Zullo A, Rinaldi V, Meddi P, Winn S, Moscatelli R, Attili A F
Department of Clinical Medicine-Gastroenterology, La Sapienza University, Rome, Italy.
Ital J Gastroenterol Hepatol. 1999 Dec;31(9):831-5.
Few data exist on the treatment of Helicobacter pylori infection in cirrhotic patients. In this study we assessed the efficacy of standard dual and one-week low-dose triple therapy on Helicobacter pylori eradication in cirrhotics.
In a prospective study, 83 cirrhotic patients with epigastric pain were randomised to receive either a two-week course of dual therapy, composed of omeprazole 20 mg b.d. plus amoxycillin 1 g b.d. (n = 41) or a one-week course of triple therapy, composed of omeprazole 20 mg b.d., clarithromycin 250 mg b.d., and tetracycline 500 mg b.d (n = 42). Helicobacter pylori infection at entry and eradication 6-8 weeks after the end of therapy were assessed by rapid urease test and histology on biopsies from the antrum and corpus. When eradication did not occur with either dual or triple therapy, patients were given the alternative regimen. Helicobacter pylori eradication in these patients was assessed 6-8 weeks after the end of treatment by a further endoscopy.
Helicobacter pylori eradication was achieved in 87.8% (36 out of 41; 95% confidence interval 77.8-97.8%) of patients after dual therapy and in 85.7% (36 out of 42; 95% confidence interval 75.1-96.3%) of patients treated with triple therapy (p = NS). In patients in whom initial eradication was unsuccessful, re-treatment eradicated Helicobacter pylori in 4 out of 5 patients given the triple regimen and in all 5 patients who received the dual therapy. One patient was lost to follow-up. No major side-effects were reported for either treatment regimen.
Our data show that both dual and triple therapies are effective in Helicobacter pylori eradication in cirrhotics as well as in eradication failure patients. Therefore, the use of the dual therapy regimen is strongly suggested as an initial treatment for Helicobacter pylori eradication in cirrhotic patients.
关于肝硬化患者幽门螺杆菌感染治疗的数据较少。在本研究中，我们评估了标准双联疗法和一周低剂量三联疗法对肝硬化患者幽门螺杆菌根除的疗效。
在一项前瞻性研究中，83例有上腹部疼痛的肝硬化患者被随机分为两组，一组接受为期两周的双联疗法，即奥美拉唑20毫克，每日两次，加阿莫西林1克，每日两次（n = 41）；另一组接受为期一周的三联疗法，即奥美拉唑20毫克，每日两次，克拉霉素250毫克，每日两次，四环素500毫克，每日两次（n = 42）。通过快速尿素酶试验和取自胃窦和胃体活检组织的组织学检查，评估治疗开始时及治疗结束后6 - 8周的幽门螺杆菌感染情况。若双联或三联疗法均未实现根除，则给予患者替代方案。在这些患者接受进一步内镜检查治疗结束后6 - 8周，评估幽门螺杆菌根除情况。
双联疗法后，87.8%（41例中的36例；95%置信区间77.8 - 97.8%）的患者实现了幽门螺杆菌根除；三联疗法治疗的患者中，这一比例为85.7%（42例中的36例；95%置信区间75.1 - 96.3%）（p = 无显著性差异）。在初始根除未成功的患者中，接受三联方案治疗的5例患者中有4例、接受双联疗法的所有5例患者再次治疗后实现了幽门螺杆菌根除。1例患者失访。两种治疗方案均未报告严重副作用。
我们的数据表明，双联疗法和三联疗法对肝硬化患者以及根除失败患者的幽门螺杆菌根除均有效。因此，强烈建议使用双联疗法方案作为肝硬化患者幽门螺杆菌根除的初始治疗方法。
