Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea.
Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
Helicobacter. 2021 Apr;26(2):e12780. doi: 10.1111/hel.12780. Epub 2021 Feb 17.
Eradication rate of standard triple therapy for H. pylori has declined to unacceptable level, and alternative regimens such as concomitant and sequential therapy have been introduced. We aimed to assess the consistency of eradication rates of concomitant and sequential therapies as for the first-line H. pylori eradication in Korea.
A nationwide multicenter retrospective study was conducted including 18 medical centers from January 2008 to December 2017. We included 3,800 adults who had test to confirm H. pylori eradication within 1 year after concomitant or sequential therapy.
Concomitant and sequential therapy were prescribed for 2508 and 1292 patients, respectively. The overall eradication rate of concomitant therapy was significantly higher than that of sequential therapy (91.8% vs. 86.1%, p < .001). In time trend analysis, the eradication rates of concomitant therapy were 90.2%, 88.2%, 92.1%, 94.3%, 91.1%, and 93.4% for each year from 2012 to 2017 with an increasing trend (p = .0146), while those of ST showed no significant trend (p = .0873). Among 263 patients with second-line therapy, bismuth quadruple therapy showed significantly higher eradication rate than quinolone-based triple therapy (73.9% vs. 51.5% in ITT analysis, p = .001; 82.7% vs. 63.0% in PP analysis, p = .002).
Concomitant therapy is the best regimen for the first-line H. pylori eradication showing consistently higher eradication rate with an increasing trend for the last 10 years in Korea. Bismuth quadruple therapy should be considered for second-line therapy after eradication failure using non-bismuth quadruple therapy.
标准三联疗法根除幽门螺杆菌的根除率已降至不可接受的水平，因此引入了序贯和伴同疗法等替代方案。本研究旨在评估韩国一线治疗中伴同和序贯疗法根除率的一致性。
这是一项全国性多中心回顾性研究，纳入了 2008 年 1 月至 2017 年 12 月期间的 18 家医疗中心。共纳入了 3800 例在伴同或序贯治疗后 1 年内接受幽门螺杆菌根除检测的成年人。
伴同和序贯疗法分别用于 2508 例和 1292 例患者。伴同疗法的总体根除率明显高于序贯疗法（91.8% vs. 86.1%，p<0.001）。时间趋势分析显示，2012 年至 2017 年，伴同疗法的根除率分别为 90.2%、88.2%、92.1%、94.3%、91.1%和 93.4%，呈上升趋势（p=0.0146），而序贯疗法则无明显趋势（p=0.0873）。在 263 例接受二线治疗的患者中，铋剂四联疗法的根除率明显高于基于喹诺酮的三联疗法（意向性治疗分析中分别为 73.9%和 51.5%，p=0.001；符合方案分析中分别为 82.7%和 63.0%，p=0.002）。
伴同疗法是一线治疗幽门螺杆菌根除的最佳方案，在过去 10 年中，其根除率呈上升趋势，且一致性较高。在非铋剂四联疗法根除失败后，应考虑使用铋剂四联疗法作为二线治疗。
