Department of Gastroenterology and Digestive Endoscopy, Israelitic Hospital, 00148 Rome, Italy.
World J Gastroenterol. 2012 Nov 21;18(43):6250-4. doi: 10.3748/wjg.v18.i43.6250.
To evaluate the role of sequential therapy and Lactobacillus reuteri (L. reuteri) supplementation, in the eradication treatment of Helicobacter pylori (H. pylori).
H. pylori infection was diagnosed in 90 adult dyspeptic patients. Patients were excluded if previously treated for H. pylori infection or if they were taking a proton pump inhibitor (PPI), H2-receptor antagonist or antibiotics. Patients were assigned to receive one of the following therapies: (1) 7-d triple therapy (PPI plus clarithromycin and amoxicillin or metronidazole) plus L. reuteri supplementation during antibiotic treatment; (2) 7-d triple therapy plus L. reuteri supplementation after antibiotic treatment; (3) sequential regimen (5-d PPI plus amoxicillin therapy followed by a 5-d PPI, clarithromycin and tinidazole) plus L. reuteri supplementation during antibiotic treatment; and (4) sequential regimen plus L. reuteri supplementation after antibiotic treatment. Successful eradication therapy was defined as a negative urea breath test at least 4 wk following treatment.
Ninety adult dyspeptic patients were enrolled, and 83 (30 male, 53 female; mean age 57 ± 13 years) completed the study. Nineteen patients were administered a 7-d triple treatment: 11 with L. reuteri supplementation during and 8 after therapy. Sixty-four patients were administered a sequential regimen: 32 with L. reuteri supplementation during and 32 after therapy. The eradication rate was significantly higher in the sequential group compared with the 7-d triple regimen (88% vs 63%, P = 0.01). No difference was found between two types of PPI. No difference in eradication rates was observed between patients submitted to L. reuteri supplementation during or after antibiotic treatment. Compliance with therapy was excellent in all patients. No difference in adverse effects was observed between the different antibiotic treatments and between patients submitted to L. reuteri supplementation during and after antibiotic treatment. There was a low incidence of adverse effects in all groups of patients with sequential therapy, probably due to the presence of the L. reuteri supplementation.
The sequential treatment regimen achieved a significantly higher eradication rate of H. pylori compared with standard 7-d regimen. L. reuteri supplementation could reduce the frequency and the intensity of antibiotic-associated side-effects.
评估序贯疗法和罗伊氏乳杆菌（L. reuteri）补充剂在幽门螺杆菌（H. pylori）根除治疗中的作用。
在 90 例成人消化不良患者中诊断 H. pylori 感染。如果患者既往接受过 H. pylori 感染治疗或正在服用质子泵抑制剂（PPI）、H2 受体拮抗剂或抗生素，则将其排除在外。患者被分配接受以下治疗之一：（1）7 天三联疗法（PPI 加克拉霉素和阿莫西林或甲硝唑）加抗生素治疗期间补充罗伊氏乳杆菌；（2）7 天三联疗法加抗生素治疗后补充罗伊氏乳杆菌；（3）序贯方案（5 天 PPI 加阿莫西林治疗，然后再用 5 天 PPI、克拉霉素和替硝唑）加抗生素治疗期间补充罗伊氏乳杆菌；和（4）序贯方案加抗生素治疗后补充罗伊氏乳杆菌。成功的根除治疗定义为治疗后至少 4 周尿素呼气试验阴性。
共纳入 90 例成人消化不良患者，83 例（30 例男性，53 例女性；平均年龄 57±13 岁）完成了研究。19 例患者接受了 7 天三联治疗：11 例在治疗期间和 8 例在治疗后补充了罗伊氏乳杆菌。64 例患者接受了序贯方案：32 例在治疗期间和 32 例在治疗后补充了罗伊氏乳杆菌。与 7 天三联疗法相比，序贯组的根除率显著更高（88%对 63%，P=0.01）。两种 PPI 之间无差异。在接受治疗期间或之后补充罗伊氏乳杆菌的患者之间，根除率无差异。所有患者对治疗的依从性均极佳。不同抗生素治疗之间以及接受治疗期间或之后补充罗伊氏乳杆菌的患者之间，不良反应发生率无差异。所有接受序贯治疗的患者不良反应发生率均较低，可能是由于补充了罗伊氏乳杆菌。
与标准的 7 天方案相比，序贯治疗方案可显著提高 H. pylori 的根除率。罗伊氏乳杆菌补充剂可降低抗生素相关不良反应的频率和强度。
