García S, Fuentes J, Ducóns J A, Barrera F, Yus C, Gomollón F
Digestive Diseases Service, Miguel Servet Hospital, Zaragoza, Spain.
Rev Esp Enferm Dig. 2000 Jan;92(1):5-12.
To confirm whether 1-week anti-Helicobacter therapy to achieve ulcer healing is sufficient and safe.
We retrospectively analyzed patients with peptic ulcer who were infected with Helicobacter pylori and treated with 3 different 7-day regimens, according to predefined protocols in 3 different centers in the same geographical area (Aragón, Spain). Three combinations commonly described in the literature were used: a) omeprazole (40 mg/24 h), tetracycline hydrochloride (2 g/24 h), colloidal bismuth subcitrate (480 mg/24 h) and metronidazole (750 mg/24 h) (OBTM, n = 105); b) omeprazole (40 mg/24 h), clarithromycin (1.5 g/24 h) and amoxicillin (3 g/24 h) (O40C1.5A3, n = 13); and c) omeprazole (40 mg/24 h), clarithromycin (1 g/24 h) and amoxicillin (2 g/24 h) (O40C1A2, n = 4). In all patients the diagnosis of peptic ulcer disease was confirmed endoscopically, and H. pylori infection was verified with urease testing and histological analysis. After treatment ended, no other antacids were allowed until after endoscopic examination to check eradication and ulcer healing.
122 patients were included (107 with duodenal ulcer, 12 with gastric ulcer and 3 with both). Compliance was good and side effects infrequent and mild. Eradication rates were 88.5% (93/105) in the OBTM group, 100% (13/13) with O40C1.5A3, and 75% (3/4) with O40C1A2. Healing was achieved in 98.16% (107/109) of the patients in whom the bacterial infection was eradicated, and in 23.07% (3/13) of those in whom it was not (p < 0.0001). No patient had any complications during the period without treatment.
1-week eradication therapy with previously described combinations commonly used in clinical practice achieves high ulcer healing rates with no complications in the period without antacid treatment. We consider that it is not necessary, at least in most patients, to prolong antacid therapy.
确认为期1周的抗幽门螺杆菌治疗实现溃疡愈合是否充分且安全。
我们回顾性分析了幽门螺杆菌感染的消化性溃疡患者，这些患者在同一地理区域（西班牙阿拉贡）的3个不同中心按照预定义方案接受了3种不同的7天治疗方案。使用了文献中常见描述的三种组合：a）奥美拉唑（40毫克/24小时）、盐酸四环素（2克/24小时）、枸橼酸铋钾（480毫克/24小时）和甲硝唑（750毫克/24小时）（OBTM，n = 105）；b）奥美拉唑（40毫克/24小时）、克拉霉素（1.5克/24小时）和阿莫西林（3克/24小时）（O40C1.5A3，n = 13）；c）奥美拉唑（40毫克/24小时）、克拉霉素（1克/24小时）和阿莫西林（2克/24小时）（O40C1A2，n = 4）。所有患者均通过内镜检查确诊为消化性溃疡疾病，并通过尿素酶检测和组织学分析证实幽门螺杆菌感染。治疗结束后，在内镜检查以检查根除和溃疡愈合情况之前，不允许使用其他抗酸剂。
共纳入122例患者（十二指肠溃疡107例，胃溃疡12例，两者均有的3例）。依从性良好，副作用少见且轻微。OBTM组的根除率为88.5%（93/105），O40C1.5A3组为100%（13/13），O40C1A2组为75%（3/4）。细菌感染被根除的患者中98.16%（107/109）实现了愈合，未被根除的患者中23.07%（3/13）实现了愈合（p < 0.0001）。在未进行治疗的期间，没有患者出现任何并发症。
采用临床实践中常用的上述组合进行为期1周的根除治疗，在不使用抗酸剂治疗的期间实现了高溃疡愈合率且无并发症。我们认为，至少在大多数患者中，没有必要延长抗酸剂治疗时间。
