铋剂为主的四联疗法根除幽门螺杆菌全国多中心临床研究

目的　观察以复方铋剂 (丽珠胃三联 ,含胶体枸橼酸铋 2 2 0mg、克拉霉素 2 5 0mg和替硝唑5 0 0mg)为中心的三联和四联疗法治疗幽门螺杆菌 (Hp)相关性胃炎及消化性溃疡的疗效 ,并比较丽珠胃三联、丽珠胃三联与H2 受体拮抗剂 (H2 RA)或质子泵抑制剂 (PPI)组成的四联疗法 1周与 2周方案的治疗效果。方法　胃镜和组织学证实Hp阳性的 734例患者中 ,除胃溃疡 12 6例随机入选A2、B2和C2组外 ,十二指肠溃疡 2 0 4例和慢性活动性胃炎 4 0 4例随机分成A1、A2、B1、B2及C1、C2组。A1组 :奥美拉唑 2 0mg +丽珠胃三联 4片 ,均每日 2次× 1周 ;A2组 :组方同前× 2周。B1组 :泰胃美 4 0 0mg +丽珠胃三联 4片 ,均每日 2次× 1周 ;B2组 :组方同前× 2周。C1组 :丽珠胃三联 4片 ,每日 2次× 1周 ;C2组 :组方同前× 2周。治疗结束 4周后 ,溃疡病患者复查胃镜 ,观察溃疡愈合和Hp感染状态 ,胃炎患者作13 C UBT ,观察Hp根除率 ,并采用PP和ITT分析。 结果　按PP分析 ,A2组 (95 .74 % )的Hp根除率显著高于A1(86 .2 7% )、B1(90 .10 % )、C1(84 .0 0 % )和C2组 (88.4 9% ) ;按ITT分析 ,C1组 (5 2 .17% )的溃疡愈合率显著低于A2 (76 .92 % )和B2组 (81.5 8% )。结论　丽珠胃三联是目前根除Hp和愈合消化性溃疡的一种有效且价廉的方     

消化性溃疡与幽门螺杆菌L型感染相关性研究

目的　探讨消化性溃疡 (PU)与幽门螺杆菌 L型 (HP- L )感染的关系。方法　取 386例 PU患者胃窦、胃体及十二指肠粘膜组织 ,常规切片后以革兰氏染色和免疫组化染色镜检 HP- L 型细菌 ,并计算检出率。结果　 HP- L 型检出率为 5 3.37% ,其中革兰氏染色和免疫组化染色检出率分别为 5 6 .73%、5 4 .2 9% ,差异无显著性(P>0 .0 5 ) ;胃溃疡、十二指肠溃疡 HP- L 型检出率分别为 5 8.33%、5 5 .5 0 % ,差异无显著性 (P>0 .0 5 ) ;男女患者HP- L 检出率前者 (6 1.18% )明显高于后者 (38.17% ) (P<0 .0 1) ;30岁以下、30岁～、4 0岁～、5 0岁～患者 HP- L检出率依次为 32 .0 5 %、4 1.94 %、5 9.18%、71.79% ,差异显著 (P<0 .0 1)。结论　 PU患者 Hp- L型感染率较高 ,且男性高于女性 ,HP- L型检出率随年龄增长而增高。 PU患者 HP- L型变异可能是导致溃疡迁延不愈、反复发作的重要原因之一     

幽门螺杆菌与消化性溃疡并出血的研究现状

幽门螺杆菌是消化性溃疡的确定性致病因素,其在溃疡并出血的作用尚不十分明确.目前,幽门螺杆菌在消化性溃疡并出血的感染率受检测方法、药物等影响不尽相同.幽门螺杆菌感染在一定程度上增加了消化性溃疡并出血的危险性,从长远上根除幽门螺杆菌可以降低溃疡出血风险,促进溃疡愈合.     

含枸橼酸铋雷尼替丁疗法根除幽门螺杆菌疗效观察

目的探讨一种安全、有效的幽门螺杆菌（Helicobacter pylori,H.pylori）感染相关消化性溃疡的治疗方案,评价含铋剂的H.pylori根除方案的疗效。方法 2009年1月~2009年12月符合H.pylori感染相关消化性溃疡诊断标准的患者66例,随机分为用枸橼酸铋雷尼替丁0.4＋克拉霉素0.25＋甲硝唑0.4治疗34例和雷贝拉唑10 mg＋克拉霉素0.25＋甲硝唑0.4治疗32例,均为2次/d×7 d,之后治疗组予以枸橼酸铋雷尼替丁0.4,2次/d,对照组雷贝拉唑10 mg,2次/d,巩固治疗35 d。系统治疗完成后6~8周复查胃镜及14C呼气试验检测H.pylori。结果治疗组痊愈20/34（58.8%）,有效9/34（26.5%）,总有效率为85.3%;对照组痊愈18/32（56.3%）,有效8/32（25.0%）,总有效率为81.3%,两组总有效率比较差异无统计学意义（P〉0.05）。结论含铋剂的根除H.pylori方案与雷贝拉唑加克拉霉素、甲硝唑2种抗生素的根除方案治疗H.pylori感染相关溃疡总有效率相近,但具有疗效显著,不良反应轻微的优点。     

非甾体抗炎药应用及幽门螺杆菌感染对消化性溃疡出血的影响

消化性溃疡(peptic ulcer)是消化系统常见的疾病之一,其病因多种多样.消化性溃疡的主要并发症是合并出血.近年来,幽门螺杆菌(Helicobacter pylori, H.pylori)感染和非甾体抗炎药(non-steroidal anti-inflammatory drugs, NSAIDs)应用对溃疡出血的影响日益受到重视.本文总结了这两方面因素与溃疡出血的关系,提出了相应的治疗策略.     

Fourteen-day optimized levofloxacin-based therapy versus classical quadruple therapy for Helicobacter pylori treatment failures: a randomized clinical trial

Abstract

Objective. To test the efficacy of lansoprazole, bismuth, levofloxacin, and amoxicillin therapy compared to bismuth metronidazole tetracycline (BMT) quadruple therapy for second-line treatment of Helicobacter pylori infection. Methods. A total of 284 patients who failed prior H. pylori eradication were randomized to receive 14-day regimens containing lansoprazole 30 mg twice a day (b.i.d.), bismuth subcitrate 240 mg b.i.d., and either amoxcillin, 1 g b.i.d. and levofloxacin 500 mg once daily (qd) (levofloxacin/bismuth therapy) or metronidazole 400 mg four times daily (q.i.d.) and tetracycline, 500 mg q.i.d. (BMT quadruple therapy). Endoscopy and culture were performed before treatment. Antimicrobial susceptibility was by agar dilution. H. pylori status was determined 6 weeks after the end of therapy using a ¹³C-urea breath test. Results. The metronidazole, levofloxacin, tetracycline, and amoxicillin resistance rates were 85.3%, 40.2%, 1.1%, and 0.5%, respectively. The intention-to-treat and per-protocol (PP) eradication rates were 83% (95% confidence interval [CI]: 75.9–88.3%) and 88.1% (95% CI: 81.2–92.4%) (p = 0.22) for levofloxacin-bismuth (levo-bismuth) versus BMT quadruple, respectively, and PP rates were 85.4% (95% CI: 78.5–90.3%) and 90.6% (95% CI: 84.6–94.5%) (p = 0.18). Moderate and severe side effects were significantly higher with BMT quadruple than levo-bismuth (22.4% vs. 5%, p < 0.001) and higher in women (28.4%) than men (10.4%) in BMT quadruple therapy group (p = 0.015). Conclusion. Increasing fluoroquinolone resistance has undermined levo-bismuth quadruple therapy making BMT quadruple therapy a better choice empiric second-line therapy for H. pylori infection. However, compliance was significantly higher with levo-bismuth quadruple therapy, especially among women.     

幽门螺杆菌感染、服用非甾体抗炎药与消化性溃疡的关系

目的 研究消化性溃疡患者由于幽门螺杆菌（H.pylori）感染或服用非甾体抗炎药（NSAIDs）的发生率.方法 选取湖北省武汉市武昌医院2010年3月-2012年7月诊治的152例消化性溃疡患者,将其作为治疗组,同时选取同一时间段到消化科就诊的234例非消化性溃疡患者,将其作为对照组.结果 胃溃疡组感染H.pylori的几率是对照组的2.308倍,十二指肠溃疡组是对照组的8.186倍;胃溃疡组服用NSAIDs的几率是对照组的6.072倍,十二指肠溃疡组是对照组的2.823倍;胃溃疡组同时感染H.pylori和服用NSAIDs的几率是对照组的14.972倍,十二指肠溃疡组是对照组的28.873倍.结论 H.pylori感染同时服用了NSAIDs患者增加消化性溃疡的发生危险性,两种因素同时存在可以起协同作用,增加消化性溃疡的发生几率.     

Maintenance therapy with H2-receptor antagonist until assessment of Helicobacter pylori eradication can reduce recurrence of peptic ulcer after successful eradication of the organism: prospective randomized controlled trial

PURPOSE: This study examined the possible relationship between peptic ulcer recurrence and the presence or absence of maintenance therapy with an H(2)-receptor antagonist performed until evaluation of Helicobacter pylori eradication. METHODS: The subjects were 483 patients with peptic ulcer (281 gastric ulcer and 202 duodenal ulcer) who were diagnosed as H. pylori positive. After receiving eradication therapy for H. pylori, patients were allocated at random to one of three different maintenance therapies: control group (no maintenance therapy), H(2)-receptor antagonist half-dose group, and H(2)-receptor antagonist full-dose group. The maintenance therapy was performed for 4 weeks until evaluation of H. pylori eradication. RESULTS: Among the 25 patients with a recurrent ulcer, 18 patients (72%) had a recurrence at the time of or before evaluation of H. pylori eradication. In the control group, the rate of ulcer recurrence occurring before evaluation of H. pylori eradication was 10.5% (14/133). This rate was significantly higher than those in the H(2)-receptor antagonist half-dose group (2.9%, 4/136) and the full-dose group (0%, 0/135). CONCLUSION: The results of this study suggest that maintenance therapy with an H(2)-receptor antagonist performed after eradication therapy until evaluation of H. pylori eradication is likely to greatly reduce the ulcer recurrence rate without affecting evaluation of H. pylori eradication.     

肝硬化并发消化性溃疡与Helicobacter pylori感染的临床相关性研究

目的探讨Helicobacter phylori(H.pylori)与肝硬化并发消化性溃疡的临床相关性。方法 H.pylori阳性患者1 887例和H.pylori阴性患者685例,采用Logistic回归分析计算其比值比(OR)和95%CI,以此确定H.pylori感染是否是肝硬化并发消化性溃疡的独立因素。结果 100例失代偿期肝硬化合并消化性溃疡患者,H.pylori阳性38例,H.pylori阴性62例。364例代偿期肝硬化并发消化性溃疡患者,H.pylori阳性195例,H.pylori阴性169例。非肝硬化患者消化性溃疡H.pylori阳性1 654例、H.pylori阴性454例。Logistic回归分析显示,失代偿期肝硬化患者(OR=0.25,P0.001)和代偿期肝硬化患者(OR=0.52,P0.001)H.pylori感染率较低。结论 H.pylori感染可能不是肝硬化合并消化性溃疡的主要病因。     

雷贝拉唑在消化性溃疡治疗中的作用及其安全性的大规模临床研究

目的观察雷贝拉唑片剂(波利特)单独应用或联合抗幽门螺杆菌(Hp)治疗对消化性溃疡患者主要症状的治疗作用及其安全性。方法在全国24个省市进行多中心、开放试验。经胃镜诊断为消化性溃疡活动期或愈合期的患者由医师根据其具体情况安排单独应用雷贝拉唑(10mg,每天1次,7d)或联合抗Hp治疗(其中雷贝拉唑为10mg,每天2次,每个疗程5d或7d)。观察治疗前(d0)、用药后第1(d1)、2(d2)、5(d5)和7天(d7)的症状,并记录不良反应。结果试验共入选患者25609例,其中包括胃溃疡、十二指肠溃疡、复合性溃疡、食管溃疡、应激性溃疡、吻合口溃疡。Hp总体阳性率为71.0%。单独用雷贝拉唑者11386例,联合用药14223例。在d1、d2、d5和d7,上腹痛的缓解率分别为63.0%、91.2%、99.2%和99.7%;消失率为16.0%、47.8%、80.3%及94.8%。总体症状缓解率分别为66.5%、94.6%、99.7%和99.9%。上述指标在两组之间比较差异均无统计学意义。共发生不良反应476例(1.9%)。单独用药组147例(1.3%),联合用药组329例(2.3%),两组间比较差异有非常显著意义(P<0.01)。多数不良反应轻微。结论雷贝拉唑在单独用药及与抗Hp药物合用时,对消化性溃疡患者的主要症状都具有明显的治疗作用,并具有良好的安全性。