Huh Cheal Wung, Youn Young Hoon, Jung Da Hyun, Park Jae Jun, Kim Jie-Hyun, Park Hyojin
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2016 Sep 2;11(9):e0162258. doi: 10.1371/journal.pone.0162258. eCollection 2016.
After endoscopic resection (ER) of gastric tumors, eradication of Helicobacter pylori (H. pylori) infection is advised to reduce metachronous recurrence. Optimal timing of such therapy (yet to be established) was investigated herein, examining early active and late scarring stages of post-ER iatrogenic ulcers.
Analysis included 514 patients who received proton-pump inhibitor (PPI)-based triple therapy for H. pylori eradication after ER for gastric neoplasms between January 2008 and June 2015. Clinicopathologic characteristics, particularly the timing of triple therapy, were used to compare eradication rates, assigning patients to early- (≤2 weeks), intermediate- (2-8 weeks), and late-phase (≥8 weeks) treatment groups.
H. pylori eradication rates differed significantly by timing of triple therapy after ER (early, 90.0%; intermediate, 76.2%, late, 72.4%; p <.001). However, eradication success rates were not significantly affected by age, smoking, alcohol consumption, preexisting comorbidity, method of ER, size and location of iatrogenic ulcer, and duration of therapeutic regimen. Early initiation of H. pylori eradication was also identified as a significant independent predictor of eradication success in multivariate analysis (Odds ratio = 3.67, 95% CI 2.18-6.16; p <.001).
In patients undergoing ER of gastric tumors, early post-ER attempts at eradication of H. pylori offer the best chance of eradication success.
胃肿瘤内镜切除（ER）术后，建议根除幽门螺杆菌（H. pylori）感染以减少异时性复发。本文研究了此类治疗的最佳时机（尚未确定），观察ER术后医源性溃疡的早期活动期和晚期瘢痕形成期。
分析纳入了2008年1月至2015年6月期间因胃肿瘤接受ER治疗后接受基于质子泵抑制剂（PPI）的三联疗法根除H. pylori的514例患者。利用临床病理特征，尤其是三联疗法的时机，比较根除率，将患者分为早期（≤2周）、中期（2 - 8周）和晚期（≥8周）治疗组。
ER术后三联疗法的时机不同，H. pylori根除率差异显著（早期为90.0%；中期为76.2%，晚期为72.4%；p <.001）。然而，根除成功率不受年龄、吸烟、饮酒、既往合并症、ER方法、医源性溃疡的大小和位置以及治疗方案持续时间的显著影响。在多变量分析中，早期开始根除H. pylori也被确定为根除成功的显著独立预测因素（比值比 = 3.67，95%可信区间2.18 - 6.16；p <.001）。
在接受胃肿瘤ER治疗的患者中，ER术后早期尝试根除H. pylori提供了最佳的根除成功机会。
