Kadayifci Abdurrahman, Buyukhatipoglu Hakan, Cemil Savas M, Simsek Ilkay
Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
Clin Ther. 2006 Nov;28(11):1960-6. doi: 10.1016/j.clinthera.2006.11.011.
There is increasing concern about the efficacy of current regimens for the eradication of Helicobacter pylori.
This study examined rates of H. pylori eradication with a commonly used triple-therapy regimen consisting of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin in trials performed in Turkey from 1996 to 2005. It also investigated the relationship between eradication rates and the duration of treatment (7, 10, or 14 days), choice of PPI, and indication for treatment (dyspepsia or peptic ulcer).
This was a retrospective epidemiologic analysis. Articles concerning H. pylori eradication in Turkey that were published in peer-reviewed national and international journals were identified through searches of MEDLINE using the terms Helicobacter, eradication, and Turkey, and of the Turkish Medical Index using the terms Helicobacter and eradication. Abstracts from the Turkish Gastroenterology Congress from 1996 through 2005 were searched manually. Open-label trials, controlled trials, treatment arms, and case series that included a triple-therapy regimen consisting of standard doses of any PPI (omeprazole 20 mg BID, lansoprazole 30 mg BID, pantoprazole 40 mg BID, or esomeprazole 40 mg BID) with clarithromycin 500 mg BID and amoxicillin 1 g BID for 7 to 14 days were selected for analysis. Trials including patients who had undergone a previous attempt at eradication of H. pylori were excluded.
Of 138 trials or treatment arms identified, 94 met the criteria for inclusion (3637 subjects). The pooled eradication rate was 68.8% (95% CI, 67.3-70.3). A marked decrease in eradication was noted after 2000. Pooled eradication rates each year from 1996 through 2005 were 79.4%, 83.7%, 81.8%, 81.8%, 75.1%, 61.3%, 65.6%, 65.1%, 55.3%, and 61.1%, respectively. Eradication rates were not affected by the duration of treatment, choice of PPI, or indication for treatment.
Rates of H. pylori eradication with the triple-therapy regimen decreased in Turkey over the 10-year period studied. In an era of increasing clarithromycin use, the effectiveness of this regimen for H. pylori eradication appears to require reassessment.
目前根除幽门螺杆菌的治疗方案的疗效越来越受到关注。
本研究在1996年至2005年于土耳其开展的试验中，检测了一种常用三联疗法（由质子泵抑制剂、克拉霉素和阿莫西林组成）根除幽门螺杆菌的比率。该研究还调查了根除率与治疗时长（7天、10天或14天）、质子泵抑制剂的选择以及治疗指征（消化不良或消化性溃疡）之间的关系。
这是一项回顾性流行病学分析。通过使用“幽门螺杆菌”“根除”和“土耳其”等关键词检索医学文献数据库（MEDLINE），以及使用“幽门螺杆菌”和“根除”等关键词检索土耳其医学索引，来确定在同行评审的国内和国际期刊上发表的有关土耳其幽门螺杆菌根除的文章。手动检索了1996年至2005年土耳其胃肠病学大会的摘要。选择开放标签试验、对照试验、治疗组以及病例系列进行分析，这些试验包括由任何标准剂量质子泵抑制剂（奥美拉唑20毫克每日两次、兰索拉唑30毫克每日两次、泮托拉唑40毫克每日两次或埃索美拉唑40毫克每日两次）与克拉霉素500毫克每日两次和阿莫西林1克每日两次组成的三联疗法，疗程为7至14天。排除包括曾尝试根除幽门螺杆菌的患者的试验。
在确定的138项试验或治疗组中，94项符合纳入标准（3637名受试者）。汇总根除率为68.8%（95%置信区间，67.3 - 70.3）。2000年后根除率显著下降。1996年至2005年每年的汇总根除率分别为79.4%、83.7%、81.8%、81.8%、75.1%、61.3%、65.6%、65.1%、55.3%和61.1%。根除率不受治疗时长、质子泵抑制剂的选择或治疗指征的影响。
在研究的10年期间，土耳其使用三联疗法根除幽门螺杆菌的比率下降。在克拉霉素使用增加的时代，该方案根除幽门螺杆菌的有效性似乎需要重新评估。
