根除Hp治疗对高原地区Hp相关性溃疡患者血清6种细胞因子水平的影响及其临床意义

目的观察根除幽门螺杆菌治疗对高原地区幽门螺杆菌相关性溃疡病患者血清IL-1β、IL-2、IL-4、IL-6、IL-8和TNF水平的影响,以探讨其在溃疡病发病中的可能致病机理。方法应用放射免疫法测定55例溃疡病患者血清6种细胞因子的含量,比较幽门螺杆菌感染与非感染患者含量的差异,对幽门螺杆菌感染患者进行以洛赛克为中心的三联1周疗法,比较根除前后及根除者和未根除者其含量的差异,同时比较幽门螺杆菌根除组和未根除组溃疡的愈合率。结果55例患者中,幽门螺杆菌感染者30例,感染者血清IL-4含量明显低于非感染者(P<0.01),幽门螺杆菌根除后其含量极明显高于根除前(P<0.001),未根除者前后比较无变化(P>0.05),根除者明显高于未根除者(P<0.05),而根除幽门螺杆菌治疗对IL-1β、IL-2、IL-6、IL-8和TNF均无显著性影响(P>0.05),幽门螺杆菌根除组溃疡愈合率明显高于未根除组(P<0.05)。结论幽门螺杆菌感染后IL-4降低导致的Th2免疫应答下调可能是幽门螺杆菌相关性溃疡病发生的主要致病机制之一;根除幽门螺杆菌可使IL-4分泌明显增加,Th2免疫应答上调,从而加速溃疡愈合;血清IL-4的检测有望成为根除幽门螺杆菌和溃疡愈合疗效判定的有用指标。     

双歧杆菌四联活菌片联合三联疗法治疗耐药幽门螺杆菌感染患者临床研究

目的探讨采用双歧杆菌四联活菌片联合三联疗法治疗耐药幽门螺杆菌感染患者的临床效果。方法选取2017年2月至2018年8月在我院治疗的十二指肠球部溃疡耐药幽门螺杆菌感染患者120例,随机分为观察组与对照组,每组60例。对照组患者给予铋剂四联方案(铋剂+质子泵抑制剂+四环素+甲硝唑)治疗,观察组患者给予双歧杆菌四联活菌片联合三联疗法(奥美拉唑+阿莫西林+四环素)治疗,连续治疗2周。比较两组患者的治疗效果、血清胃蛋白酶原I(PGI)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素17(G-17)水平以及不良反应发生情况。结果治疗2周后,两组患者溃疡愈合率和症状缓解率比较,差异无统计学意义(P0.05);观察组患者的幽门螺杆菌清除率(91.7%)明显高于对照组(65.0%),差异有统计学意义(P0.05)。两组患者的血清PGI、PGⅡ、G17水平均明显降低,观察组患者的水平显著低于对照组,差异有统计学意义(P0.05)。观察组患者的不良反应发生率(5.0%)显著低于对照组(20.0%),差异有统计学意义(P0.05)。结论双歧杆菌四联活菌片联合三联疗法治疗十二指肠球部溃疡耐药幽门螺杆菌感染患者,能显著提高幽门螺杆菌清除率,降低血清胃蛋白酶原与胃泌素水平,治疗安全性好,值得推广使用。     

幽门螺杆菌感染对老年消化性溃疡患者血清PGⅠ、PGⅡ、GS、PINP、TNF-α水平的影响

目的 探讨幽门螺杆菌感染对老年消化性溃疡患者血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素(GS)、Ⅰ型胶原氨基端前肽(PINP)、肿瘤坏死因子α(TNF-α)水平的影响。方法 本研究选取我院诊治的老年消化性溃疡患者200例,根据幽门螺杆菌感染状况分为阳性组(134例,其中胃溃疡82例、十二指肠溃疡52例)与阴性组(66例,其中胃溃疡40例、十二指肠溃疡26例),采用双抗体夹心酶联免疫吸附法检测血清PGⅠ、PGⅡ、GS、PINP、TNF-α水平。结果 幽门螺杆菌感染阳性消化性溃疡患者血清PGⅠ、PGⅡ、GS、TNF-α水平高于阴性患者(P<0.05),PINP低于阳性患者(P<0.05)。胃溃疡及十二指肠溃疡幽门螺杆菌感染阳性患者血清PGⅠ、PGⅡ、GS、TNF-α水平高于阴性患者(P<0.05),PINP低于阳性患者。十二指肠溃疡患者血清PGⅠ、GS高于胃溃疡患者(P<0.05),PINP低于胃溃疡患者(P<0.05),PGⅡ及TNF-α水平比较差异无统计学意义(P>0.05)。结论 幽门螺杆菌对老年消化性溃疡患者血清PGⅠ、PGⅡ、G...     

复方温中愈疡汤联合奥美拉唑治疗阳虚血瘀型十二指肠溃疡患者临床研究

目的探讨复方温中愈疡汤联合奥美拉唑治疗阳虚血瘀型十二指肠溃疡患者的临床效果及其安全性。方法将阳虚血瘀型十二指肠溃疡患者92例随机分为对照组和研究组,每组46例。对照组患者给予奥美拉唑治疗,研究组患者给予复方温中愈疡汤联合奥美拉唑治疗,两组患者均持续治疗5周。比较两组患者治疗前后中医症状评分、两组患者的临床疗效、幽门螺杆菌根除率、治疗半年后复发率及不良反应发生情况。结果治疗后,两组患者中医症状评分均显著降低(P0.05);研究组患者中医症状评分显著低于对照组、治疗总有效率和幽门螺杆菌根除率高于对照组(P0.05);研究组患者不良反应发生率显著低于对照组(P0.05);治疗半年后研究组患者复发率显著低于对照组(P0.05)。结论复方温中愈疡汤联合奥美拉唑治疗阳虚血瘀型十二指肠溃疡,临床疗效显著,安全性高,值得推广应用。     

黄芪建中汤联合奥美拉唑肠溶片治疗消化性溃疡46例疗效观察

目的观察黄芪建中汤联合奥美拉唑肠溶片治疗消化性溃疡的临床疗效。方法将91例患者随机分为两组,对照组45例,观察组46例,对照组患者口服奥美拉唑肠溶片治疗,观察组患者在同对照组治疗的基础上加用黄芪建中汤加减(药用:黄芪、党参、桂枝、白芍、炙甘草、炒白术、生姜、大枣)治疗。幽门螺杆菌阳性者口服甲硝唑片、阿莫西林胶囊1周,总疗程均为4周。观察比较两组患者症状改善情况、内镜下溃疡愈合情况和幽门螺杆菌根除效果。结果两组患者幽门螺杆菌根除率比较差异无统计学意义(P0.05),观察组症状积分、在内镜下溃疡愈合情况优于对照组(P0.05)。结论黄芪建中汤联合奥美拉唑肠溶片治疗消化性溃疡(脾胃虚寒型)能有效改善患者临床症状,提高幽门螺杆菌根除率,优于单纯使用奥美拉唑肠溶片治疗,值得临床推广应用。     

幽门螺杆菌感染对胃上皮细胞凋亡的影响

本文采用切口末端标记方法前瞻性观察了16例正常胃牯膜标本和31例幽门螺杆菌阳性胃炎患者抗幽门螺杆菌治疗前后胃窦部上皮细胞凋亡的变化。结果表明,幽门螺杆菌感染者的凋亡指数(0.7044)明显高于正常对照者(P<0.005);幽门螺杆菌根除后凋亡指数由0.7624降至0.1159(P<0.005),而持续阳性者则无明显降低;凋亡指数与胃炎程度无关。提示幽门螺杆菌能促进胃上皮细胞凋亡,这可能是幽门螺杆菌引起胃癌和溃疡的重要机理。     

奥美拉唑联合双歧三联活菌散剂根治幽门螺杆菌的临床疗效观察

目的观察奥美拉唑联合双歧三联活菌散剂根治幽门螺杆菌的疗效。方法选择100例消化性溃疡和慢性胃炎伴有幽门螺杆菌感染的患者,将其随机分成观察组和对照组。观察组给予奥美拉唑、双歧三联活菌散剂治疗,对照组给予奥美拉唑镁、阿莫西林、甲硝唑治疗,应用14C-尿素呼气试验检测有无幽门螺杆菌感染。结果观察组幽门螺杆菌根治率为78%,对照组幽门螺杆菌根治率为82%,两组疗效比较,差异无统计学意义(P>0.05)。结论奥美拉唑钠联合双歧三联活菌散剂根除幽门螺杆菌有一定疗效,值得借鉴。     

影响EMR相关溃疡愈合的相关因素分析

目的探讨影响内镜下黏膜切除术(EMR)致溃疡愈合的相关因素,确定奥美拉唑治疗EMR相关溃疡的适宜疗程。方法39例EMR手术病人,术后服用奥美拉唑20mg,共28d;EMR术后第1、2、4周,行内镜检查溃疡面积及分期,并与初始EMR相关溃疡的面积进行比较。同时记录病人的年龄、EMR术式、幽门螺杆菌(Hp)感染情况、病理结果、病损部位、服药的剂量及相关症状。结果EMR术后第2周、第4周其溃疡分期及溃疡愈合率无明显差异(P>0.05),而与第1周相比均有明显差异(P<0.01)。EMR相关溃疡的愈合与患者年龄、性别、病理结果、Hp感染溃疡部位无关(P>0.05),而与吸烟、非甾体抗炎药物、EMR术式有关(P<0.01)。吸烟、服用非甾体抗炎药物者愈合质量差,单纯EMR愈合最好,而黏膜下注射法分片黏膜切除术(EMR-P)及透明帽辅助法黏膜切除术(EMR-C)溃疡愈合差。结论应用奥美拉唑2~4周均可有效治疗EMR相关溃疡,用药4周溃疡愈合质量高,禁烟、禁服甾体抗炎药物、根除Hp有利于溃疡愈合。     

雷贝拉唑与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

目的探究奥美拉唑和雷贝拉唑三联疗法对幽门螺杆菌阳性消化溃疡的临床疗效和安全性。方法将我院160例幽门螺杆菌(H.pylori)阳性消化性溃疡患者为研究对象,随机分为对照组(79例)和实验组(81例),对照组口服奥美拉唑、甲硝唑、阿莫西林,服用2周后停用抗生素,单独服用奥美拉唑,连用6周,实验组服用雷贝拉唑、甲硝唑、阿莫西林,服用2周后停用抗生素,单独服用雷贝拉唑,连用6周,查看两组患者胃镜所见、胃pH值和H.pylori检测来判断两组治疗效果。结果两组用药后3 d症状明显改善,实验组改善情况优于对照组(P0.05);治疗7 d后比较,两组间数据无显著差异(P0.05);治疗30 d后,实验组改善情况优于对照组(P0.05)。停止治疗1个月后行胃镜检查,对照组总有效率83.54%;实验组总有效率97.53%,雷贝拉唑三联疗法总有效率明显高于奥美拉唑三联疗法(P0.05)。结论雷贝拉唑三联疗法比奥美拉唑三联疗法能有效的治愈消化性溃疡和根除H.pylori,且安全性高。     

雷贝拉唑联合克拉霉素、阿莫西林治疗胃溃疡的疗效观察

目的研究雷贝拉唑联合克拉霉素、阿莫西林治疗胃溃疡的疗效。方法将我院2015年3月~2016年2月收治的胃溃疡患者100例,各50例。奥美拉唑组用奥美拉唑联合克拉霉素、阿莫西林治疗;雷贝拉唑组采取雷贝拉唑联合克拉霉素、阿莫西林治疗。就两组患者治疗前后白细胞介素-6、C反应蛋白水平和治疗效果、幽门螺杆菌转阴率进行比较。结果雷贝拉唑组治疗效果明显高于奥美拉唑组(P0.05)。雷贝拉唑组幽门螺杆菌转阴率明显高于奥美拉唑组(P0.05)。雷贝拉唑组患者治疗后白细胞介素-6、C反应蛋白水平均明显优于奥美拉唑组(P0.05)。结论雷贝拉唑联合克拉霉素、阿莫西林治疗胃溃疡的临床疗效确切,可有效根除幽门螺杆菌,降低炎症水平,值得借鉴。     

Changing pattern of peptic ulcer in India. An endoscopic study of 1,188 ulcer patients.

Earlier studies have described a profile of peptic ulcer different in developing and developed countries. In a prospective endoscopic study in India over 5 years and 8 months involving 5,948 patients with upper gastrointestinal symptoms, we detected peptic ulcers in 1,188. There were 920 patients with duodenal ulcer (DU), 185 with gastric ulcer (GU), and 83 with combinations of the two. The male to female ratio was 4.2:1. About half the ulcers were in patients age greater than or equal to 40 years. Of the 223 (18.7%) patients with peptic ulcer complications, gastrointestinal bleeding was the most common (12.7%) and gastric outlet obstruction was less common (6.2%). Endoscopic evidence of duodenal bulb deformity was seen in 74.4% of DU patients. A comparison of these results with data from previous Indian studies suggests a changing trend of peptic ulcer with respect to age and sex distribution, the ratio between DU and GU, and complications of peptic ulcer. The profile of peptic ulcer in north India today is similar to that seen in Western countries four to five decades ago. We discuss possible factors responsible for this change.     

维敏四联治疗Hp相关的消化性溃疡

目的应用维敏胶囊（胶态果胶铋）四联药物疗法治疗Hp相关的消化性溃疡（PU）2wk，停药4wk后经内镜、14C-UBT等方法观察溃疡的愈合及Hp根除的疗效方法经内镜确诊为PU，其中十二指肠溃疡（DU）169例；胃溃疡（GU）89例．受检前2wk内未服抗生素、铋剂及质子泵阻断剂，排除孕妇和溃疡出血者，并镜下活检病理排除恶性溃疡Hp检测：先行快速尿素酶检测（RUT），阳性者再行14C-UBT检测，其中DU的Hp阳性率为95．5％；GU的Hp阳性率为81．0％．四联治疗方法：对Hp阳性PU，给予维敏胶囊100mg，4次／d；兰索拉唑30mg，2次／d；阿莫西林0．5g，4次／d；甲硝唑0．4g，2次／d，疗程为2wk．停药后4wk，同时复查内镜及14G-UBT．结果DU愈合率91．2％，Hp根除率93．0％；GU愈合率86．0％，Hp根除率92．0％．DU和GU愈合率及Hp根除率差异不明显（P＞0．05）；四联疗法后肝肾功能无异常结论Hp与PU关系密切．采用四联治疗Hp相关的PU，有良好效果．14GUBT检测Hp感染具有很高的敏感性和特异性，无创伤性，是治疗后复查Hp的首选方法     

消化性溃疡,胃癌患者胃窦粘膜中胃肠激素含量变化及其意义

研究了胃十二指肠疾病患者胃窦粘膜胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ－物质（ＳＰ）的含量变化及其意义。结果表明：胃窦粘膜ＳＳ含量在胃溃疡组低于其余各组（Ｐ均〈０．０５），而在胃癌时则显著增高（Ｐ〈０．００１）；ＳＰ浓度在十二指肠溃疡组显著低于其余各组（Ｐ均〈０．０５）；胃癌患者Ｇａｓ水平显著高于对照组（Ｐ〈０．０５）；ＳＳ与ＳＰ在十二指肠溃时呈明显负相关。提示：胃粘膜中Ｇａｓ、ＳＳ、ＳＰ的含量变     

白细胞介素-1基因多态性与消化性溃疡的关系

背景：大量临床流行病学证据表明消化性溃疡发病率的地域差异与宿主免疫遗传因素密切相关,目前宿主炎症因子基因多态性与消化性溃疡的关系正受到广泛关注。目的：探讨白细胞介素（IL）-1B-511、IL-1RN基因多态性与消化性溃疡的关系。方法：选取2008年9月～2009年5月昆明医学院第一附属医院确诊的57例十二指肠溃疡（DU）、38例胃溃疡（GU）以及40例非萎缩性胃炎（NAG）患者。以快速尿素酶试验和Giemsa染色检测幽门螺杆菌（H.pylori）感染,采用PCR-RFLP检测IL-1B-511、IL-1RN基因多态性。分析IL-1基因多态性、H.pylori感染、年龄与不同疾病之间的关系。结果：NAG、DU和GU组之间H.pylori感染率、IL-1B-511、IL-1RN基因型频率的差异无统计学意义。与NAG和DU相比,年龄≥60岁是GU的危险因素（OR=5.650,95%CI：1.811～17.624;OR=3.159,95%CI：1.254～7.955）。IL-1B-511、IL-1RN基因型和H.pylori感染与消化性溃疡类型无关（P〉0.05）。结论：在昆明市,年龄≥60岁是GU的危险因素,IL-1基因多态性与消化性溃疡无关。     

Influence of climatic factors in the incidence of upper gastrointestinal bleeding

BACKGROUND AND AIM: Previous reports have indicated seasonal fluctuations in the incidence of peptic ulcer activity, but the reasons for the seasonal pattern are not clear. We assessed the seasonal incidence of hematemesis caused by peptic ulcers or gastroesophageal varices, and the correlations between those and climatic factors. METHODS: We examined the number of cases of upper gastrointestinal (GI) bleeding caused by gastric ulcer (GU), duodenal ulcer (DU), or gastroesophageal varices (varix) diagnosed by urgent endoscopies between 1 January 1996 and 31 December 1999 in our hospital (Tokyo Metropolitan Bokutou Hospital). We evaluated the monthly and seasonal incidence of them and investigated correlations among the incidence and climatic factors. RESULTS: Four hundred and forty-one patients participated in this study, including 275 patients with GU (62.4%), 51 (11.6%) with DU, and 115 (26.0%) with varix. The number of cases of hematemesis caused by GU showed significant monthly and seasonal fluctuations (P = 0.0002, P = 0.0018): it decreased in summer and increased in autumn-winter. Moreover, there were inverse relations between the monthly number of cases of hematemesis caused by GU and the mean temperature (P = 0.0016) and vapor pressure (P = 0.0013), and a parallel relation to the mean atmospheric pressure (P = 0.0057). In contrast, the number of cases of hematemesis caused by DU and varices did not show any monthly or seasonal fluctuations. CONCLUSIONS: We found that the incidence of hematemesis because of GU had an inverse relationship to temperature and vapor pressure, and had a parallel relation to atmospheric pressure. Therefore, climatic factors may play an important role in hemorrhage from GU.     

Long-term Follow-up of Endoscopic Treatment for Bleeding Gastric and Duodenal Ulcers

Objective: To examine the long-term consequences of endoscopic therapy for bleeding peptic ulcers. Methods: Eighty-seven consecutive patients who underwent endoscopic treatment for bleeding gastric ulcer (GU) and/or duodenal ulcer (DU) over a 42-month period were identified. Long-term follow-up was available for 76 (mean, 495 days; SEM, 45 days). Therapy consisted of epinephrine injection, heater probe use, or both. Recurrent hemorrhage only at the primary treatment site was considered. Results: The sites of hemorrhage were GU (40 patients), DU (34 patients), and both (2 patients). Emergent surgery was required in two GU patients for whom endoscopic treatment was ineffective. Recurrent hemorrhage ultimately occurred in 33% of patients—40% of GU and 25% of DU patients. Surgical therapy was eventually required in 26% of patients after endoscopic he-mostasis and was more frequent in patients with recurrent hemorrhage from DU than GU (78% vs 56%). For those patients who re-bled within 8 days of the index endoscopy, 82% required surgery, compared with 33% of patients who re-bled more than 8 days after the index endoscopy ( p = 0.03). Conclusions: The rate of recurrent hemorrhage after endoscopic hemostasis for bleeding GU and DU was 33% in our long-term follow-up. After endoscopic hemostasis, surgery was eventually required in 24% of all patients and in 64% of patients who had recurrent hemorrhage. Patients who had recurrent hemorrhage more than 1 wk after initial endoscopic hemostasis were effectively treated by repeated endoscopic therapy and were significantly less likely to require surgery than patients who re-bled within 1 wk.     

Clinical relevance of Helicobacter pylori CagA-positive strains: gastroduodenal peptic lesions marker.

OBJECTIVES: peptic ulcer is characterized by its recurrent nature, which necessitates maintenance treatment in most patients. But this natural history can be changed in patients with peptic ulcer associated to Helicobacter pylori, as shown by the low rates of recurrence and decreased hemorrhagic recidivism associated with this infection. Whether CagA or VacA strains are associated with a greater risk of peptic ulcer is controversial. This study was designed to examine endoscopic findings and their relation with H. pylori phenotype (CagA or VacA). METHODS: 106 selected dyspeptic patients underwent upper gastrointestinal tract endoscopic examination between September 1996 and May 1997 [69 with H. pylori (Hp) and 37 without this infection]. Endoscopic findings were classified as gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenitis (Du), chronic gastritis (CG) and normal mucosa (NM). Hp phenotype was analyzed with a western blot test. RESULTS: 75% of H. pylori strains were CagA-positive and 54.2% were VacA-positive. 82.4% of the cases of DU were associated with a CagA+ phenotype, but the association was not statistically significant. Otherwise 100% of gastric ulcers were associated with CagA+ strains (p < 0.005). VacA phenotype was not associated with any particular endoscopic finding. Peptic ulcer (DU or GU) was also associated with the CagA+ phenotype (p < 0.05). CONCLUSIONS: the CagA+ H. pylori phenotype seems to be a peptic lesion marker, but was more frequently related with GU than with DU in our sample of Spanish patients.     

奥美拉唑镁肠溶片与奥美拉唑胶囊治疗消化性溃疡的临床随机对照研究

目的　验证奥美拉唑镁肠溶片与奥美拉唑胶囊治疗消化性溃疡的生物等效性及评价其不良反应。方法　采用随机对照和开放试验的方法治疗经胃镜检查证实的消化性溃疡共 171例 ,其中奥美拉唑镁肠溶片组 (试验组 ) 68例 ,胃溃疡 2 1例 ,十二指肠溃疡 47例 ;奥美拉唑胶囊组 (对照组 ) 67例 ,其中胃溃疡 2 1例 ,十二指肠溃疡 46例 ;开放试验组 3 6例 ,其中十二指肠溃疡 2 9例 ,胃溃疡 7例。结果　试验组中胃溃疡的愈合率和总有效率分别为 80 9%和 10 0 %十二指肠溃疡的愈合率和总有效率分别为87 2 %和 97 8% ;对照组中胃溃疡的愈合率和总有效率为 85 7%和 95 2 % ,十二指肠溃疡的愈合率和总有效率为 84 7%和 97 8% ;开放试验组中胃溃疡的愈合率和总有效率均为 10 0 0 %十二指肠溃疡的愈合率和总有效率分别为 86 2 %和 10 0 % ;试验组中疼痛消失率及其他消化道症状的消失率在胃溃疡为 95 2 %和 89 0 %在十二指肠溃疡则为 97 8%和 98 3 % ;对照组中疼痛及其他消化道症状的消失率在胃溃疡为 95 2 %和 92 7% ,在十二指肠溃疡为 97 8%和 98 7%。两组在愈合率、总有效率、疼痛消失率和其他消化道症状消失率方面相比均无显著差别 (P >O 0 5 )。两组在治疗过程中均未见明显的不良反应。结论　奥美拉唑镁肠溶片与奥     

Anti-CagA and anti-VacA antibodies in Helicobacter pylori-infected patients with and without peptic ulcer disease in Serbia and Montenegro

BACKGROUND: The expression of two Helicobacter pylori proteins, CagA and VacA, is associated with more severe pathogenesis and clinical outcomes of the infection. However, this association varies among geographical regions and ethnic groups. We therefore evaluated CagA and VacA seroprevalence in H. pylori-positive dyspeptic patients in Serbia and Montenegro. METHODS: In 173 consecutive dyspeptic patients referred to endoscopy (67M, mean age 49 +/- 15, 76 smokers), immunoblot assay was used to detect serum antibodies against CagA and VacA. Presence of H. pylori infection was assessed using a rapid urease test (RUT), routine histology and serology (anti-IgG ELISA). Duodenal ulcer (DU) was diagnosed in 28, gastric ulcer (GU) in 3 and non-ulcer dyspepsia (NUD) in the remaining 142 patients. RESULTS: 129 (74.6%) patients were H. pylori-positive, 27 (96.4%) with DU, 3 (100%) with GU and 99 (69.7%) with NUD (P < 0.01); 121 (93.8%) patients carried anti-CagA antibodies and there was no difference between the DU and NUD groups. VacA antibodies were detected in sera of 50 (38.75%) and were more prevalent in patients with DU compared to the NUD group (P < 0.05). CONCLUSIONS: In Serbia and Montenegro there is high seroprevalence of CagA-positive H. pylori strains in dyspeptic patients with and without peptic ulcer, while VacA-positive strains are more closely related to peptic ulcer disease.     

Changing trends in peptic ulcer prevalence in a tertiary care setting in the Philippines: a seven-year study

BACKGROUND AND AIMS: The declining global prevalence of peptic ulcer disease (PUD) might be because of the decreasing prevalence of Helicobacter pylori (Hp) infection. The aims of the present study were to determine the prevalence of PUD during a 7-year period and to investigate its relationship with the prevalence of Hp infection during the same period. METHODS: All upper gastrointestinal endoscopies carried out at Santo Tomas Hospital in Manila from January 1996 to December 2002 were evaluated. Endoscopies reporting gastric ulcers (GU) and duodenal ulcers (DU) with Hp status were analyzed. RESULTS: A total of 15 341 endoscopies were evaluated. Overall, 2600 (16.95%) GU and 1575 (10.27%) DU were identified. There was a decreasing trend in the prevalence of GU (P < 0.0001) and DU (P < 0.0001) during the study period. Overall PUD prevalence declined from 35.87% in 1996 to 18.80% in 2002. This decline was seen for both GU and DU (20.05 vs 14.34%, and 15.83 vs 7.02%, respectively). The prevalence of Hp infection decreased significantly from 1996 to 2002 for both GU and DU (68.13 vs 33.48%, P < 0.0001; and 76.67 vs 36.50%, P < 0.0001, respectively). The decrease in Hp prevalence was significantly related to the decrease in ulcer prevalence (r = 0.97, P = 0.0004 for GU; r = 0.89, P = 0.0079 for DU; and r = 0.92, P = 0.0035 for all PUD). The prevalence of bleeding secondary to PUD remained stable during the 7-year period (P = 0.87). CONCLUSIONS: During the 7-year period, there was a significant decline in the prevalence of PUD. This decline in PUD prevalence was associated with a corresponding decrease in Hp prevalence.