Hsieh Y H, Lin H J, Tseng G Y, Perng C L, Chang F Y, Lee S D
Division of Gastroenterology, Department of Medicine, VGH-Taipei, Shih-Pai Rd, Sec 2, Taipei, Taiwan, 11217, ROC.
Hepatogastroenterology. 2001 Jul-Aug;48(40):1078-81.
BACKGROUND/AIMS: One-week triple therapy has been recommended as a standard regimen for eradicating Helicobacter pylori infection. The emergence of antibiotic-resistant strains, adverse drug effects, poor compliance and high cost of therapy add problems to the management of these patients. In this study, we assessed whether a 3-day triple therapy could be effective in eradicating Helicobacter pylori infection in bleeding peptic ulcer patients.
Peptic ulcer patients with Helicobacter pylori infection were enrolled in this study. Patients enrolled at the outpatient department (group A) received a 7-day oral regimen: bismuth subcitrate colloid 300 mg + amoxicillin 500 mg + metronidazole 250 mg four times per day. Patients who were admitted to the wards due to peptic ulcer bleeding (group B) received a 3-day regimen including omeprazole 40 mg intravenously every 6 hours, amoxicillin 500 mg + metronidazole 250 mg orally four times daily after hemostasis had been achieved. Patients of both groups received omeprazole 20 mg once per day or cimetidine 400 mg twice daily per os for at least-one month after anti-Helicobacter pylori therapy. We followed every patient endoscopically two months after anti-Helicobacter pylori therapy.
From June 1997 to April 1999, a total of 57 patients (30 in group A and 27 in group B) with gastric or duodenal ulcer and Helicobacter pylori infection completed anti-Helicobacter pylori therapy. Two months after anti-Helicobacter pylori therapy, peptic ulcer was found to be healed with a scar in 26 (86.7%) of group A and 23 (85.2%) of group B (P > 0.1). The eradication rates of Helicobacter pylori in the two groups were not significantly different in an intention-to-treat analysis [group A: 78.8% (26/33), 95% CI: 64.9-92.7%; group B: 80% (24/30), 95% CI: 65.7-94.3%, P > 0.1] and in a per protocol analysis [group A: 86.7% (26/30), 95% CI: 74.5-98.9%, group B: 88.9% (24/27), 95% CI: 77.1-100.7%, P > 0.1]. Fewer side effects occurred in group B (3/30) than those in group A (7/33) (P > 0.1).
In patients with peptic ulcer bleeding a 3-day anti-Helicobacter pylori therapy is a good alternative for eradicating Helicobacter pylori infection.
背景/目的：一周三联疗法已被推荐为根除幽门螺杆菌感染的标准方案。抗生素耐药菌株的出现、药物不良反应、依从性差以及治疗费用高昂给这些患者的管理带来了问题。在本研究中，我们评估了3天三联疗法在根除消化性溃疡出血患者幽门螺杆菌感染方面是否有效。
纳入幽门螺杆菌感染的消化性溃疡患者。门诊患者（A组）接受为期7天的口服方案：枸橼酸铋钾胶体300毫克+阿莫西林500毫克+甲硝唑250毫克，每日4次。因消化性溃疡出血入院的患者（B组）接受为期3天的方案，包括每6小时静脉注射奥美拉唑40毫克，止血后口服阿莫西林500毫克+甲硝唑250毫克，每日4次。两组患者在抗幽门螺杆菌治疗后至少1个月内，每日口服奥美拉唑20毫克或西咪替丁400毫克，每日2次。抗幽门螺杆菌治疗2个月后，对每位患者进行内镜随访。
1997年6月至1999年4月，共有57例胃或十二指肠溃疡合并幽门螺杆菌感染的患者（A组30例，B组27例）完成了抗幽门螺杆菌治疗。抗幽门螺杆菌治疗2个月后，A组26例（86.7%）和B组23例（85.2%）的消化性溃疡愈合并形成瘢痕（P>0.1）。在意向性分析中，两组幽门螺杆菌根除率无显著差异[A组：78.8%（26/33），95%可信区间：64.9 - 92.7%；B组：80%（24/30），95%可信区间：65.7 - 94.3%，P>0.1]，在符合方案分析中也无显著差异[A组：86.7%（26/30），95%可信区间：74.5 - 98.9%，B组：88.9%（24/27），95%可信区间：77.1 - 100.7%，P>0.1]。B组（3/30）的副作用少于A组（7/33）（P>0.1）。
对于消化性溃疡出血患者，3天抗幽门螺杆菌治疗是根除幽门螺杆菌感染的良好替代方案。
