幽门螺杆菌根除对老年人反流性食管炎和慢性胃炎结局的影响。一项随机、多中心、为期八个月的研究。

Effect of Helicobacter pylori eradication on the outcome of reflux esophagitis and chronic gastritis in the elderly. A randomized, multicenter, eight-month study.

作者信息

Pilotto Alberto, Perri Francesco, Leandro Gioacchino, Franceschi Marilisa

机构信息

Geriatric Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.

出版信息

Gerontology. 2006;52(2):99-106. doi: 10.1159/000090955.

DOI:10.1159/000090955

PMID:16508317

Abstract

BACKGROUND

The effect of Helicobacter pylori eradication on the clinical outcome of esophagitis in elderly patients is controversial.

AIM

To evaluate the effect of H. pylori eradication on clinical outcome of esophagitis and on chronic gastritis and its activity.

MATERIALS AND METHODS

Sixty-one symptomatic elderly patients with esophagitis and H. pylori infection were randomized into two groups. Group 1 (PPI-only, 30 patients) was treated with pantoprazole 40 mg daily for 2 months followed by pantoprazole 20 mg daily for a further 6 months; group 2 (PPI + eradication, 31 patients) was treated as group 1 plus a 1-week course of amoxicillin 1 g twice daily and clarithromycin 250 mg twice daily. Endoscopy with gastric biopsies, 13C-UBT and clinical visits were repeated after 2 and 8 months.

RESULTS

After 8 months, the intention-to-treat H. pylori eradication rates were 19.2% in group 1 vs. 80.7% in group 2 (p < 0.0001). No differences between group 1 and group 2 were observed in symptoms improvement (77 vs. 77%, p = n.s.) and healing rates of esophagitis (92.3 vs. 88.5%, p = n.s.). A significant decrease in the prevalence of moderate/severe chronic gastritis (from 52.2 to 4.7%, p = 0.002) and its activity (from 38 to 4.7%, p = 0.02) was observed in the antrum of patients of group 2, and not in patients of group 1. While a nonsignificant reduction in the chronic gastritis activity (from 28.6 to 4.7%, p = 0.09) was observed in the corpus of the eradicated patients of group 2, conversely a significant worsening of the chronic gastritis activity was found in the corpus of group 1 patients (from 25 to 60%, p = 0.05).

CONCLUSION

The eradication of H. pylori infection does not affect the clinical outcome of esophagitis, while it improves chronic gastritis and its activity in elderly patients on short- and long-term treatment with PPIs. These findings suggest that H. pylori infection should be eradicated in elderly patients with esophagitis who need maintenance treatment with PPI.

摘要

背景

幽门螺杆菌根除治疗对老年食管炎患者临床结局的影响存在争议。

目的

评估幽门螺杆菌根除治疗对食管炎临床结局以及慢性胃炎及其活动性的影响。

材料与方法

61例有症状的老年食管炎合并幽门螺杆菌感染患者被随机分为两组。第1组（仅用质子泵抑制剂，30例患者）接受泮托拉唑40mg每日1次治疗2个月，随后泮托拉唑20mg每日1次再治疗6个月；第2组（质子泵抑制剂+根除治疗，31例患者）治疗方案同第1组，加用阿莫西林1g每日2次和克拉霉素250mg每日2次，疗程1周。在2个月和8个月后重复进行胃镜检查及胃活检、13C-尿素呼气试验（13C-UBT）和临床随访。

结果

8个月后，按意向性分析，第1组幽门螺杆菌根除率为19.2%，第2组为80.7%（p<0.0001）。第1组和第2组在症状改善方面（分别为77%和77%，p=无统计学意义）以及食管炎愈合率方面（分别为92.3%和88.5%，p=无统计学意义）未观察到差异。第2组患者胃窦部中度/重度慢性胃炎患病率（从52.2%降至4.7%，p=0.002）及其活动性（从38%降至4.7%，p=0.02）显著降低，而第1组患者未出现此情况。虽然第2组根除治疗患者胃体部慢性胃炎活动性有非显著性降低（从28.6%降至4.7%，p=0.09），相反，第1组患者胃体部慢性胃炎活动性显著恶化（从25%升至60%，p=0.05）。