Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden.
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Gastrointest Endosc. 2018 Aug;88(2):242-250.e1. doi: 10.1016/j.gie.2017.11.035. Epub 2017 Dec 9.
Helicobacter pylori is associated with peptic ulcer disease and gastric cancer. Therefore we wanted to test how various lengths of delays in H pylori eradication therapy influence the risk of recurrent peptic ulcer, ulcer adverse events, and gastric cancer.
This population-based nationwide Swedish cohort study included 29,032 patients receiving H pylori eradication therapy after peptic ulcer disease in 2005 to 2013. Predefined time intervals between date of peptic ulcer diagnosis and date of eradication therapy were analyzed in relation to study outcomes. Cox regression provided hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusted for age, sex, comorbidity, history of ulcer disease, use of ulcerogenic drugs, and use of proton pump inhibitors (PPIs).
Compared with eradication therapy within 7 days of peptic ulcer diagnosis, eradication therapy within 8 to 30, 31 to 60, 61 to 365, and >365 days corresponded with HRs of recurrent ulcer of 1.17 (95% CI, 1.08-1.25), 2.37 (95% CI, 2.16-2.59), 2.96 (95% CI, 2.76-3.16), and 3.55 (95% CI, 3.33-3.79), respectively. The corresponding HRs for complicated ulcer were 1.55 (95% CI, 1.35-1.78), 3.19 (95% CI, 2.69-3.78), 4.00 (95% CI, 3.51-4.55), and 6.14, (95% CI, 5.47-6.89), respectively. For gastric cancer the corresponding HRs were .85 (95% CI, .32-2.23), 1.31 (95% CI, .31-5.54), 3.64 (95% CI, 1.55-8.56), and 4.71 (95% CI, 2.36-9.38), respectively.
Delays in H pylori eradication therapy after peptic ulcer diagnosis time-dependently increase the risk of recurrent ulcer, even more so for complicated ulcer, starting from delays of 8 to 30 days.
幽门螺杆菌与消化性溃疡病和胃癌有关。因此，我们想要测试幽门螺杆菌根除治疗的不同延迟时间如何影响复发性消化性溃疡、溃疡不良事件和胃癌的风险。
这项基于人群的全国性瑞典队列研究纳入了 2005 年至 2013 年间接受幽门螺杆菌根除治疗的 29032 例消化性溃疡病患者。分析了从消化性溃疡诊断日期到根除治疗日期之间的预定时间间隔与研究结果的关系。Cox 回归提供了风险比（HR）和 95%置信区间（95%CI），调整了年龄、性别、合并症、溃疡病史、溃疡形成药物的使用和质子泵抑制剂（PPIs）的使用。
与消化性溃疡诊断后 7 天内进行根除治疗相比，8-30 天、31-60 天、61-365 天和>365 天进行根除治疗的复发性溃疡的 HR 分别为 1.17（95%CI，1.08-1.25）、2.37（95%CI，2.16-2.59）、2.96（95%CI，2.76-3.16）和 3.55（95%CI，3.33-3.79）。复杂溃疡的相应 HR 分别为 1.55（95%CI，1.35-1.78）、3.19（95%CI，2.69-3.78）、4.00（95%CI，3.51-4.55）和 6.14（95%CI，5.47-6.89）。胃癌的相应 HR 分别为.85（95%CI，.32-2.23）、1.31（95%CI，.31-5.54）、3.64（95%CI，1.55-8.56）和 4.71（95%CI，2.36-9.38）。
消化性溃疡诊断后幽门螺杆菌根除治疗的延迟时间与复发性溃疡的风险呈时间依赖性相关，从 8-30 天开始，这种相关性对复杂溃疡更为明显。
