Meta-analysis: Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer

AIM: To perform a meta-analysis comparing the efficacy of Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. METHODS: A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. RESULTS: In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori eradication therapy group was 4.5%, compared with 23.7% in the non-eradication therapy group without long-term antisecretory therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09-0.37; 'number needed to treat' (NNT), 5; 95% CI, 4-8]. In the second meta-analysis, the re-bleeding rate in the H. pylori eradication therapy group was 1.6%, compared with 5.6% in the non-eradication therapy group with maintenance antisecretory therapy (odds ratio, 0.25; 95% CI, 0.08-0.76; NNT, 20; 95% CI, 12-100). When only patients with successful H. pylori eradication were included, the re-bleeding rate was 1%. CONCLUSIONS: The treatment of H. pylori infection is more effective than antisecretory non-eradication therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and eradication therapy should be prescribed to infected patients.     

The outcome of peptic ulcer haemorrhage in relation to consumption of nonsteroidal anti-inflammatory drugs or aspirin

Aim: To compare the outcome of 76 patients who presented with severe peptic ulcer haemorrhage whilst taking nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin with that of 112 patients who were not taking these drugs and who developed peptic ulcer haemorrhage over the same time period. Methods: The two groups of patients were managed identically and endoscopic therapy was attempted in all cases. Results: The group taking NSAIDs or aspirin tended to be older and had a higher prevalence of cardio-respiratory disease. The severity of bleeding (as assessed by the presence of shock, anaemia and endoscopic stigmata) was similar in the two groups. Outcome in terms of uncontrolled haemorrhage, rebleeding and blood transfusion requirements did not differ significantly in the two groups. The NSAID group had a significantly longer duration of admission, almost certainly attributable to a higher prevalence of co-morbid diseases. Conclusions: Despite the deleterious effects of NSAIDs and aspirin upon renal and platelet function, the prognosis of peptic ulcer bleeding is not adversely affected by NSAID or aspirin therapy.     

Somatostatin in peptic ulcer bleeding--results of a double-blind controlled trial

The aim of this work was to assess the usefulness of somatostatin in acute peptic ulcer bleeding. Sixty-four patients with endoscopic evidence of duodenal ulcer bleeding completed a double-blind trial to compare the effectiveness of somatostain (6 mg i.v. per day) with that of placebo; incidence of treatment failure (i.e., rebleeding or persistent haemorrhage) was not different in the somatostatin and in the placebo groups (respectively 24% and 23%). Because the efficacy of cimetidine had previously been demonstrated in gastric ulcer bleeding, somatostatin was tested against cimetidine (1.6 g per day) in 50 patients with gastric ulcer haemorrhage. The treatment failed to control bleeding in 15% of somatostatin and in 17% of cimetidine treated subjects (n.s.). Both treatments were well tolerated and blood requirements were not different in the trial groups. These results show that the efficacy of somatostain in peptic ulcer bleeding is not different from placebo in duodenal ulcers and not different from cimetidine in gastric ulcers.     

吻合口溃疡出血的内科治疗体会

目的：观察吻合口溃疡出血的内科治疗特点及疗效。方法：选取2006年5月～2011年3月本院消化科收治的经内镜诊断为胃大部分切除术后吻合口溃疡出血患者48例（观察组）及消化性溃疡出血患者50例（对照组）,进行内镜下治疗及常规的内科治疗,对两组治疗效果及临床观察指标进行分析比较。结果：两组总有效率（观察组为95.83%,对照组为86.00%）比较,差异有统计学意义（P〈0.05）;观察组与对照组组输血量[（2.1±0.9）Uvs（1.4±0.3）U]、住院时间[（20.5±8.7）dvs（17.4±9.8）d]比较,差异有统计学意义（P〈0.05）,其余指标比较,差异无统计学意义（P〉0.05）。结论：抑酸药物治疗结合内镜下治疗可有效治疗吻合口溃疡出血,根据内镜下出血征象予注射治疗,可提高治疗效果,值得临床推广应用。     

奥美拉唑联合蛇毒血凝酶治疗消化道溃疡大出血的疗效观察

目的 探讨奥美拉唑（洛赛克）联合蛇毒血凝酶治疗消化道溃疡大出血的临床效果。方法 152例患者随机分为对照组和治疗组,对照组采用蛇血凝酶进行治疗,治疗组在对照组的基础上采用奥美拉唑进行治疗,比较两组患者的临床疗效及愈合情况。结果 治疗后,治疗组的总有效率为96.05%、愈合情况总有效率为90.79%明显高于对照组,差异有统计学意义（P〈0.05）。结论 奥美拉唑联合蛇毒凝酶治疗消化道大出血具有较好的临床效果,值得在临床上推广使用。     

肾上腺素治疗消化性溃疡大出血的效果观察

目的 探讨临床有效控制消化性溃疡大出血的方法.方法 本院2010年8月～2012年9月共收治消化性溃疡大出血患者100例,随机分为治疗组以及对照组.对照组给予泮托拉唑治疗,治疗组患者在病灶部位注射一定浓度的肾上腺素,观察两组治疗效果.结果 对照组24 h止血率为64.0％,48 h止血率为88.0％,而治疗组24 h止血率为82.0％,48 h止血率为98.0％,两组差异有统计学意义（P＜0.01）.结论 在消化性胃溃疡大出血治疗过程中,肾上腺素病灶部位注射能够有效改善患者的出血情况,其临床效果显著.     

120例上消化道出血患者临床分析

目的 探讨奥美拉唑静脉注射治疗消化性溃疡引起的上消化道出血临床效果.方法 选取本院近年来收治消化性溃疡引起上消化道出血患者120例,采用随机数字表法分为对照组和观察组,其中对照组患者60例,采用常规上消化道出血内科治疗;观察组患者在对照组治疗基础上,加用奥美拉唑静脉滴注治疗;比较两组患者临床改善总有效率及止血率等.结果 观察组患者临床治疗总有效率明显高于对照组,组间比较差异有统计学意义P＜0.05）;同时观察组患者止血率明显高于对照组,组间比较差异有统计学意义（P＜0.05）.结论 奥美拉唑静脉滴注用于消化性溃疡引起的上消化道出血可有效改善临床症状,提高止血效果.     

High incidence of clopidogrel-associated gastrointestinal bleeding in patients with previous peptic ulcer disease

BACKGROUND: In average-risk patients, the new anti-platelet agent, clopidogrel, causes less upper gastrointestinal adverse events than aspirin. However, there are no safety data on the use of clopidogrel in high-risk patients. AIM: To evaluate the safety of clopidogrel in patients with peptic ulcer disease in a retrospective cohort longitudinal study. METHODS: During the period from January 2000 to May 2002, 70 patients who were prescribed clopidogrel (75 mg/day) for a previous history of non-aspirin-related peptic ulcer disease or a history of aspirin-related gastrointestinal complications (dyspepsia or peptic ulcer) were recruited. The occurrence of ulcer complications (bleeding/perforation/obstruction) was the primary end-point. RESULTS: After a median follow-up of 1 year, nine patients (12%) developed gastrointestinal bleeding and one had a perforated peptic ulcer. Clopidogrel-associated gastrointestinal bleeding was significantly more common in patients with a history of gastrointestinal bleeding than in those without (22% vs. 0%; P = 0.007; odds ratio, 1.3; 95% confidence interval, 1.1-1.5). CONCLUSIONS: Clopidogrel is associated with a high incidence of upper gastrointestinal bleeding in high-risk patients. A previous history of gastrointestinal bleeding appears to be a predictor of adverse gastrointestinal events.     

Somatostatin compared with cimetidine in the treatment of bleeding peptic ulcer without visible vessel

In a randomized double-blind trial 100 patients with severe bleeding peptic ulcers were treated with an intravenous (i.v.) infusion of cimetidine or somatostatin. Only those patients in whom endoscopy performed within 6 h of admission showed non-arterial bleeding or signs of recent haemorrhage without a visible vessel entered the trial. The two treatment groups were well matched for age, sex, presence of underlying disease, prior ingestion of ulcerogenic drugs, tobacco habits, type of bleeding, haematocrit at admission, presence of hypovolaemic shock, source of bleeding and endoscopic findings. Four patients in each group were excluded after randomization. Further haemorrhage occurred in eight (17.3%) patients in the somatostatin group and in 10 (21.7%) in the cimetidine group, but the difference was not statistically significant. The number of surgical procedures, blood transfusion requirement, duration of hospitalization and mortality rates were similar in the two treatment groups. These results suggest that somatostatin does not improve the results obtained with cimetidine in patients with bleeding peptic ulcer, in whom the endoscopy discloses non-arterial bleeding or signs of recent haemorrhage without a visible vessel.     

Prospective evaluation of patients with upper gastrointestinal haemorrhage

A prospective study was conducted to collect data on clinical and endoscopic diagnosis, associated factors and outcome of 112 consecutive patients with acute upper gastrointestinal haemorrhage admitted to the Dunedin public hospitals over an 18 month period. The mean interval between admission and endoscopy was 20.2 hours. There was a poor correlation between the provisional clinical diagnosis and the endoscopic diagnosis. The causes of bleeding were demonstrated at endoscopy in 87.5% of patients. A history of salicylate, non-steroidal anti-inflammatory drug or significant alcohol ingestion was present in about two-thirds of patients with mucosal abnormalities. The incidence of continued or repeated bleeding was 16%; peptic ulcers accounted for half of these patients. The presence of active bleeding or a visible vessel or blood clot on the ulcer surface indicated a 33% chance of rebleeding; none of the peptic ulcer patients without these signs rebled. Surgery was performed in 11.6% of patients, predominantly for peptic ulcer. The overall mortality was 8% (reducing to 5.4% if patients dying in hepatic failure are excluded), most of the deaths occurring in older patients with complicating medical conditions, and not from uncontrolled haemorrhage.     

Helicobacter pylori‐associated ulcer bleeding: should we test for eradication after treatment?

BACKGROUND: Eradication of Helicobacter pylori after peptic ulcer haemorrhage reduces the risk of recurrence. Because H. pylori treatment is very effective, it is unclear whether testing to confirm eradication is worthwhile. AIMS: To examine whether patients with H. pylori-associated peptic ulcer haemorrhage should be tested for successful eradication after completion of antibiotic therapy. METHODS: A Markov cost-effectiveness model was developed to compare testing vs. non-testing of H. pylori eradication in peptic ulcer haemorrhage. Probability estimates and average costs were derived from published information. RESULTS: Testing for H. pylori eradication resulted in a benefit of 0.07 quality-adjusted life-years and cost 836 US dollars less than the strategy of not confirming eradication. Testing remained the superior strategy when varying the model regarding age, the initial success of eradication, various test and retreatment strategies, and the rate and costs of recurrent bleeding. Assuming a high eradication rate (95%), the test strategy becomes more expensive only if the cost of H. pylori testing reaches 265 US dollars; however, even under these conditions it remains cost-effective. CONCLUSIONS: Patients with H. pylori-associated peptic ulcer bleeding should be tested to confirm eradiation of H. pylori after completion of antibiotic treatment.     

重症消化性溃疡上消化道出血患者应用泮托拉唑的疗效观察

目的探讨重症消化性溃疡上消化道大出血应用泮托拉唑双倍剂量的治疗后临床疗效及观察。方法随机将重症消化性溃疡上消化道大出血72例分为两组：治疗组36例静脉应用泮托拉唑,对照组36例静脉应用奥美拉唑。结果两组重症消化性溃疡上消化道大出血分组治疗后：治疗组：显效19例占52.8%、有效12例占33.3%、无效5例占13.9%,总有效率31例占86.1%;对照组：显效17例占47.2%、有效11例占30.6%、无效8例占22.2%,总有效率77.8%。药物不良反应较轻,治疗组发生皮疹1例,失眠2例,头晕1例;对照组头晕3例,腹胀2例。结论双倍剂量泮托拉唑治疗重症消化性溃疡上消化道大出血,是治疗消化性溃疡出血的一种安全、有效的药物。     

奥曲肽联合泮托拉唑治疗老年患者消化性溃疡并出血疗效观察

【摘要】目的观察奥曲肽联合泮托拉唑对老年患者消化性溃疡并出血的治疗效果。方法选取符合诊断标准的消化性溃疡合并上消化道出血老年患者70例,随机分成观察组和对照组,每组各35例,治疗组应用奥曲肽联合泮托拉唑治疗,对照组单独用泮托拉唑进行治疗,观察及比较两组治疗效果、总有效率以及再出血情况。结果奥曲肽联合泮托拉唑治疗组总有效率为94．28％,对照组总有效率为82．86％,两组比较差异具有统计学意义（P〈0．05）。结论奥曲肽联合泮托拉唑治疗老年患者消化性溃疡并出血疗效优于单用泮托拉唑治疗。     

内镜下注射治疗消化性溃疡出血与Forrest分级的关系

目的 探讨消化性溃疡出血患者行急诊内镜下注射治疗与Forrest分级的关系，评估不同Forrest分级溃疡出血患者急诊内镜下注射治疗的必要性。方法 选自2004年1月至2007年1月因呕血和（或）黑便入院，经急诊内镜检查确诊为溃疡性出血患者285例，溃疡出血按Forrest镜下表现分级，内镜注射止血治疗组145例，内科治疗组140例。结果 内镜组145例，止血成功率95．9％，对照组140例，止血成功率80．0％，两组差异有统计学意义（P〈0．05）。其中Forrest Ⅰ级、Ⅱa级内镜组止血成功率（29／32、18／21）均高于对照组（13／28、12／19），Ⅱb级、ⅡC级与Ⅲ级两组无明显差异。结论 内镜注射止血治疗简单有效，优于单纯药物治疗，镜下表现为ForrestⅠ级和Ⅱa级的溃疡出血患者，内镜下注射治疗是有效且必要的。     

Intragastric pH monitoring in acute upper gastrointestinal bleeding and the effect of intravenous cimetidine and ranitidine

Intragastric pH was measured continuously from 1800 to 1200 hours the following day in 22 duodenal ulcer patients and in eight gastric ulcer patients, all of whom had been admitted as emergencies with acute upper gastrointestinal haemorrhage. The effects of intravenous cimetidine or ranitidine were compared with no treatment. In patients with duodenal ulcer, median intragastric pH was 1.8 (range 1.0-4.9) in the group receiving no treatment. In the cimetidine group (400 mg, 6-hourly, n = 8) median pH was 4.7 (range 1.5-7.7) and after ranitidine (50 mg, 6-hourly, n = 10) it was 3.8 (range 1.2-7.8). The pH remained above 4.0 for 67% of the recording time with cimetidine, 47% with ranitidine and for only 3% with placebo. Intragastric pH in gastric ulcer patients without treatment was higher (median 3.4, range 1.0-6.9) than in duodenal ulcer patients with treatment. Both H2 antagonists raised intragastric pH in patients with gastric ulcer and maintained a gastric pH of greater than 4.0 for at least 50% of the time. Presently recommended i.v. doses of cimetidine and ranitidine do not consistently maintain gastric pH above 4.0 for long periods in patients with peptic ulcer bleeding.     

胃镜下云南白药联合埃索美拉唑治疗消化性溃疡出血疗效观察

目的观察胃镜下云南白药联合埃索美拉唑治疗消化性溃疡出血疗效。方法 85例患者均经胃镜确诊为消化性溃疡并出血,随机分为2组,治疗组45例胃镜下云南白药喷洒及静脉应用埃索美拉唑治疗。对照组40例仅予静脉应用埃索美拉唑治疗及常规对症治疗。结果治疗组中,显效24例,有效止血18例,3例无效。对照组中,显效15例,有效止血15例,10例无效,两组比较,差异有统计学意义。结论胃镜下云南白药联合静脉埃索美拉唑治疗消化性溃疡出血效果好,值得临床推广。     

西咪替丁与兰索拉唑治疗消化性溃疡出血的临床疗效对比分析

目的：比较西咪替丁和兰索拉唑治疗消化性溃疡的临床疗效。方法：选取2008年3月～2011年3月我院收治的消化性溃疡出血患者58例作为研究对象。随机分为兰索拉唑治疗组和西咪替丁治疗组。两组患者均采用常规止血药、输液、输血、抗感染治疗,兰索拉唑治疗组患者在此基础上予以兰索拉唑注射液静滴治疗,西咪替丁治疗组患者在此基础上予以注射用西咪替丁静滴治疗,比较两组患者治疗前及治疗1d、2d、3d后的胃内pH值、出血情况,比较两组患者治疗3d后的总疗效,综合以上指标判断西咪替丁与兰索拉唑治疗消化性溃疡出血的临床疗效。结果：两组患者治疗1d、2d、3d后,出血情况及胃内pH值均有改善,但兰索拉唑组前3d的止血率明显高于西咪替丁组,平均止血时间明显低于西咪替丁组,pH值上升至4.0以上的患者比率明显高于西咪替丁组,P值均〈0.05,均具有统计学意义。两组患者治疗3d后的总有效率比较,兰索拉唑组明显高于西咪替丁组,两组比较差异明显,P〈0.05,具有统计学意义。结论：拉索拉唑治疗消化性溃疡出血的临床疗效优于西咪替丁。     

泮托拉唑与奥美拉唑治疗消化性溃疡出血的疗效比较

目的对比泮托拉唑与奥美拉唑治疗消化性溃疡合并上消化道出血的疗效。方法将120例经内镜证实由消化性溃疡引起的上消化道出血患者随机均分成2组,在常规治疗的基础上分别静脉滴注泮托拉唑40mg（A组）或奥美拉唑40mg（B组）,每12h用药1次,疗程5d。结果在提高胃内pH方面,A组强于B组（P〈0．05）。A组57例（95．00％）3d内止血,3例（5．00％）4-5d内止血;B组58例（96．67％）3d内止血,2例（3．33％）4-5d内止血。两组总有效率均为100％（P〉0．05）。结论在相同的治疗剂量下,泮托拉唑抑制胃酸的作用比奥美拉唑强,但在控制消化性溃疡出血的疗效方面两药相似。