Basyigit Sebahat, Kefeli Ayse, Sapmaz Ferdane, Yeniova Abdullah Ozgür, Asilturk Zeliha, Hokkaomeroglu Murat, Uzman Metin, Nazligul Yasar
Kecioren Research and Training Hospital, Department of Gastroenterology, Ankara, Turkey.
Bosn J Basic Med Sci. 2015 Oct 25;15(4):50-4. doi: 10.17305/bjbms.2015.573.
The success of the current anti-Helicobacter pylori (H. pylori) treatment protocols is reported to decrease by years, and research is needed to strengthen the H. pylori eradication treatment. Sequential treatment (ST), one of the treatment modalities for H. pylori eradication, includes amoxicillin 1 gr b.i.d and proton pump inhibitor b.i.d for first 5 days and then includes clarithromycin 500 mg b.i.d, metronidazole 500 mg b.i.d and a proton pump inhibitor b.i.d for remaining 5 days. In this study, we investigated efficacy and tolerability of bismuth addition in to ST. We included patients that underwent upper gastrointestinal endoscopy in which H. pylori infection was diagnosed by histological examination of antral and corporal gastric mucosa biopsy. Participants were randomly administered ST or bismuth containing ST (BST) protocols for the first-line H. pylori eradication therapy. Participants have been tested by urea breath test for eradication success 6 weeks after the completion of treatment. One hundred and fifty patients (93 female, 57 male) were enrolled. There were no significant differences in eradication rates for both intention to treat population (70.2%, 95% confidence interval [CI]: 66.3-74.1% vs. 71.8%, 95% CI: 61.8-81.7%, for ST and BST, respectively, p>0.05) and per protocol population (74.6%, 95% CI: 63.2-85.8% vs. 73.7%, 95% CI: 63.9-83.5% for ST and BST, respectively, p>0.05). Despite the undeniable effect of bismuth, there may be several possible reasons of unsatisfactory eradication success. Drug administration time, coadministration of other drugs, possible H. pylori resistance to bismuth may affect the eradication success. The addition of bismuth subcitrate to ST regimen does not provide significant increase in eradication rates.
据报道，目前的抗幽门螺杆菌（H. pylori）治疗方案的成功率逐年下降，因此需要开展研究以加强幽门螺杆菌根除治疗。序贯疗法（ST）是根除幽门螺杆菌的治疗方式之一，前5天包括阿莫西林1克，每日2次和质子泵抑制剂，每日2次，然后后5天包括克拉霉素500毫克，每日2次、甲硝唑500毫克，每日2次和质子泵抑制剂，每日2次。在本研究中，我们调查了在序贯疗法中添加铋剂的疗效和耐受性。我们纳入了接受上消化道内镜检查的患者，通过对胃窦和胃体黏膜活检进行组织学检查诊断幽门螺杆菌感染。参与者被随机给予序贯疗法或含铋剂的序贯疗法（BST）方案用于一线幽门螺杆菌根除治疗。治疗完成6周后，通过尿素呼气试验检测参与者的根除成功率。共纳入150例患者（93例女性，57例男性）。在意向性治疗人群中，两种方案的根除率无显著差异（序贯疗法为70.2%，95%置信区间[CI]：66.3 - 74.1%；含铋剂序贯疗法为71.8%，95% CI：61.8 - 81.7%，p>0.05）；在符合方案人群中，两种方案的根除率也无显著差异（序贯疗法为74.6%，95% CI：63.2 - 85.8%；含铋剂序贯疗法为73.7%，95% CI：63.9 - 83.5%，p>0.05）。尽管铋剂有不可否认的作用，但根除成功率不理想可能有几个原因。给药时间、其他药物的联合使用、幽门螺杆菌对铋剂可能的耐药性都可能影响根除成功率。在序贯疗法方案中添加枸橼酸铋并不显著提高根除率。
