Tanaka Eiichi, Kamitsuji Shigeo, Inoue Eisuke, Yamada Toru, Nakajima Ayako, Takeuchi Etsuko, Yanagisawa Akiko, Misaka Ryouichi, Shigemoto Mutsuo, Yamashita Katsuko, Imamura Tetsuo, Hara Masako, Tomatsu Taisuke, Saito Terunobu, Lauren Gerson, Triadafilopoulos George, Kamatani Naoyuki, Singh Gurkirpal, Yamanaka Hisashi
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo 162-0054, Japan.
Mod Rheumatol. 2007;17(3):228-34. doi: 10.1007/s10165-007-0570-2. Epub 2007 Jun 20.
We evaluated the effects of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) on endoscopic and histological findings in patients with rheumatoid arthritis (RA) before and after the eradication of Helicobacter pylori infection. Helicobacter pylori (H. pylori) eradication using lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 mg twice daily for 1 week was conducted in 44 patients (mean age: 56.5 years) with RA. Using the updated Sydney system, endoscopic and histological findings of the greater curvature of the antrum, the greater curvature of the upper corpus, and the lesser curvature of the lower corpus were compared before and after eradication, for a mean follow-up period of 3.5 months. Overall, H. pylori eradication was successful in 32 patients (72.7%). Of these 32 patients, 23 were NSAID users. In the successful eradication group, (1) there was no significant change on endoscopic findings, including gastric erythema and erosion in all three regions irrespective of NSAIDs use; (2) of 17 active ulcers before eradication in NSAIDs users, all healed except for one duodenal ulcer that persisted, where one patient newly developed a gastric ulcer, one developed erosive duodenitis, and two developed reflux esophagitis, all in NSAID users; (3) neutrophil infiltration and chronic inflammation were significantly improved in all three regions after H. pylori eradication irrespective of use of NSAIDs, while atrophic change and intestinal metaplasia did not change. In the eradication failure group; (1) there was no significant change on endoscopic and histological findings in the three regions; (2) two of three ulcers present before eradication on NSAID users persisted even after eradication, and no new cases of gastric ulcer or erosive duodenitis occurred. In conclusion, over a mean follow-up period of 3.5 months, use of NSAIDs in Japanese patients with RA did not impair the healing process of gastric and duodenal ulcers nor did it affect the endoscopic and histological improvements associated with H. pylori eradication.
我们评估了在根除幽门螺杆菌感染前后，使用非甾体抗炎药（NSAIDs）对类风湿关节炎（RA）患者内镜及组织学检查结果的影响。44例（平均年龄：56.5岁）RA患者接受了为期1周的根除幽门螺杆菌治疗，具体方案为：每日2次口服兰索拉唑30 mg、阿莫西林750 mg及克拉霉素200 mg。采用更新后的悉尼系统，比较根除前后胃窦大弯、胃体上部大弯及胃体下部小弯的内镜及组织学检查结果，平均随访期为3.5个月。总体而言，32例患者（72.7%）根除幽门螺杆菌成功。在这32例成功根除的患者中，23例为NSAIDs使用者。在成功根除组中：（1）无论是否使用NSAIDs，所有三个区域的内镜检查结果，包括胃红斑和糜烂均无显著变化；（2）在根除前使用NSAIDs的患者中，17例活动性溃疡除1例十二指肠溃疡持续存在外均愈合，1例患者新出现胃溃疡，1例出现糜烂性十二指肠炎，2例出现反流性食管炎，均为使用NSAIDs的患者；（3）无论是否使用NSAIDs，根除幽门螺杆菌后所有三个区域的中性粒细胞浸润和慢性炎症均显著改善，而萎缩性改变和肠化生未发生变化。在根除失败组中：（1）三个区域的内镜及组织学检查结果无显著变化；（2）在根除前使用NSAIDs的患者中，三个溃疡中有两个即使在根除后仍持续存在，且未出现新的胃溃疡或糜烂性十二指肠炎病例。总之，在平均3.5个月的随访期内，日本RA患者使用NSAIDs既不损害胃和十二指肠溃疡的愈合过程，也不影响与根除幽门螺杆菌相关的内镜及组织学改善。
