Chan F K, Chung S C, Suen B Y, Lee Y T, Leung W K, Leung V K, Wu J C, Lau J Y, Hui Y, Lai M S, Chan H L, Sung J J
Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
N Engl J Med. 2001 Mar 29;344(13):967-73. doi: 10.1056/NEJM200103293441304.
Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients.
We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months.
We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005).
Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs.
许多曾发生上消化道出血的患者继续服用低剂量阿司匹林以预防心血管疾病，或服用其他非甾体抗炎药（NSAIDs）来缓解肌肉骨骼疼痛。幽门螺杆菌感染是否为此类患者出血的危险因素尚不确定。
我们研究了有上消化道出血病史、感染幽门螺杆菌且正在服用低剂量阿司匹林或其他NSAIDs的患者。我们评估了根除感染或使用奥美拉唑治疗在预防复发性出血方面是否更有效。我们招募了经内镜检查确诊为上消化道出血的患者。通过每日服用20毫克奥美拉唑治疗八周或更长时间使他们的溃疡愈合。然后，那些一直在服用阿司匹林的患者每天服用80毫克阿司匹林，那些一直在服用其他NSAIDs的患者每天服用500毫克萘普生，分两次服用，持续六个月。然后将每组患者分别随机分配接受每日20毫克奥美拉唑治疗六个月，或接受为期一周的根除治疗，即每日四次服用120毫克枸橼酸铋钾、500毫克四环素和400毫克甲硝唑，随后服用六个月安慰剂。
我们纳入了400例患者（其中250例服用阿司匹林，150例服用其他NSAIDs）。在服用阿司匹林的患者中，接受根除治疗的患者在六个月期间复发性出血的概率为1.9%，接受奥美拉唑治疗的患者为0.9%（绝对差异为1.0%；差异的95%置信区间为-1.9%至3.9%）。在服用其他NSAIDs的患者中，接受根除治疗的患者复发性出血的概率为18.8%，接受奥美拉唑治疗的患者为4.4%（绝对差异为14.4%；差异的95%置信区间为4.4%至24.4%；P = 0.005）。
在感染幽门螺杆菌且有上消化道出血病史并服用低剂量阿司匹林的患者中，根除幽门螺杆菌在预防复发性出血方面与使用奥美拉唑治疗效果相当。在服用其他NSAIDs的患者中，奥美拉唑在预防复发性出血方面优于根除幽门螺杆菌治疗。
