努力提高幽门螺杆菌根除率

随着对幽门螺杆菌(Hp)感染危害认知度的提高,其根除指征不断扩大。《幽门螺杆菌胃炎京都全球共识》提出的"治疗所有Hp感染者,除非有抗衡因素"的观点已为越来越多的学者所接受,我国已将"证实有Hp感染"作为根除指征。然而,随着Hp耐药率的增加,其根除率逐渐下降,多次治疗失败者的比例不断增加。本文对Hp根除治疗相关问题进行概述,以期提高Hp感染根除率。     

努力提高幽门螺杆菌根除率(二)

正第二部分如何提高幽门螺杆菌耐药菌株根除率幽门螺杆菌(Hp)对抗菌药物耐药率上升是Hp根除率下降的主要原因。如果Hp对应用的抗菌药物敏感,则目前仍有很多方案的根除率90%,2周疗程根除率甚至95%[1],因此需要提高的是Hp耐药菌株感染的根除率。一、基于药敏试验结果治疗1.随着耐药率的上升,药敏试验受到重视:早年,当标准三联方案[质子泵抑制剂(PPI)+克拉霉     

努力提高幽门螺杆菌根除率(一)

幽门螺杆菌(Hp)根除适应证已从最初的消化性溃疡逐步扩大至"证实有Hp感染"。《幽门螺杆菌胃炎京都全球共识报告》已将Hp胃炎定义为一种感染(传染)性疾病,提出"除非存在抗衡因素,Hp感染者均应给予根除治疗"。当前Hp感染防治中的主要问题已不再是是否需要根除,而是应该如何有效根除。然而,随着Hp对抗菌药物耐药率的上升,Hp根除难度越来越大。本系列讲座就如何提高Hp根除率问题,从以下方面:1根除Hp治疗的现状,2如何提高Hp耐药菌株根除率,3借鉴国际共识,探讨适合我国国情的根除方案,作详尽阐述。     

努力提高幽门螺杆菌根除率(三)

正第三部分借鉴国际共识,探讨适合我国国情的根除幽门螺杆菌方案自2012年第四次全国幽门螺杆菌感染处理共识会议[1]以来,国际上发表了3个重要的幽门螺杆菌(Hp)感染处理共识报告,这些共识报告分别是:《幽门螺杆菌胃炎京都全球共识》[2]、《多伦多成人幽门螺杆菌感染治疗共识》[3]和最近已在互联网上预发表的《幽门螺杆菌感染的处理:Maastricht V/Florence共识》[4]。第一个共识强调了Hp胃炎是一     

幽门螺杆菌根除率的影响因素

正幽门螺杆菌(Hp)感染率在西方国家是20%~50%,发展中国家是80%。Hp与胃炎、消化性溃疡、胃癌等上消化道疾病的发生有关。此外,还与其他肠外疾病包括特发性血小板减少性紫癜、不明原因的缺铁性贫血、胰岛素抵抗(代谢综合征)及慢性特发性荨麻疹密切相关~[1]。有报道,1983—1997年Hp平均根除率为75%~90%,1996—2005年下降     

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。     

慢性胃炎患者口腔幽门螺杆菌对胃幽门螺杆菌根除率的影响

幽门螺杆菌(Helicobacter pylori,Hp)是一类微需氧、革兰染色阴性、能移动的螺杆菌,一旦感染,绝大多数长期在胃内定植,极少数可自然消退(每年约1%).近年来的研究表明,Hp是慢性胃炎和十二指肠溃疡的主要致病因素,与胃溃疡密切相关,与胃癌的发生有关[1].     

溃疡分期对幽门螺杆菌根除率的影响

背景:幽门螺杆菌(Hp)感染与多种胃肠道疾病的发生相关。研究表明,Hp根除率可能受疾病种类、疾病进展阶段的影响。目的:探讨内镜下溃疡分期对Hp根除率的影响。方法:收集2015年1月—2016年7月新疆维吾尔自治区人民医院收治的Hp感染消化性溃疡(PU)患者423例,其中胃溃疡(GU)组133例,十二指肠溃疡(DU)组255例,予14 d含铋剂四联疗法根除Hp治疗。比较不同内镜分期溃疡患者Hp根除率的差异,对Hp根除率影响因素进行单因素分析。结果:GU与DU组间Hp根除率差异无统计学意义(82.7%对83.9%,P0.05)。GU组活动期溃疡患者根除率显著高于非活动期(89.0%对75.0%,P0.05),而DU组两亚组间根除率无明显差异(85.6%对83.0%,P0.05)。单因素分析显示,溃疡分期与是否能成功根除Hp相关,活动期PU患者根除率显著高于非活动期(87.8%对80.3%,P0.05)。结论:内镜下溃疡分期与PU尤其是GU患者的Hp根除率有关,在溃疡活动期进行Hp根除治疗能显著提高根除率。     

口腔幽门螺杆菌感染与胃幽门螺杆菌感染及根除率的相关性

目的:探讨口腔幽门螺杆菌(Helicobacter pylori,H.pylori)感染与胃H.pylori感染及根除率的相关性.方法:对150例患者采用~(14)C-尿素呼气试验(~(14)C-urea breath test,~(14)C-UBT)、胃黏膜组织学检查(改良Giemsa染色)及细菌培养联合检测来判断胃内H.pylori感染情况,用H.pylori唾液测试板(HPS法)判断口腔H.pylori感染情况.选取胃与口腔H.pylori均阳性患者81例,随机分组后分别予以方案A(常规四联药物)或方案B[常规四联药物+多聚赖氨酸复合体漱口液(迪倍思)清洁口腔]治疗,胃H.pylori阳性、口腔H.pylori阴性患者27例则全部予方案A治疗,治疗结束后4、12 wk复查~(14)C-UBT及HPS观察胃及口腔H.pylori感染及根除情况.结果:150例患者中,胃H.pylori阳性患者口腔H.pylori阳性率75.00%(81/108)高于胃H.pylori阴性患者口腔H.pylori阳性率38.10%(16/42),差异有统计学意义(X~2=18.025,P0.05),治疗后4wk方案A胃H.pylori根除率:口腔H.pylori阳性组为60.98%(25/41),低于口腔H.pylori阴性组88.89%(24/27),两组比较有统计学差异(X~2=6.300,P0.05);方案B治疗胃H.pylori根除率90.00%(36/40),口腔H.pylori根除率65.00%(26/40),均高于方案A治疗组(60.98%、17.07%),比较有统计学差异(X~2=7.168,P0.05),治疗后12 w k各组根除率比较与4 wk结果类似.结论:口腔H.pylori感染与胃H.pylori感染有相关性,并可降低常规药物治疗H.pylori的根除率;口腔与胃的多途径综合治疗方案可显著提高H.pylori感染的根除率.     

Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection

AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid , clarithromycin 500 mg bid , and amoxicillin 1000 mg bid ; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107 Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods. RESULTS:PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction. CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.     

共同治疗策略对根除幽门螺杆菌的影响

[目的]研究存在幽门螺杆菌(Hp)感染家庭聚集的感染患者Hp根除治疗后复发情况,探讨共同根除治疗策略对远期根除Hp的影响。[方法]通过对内镜检查确诊的195例Hp感染患者的家庭成员采用13碳呼气试验进行Hp感染调查,筛选有家庭成员Hp感染的患者140例。按照对Hp感染家庭成员有无根除治疗,将140例随机分成家庭成员共同根治组和单独根治组,每组70例。治疗后每月随访患者感染复发情况,观察不同根治策略对Hp根除的影响。[结果]134例患者参与根治后4、6、12、18、24个月随访,其中家庭成员共同根除治疗患者68例,Hp感染复发患者分别为0、1、2、4、5例,累积复发率为7.4%,平均复发时间为(12.6±6.1)个月;而66例单独根治患者复发者则分别为3、5、9、11、13例,累积复发率为19.7%,平均复发时间为(11.1±6.3)个月。χ2检验分析发现,在根除治疗后4、6个月时,2组复发率比较差异无统计学意义(P0.05);随着时间推移,治疗后12、18、24个月,共同根治组患者Hp感染再发率显著少于单独根治组(P0.05)。[结论]从远期观察,对于存在Hp感染家庭聚集的Hp感染患者,Hp感染成员共同根除治疗可有效降低根治后感染再发。     

Economics of Helicobacter pylori eradication therapy

The annual incidence of peptic ulcer disease in developed countries is around one to three per thousand inhabitants. Since the introduction of acid-secretion inhibitors, the indirect costs of this disease, which has a high rate of relapse, have steadily decreased, although direct costs have been increasing. The possibility of healing the patient through Helicobacter pylori eradication has the potential for a huge economic impact considering the long-term cost: benefit ratio. A recent study has shown that H. pylori eradication therapy can save between US$750,000 and US$1,000,000 per year per million inhabitants in western Europe compared to maintenance or episodic therapy. This paper reviews the cost implications of various management strategies for peptic ulcer disease, comparing the cost: benefit ratios of five different treatment regimens.     

Helicobacter pylori eradication in the Swedish population

Objectives: Helicobacter pylori is associated with peptic ulcers and gastric cancer and its eradication aims to prevent these conditions. The recommended eradication regimen is triple therapy, consisting of a proton-pump inhibitor in combination with clarithromycin and amoxicillin or metronidazole for 7 days. Yet, other antibiotic regimens are sometimes prescribed. We aimed to assess the use of eradication therapy for H. pylori in the Swedish population during the last decade.

Materials and methods: This population-based study used data from the Swedish Prescribed Drug Register. From July 2005 until December 2014, all regimens that can eradicate H. pylori were identified and evaluated according to patients’ age and sex and calendar year of eradication.

Results: We identified 157,915 eradication episodes in 140,391 individuals (53.8% women, 42.6% older than 60 years), who correspond to 1.5% of the Swedish population. The absolute number and incidence of eradications decreased over the study period. Overall, 91.0% had one eradication and 0.1% had more than three. Of all eradications, 95.4% followed the recommended regimen, while 4.7% did not. The latter group was overrepresented among individuals aged ≥80 years (7.8%). Amoxicillin and clarithromycin were most frequently prescribed, while metronidazole was rarely used (0.01%). Other prescribed antibiotics were ciprofloxacin (2.4%), doxycycline (1.4%), nitrofurantoin (0.7%), norfloxacin (0.5%) and erythromycin (0.3%).

Conclusions: During the last decade in Sweden H. pylori eradication has been frequently prescribed, but the incidence of eradication has slowly declined. Most eradications followed the recommended regimen, including those occurring after a previous eradication.     

关注幽门螺杆菌根除治疗适应证的修改

自2003年第二次全国幽门螺杆菌共识会议(安徽桐城)以来,有关幽门螺杆菌及其相关疾病的研究又获得了很大进展.     

Helicobacter pylori eradication therapy in Korea

Helicobacter pylori (H. pylori) is known to be associated with many gastrointestinal diseases including peptic ulcer. In Korea, eradication of H. pylori is recommended for peptic ulcer disease, low grade gastric mucosa-associated lymphoid tissue lymphoma, and early gastric cancer. Standard triple therapy using proton pump inhibitor, clarithromycin, and amoxicillin and bismuth-containing quadruple therapy have been the main first-line and second-line therapy for H. pylori in Korea. Although eradication rate of second-line quadruple therapy remains similar to that of the past, the success rate of eradication with triple therapy has decreased with increasing antimicrobial resistance to H. pylori. There is no standard third-line therapy, and some regimens that incorporate levofloxacin, moxifloxacin, and rifabutin can be used. New regimens such as sequential or concomitant therapy are suggested as alternative treatment for H. pylori. We need more well designed randomized controlled studies to choose proper treatment for H. pylori infection.