Gal Eyal, Abuksis Galia, Fraser Gerald, Koren Rivka, Shmueli Chaim, Yahav Yaakov, Niv Yaron
Helicobacter Pylori Central Laboratory, Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Clalit Health Services, Petach Tiqva, Israel.
Isr Med Assoc J. 2003 Feb;5(2):98-100.
The 13C-urea breath test is the best non-invasive test to validate Helicobacter pylori eradication. Serology is unreliable for this purpose due to the slow and unpredictable decline in the antibody titer.
To characterize a specific group of patients who were treated for H. pylori and tested for successful eradication by 13C-UBT in our central laboratory, to correlate the eradication success rate with specific drug combinations, and to evaluate other factors that may influence eradication success.
13C-UBT for H. pylori was performed in the central laboratory of Clalit Health Services. The breath test was performed by dedicated nurses in 25 regional laboratories and the samples were analyzed by a mass spectrometer (Analytical Precision 2003, UK). The physician who ordered the test completed a questionnaire computing demographic data (age, gender, origin), indication, use of non-steroidal anti-inflammatory drugs or proton pump inhibitor, and combination of eradication therapy.
Of the 1,986 patients tested to validate successful H. pylori eradication, 539 (27%) had a positive test (treatment failure group) and 1,447 (73%) had a negative test (successful treatment group). Male gender, older age and European-American origin predicted better eradication rates. Dyspeptic symptoms and chronic PPI therapy predicted treatment failure. Combination therapy that included clarithromycin had a higher eradication rate than a combination containing metronidazole. The combination of omeprazole, amoxicillin and clarithromycin achieved an eradication rate of 81.3%, which was better than the combination of omeprazole, metronidazole and clarithromycin (77.2%) (not significant), or of omeprazole, amoxicillin and metronidazole (66.1%) (P < 0.01).
Gender, age, origin, dyspepsia and PPI therapy may predict H. pylori eradication results. Our findings also support an increase in metronidazole resistance of H. pylori strains in Israel, as reported in other countries. We recommend combination therapy with omeprazole, amoxicillin and clarithromycin and avoidance of metronidazole as one of the first-line eradication drugs.
13C尿素呼气试验是验证幽门螺杆菌根除效果的最佳非侵入性检测方法。由于抗体滴度下降缓慢且不可预测，血清学检测在此目的上不可靠。
对在我们中心实验室接受幽门螺杆菌治疗并通过13C尿素呼气试验检测根除成功的特定患者群体进行特征描述，将根除成功率与特定药物组合相关联，并评估其他可能影响根除成功的因素。
在克拉利特卫生服务中心实验室进行幽门螺杆菌的13C尿素呼气试验。呼气试验由25个地区实验室的专业护士进行，样本由质谱仪（英国Analytical Precision 2003）分析。开具检测医嘱的医生填写一份问卷，统计人口统计学数据（年龄、性别、籍贯）、指征、非甾体抗炎药或质子泵抑制剂的使用情况以及根除治疗的组合。
在1986例接受检测以验证幽门螺杆菌根除成功的患者中，539例（27%）检测结果为阳性（治疗失败组），1447例（73%）检测结果为阴性（治疗成功组）。男性、年龄较大和欧美籍贯预示着更高的根除率。消化不良症状和长期使用质子泵抑制剂预示着治疗失败。包含克拉霉素的联合治疗根除率高于包含甲硝唑的联合治疗。奥美拉唑、阿莫西林和克拉霉素的联合治疗根除率为81.3%，优于奥美拉唑、甲硝唑和克拉霉素的联合治疗（77.2%）（无显著差异），或奥美拉唑、阿莫西林和甲硝唑的联合治疗（66.1%）（P<0.01）。
性别、年龄、籍贯、消化不良和质子泵抑制剂治疗可能预示幽门螺杆菌的根除结果。我们的研究结果也支持以色列幽门螺杆菌菌株对甲硝唑的耐药性增加，正如其他国家所报道的那样。我们建议使用奥美拉唑、阿莫西林和克拉霉素的联合治疗，避免将甲硝唑作为一线根除药物之一。
