Ocaña Andrade E, Espinosa Soberanes J A, Mares Zambrano M A, Rosete Reyes A
Servicio de Gastroenterología, Hospital Central Norte de Petróleos Mexicanos, México, D.F.
Rev Gastroenterol Mex. 1998 Oct-Dec;63(4):182-6.
We studied during a 12-months follow-up the effect of the eradication of Helicobacter pylori (Hp) on the recurrence of duodenal ulcer (DU).
The eradication of Hp from the gastric mucosa has been the objective of numerous therapeutic trials for preventing DU recurrence; however, an optimal treatment has not yet been established.
51 patients with Hp infection and active DU confirmed by endoscopy were randomized in two groups. All patients received ranitidine 300 mg daily for eight weeks. Group A (26 patients) received a 5 day course of amoxycillin 500 mg t.i.d., metronidazole 500 mg t.i.d., and furoxone 100 mg t.i.d., during the 3rd week. After ranitidine treatment, none patient of this group received further treatment. Group B (25 patients) received 150 mg of ranitidine daily during 12 months. Endoscopy was performed at the end of the first eight weeks of the ranitidine treatment as well as at the 6th and 12th month of follow-up or sooner if symptoms recurred. Two biopsies were taken from gastric antrum at each endoscopy examination for Hp detection with Giemsa and hematoxylin/eosine stains. Each patient gave informed consent and this trial was approved by the regional Ethics Committee. Statistical analysis was performed using chi 2 test.
After eight weeks of ranitidine treatment, the ulcer of all patients from both groups was healed. The percentage of Hp eradication was 92% (24/26 pt) in group A and none in group B (p < 0.001). Recurrence of Hp infection occurred in 9/24 patients (37.5%) during a 12 months follow-up (group A) and of these, one patient had recurrence of DU. In contrast, all 25 patients of group B were persistently Hp positive and 7 developed recurrent DU (p < 0.05). Both treatments were well tolerated.
The combined therapy with amoxycillin, metronidazole, furoxone and ranitidine is highly effective in both Hp eradication and prevention of DU recurrence.
我们在为期12个月的随访中研究了根除幽门螺杆菌（Hp）对十二指肠溃疡（DU）复发的影响。
从胃黏膜根除Hp一直是众多预防DU复发治疗试验的目标；然而，尚未确立最佳治疗方法。
51例经内镜确诊为Hp感染和活动性DU的患者被随机分为两组。所有患者每天接受300mg雷尼替丁治疗，为期8周。A组（26例患者）在第3周接受为期5天的阿莫西林500mg每日三次、甲硝唑500mg每日三次和呋喃唑酮100mg每日三次的治疗。雷尼替丁治疗后，该组无患者接受进一步治疗。B组（25例患者）在12个月内每天接受150mg雷尼替丁治疗。在雷尼替丁治疗的前8周结束时以及随访的第6个月和第12个月进行内镜检查，若症状复发则提前检查。每次内镜检查时从胃窦取两块活检组织，用吉姆萨染色和苏木精/伊红染色检测Hp。每位患者均签署知情同意书，本试验经地区伦理委员会批准。采用卡方检验进行统计分析。
雷尼替丁治疗8周后，两组所有患者的溃疡均愈合。A组Hp根除率为92%（24/26例患者），B组为0（p<0.001）。在12个月的随访期间，A组9/24例患者（37.5%）发生Hp感染复发，其中1例患者DU复发。相比之下，B组的所有25例患者Hp持续阳性，7例发生DU复发（p<0.05）。两种治疗耐受性均良好结论：阿莫西林、甲硝唑、呋喃唑酮和雷尼替丁联合治疗在根除Hp和预防DU复发方面均非常有效。
