Dzieniszewski J, Jarosz M
Department of Dietetics and Nutrition, Clinic of Metabolic Diseases and Gastroenterology, National Food and Nutrition Institute, Warsaw, Poland.
J Physiol Pharmacol. 2006 Sep;57 Suppl 3:143-54.
Scientific evidence based on controlled clinical research confirm substantial benefits resulting from the eradication of H. pylori infection in such pathologies of the alimentary tract as: gastric peptic and duodenal ulcer (active or confirmed in the future and ulcer disease complications), MALT (Mucosa Associated Limphoid Tissue) lymphoma, atrophic gastritis, past stomach resection, gastric cancer in the family. The above group of indications is strongly recommended for eradicative treatment. During the last several years there have been many guidelines made by international and national specialist groups. "Test and treat" strategy of undiagnosed dyspepsia treatment is based on possibility to carry out non-invasive tests confirming H. pylori infection. First symptoms of dyspepsia in people over 45 years of age constitute recommendation for endoscopy, as well as symptoms assumed to be "alarming" (loss of weight, anaemia, bloody vomiting, tarry stool, dysphagia) regardless of patient age. An individual approach to eradication is proposed in gastroesophageal reflux disease, and use of non-steroid anti-inflammatory drugs. Antibacterial activity towards H. pylori is shown by many antibiotics (amoxicillin, macrolides, tetracyclines) and some other chemotherapeutic agents (nitroimidazoles) and bismuth. PPIs are recommended, because through increase of pH in stomach they create conditions to act for antibiotics. During the stage of first line triple therapy, it is advised to apply PPI and two antibacterial medicines at the same time (PPI + amoxicillin+metronidazole or clarithromycin). Such therapeutic action ensures achievement of eradication of H. pylori infection in 80-90% of cases. In case of lack of treatment efficiency in the first-line therapy, 7-14 day treatment may be repeated using triple therapies (PPI + 2 antibiotics) substituting the antibiotic with the metronidazole or tetracycline, or quadruple therapies (PPI + bismuth citrate + 2 antibiotics). Side effects during eradicative treatments occur quite rarely (from 15 to 30%).
基于对照临床研究的科学证据证实，根除幽门螺杆菌感染对消化道的以下病症具有显著益处：胃溃疡和十二指肠溃疡（现患或未来确诊以及溃疡病并发症）、黏膜相关淋巴组织（MALT）淋巴瘤、萎缩性胃炎、既往胃切除术、家族性胃癌。强烈建议对上述适应证进行根除治疗。在过去几年中，国际和国家专家小组制定了许多指南。未确诊消化不良的“检测和治疗”策略基于进行非侵入性检测以确认幽门螺杆菌感染的可能性。45岁以上人群消化不良的首发症状建议进行内镜检查，无论患者年龄大小，出现“警示”症状（体重减轻、贫血、呕血、黑便、吞咽困难）也建议进行内镜检查。对于胃食管反流病和使用非甾体抗炎药的情况，建议采用个体化的根除方法。许多抗生素（阿莫西林、大环内酯类、四环素类）以及其他一些化疗药物（硝基咪唑类）和铋剂对幽门螺杆菌具有抗菌活性。推荐使用质子泵抑制剂（PPI），因为它们通过提高胃内pH值为抗生素发挥作用创造条件。在一线三联疗法阶段，建议同时应用PPI和两种抗菌药物（PPI + 阿莫西林 + 甲硝唑或克拉霉素）。这种治疗方法可确保在80% - 90%的病例中实现幽门螺杆菌感染的根除。如果一线治疗无效，可使用三联疗法（PPI + 2种抗生素），用甲硝唑或四环素替代其中一种抗生素，或使用四联疗法（PPI + 枸橼酸铋钾 + 2种抗生素），进行7 - 14天的重复治疗。根除治疗期间的副作用很少发生（15%至30%）。
