根除幽门螺杆菌和消化性溃疡再出血的关系研究

目的探讨根除幽门螺杆菌（Ｈｐ）对预防消化性溃疡再出血作用。方法对消化性溃疡并出血病人行急诊胃镜检查，取胃窦组织检测Ｈｐ。随机选择Ｈｐ阳性病人分为Ａ、Ｂ两组，分别用洛赛克（２０ｍｇ／次）＋羟氨苄青霉素（７５０ｍｇ／次）和单独用洛赛克（２０ｍｇ／次）治疗，每天２次，共２周。Ｈｐ阴性组（Ｃ组）单用洛赛克（２０ｍｇ／次）治疗，每天２次，共２周。之后，三组病人再用洛赛克（２０ｍｇ／次），一日一次，治疗２周。疗程结束，复查胃镜及检测Ｈｐ，并随访１８个月。结果Ａ、Ｂ、Ｃ三组病人经治疗后，溃疡愈合率分别为１００％，９６８％和９７５％，三组之间相互比较无明显差异，（Ｐ＞００５）。Ａ、Ｂ两组Ｈｐ根除率分别为８３３％和１８７％，两者比较有显著性差异（Ｐ＜００５）。随访１８个月后，Ａ、Ｂ两组的再出血率分别为２７％和３１３％，两者比较有显著性差异（Ｐ＜００５），而Ｃ组再出血率为１２５％，分别与Ａ、Ｂ两组比较，再出血率无显著性差异（Ｐ＞００５）。结论根除Ｈｐ能降低消化性溃疡再出血，所有Ｈｐ阳性的消化性溃疡并出血病人需要进行根除Ｈｐ治疗，以防溃疡再出血     

龙黄合剂抑Hp实验及临床应用

目的探讨龙黄合剂体外抑Ｈｐ作用，及对Ｈｐ阳性十二指肠溃疡的疗效．方法采用纸片扩散法和琼脂稀释法，对龙黄合剂中单味中药及复合制剂进行体外抑Ｈｐ实验，并与部分中成药抑Ｈｐ效果对比．将１２８例Ｈｐ阳性十二指肠溃疡随机分成龙黄合剂组（Ａ组），雷尼替丁＋呋喃唑酮组（Ｂ组）及龙黄合剂＋呋喃唑酮＋雷尼替丁（Ｃ组）３组进行治疗，观察各组溃疡愈合率，复发率，Ｈｐ根除率，胃窦粘膜病理好转率，药物副反应发生率．结果龙黄合剂有较好体外抑Ｈｐ作用．Ｃ组Ｈｐ根除率为８４８％，溃疡１ａ复发率１３５％，胃窦粘膜炎症病理好转率为６５３％，副反应发生率为１３０％，均优于Ａ组（４５２％，３７５％，５７１％，７１％）及Ｂ组（３７５％，５００％，３７５％，１９５％），统计学处理有显著或极显著差异（Ｐ＜００５或００１）．３组溃疡愈合有效率分别为Ｃ组１０００％，Ａ组９００％，Ｂ组９０５％，统计学处理无显著差异（Ｐ＞００５）．结论体外试验证明龙黄合剂对Ｈｐ有较好抑制作用，龙黄合剂＋雷尼替丁＋呋喃唑酮用于Ｈｐ阳性的十二指肠溃疡治疗，可提高Ｈｐ根除率，减少复发率，副作用小，价格低廉，服用方便，适合国情，值得推广     

根治Hp对预防老年十二指肠溃疡再出血的临床价值

目的观察根除Ｈｐ对老年人十二指肠溃疡再出血的影响。方法选择７０例Ｈｐ感染十二指肠溃疡并出血的老年病人并随机分成Ａ、Ｂ２组。Ａ组应用奥美拉唑（洛赛克）、胶态次枸橼酸铋（德诺）胶囊和羟氨苄青霉素进行根除Ｈｐ治疗；Ｂ组单独用洛赛克治疗。４周后停药追踪观察１８个月。结果２组溃疡愈合率分别为１００％、９６．１％，２者比较无显著性差异（Ｐ＞０．０５）；Ａ、Ｂ２组Ｈｐ根除率分别为８５％和１６．６％，２者比较有显著性差异（Ｐ＜０．０５）。随访１８个月后，Ａ、Ｂ２组再出血率分别为２．９４％和２８％，２者比较有显著性差异（Ｐ＜０．０５）。结论根除Ｈｐ对老年人十二指肠溃疡再出血有一定的预防作用。     

兰索拉唑、羟氨苄青霉素、替硝唑联合根除幽门螺杆菌的疗效观察

目的评价兰索拉唑（达克普隆）、羟氨苄青霉素、替硝唑三联疗法对幽门螺杆菌（Ｈｐ）相关性消化性溃疡的疗效。方法将８７例Ｈｐ阳性的十二指肠和（或）胃溃疡患者随机分为２组：第１组４３例,每次口服兰索拉唑３０ｍｇ、羟氨苄青霉素１０００ｍｇ、替硝唑５００ｍｇ,均每日２次,２周为一疗程;第２组４４例,给药方式同第１组,只是疗程缩短为１周,疗程结束后继续每日口服兰索拉唑３０ｍｇ,持续１周。疗程结束达４周时复查胃镜及Ｈｐ。３５例Ｈｐ根除后６个月行１４Ｃ－尿素呼气试验（ＵＢＴ）。结果第１组有３例因过敏性皮疹而退出观察,４０例用于统计学分析。第１组和第２组的Ｈｐ根除率分别为９００％和８１８％,十二指肠溃疡和胃溃疡的愈合率分别为９２５％和８８６％。６个月的Ｈｐ再感染率为８６％。结论第１组Ｈｐ根除率和溃疡愈合率均略高于第２组,两组相比差异无显著性（Ｐ＞００５）。两组均有较理想的溃疡愈合率和Ｈｐ根除率。     

幽门螺杆菌球形菌与溃疡复发关系的临床研究

目的：探讨幽门螺杆菌（Ｈｐ）球形菌与溃疡复发的关系。方法：１１例Ｈｐ阳性活动期十二指肠溃疡（ＤＵ）患者，经标准三联疗法（铋剂１０ｍｇ、四环素５００ｍｇ、甲硝唑４０ｍｇ，每日３次共１４天）治疗后４周，复查胃镜，胃粘膜涂片Ｇｒａｍ及免疫组织化学染色检查Ｈｐ球形菌，以及尿素酶试验和ＰＣＲ检测。结果：ＤＵ愈合率９６％，Ｈｐ根除率８５％。１２人检出Ｈｐ球形菌且ＤＵ均愈合占１０４％，其中９人完成一年随访，溃疡均复发占１０％，涂片均检出典型Ｈｐ。而Ｈｐ根除组８６人随访一年４人溃疡复发占４７％，均为Ｈｐ阳性。比较两组溃疡复发率差异显著（Ｐ＜００５）。结论：Ｈｐ球形菌可致溃疡复发     

毫米波加药物治疗Hp+消化性溃疡50例

目的探讨幽门螺杆菌阳性（Ｈｐ＋）的消化性溃疡（ＰＵ）愈合和复发的物理治疗（毫米波ｍｍＷ）及其联合药物治疗的前景．方法本组ＰＵ９３例采用ｍｍＷ辐射探头对ＰＵ患者体表胃投影区照射３０ｍｉｎ，（ｎ＝５０）每日１～２次，联合药物（甲哨唑＋西咪替丁）在Ｈｐ＋的ＰＵ愈合和复发的疗效进行研究，并与对照组４３例进行比较．结果ｍｍＷ治疗及联合药物治疗组与对照组单用药物Ｈ２受体阻滞剂西咪替丁相比较，结果治疗组溃疡愈合率及Ｈｐ根除率１００％（５０／５０）及９８％（４９／５０）．１年后复发率为４％（２／５０）；而对照组溃疡愈合率９０５％（３８／４３），Ｈｐ根除率５０８％（２５／４３），１年后复发率２０９％（９／４３）．说明Ｈｐ根除与溃疡复发有一定关系，２组相比有显著差异（Ｐ＜００５～００１）．结论ｍｍＶ联合药物治疗Ｈｐ＋ＰＵ愈合和复发优于单用Ｈ２受体阻滞剂．     

根除幽门螺杆菌治疗十二指肠溃疡的随机对照研究

通过根除幽门螺杆菌（Ｈｐ）治疗（不加用任何抗酸或抑酸药物）观察十二指肠溃疡（ＤＵ）的愈合率。方法：１１５例Ｈｐ感染的ＤＵ患者随机分为两组,接受７天铋剂三联治疗。Ａ组口服替硝唑５００ｍｇ、克拉霉素２５０ｍｇ和胶体次构橼酸铋２２０ｍｇ各每日２次,疗程７天,Ｂ组在Ａ组基础上加服奥美拉唑每日２０ｍｇ,疗程４周。服药前和停止抗ＨＰ治疗后４周作胃镜检查及~ （１３）Ｃ－尿素呼气试验。结果：１０７例患者完成治疗和复查,８例失访。Ａ、Ｂ两组的ＤＵ愈合率分别为９２．５％（９５％可信区间为８５．４％～９９．６％）和９６．３％（９５％可信区间为９１．３％～１００％）;两组Ｈｐ根除率分别为９４．３％（９５％可信区间为８８．１％～１００％）和９８．１％（９５％可信区间为９４．５％～１００％）,统计学上均无显著差异（＞０．０５）。服药１周内上腹痛缓解率Ｂ组明显高于Ａ组（Ｐ＜０．００５）。两组方案均未发现有明显不良反应。结论：Ｈｐ感染的ＤＵ患者经根除ＨＰ治疗,溃疡能自行愈合而不需使用抑酸药物;奥美拉唑能迅速减轻或消除ＤＵ患者的上腹痛症状;本治疗方案具有Ｈｐ根除率高、疗程短、依从性好和不良反应少等优点。     

球部幽门螺杆菌感染与不同期十二指肠溃疡的关系

目的研究十二指肠溃疡（ＤＵ）的胃镜下和组织学愈合是否受球部幽门螺杆菌（Ｈｐ）感染的影响。方法对７０例活动期ＤＵ（Ａ）和４０例瘢痕期ＤＵ（Ｓ组）患者溃疡边缘粘膜活检标本采用快速尿素酶试验和改良姬姆萨染色检测Ｈｐ,并对粘膜固有层内中性多形核白细胞（ＰＭＮ）浸润状态进行观察。结果Ｓ组和Ａ组Ｈｐ阳性率各为６００％和７１４％,差异无显著性（Ｐ＞０．０５）。Ｓ组和Ａ组中Ｈｐ阳性者ＰＭＮ浸润率和ＰＭＮ计数（各为９１７％;２０３±０．５１和１０００％;２３４±０．４０）分别明显高于（Ｐ均＜００１）其Ｈｐ阴性者（各为５６３％;０６７±０．２９和６５０％;１１１±０．３２）。在Ｈｐ阳性者,Ｓ组ＰＭＮ浸润率和ＰＭＮ计数均与Ａ组相近（Ｐ＞０．０５）;在Ｈｐ阴性者,Ｓ组仅ＰＭＮ浸润与Ａ组相近（Ｐ＞０．０５）,其ＰＭＮ计数则明显低于Ａ组（Ｐ＜０．０１）。结论ＤＵ的胃镜下愈合可不受球部Ｈｐ感染的影响,但后者与溃疡边缘粘膜活动性炎症密切相关从而使ＤＵ的组织学愈合质量明显受其影响。     

奥美拉唑、替硝唑、克拉霉素短程三联疗法根除老年人幽门螺杆菌的疗效观察

目的观察奥美拉唑、替硝唑、克拉霉素短程三联疗法对老年人幽门螺杆菌（Ｈｐ）感染的根除效果及其副反应。方法将８７例伴有Ｈｐ感染的消化性溃疡或糜烂性胃窦炎老年患者随机分为两组，Ａ组４４例，给予奥美拉唑２０ｍｇ、替硝唑５００ｍｇ及克拉霉素２５０ｍｇ，每天２次口服，疗程７天（方案Ａ）；Ｂ组４３例，治疗同Ａ组，只是将克拉霉素改为５００ｍｇ（方案Ｂ）。活动期溃疡病患者继服奥美拉唑２０ｍｇ／ｄ，３周。疗程结束１个月后复查胃镜，检查Ｈｐ。结果Ａ组Ｈｐ根除率９０．９％、活动期溃疡愈合率１００．０％、糜烂性胃窦炎愈合率７９．３％、副反应发生率１３．６％，Ｂ组分别为８８．４％、９３．３％、８０．８％和２３．３％；两组比较差异无显著性。结论两种短程三联疗法对老年人Ｈｐ感染的根除均有良好疗效，而方案Ａ费用较低。     

不同三联方案治疗幽门螺杆菌阳性消化性溃疡的多中心临床研究

目的 观察不同三联方案“丽珠胃三联”药物搭配、疗程和剂量的效果来探索较理想的治疗幽门螺杆菌（Ｈｐ）的方案。方法 Ｈｐ阳性的十二指肠溃疡１２６例、胃溃疡４０例。随枘发成三组：Ａ组；枸椽酸铋钾０．２２ｇ／次＋克拉霉素０．２５ｇ／次＋替硝唑０．５ｇ／次，称“丽珠胃三联”，均为２次／ｄ，疗程７ｄ：Ｂ组：药物组成、用法同Ａ组，但疗程为１４ｄ；Ｃ组：奥美拉唑２０ｍｇ，甲硝唑４００ｍｇ，阿莫西林１ｇ，均为２次／ｄ，疗程７ｄ，观察记录Ｈｐ根除情况、溃疡愈合情况、临床症状改善情况及不良反应。结果 １６０例完成治疗及复查，失记６例，Ｈｐ根除率Ａ、Ｂ、Ｃ三组分别为８７．９％，８７．０％，８６．８％。差异无显著性（Ｐ〉０．０５）；胃溃疡治疗后的总有效率分别为９２．３％。９０．９％及９２．９％；十二指肠溃疡治疗后的总有效率分别为９７．８     

Impact of Colloidal Bismuth Subcitrate in the Eradication Rates of Helicobacter pylori Infection-Associated Duodenal Ulcer Using a Short Treatment Regimen with Omeprazole and Clarithromycin: A Randomized Study

Recent trials have shown that duodenal ulcers treated by H2-blockers heal faster if Helicobacter pylori is eradicated concurrently. Objectives : To evaluate the efficacy of a short treatment regimen in H. pylori eradication and ulcer healing and to assess the impact of colloidal bismuth suhnitrate (CBS) in H. pylori eradication rate. Methods : Sixty-one patients with H. pylori -associated duodenal ulcer were randomized in two short treatment groups. Group A patients (31) were given omeprazole 20 mg b.i.d. ± 8 days. Clarithromycin <500 mg, b.i.d. ) and CBS (120 mg, q.i.d. ) were added 24 h after starting omeprazole and were given for 7 days. Group B patients (30) were treated as group A patients but without CBS. Endoseopics were performed at entry and 4 wk after the end of treatment. Presence of H. pylori was assessed at each endoscopy by urease test, and biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H. pylori infection. No patient received follow-up treatment. Results: H. pylori eradication rates were achieved in 25/31 (80.6%) group A patients and in 15/30 (50%) in group B patients ( p = 0.012). Duodenal ulcer healing was documented in 30/31 (96.8%) patients in group A and in 25/30 (83%) patients in group B. Conclusions : The addition of CBS to the double therapy with omeprazole and Clarithromycin substantially improves the eradication rate of H. pylori . Short therapy with omeprazole 20 mg/b.i.d. , clarithro-mycin 500 mg/b,i.d. , and CBS 120 mg/q.i.d. is a safe, well tolerated combination that achieves a 80.6% eradication rate of H. pylori and duodenal ulcer healing rates as good as those achieved by omeprazole 20 mg/d when given for 4 wk.     

Eradication of helicobacter pylori reduces the rate of duodenal ulcer rebleeding: a long-term follow-up study

Objectives: The long-term efficacy of Helicobacter pylori eradication to reduce the rate of recurrence of peptic ulcer bleeding is still uncertain. We evaluated the rate of duodenal ulcer rebleeding for 48 months after H. pylori eradication.
Methods: Thirty-two male patients with H. pylori infection and duodenal ulcer bleeding were treated with omeprazole (40 mg/day for 4 wk), colloidal bismuth (480 mg/day for 2 wk), amoxicillin (2 g/day for 1 wk), and metronidazole (750 mg/day for 1 wk), and followed up for 48 months. Endoscopy and tests for H. pylori infection were repeated every year.
Results: Ulcer healed in all patients, but H. pylori infection persisted or recurred in 11 patients. Within 48 months, rebleeding occurred in nine (81.8%) of these patients, whereas the 21 patients who were persistently negative for H. pylori infection remained asymptomatic without rebleeding (0/21 = 0%,   p < 0.002  ) during the whole follow-up.
Conclusions: Eradication of H. pylori can reduce the rate of duodenal ulcer rebleeding for at least 4 yr, thus potentially modifying the natural history of the disease.     

Ranitidine bismuth citrate-based triple therapy for seven days, with or without further anti-secretory therapy, is highly effective in patients with duodenal ulcer and Helicobacter pylori infection

OBJECTIVE: To compare the efficacy of two protocols for the eradication of Helicobacter pylori infection and the healing of active duodenal ulcer: (i) ranitidine bismuth citrate (RBC) plus two antibiotics for 7 days, and (ii) the same triple therapy followed by 3 weeks of anti-secretory drug treatment. METHODS: The study comprised 102 patients with active duodenal ulcer and H. pylori infection; the patients were randomized to open treatment with either RBC 400 mg b.d. plus amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. for 7 days, or the same treatment followed by 3 weeks of RBC 400 mg b.d. alone. Ulcer healing was confirmed by endoscopy. H. pylori eradication was assessed by endoscopy, rapid urease test and histology. RESULTS: The ulcer healed in 48/50 patients on RBC-based triple therapy alone (96.0%) and in 51/52 patients on triple therapy plus further anti-secretory treatment (98.1%). On an intention-to-treat basis, H. pylori had been successfully eradicated in 42/50 patients on triple therapy (84.0%) and in 44/52 patients on triple therapy plus anti-secretory treatment (84.6%), while by per protocol analysis the H. pylori eradication rates were 91.3% (42/46) and 89.8% (44/49), respectively. CONCLUSIONS: One-week triple therapy with RBC, amoxycillin and clarithromycin is highly effective in eradicating H. pylori and healing duodenal ulcers, even if not followed by anti-secretory drug treatment.     

Acid suppression therapy is not required after one-week anti-Helicobacter pylori triple therapy for duodenal ulcer healing

AIM: To compare healing of Helicobacter pylori-related non complicated duodenal ulcer after one-week eradication triple therapy alone and after triple therapy with further 3-weeks antisecretory treatment with ranitidine. METHODS: Three hundred and forty three patients with symptomatic H. pylori positive duodenal ulcer were included in this randomized double-blind placebo controlled study. H. pylori infection was established by rapid urease test and histopathology of antral biopsies. All patients were treated for one week with ranitidine 300 mg b.i.d., amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d., and then randomly treated for the following 3 weeks either with ranitidine 300 mg once daily (triple therapy + ranitidine, n =180) or placebo (triple therapy alone, n =163). Ulcer healing was assessed by endoscopy 4 weeks after inclusion. H. pylori eradication was established by (13) C-urea breath testing 5 weeks after the end of triple therapy. RESULTS: In intention to treat, duodenal ulcer healed at 4 weeks in 86 % of patients treated with triple therapy + ranitidine and in 83 % of patients treated with triple therapy alone (equivalence: 90 % CI [-3. 8 %; 9.2 %]). The H. pylori eradication rates were 67 % and 69 % respectively. Ulcer healed in 88 % of patients in whom H. pylori eradication was achieved and in 77 % of patients in whom eradication failed. CONCLUSION: These results demonstrate that one-week triple therapy alone is highly effective in healing non complicated H. pylori associated duodenal ulcer without additional antisecretory treatment.     

Duodenal ulcer healing rates in a one-year follow-up study with ranitidine bismuth citrate and antibiotics

BACKGROUND/AIMS: The aim of this study was to determine the one-year outcome of an eradication therapy with ranitidine bismuth citrate and antibiotics in Helicobacter pylori-positive duodenal ulcer patients in respect to ulcer and Helicobacter pylori relapse rates. METHODOLOGY: This multicenter, randomized, double-blind study involved 648 duodenal ulcer patients and had been carried out to compare the following regimens: ranitidine bismuth citrate b.i.d. co-prescribed with either clarithromycin 250 mg q.i.d. or clarithromycin 500 mg b.i.d. or clarithromycin 500 mg b.i.d. plus metronidazole 400 mg b.i.d. for 2 weeks, followed by a further 14 days of treatment with ranitidine bismuth citrate 400 mg b.i.d. to facilitate ulcer healing. H. pylori eradication was assessed by 13C-urea breath test and histology at least 4 weeks, 26 weeks and 52 weeks after the end of treatment. Ulcer relapse and H. pylori status were assessed 4 weeks, 26 weeks and 52 weeks post-treatment or if ulcer symptoms recurred. For the remainder of the follow-up period only serious adverse events were collected. RESULTS: At 12 months data of 438 (69%) patients were evaluable. The observed H. pylori eradication rates were 88-91%. H. pylori relapse rates were 2.1% after 26 weeks and 3.9% after 52 weeks. At the week 26 visit 26 patients (5.6%) and at the week 52 visit 25 patients (5.7%) had documented gastroesophageal reflux disease. CONCLUSIONS: Our data confirm the reduction of duodenal ulcer relapses after the cure of Helicobacter pylori infection.     

Ranitidine Bismuth Citrate With Clarithromycin Given Twice Daily Effectively Eradicates Helicobacter pylori and Heals Duodenal Ulcers

Objective : Ranitidine bismuth citrate (RBC) b.i.d. with Clarithromycin q.i.d. eradicates Helicobacter pylori (H. pylori ) in 82–94% of patients, and heals duodenal ulcers in 88–90% of patients. This double blind, placebo-controlled study examines the efficacy of a simpler b.i.d. treatment regimen, and examines the potential benefit of including a second antibiotic, metronidazole, to the b.i.d. treatment regimen. Methods : A total of 648 patients with active duodenal ulcer received RBC 400 mg b.i.d. for 4 wk, coprescribed with Clarithromycin 250 mg q.i.d. , Clarithromycin 500 mg b.i.d. , or Clarithromycin 500 mg b.i.d. with metronidazole 400 mg b.i.d. for the first 2 wk of treatment. Endoscopies were performed prestudy, after 4 wk of treatment, and at least 4 wk posttreatment. H. pylori status was assessed by CLOtest, ¹³C-urea breath test (UBT), and histology prestudy, and by UBT and histology at least 4 wk posttreatment. Adverse events were recorded at each visit. Results : All three regimens were highly effective and well tolerated. H. pylori eradication rates were 84–94% and duodenal ulcer healing rates were 92–96% (observed data). Highest H. pylori eradication and ulcer healing rates were achieved with RBC 400 mg b.i.d. with Clarithromycin 500 mg b.i.d. Conclusion : Ranitidine bismuth citrate with Clarithromycin 500 mg b.i.d. provides an effective, simple and well tolerated regimen for the eradication of H. pylori and healing of duodenal ulcers.     

Body mass index and per capita income influence duodenal ulcer healing and H. pylori eradication whilst dietary factors play no part.

BACKGROUND: The role of dietary and sociodemographic factors in the healing of duodenal ulcer following H. pylori eradication remains undefined. AIM: To assess the role of diet, sociodemography and body mass index in the healing of duodenal ulcer and eradication of H. pylori. METHODS: A cross-sectional study consisting of 67 consecutive duodenal ulcer patients was undertaken. Sociodemographic factors studied included age, sex, occupation, educational status, religion, type of family, number of family members, per capita income and residence (urban vs. rural). Personal habits studied included alcohol consumption and smoking. Regular dietary intake over a two-month period was assessed using the food frequency questionnaire. All patients had documented H. pylori infection at the time of inclusion and received standard triple eradication therapy. Follow-up endoscopy and testing for H. pylori were done 4 weeks after completion of eradication therapy. RESULTS: The mean age of the 67 patients (60 male, 7 female) was 39.9+/-13.6 years. Healing of duodenal ulcer was documented in 51 patients. H. pylori infection was successfully eradicated in 31 patients but not in the other 36. There was no difference between the groups (Group A1: H. pylori eradicated, Group B1: H. pylori not eradicated) with regard to dietary and socio-demographic variables, except for BMI, which was significantly higher in patients in whom H. pylori had been eradicated. Per capita income was significantly higher in Group A2 (healed duodenal ulcer) as compared to Group B2 (duodenal ulcer not healed) while there was no difference in dietary and socio-demographic variables in these two groups. CONCLUSION: We found that higher body mass index and higher per capita income were associated with successful H. pylori eradication and duodenal ulcer healing, respectively, and that diet had no role to play in either. Further epidemiological studies from different parts of India and studies that control for Helicobacter pylori are required to establish predictive factors.     

Density of Helioobacterpylo／Ymay affect the efficacy of eradication therapy and ulcer healing in patients with active duodenal ulcers

AIM: To evaluate the association of pre-treatment Helicobacter pylori (H. pylori) density with bacterial eradication and ulcer healing rates in patients with active duodenal ulcer. METHODS: One hundred and four consecutive duodenal ulcer outpatients with H. pylori infection ascertained by gastric histopathology and (13)C-urea breath test (UBT) were enrolled in this study. H. pylori density was graded histologically according to the Sydney system (normal, mild, moderate, and marked). In each patient, lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1 g b.i.d.) were used for 1 week, then 30 mg lansoprazole once daily was continued for an additional 3 weeks. Follow-up endoscopy was performed at 4 weeks after completion of the therapy, and UBT was done at 4 and 8 weeks after completion of the therapy. RESULTS: The H. pylori eradication rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 69.7 %/85.2 %; and the ulcer healing rates were 88.9 %/100.0 %, 94.3 %/100.0 %, and 63.6 %/77.8 % (intention-to-treat/per protocol analysis) in the mild, moderate, and marked H. pylori density groups, respectively. The association of pretreatment H. pylori density with the eradication rate and ulcer healing rate was both statistically significant (P=0.013/0.006 and 0.002/<0.001, respectively; using results of intention-to-treat/per protocol analysis). CONCLUSION: Intragastric bacterial load may affect both the outcome of eradication treatment and ulcer healing in patients with active duodenal ulcer disease.     

Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage--a long-term randomized, controlled study

OBJECTIVE: Eradication of Helicobacter pylori (H. pylori) in patients with uncomplicated duodenal ulcers prevents long-term recurrence of ulcers. We aimed to study whether treatment of H. pylori prevents the long-term recurrence of duodenal ulcer hemorrhage. METHODS: Patients with duodenal ulcer bleeding and confirmed H. pylori infection were recruited. A total of 120 patients were randomly assigned to triple therapy (DeNoltab 120 mg, amoxycillin 500 mg, and metronidazole 300 mg four times daily) or DeNoltab 120 mg four times daily alone. No maintenance therapy was given during the follow-up period. The endpoints were the cumulative rates of symptomatic and bleeding duodenal ulcer recurrences. RESULTS: Of the patients receiving the triple regimen, 85.1% had H. pylori eradicated as compared to 2.0% of patients receiving DeNoltab (p < 0.05). More patients in the DeNoltab group than those in the Triple group had recurrence of ulcer bleeding, but this did not reach statistical significance (12/60 vs 6/60, p = 0.20). Logistic regression analysis on clinical, personal, and endoscopic characteristics identified persistent H. pylori infection as the only independent predictor of recurrence of duodenal ulcer bleeding. CONCLUSIONS: Treatment of H. pylori alone with the present bismuth-based triple therapy in patients with duodenal ulcer hemorrhage did not result in significant reduction in further bleeding episodes, although a trend was seen for the group that was given triple therapy. On the other hand, posttreatment H. pylori status was found to be an independent predictor of bleeding recurrence.     

十二指肠溃疡患者根除幽门螺杆菌后抑酸维持治疗的疗效研究

背景：对感染幽门螺杆菌（H.pylori）的消化性溃疡患者成功根除且H.ylori后,是否应继续行抑酸治疗,目前尚存在争议。目的：探讨合并H.pylori感染的十二指肠溃疡（DU）患者根除H.pylori后抑酸维持治疗的疗效。方法：112例合并H.pylori感染的DU患者随机分为A组和B组,A组给予10d四联疗法：兰索拉唑30mg＋阿莫西林1g＋克拉霉素0．5gbid＋枸橼酸铋钾110mg qid,疗程10d。B组：在A组方案的基础上,疗程结束后再予兰索拉唑30mg,1次／d,维持4周。治疗结束4周后复查胃镜,评估H.pylori根除疗效、溃疡愈合率和腹痛缓解率。结果：109例患者完成方案。A、B两组按意向治疗（ITT）和按方案（PP）分析的H.pylori根除率（ITT：85．7％对87．5％;PP：88．9％对89．1％）和溃疡愈合率（ITT：87．5％对94．6％;PP：90．7％对96．4％）以及腹痛缓解率（95．6％对95．7％）相比差异均无统计学意义（P〉0．05）。结论：以10d四联疗法根除H.pylori后,可使多数DU患者的溃疡愈合,无需进一步行维持抑酸治疗。