Treiber G, Schwabe M, Ammon S, Walker S, Klotz U, Malfertheiner P
Department of Gastroenterology/Hepatology, University Hospital, Magdeburg, Germany.
Aliment Pharmacol Ther. 2004 Jan 15;19(2):219-31. doi: 10.1111/j.1365-2036.2004.01751.x.
Dyspepsia can be associated with H. pylori infection.
To assess dyspeptic symptoms and potentially influencing factors before and up to 6 months following successful H. pylori eradication therapy.
Prospective cohort study involving H. pylori positive subjects from ambulatory or hospitalized care. Main outcome measures were symptoms during baseline and follow-up, the proportion of symptom-free patients, and symptom scores.
After successful eradication, the summary score of all dyspeptic symptoms decreased and during follow-up, the proportion of symptom-free patients was higher in the group with peptic ulcers (69.4% vs. 40.9%, P < 0.0001) than with functional dyspepsia (FD). Regardless of diagnosis, virulent strains of H. pylori were associated with a higher prevalence of epigastric pain before treatment: absolute risk-difference (ARD) with Oip-A: 18.2%, Odds Ratio (OR) 2.35 [1.3-4.2, 95%-CI], P = 0.01; with Cag-A: 24.6%, OR 2.81 [1.6-5], P = 0.01. Low-dose aspirin in part was a major risk factor in FD for previous weight loss bdfore study entry. Post-treatment, non-ulcer patients were more likely to suffer from distention/bloating. Likewise, alcohol induced persistence of nausea and vomiting in this population.
Dyspeptic symptoms in H. pylori infected patients are more common with virulent strains. Symptoms are more likely to persist despite successful eradication if patients initially harboured virulent strains or concomitant aspirin or alcohol intake are present. In one-third of peptic ulcer patients, symptoms will not be cured 3 months after therapy.
消化不良可能与幽门螺杆菌感染有关。
评估幽门螺杆菌根除治疗成功前及治疗后长达6个月的消化不良症状及潜在影响因素。
对来自门诊或住院治疗的幽门螺杆菌阳性受试者进行前瞻性队列研究。主要观察指标为基线期和随访期的症状、无症状患者比例及症状评分。
根除成功后，所有消化不良症状的综合评分下降，随访期间，消化性溃疡组无症状患者比例（69.4%对40.9%，P<0.0001）高于功能性消化不良（FD）组。无论诊断如何，幽门螺杆菌毒力菌株与治疗前上腹部疼痛的较高患病率相关：与Oip-A的绝对风险差异（ARD）为18.2%，优势比（OR）为2.35[1.3-4.2，95%可信区间]，P=0.01；与Cag-A的ARD为24.6%，OR为2.81[1.6-5]，P=0.01。低剂量阿司匹林在一定程度上是FD患者在研究入组前体重减轻的主要危险因素。治疗后，非溃疡患者更易出现腹胀。同样，酒精会导致该人群恶心和呕吐持续存在。
幽门螺杆菌感染患者的消化不良症状在有毒力菌株时更常见。如果患者最初携带毒力菌株或同时服用阿司匹林或饮酒，即使根除成功，症状也更可能持续存在。三分之一的消化性溃疡患者在治疗3个月后症状仍未治愈。
