幽门螺杆菌感染根除后复发的问题

幽门螺杆菌 (Hp)感染被根除后复发率为 0 %～ 4 0 % ,各家报告差异很大 ,复发率高则根除的价值受限。本文就影响复发的因素、复发的预防和治疗等进行综述。     

幽门螺杆菌根除后再感染与溃疡复发

目的明确广州地区十二指肠溃疡患者幽门螺杆菌（Ｈｐ）根除后再感染和溃疡复发情况。方法以１４Ｃ－尿素呼气试验和胃镜检查（尿素酶、组织学及细菌培养），对十二指肠溃疡患者Ｈｐ根除后共１８４例进行２年定期随访，并配合随机引物扩增的ＤＮＡ多态指模技术鉴定Ｈｐ菌株复发与再感染。结果Ｈｐ根除后第１、２年再感染率分别为１．１０％和０．５６％；溃疡复发率分别为２．７２％和０．５６％；全部病例未发生溃疡出血，而同期Ｈｐ未根除的对照组２年溃疡累积再出血率为２６．９％（Ｐ＜０．００５）。结论成人患者Ｈｐ根除后对Ｈｐ再感染不易感，而且发展中国家Ｈｐ根除后再感染率也相当低，以预防溃疡复发为目的的Ｈｐ根除疗法同样适用于高Ｈｐ感染率地区。     

幽门螺杆菌根除后再感染与溃疡复发

为明确本地区患幽门螺杆菌(Hp)根除后再感染和溃疡复发情况，本研究以^14C-尿素呼气试验和胃镜检查(尿素酶、组织学及细菌培养)，对十二指肠溃疡患Hp根除后共184例进行2年定期随访，并配合随机引物扩增的DNA多态指模技术鉴定Hp复发与再感染，结果发现：Hp根除后第1、2年再感染率力0．55%和0．56%，Hp持续阴性仅有1．1%溃疡复发，全部病例未发生溃疡出血，而同期Hp无根除的对照组2年溃疡累积再出血率为26.6%(P<0．005)。结果证明，成人患Hp根除后对Hp再感染不易感，发展中国家Hp根除后再感染率也相当低，以预防溃疡复发为目的的Hp根除疗法同样适用于高Hp感染率地区。     

幽门螺杆菌根除后再感染与溃疡复发

为明确本地区患者幽门螺杆菌(Hp)根除后再感染和溃疡复发情况,本研究以~(14)C-尿素呼气试验和胃镜检查(尿素酶、组织学及细菌培养),对十二指肠溃疡患者 Hp 根除后共184例进行2年定期随访,并配合随机引物扩增的 DNA 多态指模技术鉴定 Hp 复发与再感染。结果发现:Hp 根除后第1、2年再感染率为0.55%和0.56%;Hp 持续阴性者仅有1.1%溃疡复发;全部病例未发生溃疡出血,而同期 Hp 无根除的对照组2年溃疡累积再出血率为26.6%(P<0.005)。结果证明,成人患者 Hp 根除后对 Hp 再感染不易感,发展中国家 Hp 根除后再感染率也相当低,以预防溃疡复发为目的的 Hp 根除疗法同样适用于高 Hp 感染率地区。     

幽门螺杆菌根除后消化性溃疡复发

消化性溃疡的复发一直是一个棘手的问题。近年来 ,许多研究发现根除幽门螺杆菌 (Ｈｐ)可明显降低消化性溃疡的复发 ,但是否能有效替代长期抗酸治疗尚不能肯定。本研究对 4 2例活动期消化性溃疡患者根除Ｈｐ后随访 3年 ,观察消化性溃疡复发及再出血的情况。一、对象和方法1.对象 :5 2例消化性溃疡患者 ,其中十二指肠溃疡 4 9例 ,复合性溃疡 3例 ,均存在Ｈｐ感染 ,合并上消化道出血 16例。男 4 1例 ,女 11例 ,年龄 15～ 71岁 ,平均 4 3岁。上述患者均经胃镜确诊为活动期溃疡 ,胃窦活检 ,快速尿素酶试验及病理检查均为阳性 ,证实有Ｈｐ感染。有…     

影响幽门螺杆菌根除与复发的因素

质子泵抑制剂（PPI）被用于幽门螺杆菌（Hp）的治疗是因为此类药物对抗生素作用于微生物有极大影响。在胃内胃酸能够降解抗生素，而用于治疗Hp的抗生素对酸的敏感性不同。甲硝唑（Metronidazole）在pH2和pH7的胃酸中非常稳定。其半衰期超过800h。阿莫西林（Amoxicillin）虽然在低pH胃酸中不稳定，但其半衰期在pH=2时仍然能够维持15h。相反，克拉霉素（clarithromycin）对酸特别敏感，在pH=2时半衰期〈1h，因此PPI的使用在防止克拉霉素被酸降解方面发挥重要作用。抗生素依靠脂质弥散通过细胞，即药物溶解于细胞膜的脂质中通过浓度梯度转运。药物离子化也发挥作用，非离子化的药物容易通过细胞膜，而多极化分子越过则较为困难。甲硝唑主要以非离子化形式存在于血浆，因此随着胃酸的分泌越过胃的黏膜进入胃液就比较容易。奥美拉唑通过减少酸的分泌从而降低甲硝唑在胃内的浓度．但可以通过减少胃液量从而增加阿莫西林的浓度。     

幽门螺杆菌感染根除后复发的影响

幽门螺杆菌感染被根除后复后０％－４０％，各家报告差异很大，复发率高则根除的价值受限。本文就影响复发的因素，复发的预防和治疗等进行综述。     

幽门螺杆菌感染根除后复发及其影响因素的研究

背景:幽门螺杆菌(Hp)是一种定植于人胃黏膜的革兰阴性杆菌,其感染与多种消化系统疾病密切相关,根除后仍存在复发的可能。目的:探讨Hp感染根除后的复发情况及其影响因素。方法:回顾性分析2015年1月—2018年7月陆军军医大学大坪医院确诊的317例Hp感染患者的临床资料,记录Hp根除后的复发情况,采用单因素分析和多元Logistic回归分析探讨Hp复发的影响因素。结果:25例Hp感染复发,复发率7. 9%。其中10例患者1年内复发,11例1～2年复发,4例2年以上复发。含有克拉霉素+替硝唑的根除方案的Hp复发率最高(37. 5%),而阿莫西林+PPI的优化二联方案的复发率最低(3. 4%)。单因素分析和多元Logistic回归分析显示,较多的家庭人口、消化性溃疡以及根除后接受胃镜检查是Hp感染复发的独立危险因素(P 0. 05)。结论:较多的家庭人口、患有消化性溃疡以及根除后接受胃镜检查是Hp感染复发的危险因素。对于Hp复发的高危人群,需谨慎选择根除率较高的根除方案,并加强后续随访检查。     

幽门螺杆菌根除后消化性溃疡复发情况观察

1996年3月至1998年8月，我们对52例活动期溃疡患者行根除幽门螺杆菌(HP)后随访4年，以观察消化性溃疡复发及再出血情况。现报告如下。     

Long-Term Helicobacter pylori Recurrence after Successful Eradication with Triple Therapy

To establish the rate of Helicobacter pylori recurrence after a standard triple-therapy regimen (bismuth subsalicylate, tetracyeline, metronidazole) and determine which clinical factors affect reinfection, we prospectively followed 118 patients after successful H. pylori eradication. Elimination of H. pylori was confirmed by repeat endoscopy and urea breath test 4 wk after completion of therapy. Serial [¹³]urea breath tests were performed at 3-month intervals; antral biopsies were used to verify reinfection. Recurrence of H. pylori infection occurred in 4/118 (3.4%) patients. Three of the four relapses occurred in the 1st yr after treatment. Gender, age, ethnic group, alcohol consumption, cigarette use, and gastrointestinal diagnosis do not predict H. pylori recurrence. We conclude that the rate of recurrence after successful H. pylori eradication is low, and that when reinfection takes place, if occurs most commonly within the 1st yr after treatment.     

Helicobacter pylori and Duodenal Ulcer Recurrence

Preliminary evidence suggests that eradication of Helicobacter pylori (H. pylori) may lead to prolonged remission of duodenal ulcer (DU). The aim of this study was to assess the long-term effect of eradication of H. pylori on the natural history of DU. Fifty-one patients with endoscopically proven duodenal ulcers, who were found to have H. pylori infection on histology and culture, and who were successfully eradicated of H. pylori with combination treatment of colloidal bismuth subcitrate and antibiotics, were studied. All patients were endoscoped at entry, 4 wk after cessation of treatment and again at 1 yr or sooner, if symptoms recurred. At each endoscopy, two antral biopsies were taken and assessed histologically and microbiologically for evidence of H. pylori infection. Recurrence of H. pylori infection occurred in 18/51 patients (35.3%) and, of these, 12 patients had evidence of recurrent peptic disease (five DU, seven duodenitis). In contrast, of the 33 who remained negative for H. pylori at 1 yr, none developed evidence of recurrent DU. Overall, DU recurrence occurred in 5/51 patients (11.7%), and occurred only in patients reinfected with H. pylori. This relapse rate compares favorably with patients on maintenance H2-receptor antagonist treatment. These results lend further support to the hypothesis that antral reinfection with H. pylori is associated with relapse of DU.     

Helicobacter pylori VacA and Gastric Ulcer

VacA, the only protein toxin produced by Helicobacter pylori, vacuolates cultured cells. The presence of 2 VacA receptors has been demonstrated. One is the receptor-type protein tyrosine phosphatase (RPTP) zeta/beta (PTP zeta/beta), and the other is RPTP alpha. VacA binds to PTP zeta/beta, resulting in gastric epithelial detachment through the tyrosine phosphorylation of Git-1, which then leads to gastric ulceration by the direct action of gastric acid. Thus, disturbance of adhesion between gastric epithelial cells and the extracellular matrix due to an abnormal PTP zeta/beta signal is the main mechanism of gastric ulceration.     

Smoking Does Not Contribute to Duodenal Ulcer Relapse after Helicobacter pylori Eradication

Cigarette smoking is believed to be one of the major factors influencing duodenal ulcer (DU) recurrence. However, the influence of cigarette smoking on DU recurrence after the eradication of Helicobacter pylori has not been separately addressed. The aim of this study was to investigate DU relapse rate in smokers and nonsmokers, both with confirmed eradication of H. pylori. Patients with H. pylori eradication, demonstrated at endoscopy 4 wk post-treatment, were included in the study. Smoking history was obtained with a standard questionnaire, and patients were followed endoscopically, both yearly and at symptomatic recurrence, to detect anatomical DU recurrence. Of the 197 (121M:76F) patients enrolled in the study and followed for 1-6 yr, 80 (41%) were smokers, smoking 5-40 cigarettes/day. The 117 (59%) nonsmokers included 31 (26%) patients who had ceased smoking 4-20 yr ago. Another seven (9%) smokers ceased smoking during the follow-up period. In the 197 patients with eradicated H. pylori and cured DU, there has been no recurrence of ulcer, regardless of smoking status. We conclude that in patients with DU in whom H. pylori infection is eradicated, ulcer disease does not recur, as observed for up to 6 yr. Furthermore, cigarette smoking is not a risk factor for DU recurrence, provided H. pylori is eradicated.     

Regression of Advanced Gastric MALT Lymphoma after the Eradication of Helicobacter pylori

A 66-year-old female presented with a 1-month history of dyspepsia. An initial upper gastrointestinal endoscopy with biopsy revealed a low-grade mucosa-associated lymphoid tissue (MALT) lymphoma. A rapid urease test was positive for Helicobacter pylori. Endoscopic ultrasound (EUS) and computed tomography (CT) revealed a 30×15-mm lymph node (LN) in the subcarinal area. Histopathologic and phenotypic analyses of the biopsy specimens obtained by EUS-guided fine-needle aspiration revealed a MALT lymphoma, and the patient was diagnosed with a stage 4E gastric MALT lymphoma. One year after H. pylori eradication, the lesion had disappeared, as demonstrated by endoscopy with biopsy, CT, fusion whole-body positron emission tomography, and EUS. Here, we describe a patient with gastric MALT lymphoma that metastasized to the mediastinal LN and regressed following H. pylori eradication.     

Characteristics and Early Diagnosis of Gastric Cancer Discovered after Helicobacter pylori Eradication

The prevalence of gastric cancer after eradication (GCAE) is increasing dramatically in Japan. GCAE has characteristic features, and we must understand these features in endoscopic examinations. Differentiated cancer types were frequently found after eradication and included characteristic endoscopic features such as reddish depression (RD). However, benign RD can be difficult to distinguish from gastric cancer because of histological alterations in the surface structures (nonneoplastic epithelium or epithelium with low-grade atypia [ELA]) as well as multiple appearances of RD. Recently, we clarified similar alterations in genetic mutations between ELA and gastric cancer, suggesting that ELA is derived from gastric cancer. Clinically, submucosal invasive cancer was frequently found in patients after eradication therapy even if they received annual endoscopic surveillance. We can improve the diagnostic ability using image-enhanced endoscopy with magnified observation. (Gut Liver 2021;15:-345)     

Bismuth-free Triple Therapy for Eradicating Helicobacter pylori and Reducing the Gastric Ulcer Recurrence Rate

Objectives: The goals of this study were to assess the effectiveness of a new triple therapy consisting of amox–icillin and metronidazoie with plaunotol in the eradication of Helicobacter pylori infection in hnmans, and to determine whether this treatment regimen reduces the rate of recurrence of gastric ulcer in patients infected with H. pylori , without instituting maintenance therapy with H2–receptor antagonists. Methods: Thirty patients with active gastric ulcer who were infected with H. pylori were first treated with omeprazole until scarring occurred. Patients then received plaunotol for 4 wk, with amoxicillin and metronidazoie for 7 days. Results: This triple therapy resulted in the safe eradication of H. pylori in 26 (86.7%) of 30 patients, with no recurrence of ulcer seen during a 12-month follow-up period in patients who tested negative for the presence of H. pylori . In addition, histological inflammatory changes improved in these patients. Of the four patients with persistent H. pylori infection, in three (75%), ulcers recurred. Conclusion: This new triple therapy was very effective in eradicating H. pylori in infected patients and in reducing the rate of recurrence of gastric ulcer in these patients.