Kim Yeon-Ji, Chung Woo Chul, Kim Byung Wook, Kim Sung Soo, Kim Jin Il, Kim Na Jin, Yoo Jinho, Kim Soo Hwan
Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
Medical Library, The Catholic University of Korea, Seoul, Korea.
J Neurogastroenterol Motil. 2017 Oct 30;23(4):504-516. doi: 10.5056/jnm17066.
BACKGROUND/AIMS: To assess the long-term effect of eradication on symptomatic improvement according to the type of antibiotic and the duration of treatment in -associated functional dyspepsia. METHODS: We searched Pubmed, Embase, CINAHL, and the Cochrane library databases for randomized controlled trials written in English and undertaken up to August 2016 that met our eligibility criteria. The search methodology used combinations of the following keywords: OR OR HP; dyspepsia OR functional dyspepsia OR non-ulcer dyspepsia; eradication OR cure OR treatment. The study outcome was the summary odds ratio (OR) for symptomatic improvement in -associated functional dyspepsia with successful eradication therapy. Subgroup analyses were performed based on the type of antibiotic, and the duration of treatment, whether or not patients had symptoms of irritable bowel syndrome, and on race. RESULTS: Sixteen randomized controlled trials met the inclusion criteria. The summary OR for symptomatic improvement in patients in our eradication group was 1.33 (95% confidence interval [CI], 1.16-1.54; < 0.01). In a subgroup analysis on type of antibiotic, symptomatic improvement with metronidazole-containing regimen (OR, 1.87; 95% CI, 1.26-2.77) was better than treatment with clarithromycin (OR, 1.29; 95% CI, 1.11-1.50). eradication therapy given for 10-14 days was the more effective for symptom improvement than 7-day therapy. When the studies excluding irritable bowel syndrome cases were analyzed, there were no therapeutic effects of eradication on symptomatic improvement. CONCLUSIONS: In the clinical setting, the most effective eradication regimen for functional dyspepsia to provide relief of symptoms is a metronidazole-based treatment regimen for at least 10 days. The explanation for this is that -associated functional dyspepsia could be associated with dysbiosis.
背景/目的:根据抗生素类型和治疗时长评估根除幽门螺杆菌对幽门螺杆菌相关性功能性消化不良症状改善的长期影响。 方法:我们检索了Pubmed、Embase、CINAHL和Cochrane图书馆数据库,查找截至2016年8月撰写的、符合我们纳入标准的英文随机对照试验。检索方法使用了以下关键词的组合:幽门螺杆菌或HP;消化不良或功能性消化不良或非溃疡性消化不良;根除或治愈或治疗。研究结果是成功根除治疗的幽门螺杆菌相关性功能性消化不良症状改善的汇总比值比(OR)。基于抗生素类型、治疗时长、患者是否有肠易激综合征症状以及种族进行亚组分析。 结果:16项随机对照试验符合纳入标准。我们根除组患者症状改善的汇总OR为1.33(95%置信区间[CI],1.16 - 1.54;P < 0.01)。在抗生素类型的亚组分析中,含甲硝唑方案的症状改善(OR,1.87;95% CI,1.26 - 2.77)优于含克拉霉素治疗(OR,1.29;95% CI,1.11 - 1.50)。给予10 - 14天的根除治疗比7天治疗对症状改善更有效。当分析排除肠易激综合征病例的研究时,根除幽门螺杆菌对症状改善没有治疗效果。 结论:在临床环境中,对功能性消化不良提供症状缓解最有效的根除幽门螺杆菌方案是基于甲硝唑的治疗方案,至少持续10天。对此的解释是幽门螺杆菌相关性功能性消化不良可能与肠道菌群失调有关。
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