Di Ciaula Agostino, Scaccianoce Giuseppe, Venerito Marino, Zullo Angelo, Bonfrate Leonilde, Rokkas Theodore, Portincasa Piero
Division of Internal Medicine, Hospital of Bisceglie, Italy.
Gastrointestinal Endoscopy Unit, Ospedale della Murgia F. Perinei, Altamura;Clinica Medica A. Murri, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
J Gastrointestin Liver Dis. 2017 Jun;26(2):129-137. doi: 10.15403/jgld.2014.1121.262.itl.
H. pylori eradication is strongly affected by various factors, including the ongoing antibiotic resistance. We describe a "real life" scenario in patients managed for H. pylori-related conditions, living in a southern Italian region (Apulia), an area with clarithromycin resistance >15%.
2,224 subjects were studied in two tertiary referral centers in Apulia. Analyses included: reason for referral, H. pylori infection rates (13C-urea breath test - UBT or upper endoscopy), and eradication rates following distinct regimens previously prescribed or prospectively prescribed (such as the bismuth-based quadruple therapy Pylera®, recently marketed in Italy).
Over 80% of the patients were referred by family physicians (60% naïve subjects). The overall infection rate was 32.5% and it was similar in asymptomatic patients (31.1%) or with H. pylori-related symptoms/clinical conditions (34.3%). In the 987 H. pylori+ve patients receiving therapy, the overall eradication rate was 80.2% (ITT). Observed eradication rate varied greatly across different regimens: 57.1% (2nd line levofloxacin), 59.6% (unconventional), 70.7% (7-day triple), 73.2% (7-day undefined), 89% (10-day sequential) and 96.9% (ITT, 10 day Pylera®, 1st to 5th line regimens given to 227 patients).
A heterogeneous "real life" scenario in Southern Europe shows that H. pylori+ve patients are put at risk of poor outcomes and points to the need of a susceptibility-based therapy according to guidelines and local microbial resistance. In the present setting (i.e. high clarithromycin resistance), despite the high observed eradication rate, sequential therapy should not be recommended (absent in guidelines, unneeded antibiotic). Bismuth-based quadruple treatment (1st, 2nd or subsequent lines) yields the highest eradication rates.
幽门螺杆菌根除受到多种因素的强烈影响，包括持续存在的抗生素耐药性。我们描述了在意大利南部地区（普利亚）管理的幽门螺杆菌相关疾病患者的“真实生活”情况，该地区克拉霉素耐药率>15%。
在普利亚的两个三级转诊中心对2224名受试者进行了研究。分析内容包括：转诊原因、幽门螺杆菌感染率（13C尿素呼气试验 - UBT或上消化道内镜检查）以及先前规定或前瞻性规定的不同治疗方案后的根除率（如意大利最近上市的基于铋剂的四联疗法Pylera®）。
超过80%的患者由家庭医生转诊（60%为初治患者）。总体感染率为32.5%，无症状患者（31.1%）或有幽门螺杆菌相关症状/临床疾病的患者（34.3%）中感染率相似。在987例接受治疗的幽门螺杆菌阳性患者中，总体根除率为80.2%（意向性分析）。观察到的根除率在不同治疗方案之间差异很大：57.1%（二线左氧氟沙星）、59.6%（非常规方案）、70.7%（7天三联疗法）、73.2%（7天未明确方案）、89%（10天序贯疗法）和96.9%（意向性分析，10天Pylera®，给予227例患者的第1至第5线治疗方案）。
南欧的一个异质性“真实生活”情况表明，幽门螺杆菌阳性患者面临治疗效果不佳的风险，并指出需要根据指南和当地微生物耐药性进行基于药敏的治疗。在当前情况下（即克拉霉素耐药率高），尽管观察到的根除率较高，但不应推荐序贯疗法（指南中未提及，不需要使用抗生素）。基于铋剂的四联疗法（第1线、第2线或后续线）产生的根除率最高。
