Campillo Ana, Amorena Edurne, Ostiz Miriam, Kutz Marcos, LaIglesia Matilde
Aparato Digestivo, Hospital Reina Sofía, Tudela, Navarra, España.
Aparato Digestivo, Hospital Reina Sofía, Tudela, Navarra, España.
Gastroenterol Hepatol. 2016 Nov;39(9):584-589. doi: 10.1016/j.gastrohep.2016.03.002. Epub 2016 Apr 12.
Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen.
Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40mg/12h.
A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n=371) showed higher efficacy than triple therapy (n=248) for both intention-to-treat (85.9% vs. 65.7%; P<.001) and per protocol analysis (92.5% vs. 68.4%; P<.001). When both therapies included esomeprazole 40mg/12h administered for 10 days, quadruple concomitant therapy (n=108) also had higher efficacy than triple therapy (n=76) for intention-to-treat (90.7% vs. 73.6%; P=.003) and per protocol analysis (92.5% vs.74.6%; P=.002).
Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40mg/12h.
四联同步非铋剂疗法最近已成为西班牙治疗幽门螺杆菌感染最广泛使用的一线治疗方案。优化的传统三联疗法是否能达到与之相当的疗效仍有待观察。
一项回顾性研究，比较三联疗法和四联同步疗法的疗效，并对两者均使用埃索美拉唑40mg/12小时给药10天进行亚组分析。
2012年1月1日至2014年12月31日期间，对657例患者进行了一线治疗。对于意向性分析（85.9%对65.7%；P<0.001）和符合方案分析（92.5%对68.4%；P<0.001），四联疗法（n=371）的疗效均高于三联疗法（n=248）。当两种疗法均包括使用埃索美拉唑40mg/12小时给药10天时，对于意向性分析（90.7%对73.6%；P=0.003）和符合方案分析（92.5%对74.6%；P=0.002），四联同步疗法（n=108）的疗效也高于三联疗法（n=76）。
高剂量质子泵抑制剂（PPI）四联同步疗法治疗10天的根除效果显著高于优化的三联疗法，当使用的PPI为埃索美拉唑40mg/12小时时，根除率超过90%。
