Chang C S, Yang C Y, Wong F N, Chen G H, Lien H C, Yeh H Z, Poon S K
Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2713-7.
BACKGROUND/AIMS: Adding an acid secretion inhibitor to anti-H. pylori regimens may be potentially valuable for enhancing the effectiveness of antimicrobials that exhibit markedly reduced activity at low pH. This study was conducted to evaluate intragastric acidity as a factor in H. pylori eradication with bismuth-based triple therapy.
Forty patients with duodenal ulcer and H. pylori infection were included. The patients were divided into 2 groups--normacid (n = 20) and hyperacid (n = 20)--based on the amount of time that 24-hour intragastric pH took to reach the level pH > or = 3. All patients received bismuth subsalicylate (600 mg 3 times daily), metronidazole (500 mg 3 times daily) and amoxicillin (500 mg 3 times daily) for 2 weeks. Then, all patients continued treatment with ranitidine (150 mg twice daily) for 8 weeks prior to the follow-up examination. Blood samples were collected before treatment for measurement of fasting gastrin and pepsinogen-I.
Nine patients (45%) in the normacid group and 8 patients (40%) in the hyperacid group reported side effects. However, there were only 2 patients (10%) in each group who withdrew from the study due to intolerance of side-effects. There was no difference in the H. pylori eradication rate between the normacid and hyperacid groups (16/18, 88.9% vs. 15/18, 83.3%).
Without co-administration of anti-secretary agents, intragastric acid is not a significant factor in the effectiveness of H. pylori eradication with bismuth-based triple therapy.
背景/目的：在抗幽门螺杆菌治疗方案中添加酸分泌抑制剂可能对提高在低pH值下活性显著降低的抗菌药物的疗效具有潜在价值。本研究旨在评估胃内酸度作为铋剂三联疗法根除幽门螺杆菌的一个因素。
纳入40例十二指肠溃疡合并幽门螺杆菌感染患者。根据24小时胃内pH值达到pH≥3水平所需时间，将患者分为两组——胃酸正常组（n = 20）和胃酸过多组（n = 20）。所有患者接受次水杨酸铋（600 mg，每日3次）、甲硝唑（500 mg，每日3次）和阿莫西林（500 mg，每日3次）治疗2周。然后，所有患者在随访检查前继续服用雷尼替丁（150 mg，每日2次）治疗8周。治疗前采集血样测定空腹胃泌素和胃蛋白酶原I。
胃酸正常组9例患者（45%）和胃酸过多组8例患者（40%）报告有副作用。然而，每组仅2例患者（10%）因副作用不耐受而退出研究。胃酸正常组和胃酸过多组的幽门螺杆菌根除率无差异（16/18，88.9%对15/18，83.3%）。
在不联合使用抗分泌药物的情况下，胃内酸度不是铋剂三联疗法根除幽门螺杆菌疗效的重要因素。
