Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan.
Shinozaki Medical Clinic, Utsunomiya, Japan,
Digestion. 2020;101(3):332-338. doi: 10.1159/000499857. Epub 2019 Apr 16.
BACKGROUND/AIMS: Although a potassium-competitive acid blocker (PCAB)-based regimen improves the rate of successful Helicobacter pylori first-line eradication, the efficacy of a PCAB-based regimen as second-line therapy is unclear. The aim of this study is to compare the success of second-line eradication of H. pylori using PCAB and proton pump inhibitor (PPI)-based regimens.
From 2014 to 2017, 624 patients who underwent second-line H. pylori eradication were enrolled. A standard triple regimen for second-line H. pylori eradication includes metronidazole 250 mg, amoxicillin 750 mg, and PPI or PCAB twice daily for 7 days. The success of eradication was compared using intention-to-treat, per-protocol, and propensity-score matching analysis.
All patients completed the 7-day course of therapy. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen in both intention-to-treat (90% [298/330] vs. 85% [250/294], p = 0.045) and per-protocol analyses (96% [298/309] vs. 91% [250/274], p = 0.008). Adverse events occurred in 4 patients. Propensity score matching analysis acquired 274 matched pairs. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen (96% [264/274] vs. 91% [250/274], p = 0.013).
PCAB-based second-line H. pylori eradication is significantly better than PPI-based therapy.
背景/目的：虽然钾竞争性酸阻滞剂（PCAB）为基础的方案可提高幽门螺杆菌一线根除率，但 PCAB 为基础方案作为二线治疗的疗效尚不清楚。本研究旨在比较 PCAB 和质子泵抑制剂（PPI）为基础方案二线治疗幽门螺杆菌根除的疗效。
2014 年至 2017 年，共纳入 624 例接受二线幽门螺杆菌根除的患者。二线幽门螺杆菌根除的标准三联方案包括甲硝唑 250mg、阿莫西林 750mg 和 PPI 或 PCAB，每日两次，连用 7 天。采用意向治疗、方案治疗和倾向评分匹配分析比较根除的疗效。
所有患者均完成了 7 天的治疗疗程。在意向治疗（90%[298/330]比 85%[250/294]，p=0.045）和方案治疗分析（96%[298/309]比 91%[250/274]，p=0.008）中，使用 PCAB 为基础方案的患者根除率均高于使用 PPI 为基础方案的患者。4 例患者出现不良反应。通过倾向评分匹配分析获得了 274 对匹配对。使用 PCAB 为基础方案的患者根除率高于使用 PPI 为基础方案的患者（96%[264/274]比 91%[250/274]，p=0.013）。
PCAB 为基础的二线幽门螺杆菌根除明显优于 PPI 为基础的治疗。
