Shah Shailja, Hubscher Elizabeth, Pelletier Corey, Jacob Rinu, Vinals Lydia, Yadlapati Rena
Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.
Real-World Advanced Analytics, Cytel, Inc, Waltham, Massachusetts, USA.
Expert Rev Gastroenterol Hepatol. 2022 Apr;16(4):341-357. doi: 10.1080/17474124.2022.2056015. Epub 2022 Apr 1.
(Hp) is causal in benign and malignant gastrointestinal diseases. Accordingly, current guidelines recommend Hp eradication in patients with active infection. Unfortunately, treatment failure is common, exposing patients to complications associated with persistent Hp infection and consequences of repeated treatment, including promotion of antibiotic resistance. In the United States (US), data regarding eradication rates with available therapies are limited. Moreover, the clinical and economic burden of eradication treatment failure have not been thoroughly described.
We aimed to characterize Hp eradication rates and the clinical consequences and associated costs of persistent Hp infection among US adults. We conducted focused literature reviews using initial searches in Embase, MEDLINE, and Cochrane Database of Systematic Reviews via Ovid followed by manual searches to identify relevant publications.
Hp eradication rates were suboptimal, with most studies reporting rates ≤80% with clarithromycin-based triple therapy and bismuth quadruple therapy. There was direct evidence supporting numerous benefits of successful Hp eradication, including decreased risk of recurrent or complicated peptic disease and non-cardia gastric cancer. Cost benefits of eradication were related to mitigation of conditions associated with persistent Hp infection, (e.g. complicated peptic ulcer disease, and gastric cancer) which altogether exceed US$5.3 billion.
幽门螺杆菌（Hp）是胃肠道良性和恶性疾病的病因。因此，当前指南建议对活动性感染患者进行Hp根除治疗。不幸的是，治疗失败很常见，这使患者面临与Hp持续感染相关的并发症以及重复治疗的后果，包括抗生素耐药性的增加。在美国，关于现有治疗方法根除率的数据有限。此外，根除治疗失败的临床和经济负担尚未得到充分描述。
我们旨在描述美国成年人中Hp根除率、Hp持续感染的临床后果及相关成本。我们通过Ovid在Embase、MEDLINE和Cochrane系统评价数据库中进行初步检索，随后进行人工检索以识别相关出版物，从而开展了重点文献综述。
Hp根除率不理想，大多数研究报告基于克拉霉素的三联疗法和铋剂四联疗法的根除率≤80%。有直接证据支持成功根除Hp有诸多益处，包括降低复发性或复杂性消化性疾病以及非贲门胃癌的风险。根除治疗的成本效益与减轻与Hp持续感染相关的疾病（如复杂性消化性溃疡病和胃癌）有关，这些疾病的总成本超过53亿美元。
