Pediatric Gastroenterology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Pediatric Gastroenterology Unit, Hospital Universitario de Guadalajara, Spain.
Helicobacter. 2024 Sep-Oct;29(5):e13142. doi: 10.1111/hel.13142.
To evaluate the efficacy of colloidal bismuth subcitrate (CBS) therapy for the eradication of H. pylori in patients from a national pediatric registry of H. pylori infection.
The Spanish Registry of Children with H. pylori Infection (RENIHp) is a national, multi-center, prospective, non-interventional registry that includes children aged 5-18 years with H. pylori infection diagnosed by endoscopy. All patients in the registry who were treated with CBS between the period 2020 and 2023 were included in this study. The primary outcome was the eradication rate, which was assessed using a C-urea breath test or monoclonal antigen in the stool 6-8 weeks post-treatment.
The registry included 682 patients, 38 (5.6%) of whom underwent treatment with CBS. Fifty percent (19/38) of patients had previously undergone unsuccessful eradication treatment. In 78.9% (30/38) of patients, treatment was guided by an antibiotic sensitivity test. In the remaining patients, an empirical approach was employed. The CBS therapies used were as follows: quadruple therapy with proton pump inhibitors (PPIs), CBS, amoxicillin, and metronidazole (MET) [18/38 (47.3%)]; quadruple therapy with PPIs, CBS, tetracycline, and MET [13/38 (34.2%)]; and other therapies [7/38 (18.4%)]. Thirty-two patients (84.2%) treated with CBS were followed-up with eradication monitoring. The overall eradication rate in patients treated with CBS was 93.8% (30/32, [95% CI: 85.4%-100%]), whereas it was 86.7% in patients in the registry who were not on CBS treatment (430/496, [95% CI: 83.3%-89.5%], p = 0.208). In the six patients with dual resistance to clarithromycin (CLA) and MET who were treated with quadruple therapy with CBS, the eradication rate was 100% (n = 6/6, [95% CI: 61.0%-100%]).
CBS therapies in our registry, although only used in selected cases and at lower than recommended levels, were very effective and showed an eradication rate of > 90%.
评估胶体次枸橼酸铋（CBS）疗法在国家幽门螺杆菌感染儿科注册中心患者中根除 H. pylori 的疗效。
西班牙儿童幽门螺杆菌感染注册中心（RENIHp）是一个全国性、多中心、前瞻性、非干预性注册中心，纳入了年龄在 5-18 岁、经内镜诊断为 H. pylori 感染的儿童。本研究纳入了 2020 年至 2023 年期间接受 CBS 治疗的所有 RENIHp 注册中心患者。主要结局是治疗后 6-8 周通过 C-尿素呼气试验或粪便单克隆抗原检测的根除率。
该注册中心共纳入了 682 例患者，其中 38 例（5.6%）接受 CBS 治疗。50%（19/38）的患者曾接受过不成功的根除治疗。78.9%（30/38）的患者根据抗生素药敏试验指导治疗，其余患者采用经验性治疗。CBS 治疗方案如下：质子泵抑制剂（PPIs）、CBS、阿莫西林和甲硝唑（MET）四联疗法[18/38（47.3%）]；PPIs、CBS、四环素和 MET 四联疗法[13/38（34.2%）]；以及其他疗法[7/38（18.4%）]。32 例接受 CBS 治疗的患者进行了根除监测随访。接受 CBS 治疗的患者总体根除率为 93.8%（30/32，[95%CI：85.4%-100%]），而未接受 CBS 治疗的患者（430/496，[95%CI：83.3%-89.5%]）为 86.7%，差异无统计学意义（p=0.208）。6 例对克拉霉素（CLA）和 MET 双重耐药的患者接受 CBS 四联疗法治疗，根除率为 100%（n=6/6，[95%CI：61.0%-100%]）。
尽管本研究中的 CBS 疗法仅在选定病例中使用且低于推荐水平，但非常有效，根除率>90%。
