Cheon Jae Hee, Kim Nayoung, Lee Dong Ho, Kim Jung Mogg, Kim Joo Sung, Jung Hyun Chae, Song In Sung
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Eur J Gastroenterol Hepatol. 2006 May;18(5):515-9. doi: 10.1097/00042737-200605000-00010.
To determine the long-term outcomes in terms of Helicobacter pylori and ulcer recurrence after second-line eradication with bismuth-containing quadruple regimens in Korea.
Sixty-seven patients with peptic ulcer disease after successful eradication using second-line quadruple therapies were prospectively followed up 1 month after treatment and then every 6 months or when dyspeptic symptoms reappeared to ascertain H. pylori and ulcer status.
Three patients were lost during follow-up. The median duration of follow-up of the remaining 64 patients was 26.8 months. H. pylori recurrence occurred in 11 of these 64 patients (17.2%), giving a calculated reinfection rate of 6.0% per patient-year. Only one of the 11 patients was reinfected by 12 months after treatment completion. Four of 11 patients (36.4%) who became reinfected experienced peptic ulcer recurrence, but none of 53 patients who were not reinfected experienced recurrence. No evidence was obtained to indicate that the reinfection rate depended on the age, sex, ulcer location, or eradication regimens. The relapse of dyspeptic symptoms was the only factor predictive of H. pylori recurrence.
This study suggests that the recurrence rate of H. pylori at 1 year after second-line, bismuth-containing quadruple therapy is low, but the annual reinfection rate is as high as 6%. Surveillance for H. pylori reinfection facilitating peptic ulcer recurrence may be warranted even after a second eradication, especially when dyspeptic symptoms reappear in Korea.
确定在韩国使用含铋四联方案进行二线根除治疗后幽门螺杆菌及溃疡复发的长期结局。
67例使用二线四联疗法成功根除幽门螺杆菌的消化性溃疡患者在治疗后1个月进行前瞻性随访，之后每6个月或消化不良症状再次出现时确定幽门螺杆菌及溃疡状态。
随访期间有3例患者失访。其余64例患者的中位随访时间为26.8个月。这64例患者中有11例（17.2%）出现幽门螺杆菌复发，计算得出的患者年再感染率为6.0%。在完成治疗后12个月内，11例患者中只有1例再次感染。11例再次感染的患者中有4例（36.4%）出现消化性溃疡复发，但53例未再次感染的患者均未复发。没有证据表明再感染率取决于年龄、性别、溃疡部位或根除方案。消化不良症状复发是幽门螺杆菌复发的唯一预测因素。
本研究表明，二线含铋四联疗法治疗后1年幽门螺杆菌复发率较低，但年再感染率高达6%。即使在第二次根除治疗后，尤其是在韩国消化不良症状再次出现时，对促进消化性溃疡复发的幽门螺杆菌再感染进行监测可能是必要的。
