Kusunoki Maho, Yuki Mika, Ishitobi Hitomi, Kobayashi Yoshiya, Nagaoka Makoto, Takahashi Yoshiko, Fukuba Nobuhiko, Komazawa Yoshinori, Shizuku Toshihiro, Kinoshita Yoshikazu
Department of Internal Medicine, Izumo City General Medical Center, Japan.
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Japan.
Intern Med. 2019 Jun 1;58(11):1549-1555. doi: 10.2169/internalmedicine.2233-18. Epub 2019 Feb 1.
Objective We evaluated the efficacy of vonoprazan-based eradication therapy for Helicobacter pylori (H. pylori), including the effects of age, gender, and grade of atrophy in comparison to proton pump inhibitor-based therapy. Method We retrospectively reviewed the records of 1,172 patients who received first-line triple therapy with amoxicillin, clarithromycin, and vonoprazan or a proton pump inhibitor (PPI) for H. pylori eradication, as well as 157 patients treated with second-line therapy consisting of amoxicillin, metronidazole, and vonoprazan or a PPI. Results The eradication rate of all cases treated with first-line triple therapy was 86.9% (1,019/1,172), while that in those treated with vonoprazan-based therapy was 92.5% (384/415). Our analysis showed that the use of vonoprazan resulted in a significantly improved success rate of first-line eradication therapy in comparison to proton pump inhibitor-based therapy [odds ratio (OR), 2.36; 95% confidence interval (CI) 1.55 to 3.56]. The superiority of vonoprazan was remarkable in non-elderly patients, while its effect was unclear in elderly patients. When used as second-line eradication therapy, the advantage of vonoprazan over PPI administration was not clear. Conclusion The inclusion of vonoprazan increased the success rate of first-line eradication therapy; however, the advantage was reduced with aging and remained unclear in elderly patients.
目的 我们评估了基于沃克帕唑的幽门螺杆菌（H. pylori）根除疗法的疗效，包括与基于质子泵抑制剂的疗法相比，年龄、性别和萎缩程度的影响。方法 我们回顾性分析了1172例接受阿莫西林、克拉霉素和沃克帕唑或质子泵抑制剂（PPI）一线三联疗法根除幽门螺杆菌的患者记录，以及157例接受阿莫西林、甲硝唑和沃克帕唑或PPI二线疗法治疗的患者记录。结果 一线三联疗法治疗的所有病例的根除率为86.9%（1019/1172），而基于沃克帕唑疗法的根除率为92.5%（384/415）。我们的分析表明，与基于质子泵抑制剂的疗法相比，使用沃克帕唑可显著提高一线根除疗法的成功率[优势比（OR），2.36；95%置信区间（CI）1.55至3.56]。沃克帕唑在非老年患者中的优势显著，而在老年患者中的效果尚不清楚。当用作二线根除疗法时，沃克帕唑相对于PPI给药的优势不明显。结论 加入沃克帕唑可提高一线根除疗法的成功率；然而，随着年龄增长优势降低，在老年患者中仍不明确。
