Liou Jyh-Ming, Wu Ming-Shiang, Lin Jaw-Town
Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Gastroenterol Hepatol. 2016 Dec;31(12):1918-1926. doi: 10.1111/jgh.13418.
Gastric cancer and Helicobacter pylori infection remain a burden in many Asian countries. In the face of rising antibiotic resistance, the eradication rate of standard triple therapy is declining in many Asian countries. We reviewed the updated epidemiology of gastric cancer, prevalence of H. pylori infection, and antibiotic resistance in Asia. We also reviewed the strategies to improve the efficacy of H. pylori eradication therapies, including the use of high dose proton pump inhibitor, four drug therapies (including bismuth quadruple, concomitant, and sequential therapy), susceptibility guided therapy, extending the treatment duration to 14 days, and development of effective rescue therapy. Four drug therapies are usually more effective than triple therapy when given in the same duration, except in areas with concomitantly high metronidazole resistance and low clarithromycin resistance. The efficacies of different four drug regimens appeared to be similar. However, trials from different geographic areas showed contradictory results, indicating that the optimal therapy should be decided according to the local prevalence of antibiotic resistance. We proposed a prediction model to calculate the efficacy of different regimens according to the prevalence of antibiotic resistance. More large randomized trials which provide information on the antibiotic resistance are urgently needed to build a more accurate and reliable model. It is hoped that we will be able to decide the optimal regimens by routine surveillance of antibiotic resistance.
在许多亚洲国家，胃癌和幽门螺杆菌感染仍然是一项负担。面对日益增加的抗生素耐药性，许多亚洲国家标准三联疗法的根除率正在下降。我们回顾了亚洲胃癌的最新流行病学、幽门螺杆菌感染率及抗生素耐药性。我们还回顾了提高幽门螺杆菌根除疗法疗效的策略，包括使用高剂量质子泵抑制剂、四联疗法（包括铋剂四联、联合和序贯疗法）、药敏指导疗法、将治疗疗程延长至14天以及开发有效的补救疗法。在相同疗程下，四联疗法通常比三联疗法更有效，但在甲硝唑耐药性高且克拉霉素耐药性低的地区除外。不同四联方案的疗效似乎相似。然而，来自不同地理区域的试验显示出相互矛盾的结果，这表明应根据当地抗生素耐药性流行情况来决定最佳疗法。我们提出了一个预测模型，根据抗生素耐药性流行情况计算不同方案的疗效。迫切需要更多提供抗生素耐药性信息的大型随机试验，以建立更准确可靠的模型。希望我们能够通过对抗生素耐药性的常规监测来确定最佳方案。
