Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Intern Emerg Med. 2012 Dec;7(6):517-22. doi: 10.1007/s11739-011-0730-4. Epub 2011 Nov 22.
Helicobacter pylori eradication rate following standard triple therapy is decreasing. Identification of predictive factors of therapy success would be useful for H. pylori management in clinical practice. This study aimed to evaluate the role of different gastritis patterns on the efficacy of the currently suggested 14-day triple therapy regimen. One-hundred and seventeen, consecutive, non-ulcer dyspeptic patients, with H. pylori infection diagnosed at endoscopy, were enrolled. All patients received a 14-day, triple therapy with lansoprazole 30 mg, clarithromycin 500 mg and amoxicillin 1 g, all given twice daily. Bacterial eradication was assessed with (13)C-urea breath test 4-6 weeks after completion of therapy. H. pylori infection was cured in 70.1% at ITT analysis and 83.7% at PP analysis. The eradication rate tended to be lower in patients with corpus-predominant gastritis as compared to those with antral-predominant gastritis at both ITT (66.1 vs 74.5%) and PP (80.4 vs 87.2%) analyses. The multivariate analysis failed to identify factors associated with therapy success. However, 14-day triple therapy does not achieve acceptable H. pylori cure rate in Italy, and should be not recommended in clinical practice.
标准三联疗法治疗后幽门螺杆菌的根除率正在下降。识别治疗成功的预测因素将有助于临床实践中幽门螺杆菌的管理。本研究旨在评估不同胃炎模式对目前建议的 14 天三联疗法方案疗效的影响。
共纳入 117 例连续的非溃疡性消化不良患者，这些患者在胃镜检查时被诊断为幽门螺杆菌感染。所有患者均接受了为期 14 天的三联疗法，即每日两次给予兰索拉唑 30mg、克拉霉素 500mg 和阿莫西林 1g。治疗结束后 4-6 周，采用（13）C-尿素呼气试验评估细菌根除情况。在意向性治疗（ITT）分析中，70.1%的患者幽门螺杆菌感染得到治愈，在符合方案（PP）分析中，83.7%的患者幽门螺杆菌感染得到治愈。在 ITT（66.1%比 74.5%）和 PP（80.4%比 87.2%）分析中，与以胃窦为主的胃炎相比，以胃体为主的胃炎患者的根除率较低。多变量分析未发现与治疗成功相关的因素。然而，14 天三联疗法在意大利未能达到可接受的幽门螺杆菌治愈率，不应在临床实践中推荐。
