A comparative study; one week treatment versus two weeks treatment with lansoprazol, amoxycillin and clarythromycin for the eradication of Helicobacter pylori in patient with gastric and duodenal ulcer

The combination therapy of lansoprazol (LPZ), amoxycillin (AMPC), and clarythromycin (CAM) (LAC regimen) is one of the most effective eradication regimen of Helicobacter pylori (HP) positive ulcer patients, but the optimal treatment period of this therapy is still pending. The aim of this study was to assess the optimal treatment period of this regimen. One hundred and six patients who diagnosed as HP positive gastric and duodenal ulcer since August 1996 were randomized to one-week treatment group (group 1) or to two-weeks treatment group (group 2): LPZ 30 mg once daily, AMPC 1500 mg twice daily, CAM 800 mg twice daily. Both group received four weeks LPZ treatment (30 mg once daily) following the each combination therapy. The eradication rate of HP was 82.1% (43/56) in group 1 and 85.7% (36/42) in group 2. There was no statistical significant difference between two groups (p = 0.636). Although both treatment regimen was very useful for eradicating HP in the HP positive ulcer patients, one week LAC regimen would be better choice judging from the cost benefit.     

Comparison of the effectiveness of tri- and quadricomponent eradication therapy in patients with peptic ulcer

The purpose of the study was to compare the effectiveness of tri- and quadri-component therapy of Helicobacter pylori (HP)-associated peptic ulcer (PU). The subjects were 65 patients with duodenal ulcer (DU), divided into two groups. The first, OKM/A group, included 35 patients receiving omeprazole in a dose of 20 mg twice a day, clarythromycin--500 mg twice a day, and metronidazole--500 mg or amoxicillin--1,000 mg twice a day. The second, OBTM group, included 30 patients receiving omeprazole in a dose of 20 mg twice a day, colloid bismuth subcitrate (de-nol)--120 mg four times a day, tetracycline--500 mg four times a day, and metronidazole--500 mg twice or 250 mg four times a day. The study demonstrated high effectiveness of these regimens in HP eradication, time of coping with pain syndrome, and time of ulcer healing. Although the difference between the results in the groups was insignificant, there were certain trends observed. On the one hand, the regimen including clarythromycin seemed to be more effective vs. the regimen including tetracycline. On the other hand, the cost of the clarythromycin regimen is about 1.8 times higher than the tetracycline regimen, due to high cost of clarythromycin. The study shows that quadri-therapy in patients with a DU relapse allows maintenance of the intragastric acidity at the level which is optimal for quick coping with pain and dyspeptic syndromes, lowering of the degree of inflammatory alterations in the gastric and duodenal mucosa, HP eradication, and ulcer healing.     

Efficacy of different schemes of anti-helicobacter therapy in duodenal ulcer

AIM: To study clinical efficacy and antihelicobacter activity of combined treatment of duodenal ulcer (DU) with famotidin (qamatel), metronidasol (trichopol) and jozamycin (walpraphen). MATERIAL AND METHODS: A total of 96 patients with uncomplicated DU have been treated (mean age 42.5 +/- 1.5 years). The examination included standard tests, endoscopy, pH-metry (on the treatment days 1, 15 and 28), biopsies and prints from the antral stomach and its body. The sections were stained by Gimse for morphological assessment of duodenal mucosa and detection of Helicobacter pylori (HP). Gastric acid-producing function was examined with intragastric pH-metry. The patients were divided into 3 groups: group 1 received monotherapy with famotidin (20 mg twice a day); group 2 received combined treatment with famotidin (40 mg/day), metronidasol (500 mg twice a day), josamycin (300 mg in 3 doses) for a week with following intake of famotidin alone (40 mg/day) for 3 weeks; group 3 received the same treatment plus clarythromycin. Group 1 patients benefited from the treatment but elimination of pain and dyspeptic syndromes was longer than in groups 2 and 3 (p < 0.05). Ulcer healing to treatment day 28 was observed in 71.8, 90.0 and 88.2%, respectively. Side effects occurred in 0, 10 and 16.7% cases, respectively. CONCLUSION: 1-week schemes of combined treatment with famotidin, metronidasol, josamycin or clarythromycin are highly effective in DU and their side effect rates are not very high.     

The role of the enzymatic antioxidant system and Helicobacter pylori infection in the pathogenesis of peptic ulcer and their effect on treatment efficacy

AIM: To assess activity of superoxide dismutase and catalase in acute ulcer and in the end of its treatment with antisecretory (omeprasole and zaran), anti-Helicobacter (metronidasole) and antioxidant (alpha-tocopherol) drugs in patients with duodenal ulcer. MATERIALS AND METHODS: 126 patients with duodenal ulcer were divided into 6 groups: group 1 patients had Helicobacter pylori (HP+) and were given omeprasole; group 2 patients had HP and were given omeprasole + metronizarole; group 3 patients were free of HP and received metronidasole + alpha-tocopherol; group 4 HP+ patients received zaran; group 5 HP+ patients got zaran = metronidasole; group 6 free of HP received zaran + alpha-tocopherol. The patients were examined using esophagogastroduodenoscopy, roentgenoscopy of the stomach, tests of the gastric juice. RESULTS: An acute phase of ulcer was accompanied with enhanced activity of superoxide dismutase and low activity of catalase in mucosal biopsies from ulcer lesion and periulcer zone. In remission, antioxidant system resumed normal activity depending on the kind of the combined therapy. The combination omeprasole + metronidasole was more effective in HP eradication than zaran + metronidasole. Effect of alpha-tocopherol was poor. CONCLUSION: It is suggested that HP stimulates lipid peroxidation and thus maintains inflammation in gastric and duodenal mucosa.     

Choice of anti-helicobacter treatment of gastroduodenal ulcer associated with helicobater pylori]

AIM: Choice of optimal antihelicobacter (AH) treatment of ulcer. MATERIALS AND METHODS: 249 outpatients with duodenal ulcer associated with Helicobacter pylori entered a blind multicenter controlled trial. The patients were given one of the following drugs: metronidazole, tonidazol, amoxicilline, clarithromycin, rovamycin, omeprazole, azitromycin. RESULTS: Of all the drugs used, rovamycin appeared preferable as it has high AH activity, is safe and cost-effective. CONCLUSION: Rovamycin has a high AH activity and can be applied for treatment of diseases associated with Helicobacter pylori as a drug of choice.     

Relationship between duodenal ulcer recurrence rate and the degree of gastric mucosa contamination rate with Helicobacter pylori

Recurrence rate of duodenal ulcer (DU) within one and two years after treatment was studied in 42 DU patients with incomplete eradication of Helicobacter pylori (HP) and 16 DU patients with its complete eradication. It is shown that DU recurrence rate after the treatment depends on the degree of gastric mucosa contamination with HP. The risk of the DU recurrence is much higher in moderate and high contamination with HP.     

兰索拉唑三联疗法根治胃幽门螺杆菌的疗效观察

81例经胃镜证实的HP阳性十二指肠溃疡患者，随机分成二组分别接受兰索拉唑三联或二联疗法根除HP治疗。服法：三联组兰索拉唑30mg，每日2次，阿莫西林0．5g及甲硝唑0．4g，每日3次；二联组兰索拉唑服法同上，阿莫西林0．5g,每日4次。疗程均为10d.结果：三联组根除率为95％（38／40），高于二联组80．5％（33／41）（P＜0.05）；溃疡愈合率分别为87．5％及87．8％；副反应发生率分别为15％（6／40）及4．9％（2／41），P＞0．05。结果表明：兰索拉唑三联疗法具有症状缓解迅速、HP根除率高、副反应轻、依从性好等优点，是一种较理想的根除HP治疗方案。     

Efficacy of antihelicobacter therapy in NSAID-induced gastropathies

The aim was to evaluate antihelicobacter therapy in the treatment and prophylaxis of NSAID-induced gastropathy recurrences in patients with rheumatic diseases (RD). 66 patients with RD (58 females and 8 males, mean age 53.6 +/- 12.6 years) participated in the study. They met the following criteria: the presence of ulcers or multiple (more than 10) erosions of gastric or duodenal erosions, administration of nonsteroid anti-inflammatory drugs, Helicobacter pylori (HP) in gastric mucosa biopsies. The patients were randomized into two groups matched by sex, features of RD, antirheumatic therapy, history of ulcer, GIT disease. All the patients received omeprazol in a dose 40 mg/day. Patients of group 1 took also amoxicillin (1 g/day) and klarythromycin (0.5 g/day) for 10 days. Group 2 was control. EGDS was conducted 2, 4 weeks and 6 months after the treatment. HP eradication and dynamics of morphological changes were examined in biopsies of the antral gastric mucosa and mucosa of gastric body. The efficacy of 4-week treatment (ulcer scarring and epithelization of erosions), rate of ulcer recurrences and erosions 6 months after treatment were compared. The efficacy of the treatment was 88 and 95% in group 1 and 2, respectively. HP eradication was achieved in 88% of patients of group 1. In 6 months, recurrences arose in 50 and 48.3% of patients of groups 1 and 2, HP was detected in 22% of patients of group 1. Morphological changes in group 1 patients was characterized by alleviation of chronic active gastritis. HP eradication does not raise the efficacy of the treatment and does not lower the risk of recurrences in patients with NSAID-induced gastropathies. Active chronic gastritis is not the background for recurrences of NSAID-induced gastropathy.     

血清PGⅠ、GS-17及TNF-α水平与幽门螺杆菌感染消化性溃疡相关性研究

目的 探讨血清胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)、胃泌素-17(gastrin-17,GS-17)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)与幽门螺杆菌(Helicobacter pylori,HP)感染消化性溃疡(peptic ul-cer,PU)的相关性.方法 选取...     

慢性胃炎和十二指肠球部溃疡红细胞免疫功能的变化

目的 探讨胃疾病与红细胞免疫功能变化的研究.方法 采用花环法测定红细胞C3b受体花环率(RBCC3bRR)及免疫复合物花环率(RBCICR),对103例慢性胃炎(慢性胃炎组)和75例十二脂肠球部溃疡患者(十二指肠球部溃疡组)及30名健康者(正常对照组)进行红细胞免疫功能检测.结果 正常对照组、慢性胃炎组、十二指肠球部溃疡组RBCC3bRR分别为(20.83±5.16)％、(16.26±5.17)％、(13.65±5.19)％,RBCICR分别为(7.63±4.09)％、(10.59±4.45)％、(10.04±4.13)％.2项指标慢性胃炎组和十二指肠球部溃疡组均低于正常对照组(t分别为4.963、6.070,P均＜0.01),RBCICR分别高于正常对照组(t分别为3.262、3.456,P＜0.05或P＜0.01).HP阴性慢性胃炎与HP阴性十二指肠球部溃疡、HP阳性慢性胃炎与HP阳性十二指肠球部溃疡分别比较RBCC3hRR和RBCICR差异均无统计学意义(P均＞0.05);慢性胃炎及十二指肠球部溃疡HP阳性RBCC3bRR明显低于HP阴性者(P＜0.05或P＜0.01),RBCICR明显高于HiP阴性者(P均＜0.01),HP根除后慢性胃炎和十二指肠球部溃疡患者RBCC3bRR,分别较治疗前明显升高(P＜0.05或P＜0.01).RBCICR分别较治疗前明显降低(P均＜0.01).结论 HP感染、慢性胃炎、十二指肠溃疡均可降低红细胞免疫功能.     

Treatment of duodenal ulcer associated with chronic gastric erosions

Three groups of patients received chemotherapy for duodenal ulcer and associated chronic gastric erosion. Group I was treated by the drugs combination (methacin, almagel, gastrofarm, solcoseryl, tazepam, rudotel), group II received gastrocepin, group III venter. The results of duodenal ulcer healing were similar in all the groups, yet epigastric and/or pyloroduodenal pain was relieved more rapidly in groups II and III. The latter groups were also characterized by accelerated disappearance of fibrinous patches on the surface of the erosion.     

Anti-Helicobacter therapy for duodenal peptic ulcer complicated by pyloroduodenal stenosis

The rate of persistence of and susceptibility of Helicobacter pylori (HP) to antibacterial drugs (ABDs) and the results of eradication therapy were studied in patients with duodenal peptic ulcer complicated by pyloroduodenal stenosis (PDS). The patients with PDS exhibited a high (97.1%) rate of anthral mucosal infection with HP showing a high resistance to ABDs. The efficiency of eradication therapy performed with the susceptibility of HP to ABDs kept in mind was 92.5%. The use of eradication therapy in the complex preoperative preparation of patients with ulcerative PDS increases the latter.     

泮托拉唑三联疗法治疗十二指肠溃疡的临床试验

目的观察以泮托拉唑为基础的三联疗法治疗十二指肠溃疡的疗效。方法选择符合诊断标准的十二指肠溃疡(Helicobacter pylori,Hp)阳性患者78例,采用随机数字表产生随机顺序,未执行分配隐藏,非盲法。将患者分为泮托拉唑(PAC)组39例(泮托拉唑40mg+阿莫西林1.0g+克拉霉素0.5g,bid)和奥美拉唑(OAC)组39例(奥美拉唑20mg+阿莫西林1.0g+克拉霉素0.5g,bid)。两组疗程均为7天,随访时间4~6周。以Hp根除率、症状缓解率、不良反应等指标进行疗效和安全性评估。结果本研究纳入78例,完成75例,失访3例。其PAC组失访1例,OAC组失访2例。意向治疗分析和符合方案分析结果显示,两组Hp根除率分别为87.2%/89.5%和87.2%/91.9%;临床疗效有效率分别为79.4%/81.6%和82.0%/86.5%,两组疗效差异无统计学意义(P>0.05);PAC组不良反应发生率为10.6%,OAC组为8.1%,两组差异也无统计学意义(P>0.05)。结论以泮托拉唑为基础的三联疗法治疗Hp阳性的十二指肠溃疡,其疗效与奥美拉唑相当,且不良反应少,患者耐受性好。     

Blood flow and morphofunctional status of gastroduodenal mucosa in different phases of peptic ulcer

AIM: To investigate gastric and duodenal mucosal blood flow (MBF) in different phases of gastric ulcer (GU) and duodenal ulcer (DU) and its relation both to Helicobacter pylori (HP) infection and mucosal disorders. MATERIAL AND METHODS: Upper endoscopy and histological examinations (score of inflammation, atrophy, metaplasy) were performed in 407 patients with DU and 103 with GU. Gastric and duodenal MBF were assessed by the hydrogen gas clearance technique in 102 DU and 95 GU patients. HP was detected by histology. Gastric secretion was measured in the interdigestive period and after stimulation by pentagastrin. RESULTS: Lowering of MBF in gastric antrum and duodenum was observed in DU and GU patients only with score 3 of HP infection. DU healing is accompanied with a decrease of HP value and improvement of mucosal histology. At the same time MBF exhibits a significant rise: in the duodenum (by 45%) at the stage of white scar; in gastric antrum (by 26%) and body (by 40%) at healing stage, but a decrease in white scar. During healing of GU gastric MBF reached maximum in active ulcer but in white scar MBF was significantly lower. MBF at ulcer margin and MBF in ulcer crater was the same (30 ml/min/100 g) with MBF in the region of white scar with enhanced inflammation (score 2.1) before GU relapse. CONCLUSION: Changes of MBF in different phases of ulcer are, in part, determined both by HP and by mucosal morphological disorders. The ratio MBF increase in ulcer healing/MBF reduction in ulcer relapse is the same (30% from optimal) and it is restitution entity. The MBF level of 30 ml/min/100 g was assessed as crucial in ulcerogenesis. Lowering MBF in mucosa with remaining inflammation in the scar region may predict GU relapse.     

Fromilid (clarithromycin) in eradication patients in patients with duodenal ulcer associated with Helicobacter pylori (comparison of two treatment variations)

AIM: Comparison of two treatment regimens of eradication treatment of duodenal ulcer (DU) associated with Helicobacter pylori based on fromilid (clarithromycin). MATERIAL AND METHODS: 20 DU patients associated with HP were divided into two groups. 10 patients of group 1 received omeprazol, fromilid and metronidazol and 10 patients of group 2 were given omeprazol, fromilid and furasolidon for 7 days followed by 2-week omeprazol alone. The patients were examined clinically and endoscopically; HP were detected with a fast urease test and polymerase chain reaction before and after the treatment. Control examinations were performed 6 weeks after the medication. RESULTS: In group 1 duodenal healing was observed in all the 10 patients, HP eradication occurred in 9 of 10 patients by urease test and in 4 patients by PCR, in group 2 in 8 of 10, 10 of 10 and 10 of 10, respectively. CONCLUSION: Fromilid (clarithromycin) is effective in eradication treatment in combination with fromilid and metronidazol or furazolidon.     

三联疗法对幽门螺杆菌感染者胃上皮细胞的影响

目的：观察“三联疗法”对（幽门螺杆菌）感染者胃黏膜上皮细胞凋亡与一氧化氮（NO）的影响。方法；分别用TUNEL法和NADPH—d法对HP阳性的十二指肠球部溃疡（DU）、胃溃疡（GU）治疗前后以及组织学上正常的HP阴性者各10例的胃黏膜活检组织进行细胞凋亡和一氧化氮检测。结果：在HP阳性的十二指肠溃疡、胃溃疡、HP阴性的正常组织中，细胞凋亡逐渐减少，凋亡指数除在胃溃疡与球部溃疡之间差异无显著性外（P〉0．05），两组与正常组相互比较差异均有显著性（P〈0．05）。“三联疗法”后，HP转阴，细胞凋亡显著减少，NOS阳性细胞数在HP阳性的实验组比HP阴性的正常对照组显著增多（P〈0．01），但各实验组之间差异均无显著性（P〉0．05）。在HP阳性的十二指肠溃疡、胃溃疡细胞凋亡与NOS呈显著正相关（P〈0．05）。结论：HP感染能诱导胃上皮细胞凋亡，引起胃黏膜NO的升高。“三联疗法”可使HP转阴，并通过抑制胃黏膜上皮细胞凋亡与NO的产生而达到治疗作用。     

Effects of probiotic bifiform on efficacy of Helicobacter pylori infection treatment

AIM: To study effects of the probiotic bifiform on efficacy of Helicobacter pylori (HP) eradication in patients with chronic gastritis and ulcer disease. MATERIAL AND METHODS: A total of 98 patients with verified HP infection were divided into two groups. The study group received a week three-component anti-HP therapy+a probiotic. The control group received the same treatment without the probiotic. All the patients were tested for HP before the treatment and one month after the end of the treatment. Cell composition of duodenal mucosa (DM), tissue proinflammatory cytokines, secretory immunoglobulin A (sIgA) in coprofiltrates, serum IgA, IgM, IgG, phagocytic parameters and copromicrobiology were studied. RESULTS: HP eradication rate in the study group was higher than in the control group (89.1 vs 63.5, respectively, p < 0.05). After the treatment, patients of the study group had lower rates of side effects, impaired intestinal biocenosis, tissue cytokines levels but higher concentration of plasmatic cells in CO and cIgA in coprofiltrates. CONCLUSION: The addition of probiotic bifiform to the standard three-component antihelicobacter scheme of the treatment raises its efficacy and is promising treatment of HP. Mechanisms of a potentiating action of the probiotic are related to enhancement of antibacterial activity of local immune reactions.     

药物联合物理治疗根除HP+消化性溃疡再出血的临床研究

目的 :探讨药物 (达克普隆 )联合毫米波 (mmW)对根除HP阳性的消化性溃疡再出血的疗效。方法 :对消化性溃疡并出血的病人 ,随机选择HP阳性的病人分A组 (治疗组 )、B组 (对照组 )、HP阴性组 (C组 ) ,均用达克普隆治疗 ,30mg/次 ,2次 /d ,共 2周 ,A组加用毫米波治疗。治疗 32周后 ,均再服用达克普隆 ,1次 /d ,共 2周。随访 18个月。结果 :ABC三组患者溃疡愈合率分别为 10 0 % ,94 .8% ,95 % ,三组互相比较无明显差异 (P >0 .0 5 ) ,A ,B两组Hp根除率为 87.1%和 15 .3% ,两者相比有显著差异 (P <0 .0 5 ) ,随访 18个月后 ,两组再出血率分别为 2 .5 6 %和 30 .7% ,两者相比有显著差异 (P <0 .0 5 )。而C组再出血率为 12 .5 % ,与AB两组比较无显著差异 (P >0 .0 5 )。结论 :达克普隆联合毫米波治疗对溃疡愈合与HP根除优于单用达克普隆治疗 ,且出血率也低     

Colloid bismuth versus famotidine in the treatment and prevention of duodenal ulcer relapse: results of a double-blind, double dummy randomized study

Summary— Fifty-three consecutive patients with active duodenal ulcer (DU) were randomly included in a double-blind, double-dummy study to test the healing and relapsing rate of two treatment regimens: famotidine 40 mg nocte for 4–8 weeks, followed by 20 mg for 12 months after healing of the ulcer and colloidal bismuth (CBS) (240 mg bid) for 4–8 weeks, followed by placebo maintenance treatment. The results of the short term period confirmed the efficacy of CBS in healing DU (24/25 in CBS group and 19/23 in famotidine group). However, the relapse rate in the CBS-treated group was higher (77.8% at 12 months) than in the famotidine group (35.7%) ( p = 0.041). Only 7 patients (41.2%) were cleared from Helicobacter pylori (HP) after CBS treatment. In conclusion, the high relapse rate observed in CBS treated patients may be related to the high percentage of patients with HP infection in the tested group and support the hypothesis that lack of efficacy of CBS in preventing DU recurrence is related to its poor eradication of HP.     

序贯疗法治疗幽门螺杆菌阳性消化性溃疡的效果

目的探讨含雷贝拉唑的10d序贯疗法对幽门螺杆菌（helicobacterpylori,HP）阳性的消化性溃疡的治疗效果。方法选取HP阳性的消化性溃疡80例,随机分为对照组与试验组,每组40例。对照组使用雷贝拉唑＋克拉霉素＋阿莫西林,疗程7d;试验组前5d给予雷贝拉唑＋阿莫西林,后5d给予雷贝拉唑＋替硝唑＋克拉霉素,然后进行抗溃疡治疗。观察2组HP根除率、溃疡愈合率及不良反应。结果对照组HP根除率为72．5％,试验组90．0％,2组比较差异有统计学意义（P〈0．05）;对照组溃疡愈合率92．5％,试验组为95．0％,2组比较差异无统计学意义（P〉0．05）。结论含雷贝拉唑的10d序贯疗法对HP阳性的消化性溃疡治疗安全、有效。