Brandimarte G, Tursi A, di Cesare L, Gasbarrini G
Department of Internal Medicine, Cristo Re Hospital, Rome, Italy.
Eur J Gastroenterol Hepatol. 1999 Jul;11(7):731-4. doi: 10.1097/00042737-199907000-00009.
Peptic stenosis, a complication of peptic ulcer disease, is treated by endoscopic balloon dilation or surgery. However, recent reports showed that Helicobacter pylori eradication may resolve peptic stenosis. Thus, we carried out a prospective study on a cohort of patients with peptic stenosis and H. pylori infection to evaluate the efficacy of anti- H. pylori therapy in the treatment of peptic stenosis.
DESIGN/METHODS: From May 1995 to May 1998 we studied 22 consecutive patients with benign peptic stenosis (16 with duodenal stenosis and six with pyloric stenosis) and H. pylori infection. Searches for H. pylori were made at first diagnosis of peptic stenosis and at every endoscopic control. All patients were treated with an anti- H. pylori treatment (13 with omeprazole/clarithromycin/ metronidazole and nine with omeprazole/amoxycillin/ clarithromycin), followed by 8 weeks' therapy with a proton-pump inhibitor. Endoscopic controls were performed after the end of H. pylori-eradication therapy, at 2 and 6 months, and then every 6 months.
H. pylori eradication was achieved in all patients. Peptic stenosis disappeared completely in 20/22 cases (17/20 after 2 months and 3/20 after 6 months), and in all these patients the symptoms disappeared within 2 months. At the median follow-up of 12.4 months (range 2-24), the patients remained asymptomatic, without recurrence of the stenosis, and needed no medication. In one patient the stenosis disappeared partially and symptoms improved, and it was successfully treated with cisapride. In one patient the stenosis did not disappear despite H. pylori eradication and continuous proton-pump inhibitor treatment. The patient was treated with a liquid diet due to old age, but he died 4 months after H. pylori eradication due to stroke.
H. pylori eradication is a safe and effective therapy for peptic stenosis. Endoscopic balloon dilation or surgery should be used only after failure of this conservative treatment.
消化性狭窄是消化性溃疡疾病的一种并发症，可通过内镜下球囊扩张或手术治疗。然而，最近的报告显示，根除幽门螺杆菌可能会使消化性狭窄得到缓解。因此，我们对一组患有消化性狭窄和幽门螺杆菌感染的患者进行了一项前瞻性研究，以评估抗幽门螺杆菌治疗在消化性狭窄治疗中的疗效。
设计/方法：从1995年5月至1998年5月，我们研究了22例连续的患有良性消化性狭窄（16例十二指肠狭窄和6例幽门狭窄）且感染幽门螺杆菌的患者。在消化性狭窄初次诊断时以及每次内镜检查时均进行幽门螺杆菌检测。所有患者均接受抗幽门螺杆菌治疗（13例使用奥美拉唑/克拉霉素/甲硝唑，9例使用奥美拉唑/阿莫西林/克拉霉素），随后接受8周的质子泵抑制剂治疗。在幽门螺杆菌根除治疗结束后、2个月和6个月时进行内镜检查，之后每6个月进行一次。
所有患者均实现幽门螺杆菌根除。22例中有20例（2个月后17例，6个月后3例）消化性狭窄完全消失，所有这些患者的症状在2个月内消失。在中位随访12.4个月（范围2 - 24个月）时，患者无症状，狭窄无复发，无需药物治疗。1例患者狭窄部分消失，症状改善，经西沙必利成功治疗。1例患者尽管根除了幽门螺杆菌并持续进行质子泵抑制剂治疗，但狭窄仍未消失。该患者因年老接受流食治疗，但在根除幽门螺杆菌4个月后因中风死亡。
根除幽门螺杆菌是治疗消化性狭窄的一种安全有效的方法。仅在这种保守治疗失败后才应使用内镜下球囊扩张或手术。
