Liu Roy P, Romero Roberta, Sarosiek Jerzy, Dodoo Christopher, Dwivedi Alok K, Zuckerman Marc J
From the Division of Gastroenterology and the Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center, El Paso.
South Med J. 2018 Jan;111(1):51-55. doi: 10.14423/SMJ.0000000000000747.
is prevalent worldwide, especially in Latin America. Triple and quadruple antibiotic therapies have been relatively effective; however, resistance has emerged in recent years. The treatment success rate of these regimens on the border of the United States and Mexico is unknown. Our study attempted to determine eradication rates of two major regimens based on urea breath test (UBT) results in patients previously diagnosed as having in a single center in El Paso, Texas, a city on the geographic border with Mexico.
This was a retrospective cohort study of adult patients with who underwent UBT after being treated with triple therapy (amoxicillin/clarithromycin/proton pump inhibitor for 14 days), quadruple therapy (tetracycline/metronidazole/bismuth/proton pump inhibitor, usually for 10 days), or both for from 2010 to 2015 in a county hospital. Patients were excluded if they did not complete therapy or if their treatment regimen was unknown. The Student test and the χ test were used to analyze the data. The cumulative incidence and 95% confidence interval (CI) for treatment success were estimated.
A total of 104 patients completed the treatment for and had UBT. Mean age was 53 years, 76% were women, 85% were Hispanic, and mean body mass index was 30.5 kg/m. Of the 104 patients diagnosed as having , 88 received triple therapy (84.6%) and 16 received quadruple therapy: 12 (11.5%) standard quadruple therapy, 4 (3.9%) triple therapy plus metronidazole. There were no differences between groups regarding age, sex, body mass index, or ethnicity. Overall, 90 (86.5%, 95% CI 78-92) patients had negative UBT after initial treatment. Based on posttreatment UBT, the triple therapy group had a similar eradication rate compared with the quadruple therapy group (78/88, 88.6% vs 12/16, 75.0%, = 0.22). Of the 14 patients with positive posttreatment UBT, 12 (85.7%) received retreatment (2 were lost to follow-up), 11 (91.7%) received quadruple therapy, and 1 (8.3%) received triple therapy. Eradication was successful in 9 of 12 (75%, 95% CI 43-95) patients at retreatment. As such, of the initial 104 patients, 99/104 (95.2%) achieved eradication posttreatment (either initial or retreatment).
In a predominantly Hispanic population on the US-Mexico border, eradication rates based on UBT results were relatively high and were similar for triple therapy and quadruple therapy. Quadruple therapy was effective for those who failed the initial treatment. This may have implications for cost-effective therapy in our region.
幽门螺杆菌在全球普遍存在，尤其是在拉丁美洲。三联和四联抗生素疗法相对有效；然而，近年来已出现耐药性。在美国和墨西哥边境地区这些治疗方案的治疗成功率尚不清楚。我们的研究试图根据尿素呼气试验（UBT）结果，确定在德克萨斯州埃尔帕索的一个单一中心，两种主要治疗方案对先前诊断为幽门螺杆菌感染患者的根除率，埃尔帕索是一个与墨西哥接壤的城市。
这是一项对成年幽门螺杆菌感染患者的回顾性队列研究，这些患者于2010年至2015年在一家县医院接受三联疗法（阿莫西林/克拉霉素/质子泵抑制剂，治疗14天）、四联疗法（四环素/甲硝唑/铋剂/质子泵抑制剂，通常治疗10天）或两者联合治疗幽门螺杆菌后接受了UBT。如果患者未完成治疗或其治疗方案不明，则将其排除。采用Student t检验和χ检验分析数据。估计治疗成功的累积发病率和95%置信区间（CI）。
共有104例患者完成了幽门螺杆菌治疗并进行了UBT。平均年龄为53岁，76%为女性，85%为西班牙裔，平均体重指数为30.5kg/m²。在104例诊断为幽门螺杆菌感染的患者中，88例接受了三联疗法（84.6%），16例接受了四联疗法：12例（11.5%）标准四联疗法，4例（3.9%）三联疗法加甲硝唑。两组在年龄、性别、体重指数或种族方面无差异。总体而言，90例（86.5%，95%CI 78 - 92）患者初始治疗后UBT结果为阴性。根据治疗后UBT，三联疗法组与四联疗法组的根除率相似（78/88，88.6%对12/16，75.0%，P = 0.22）。在14例治疗后UBT结果为阳性的患者中，12例（85.7%）接受了再治疗（2例失访），11例（91.7%）接受了四联疗法，1例（8.3%）接受了三联疗法。再治疗的12例患者中有9例（75%，95%CI 43 - 95）根除成功。因此，在最初的104例患者中，99/104（95.2%）在治疗后（初始治疗或再治疗）实现了幽门螺杆菌根除。
在美国 - 墨西哥边境以西班牙裔为主的人群中，基于UBT结果的幽门螺杆菌根除率相对较高，三联疗法和四联疗法相似。四联疗法对初始幽门螺杆菌治疗失败的患者有效。这可能对我们地区具有成本效益的治疗有影响。
