Helicobacter pylori infection in hemodialysis patients： Susceptibility to amoxicillin and clarithromycin

AIM: To evaluate susceptibility of Helicobacter pylori to amoxicillin and clarithromycin in end-stage renal disease(ESRD) patients and non-uremic controls.METHODS: The subjects with dyspeptic complaints were 33 ESRD patients and 46 age- and sex-matched nonuremic controls who exhibited Hpylorion antral biopsy specimens. The two groups were age and sex matched.The Hpyloristrains‘ pattern of susceptibility to amoxicillin and clarithromycin was investigated with the agar dilution technique.RESULTS: None of the Hpyloristrains from either group showed resistance to amoxicillin with the agar dilution method. Twelve (36.4%) of the ESRD group strains and7 (15.2%) of the control group strains showed resistance to clarithromycin, and this difference was statistically significant (P<0.05).CONCLUSION: Resistance to amoxicillin does not appear to be an important problem in Hpylori-infected ESRD and non-uremic patients in our region. In contrast, the rates of resistance to clarithromycin are high, particularly in the ESRD population.     

Low-dose rabeprazole, amoxicillin and metronidazole triple therapy for the treatment of Helicobacter pylori infection in Chinese patients

BACKGROUND: Rabeprazole in combination with amoxicillin and metronidazole (RAM) has been shown to be an effective second-line treatment of Helicobacter pylori infection. The effects were compared of 7-day low-dose and high dose rabeprazole in RAM for the primary treatment of H. pylori infection in Chinese patients. METHODS: Helicobacter pylori-positive dyspeptic patients were randomized to receive either (i) rabeprazole 10 mg, amoxicillin 1000 mg and metronidazole 400 mg (RAM-10) or (ii) high-dose rabeprazole 20 mg, amoxicillin 1000 mg and metronidazole 400 mg (RAM-20), each given twice daily for 7 days. Helicobacter pylori eradication was confirmed by (13)c-urea breath test 5 weeks after stopping medications. side-effects of treatments were documented. RESULTS: A total of 120 patients were eligible for analysis. By intention-to-treat and per-protocol analysis, the eradication rates were 83% and 86% in the RAM-10 group and 75% and 76% in the RAM-20 group, respectively (P = 0.26 and P = 0.17). Both regimens were well-tolerated and compliance was >98% in both groups. CONCLUSIONS: Low-dose rabeprazole in combination with amoxicillin and metronidazole is an effective, economical and well-tolerated therapy for the treatment of H. pylori infection in Chinese population.     

Relapsed duodenal ulcer after cure of Helicobacter pylori infection

We report a patient—a 42-year-old man—who had suffered from recurrent duodenal ulcer for about 20 years. Successful curative therapy for Helicobacter pylori infection was performed for 2 weeks with new triple omeprazole, anoxicillin, clarithromycin (OAC) treatment in October 1995, and cure of the infection was repeatedly confirmed by histology, culture, and the ¹³C urea breath test. One month after the curative therapy, recurrence of a small duodenal ulcer was observed and in February another duodenal ulcer and reflux esophagitis occurred, with severe symptoms, despite the continuous administration of ranitidine. None of the examinations to reconfirm cure of the infection revealed the presence of H. pylori. As the patient experienced continual psychological stress and smoked more frequently during the recurrent episode and had not used nonsteroidal anti-inflammatory drugs, stress and smoking appeared to play important roles in the relapse of duodenal ulcer in this patient after cure of H. pylori infection. (Received Aug. 18, 1997; accepted Jan. 23, 1998)     

一种新的幽门螺杆菌克拉霉素耐药相关基因

目的:分析不同克拉霉素浓度下H pylori菌株耐药的发生机制,以期发现新的耐药基因．方法:以H pylori 26695株为初发菌株,经抗生素压力筛选、转座子Tn5插入失活、E-test检测等实验方法探讨H pyolri对克拉霉素的耐药机制．结果:经12次传代,在0．5 mg／L克拉霉素浓度下培养出的耐药株经-80℃冻存30 d复苏,仍为抗性菌株;克拉霉素抗性的转座插入株于 700 bp左右出现条带;经96-168 h培养,单纯经抗生素选择压力筛选的低浓度耐药株E-test 出现椭圆形抑菌环,而经Tn5插入的克拉霉素抗性菌株无抑菌环出现．对插入位点基因的测序发现该片段与H pylori 26695菌株中“H pylori 1469”完全同源,为编码Omp3l的基因．结论:H pylori对克拉霉素的低浓度耐药,经转座后可转化为高浓度耐药,其耐药性的发生与23S rRNA点突变以外的Omp31基因有关．     

艾普拉唑、左氧氟沙星和克拉霉素三联疗法根除幽门螺杆菌的临床研究

[目的]比较艾普拉唑、左氧氟沙星和克拉霉素三联疗法和标准三联疗法根除治疗幽门螺杆菌(Helicobacter pylori,Hp)的临床疗效。[方法]将120例Hp阳性患者随机分为治疗组与对照组。治疗组60例给予艾普拉肠溶片5mg、2次/d,左氧氟沙星0.5g、1次/d,克拉霉素500mg、2次/d;对照组60例给予奥美拉唑肠溶片20mg、阿莫西林1g、克拉霉素500mg,均为2次/d;2组疗程均为7d。疗程结束后4周复查Hp。[结果]意向治疗分析:治疗组根除率为86.7%,对照组为73.3%,差异有统计学意义(P=0.037);按符合方案集分析:治疗组根除率为91.4%,对照组为77.2%,差异有统计学意义(P=0.036)。治疗组不良反应率为6.7%,对照组为8.3%,无显著差异。[结论]艾普拉唑、左氧氟沙星和克拉霉素三联疗法能有效根除Hp,且不良反应较少,是未来根除Hp有希望的一线疗法。     

幽门螺杆菌对克拉霉素耐药的分子机制研究

目的：研究幽门螺杆菌（Hp)对克拉霉素耐的分子机制。方法：用E－test进行克拉霉素药敏试验,选取治疗前敏感、治疗后耐药的配对菌株及原发耐药Hp菌株进行研究;应用随机扩增多态性DNA（RAPD）分析,确定治疗前后菌株的同一性;用PCR－限制性片段长度多态性（RFLP）分析探讨克拉霉素耐药机制。结果9株克拉霉素耐药菌23SrRNA基因功能区V PCR扩增片段,8株被BsaI酶切,9株均未被BbsI酶切,提示8株在2144位点有A→G突变。结论上海地区大多数克拉霉素耐药Hp菌株存在23SrRNA基因功能区V2144位点A→G突变。     

益生菌联合四联疗法治疗老年人幽门螺杆菌感染的临床观察

目的探讨益生菌在治疗老年人幽门螺杆菌(H.pylori)感染中的价值。方法入选2014年1月至10月解放军总医院南楼临床部消化内科120例老年H.pylori感染患者,根据年龄性别进行随机区组设计,分为益生菌治疗组和对照组,各60例。对照组给予阿莫西林+克拉霉素+雷贝拉唑+胶体果胶铋标准四联疗法,治疗组给予酪酸梭菌肠球菌三联活菌片+四联疗法,两组疗程均为14 d,治疗结束4周后复查~(13)C尿素呼气试验(~(13)C UBT),观察并比较两组患者H.pylori根除率及不良反应发生情况。结果 117例患者按方案完成治疗。治疗组和对照组按意向治疗(ITT)分析H.pylori根除率分别为83.33%和71.67%,按方案(PP)分析H.pylori根除率分别为86.21%和72.88%,治疗组ITT和PP根除率均明显高于对照组,但差异无统计学意义(P0.05),随访1年后复查,治疗组H.pylori根除率仍显著高于对照组,差异有统计学意义(P0.05);治疗组不良反应发生率为10.34%,明显低于对照组的27.12%,差异有统计学意义(P0.05)。治疗组对药物的耐受程度显著优于对照组(P0.05)。结论益生菌联合标准四联疗法能有效提高H.pylori根除率,并且能显著降低药物不良反应。     

Effect of different doses of furazolidone with amoxicillin and omeprazole on eradication of Helicobacter pylori

BACKGROUND: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with classic triple therapy. In contrast, the clarithromycin-based regimen is not cost-effective for developing countries. Furazolidone is a very good substitute for metronidazole and clarithromycin, but its many side-effects limit widespread use. The aim of the present study was to assess the efficacy of two different doses of furazolidone in combination with amoxycillin and omeprazole. METHODS: A total of 123 patients with duodenal ulcer were randomized and received the following medications for two weeks. Group A: furazolidone 2 x 200 mg + amoxycillin 2 x 1 g + omeprazole 2 x 20 mg/day. Group B: furazolidone 2 x 50 mg + amoxycillin 2 x 1 g + omeprazole 2 x 20 mg/day. Control endoscopy was performed after 6 weeks and two biopsy specimens from the antrum and two from the corpus were taken for a urease test and histology. Eradication was concluded if all tests were negative for H. pylori. RESULTS: In total, 110 patients completed the study. Four patients in group A did not tolerate the regimen on day 8 of therapy and were excluded from the study. Serious complications such as fever, and fatigue and dizziness, which occurred in the beginning of the second week of treatment (days 8-10), were more common in group A than in group B (19%, 15.9% and 14.3%, respectively, in group A vs 0% in group B). The eradication rate by per protocol analysis was significantly higher in group A than in group B (88.9%vs 67.9%, respectively, P = 0.008). However, this difference was low and not statistically significant by intention-to-treat analysis (76.2% in group A and 62.3% in group B, P = 0.09). CONCLUSION: The regimen with a non-reduced dose of furazolidone in combination with amoxycillin and omeprazole was effective when the patients tolerated the drugs and completed the study.     

Nutrition status and Helicobacter pylori infection in patients receiving hemodialysis

Chronic kidney disease(CKD) patients receiving hemodialysis(HD) often develop gastrointestinal abnormalities over their long treatment period. In general, prognosis in such patients is poor due to the development of protein-energy wasting(PEW). Therefore, it is important to clarify the etiology of PEW and to establish better strategies to deal with this condition. Chronic Helicobacter pylori(H. pylori) infection in the gastric mucosa has a close association with not only the development of peptic ulcer disease and gastric cancer, but is also associated with abnormal plasma and gastric mucosal ghrelin levels that are seen in malnutrition. It is unclear whether H. pylori infection of the gastric mucosa is directly associated with prognosis in HD patients by affecting ghrelin levels. Recent studies show that the prevalence of H. pylori infection in HD patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in HD patients, the prevalence of infection decreases as the length of time on HD increases. The severity of gastric mucosal atrophy has been suggested as the major determinant of ghrelin levels in these patients, and eradication therapy of H. pylori improves nutritional status by increasing serum cholinesterase and cholesterol levels, especially in patients with mildto-moderate gastric mucosal atrophy. Prompt H. pylori eradication to inhibit the progress of gastric atrophy may be required to prevent this decrease in ghrelin levels and subsequent PEW and improve the prognosis of HD patients by improving their nutritional status.     

Reflux esophagitis facilitates low Helicobacter pylori infection rate and gastric inflammation

BACKGROUND: Helicobacter pylori is regarded as an important pathogen in upper gastrointestinal diseases. However, little is known about the relationship between H. pylori infection and reflux esophagitis. Therefore, an investigation was undertaken in Korean subjects regarding the incidence of H. pylori infection, and a histopathological study of reflux esophagitis was also carried out. METHODS: Analysis of gastric biopsy specimens was conducted for 73 patients with reflux esophagitis and 132 control subjects without reflux esophagitis. The H. pylori infection was assessed by using rapid urease test and the immunohistochemical method, and gastric mucosal morphologic change was analyzed according to the updated Sydney system. RESULTS: The prevalence of H. pylori infection was significantly lower in patients with reflux esophagitis than in the non-reflux group. Grade of inflammation and glandular atrophy in the antrum and body were higher in patients in the non-reflux group compared with those in the reflux esophagitis group. CONCLUSIONS: It is suggested that H. pylori infection decreases the risk of reflux esophagitis by inducing atrophic gastritis.     

Reinfection rate following effective therapy against Helicobacter pylori infection in Japan

BACKGROUND AND AIM: In developed countries, reinfection of Helicobacter pylori (H. pylori) after eradication of the bacterium is unusual, while the reinfection rate in developing countries is variable. In this study, we determined the reinfection rate after successful H. pylori eradication in Japan, a country with a high prevalence of H. pylori infection. METHODS: After successful eradication, 377 patients were followed up by endoscopy and urea breath test annually. In reinfected patients, H. pylori strains isolated initially and after reinfection were compared by using random amplification of polymorphic DNA fingerprinting. RESULTS: H. pylori became positive in four of 337 patients (1.2) 1 year after eradication and in two of 133 patients (1.5) 2 years after eradication. One patient experienced an ulcer relapse 2 years after eradication therapy. Random amplification of polymorphic DNA fingerprinting of the isolated strains from four of the six patients showed two had identical strains (at 1 year) while the other two had different strains (one at 1 year and one at 2 years). When infection in the two patients reinfected with identical strains is considered a recrudescence, the true reinfection rate is < 0.8 per patient year. CONCLUSIONS: The reinfection rate after eradication of H. pylori is low in Japan despite the country's high prevalence of H. pylori infection.     

左氧氟沙星联合阿莫西林、埃索美拉唑方案根除幽门螺杆菌疗效观察

目的探讨埃索美拉唑、左氧氟沙星、阿莫西林联合根除胃幽门螺杆菌（Hp）感染的疗效与安全性。方法选择116例Hp阳性慢性胃炎或消化性溃疡患者,随机分为两组各58例。治疗组给予埃索美拉唑加左氧氟沙星加阿莫西林口服,2次/d,疗程1周;对照组给予埃索美拉唑加克拉霉素加甲硝唑,2次/d,疗程1周。5周后复查Hp,观察Hp根除率及临床症状、不良反应。结果左氧氟沙星组Hp根除率91.4%,对照组Hp根除率87.9%,两组差异无统计学意义（P〉0.05）。左氧氟沙星组临床症状缓解明显,不良反应少。结论埃索美拉唑加左氧氟沙星加阿莫西林三联一周疗法,对根除Hp可以获得较理想效果,病人不良反应发生率低,依从性较好,是根除Hp的理想方案,可被作为根除Hp一线治疗的选择。     

长疗程小剂量泮托拉唑和克拉霉素三联疗法根除幽门螺杆菌的疗效观察

目的探讨泮托拉唑联合阿莫西林和克拉霉素对幽门螺杆菌治疗的效果及适当的剂量。方法来自我市8家医院的600例患者,患有胃溃疡或十二指肠溃疡,且幽门螺杆菌阳性。随机分为两组：观察组：泮托拉唑20mg＋阿莫西林750mg＋克拉霉素125mg,对照组：泮托拉唑40mg＋阿莫西林750mg＋克拉霉素250mg。各组药物均每日口服两次,疗程2周。结果对照组对幽门螺杆菌的根除率为81.7%,观察组对幽门螺杆菌的根除率为93.7%。结论泮托拉唑、阿莫西林、克拉霉素的三联疗法对幽门螺杆菌有很高的根除率,而半剂量的泮托拉唑和克拉霉素对幽门螺杆菌的治疗效果更好,且副作用少。     

幽门螺杆菌感染与反流性食管炎的关系

目的探讨幽门螺杆菌（Hp）感染与反流性食管炎（RE）的关系。方法对在本院消化科就诊的患者行内镜下快速尿素酶测定却感染，观察比较却阴性组、却阳性组RE的发病率。对却阳性组中经胃镜及病理切片证实为消化性溃疡的患者，进行却根除治疗，3个月后复查胃镜比较抗却治疗前后RE发病率的变化。结果却阳性组RE发病率为5．28％，却阴性组RE发病率为7．59％，二者差异有统计学意义（P〈0．05）。抗却治疗前后RE发病率分别为10．7％、35．7％，二者差异有统计学意义（P〈0．05）。结论①却不是RE的病因；②抗坳治疗会导致RE发病率的升高。     

Follow-up survey of a large-scale multicenter,double-blind study of triple therapy with lansoprazole,amoxicillin, and clarithromycin for eradication of Helicobacter pylori in Japanese peptic ulcer patients

Background: To evaluate histopathological changes and effects on inhibition of ulcer recurrence, a follow-up survey was performed in Japanese patients with Helicobacter pylori-positive active peptic ulcers. These patients had previously participated in a large-scale multicenter trial of triple therapy with lansoprazole (LPZ)/amoxicillin (AMPC)/clarithromycin (CAM) for eradication of H. pylori. Methods: Patients who had been treated with LPZ only or a combination of LPZ, AMPC, and CAM for a period of 7 days and in whom ulcer healing had been confirmed after treatment were grouped according to successful or failed eradication of H. pylori. They were examined endoscopically to determine whether ulcers had recurred. The updated Sydney system was applied to study histological changes after H. pylori eradication therapy, compared with baseline. Results: Twelve months after treatment for H. pylori eradication, gastric ulcers had recurred in 11.4% of those with successful H. pylori eradication and in 64.5% of those with unsuccessful H. pylori eradication. Duodenal ulcers had recurred in 6.8% of patients for whom H. pylori eradication was successful and in 85.3% of patients in whom eradication failed. These findings proved that H. pylori eradication significantly reduced ulcer recurrence (P < 0.0001 for both types of ulcers). Histopathological findings of inflammation and activity grade in both gastric and duodenal ulcers were more favorable in patients with successful eradication than in those with unsuccessful eradication. Conclusions: H. pylori eradication significantly inhibited ulcer recurrence in Japanese peptic ulcer patients. Histopathological findings were also improved with regard to inflammation and activity (neutrophils) in patients in whom H. pylori eradication was successful. Received: May 13, 2002 / Accepted: September 6, 2002 Reprint requests to: M. Asaka Editorial on page 410     

十二指肠胃化生与幽门螺杆菌感染

本文调查了155例十二指肠溃疡旁粘膜的组织病理学变化,并与对照组相比较。结果显示:溃疡旁组织炎症、胃化生和Hp检出率分别为69.7％、75.5％和24.5％,显著高于对照组的18.8％、10.4％和4.2％(P<0.01)。Hp在胃化生组织中的检出率为32.8％,81例不伴胃化生的粘膜中均未检出Hp(P<0.01)。透射电镜观察胃化生有其特征性改变。提示胃化生可能是溃疡形成的基础,Hp在化生区定植并非是产生溃疡的唯一直接因素,还可能通过其他复杂环节间接起作用。     

幽门螺杆菌感染与Toll样受体

Toll样受体(TLR)是固有免疫系统中的细胞跨膜受体及微生物相关分子模式识别受体之一,可激活固有免疫应答,同时还是连接固有免疫和获得性免疫的桥梁。因此,Toll样受体在免疫系统中有着十分重要的作用。最近研究发现TLR信号通路和幽门螺杆菌(Hp)的感染和致病关系密切。此文主要介绍TLR的结构、信号通路及其在Hp感染和致病中的作用。