Srinarong Chanagune, Siramolpiwat Sith, Wongcha-um Arti, Mahachai Varocha, Vilaichone Ratha-korn
Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand E-mail :
Asian Pac J Cancer Prev. 2014;15(22):9909-13. doi: 10.7314/apjcp.2014.15.22.9909.
Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcer disease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However, standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy for H. pylori eradication.
In this prospective single center study, H. pylori infected gastritis patients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo. Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycin MR once daily and 1,048 mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt without probiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication was defined as a negative 13C-urea breath test at least 2 weeks after completion of treatment.
One hundred subjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%, 49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14 regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantly lower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%; p=0.04).
The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent cure rate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19 genotype. Adding a probiotic also reduced treatment-related adverse events.
幽门螺杆菌（H. pylori）仍是全球胃癌和消化性溃疡病的重要病因。治疗幽门螺杆菌感染是预防胃癌的有效方法之一。然而，在包括泰国在内的许多国家，用于根除幽门螺杆菌的标准三联疗法已不再有效。本研究旨在评估在标准三联疗法中添加铋剂和益生菌对根除幽门螺杆菌的疗效。
在这项前瞻性单中心研究中，幽门螺杆菌感染的胃炎患者被随机分为接受7天或14天的标准三联疗法加铋剂并联合益生菌或安慰剂。治疗方案包括每日两次30毫克兰索拉唑、每日两次1克阿莫西林、每日一次1克克拉霉素缓释片和每日两次1048毫克次水杨酸铋。益生菌由双歧杆菌、嗜酸乳杆菌和副干酪乳杆菌组成。安慰剂是不含益生菌的传统饮用酸奶。还进行了CYP2C19基因分型和抗生素敏感性测试。幽门螺杆菌根除定义为治疗完成后至少2周13C尿素呼气试验阴性。
共纳入100名受试者（益生菌或安慰剂组各25名接受7天和14天治疗方案）。抗生素敏感性测试显示甲硝唑耐药率为36.7%，克拉霉素耐药率为1.1%。CYP2C19基因分型显示快速代谢者、中间代谢者和慢代谢者分别为40.8%、49%和10.2%。含益生菌的7天或14天治疗方案的根除率均为100%。关于不良事件，益生菌组7天治疗方案中口苦的发生率显著低于安慰剂组7天治疗方案（40%对64%；p=0.04）。
在泰国等克拉霉素耐药率较低的地区，7天标准三联疗法加铋剂和益生菌可提供优异的幽门螺杆菌治愈率（100%），与CYP2C19基因型无关。添加益生菌还减少了治疗相关的不良事件。
