Delaney B C
Department of General Practice, University of Birmingham.
Br J Gen Pract. 1995 Sep;45(398):489-94.
The majority of patients with dyspepsia are managed in general practice. However, most of the literature on Helicobacter pylori and its association with gastrointestinal disease has originated from secondary care. This review summarizes the role of H pylori in dyspepsia from the perspective of primary care and suggests a new strategy for the management of dyspeptic patients in this setting. Recent meta-analyses and consensus statements have supported the use of eradication therapy as first-line treatment of peptic ulceration. Studies from primary care have supported the use of eradication therapy in patients who have H pylori related peptic ulcer disease and require long-term H2-antagonist medication, on both clinical benefit and cost-effectiveness grounds. Of the many regimens proposed for the eradication of H pylori, the best evidence supports a triple combination of bismuth, metronidazole and tetracycline. Regimens using proton pump inhibitors may be more acceptable to patients but lack good evidence from trials. Use of a positive serum enzyme-linked immunoabsorbent assay for H pylori antibodies as a criterion for endoscopic investigation has been shown to result in a 23% reduction in endoscopic workload. Further research should answer questions of importance to general practitioners, such as the role of eradication therapy in patients with nonulcer dyspepsia and the effectiveness of eradication of H pylori in the prevention of gastric cancer.
大多数消化不良患者在基层医疗中接受治疗。然而，关于幽门螺杆菌及其与胃肠道疾病关联的大多数文献都来自二级医疗。本综述从基层医疗的角度总结了幽门螺杆菌在消化不良中的作用，并提出了在这种情况下管理消化不良患者的新策略。最近的荟萃分析和共识声明支持将根除治疗作为消化性溃疡的一线治疗方法。基层医疗的研究支持在患有幽门螺杆菌相关消化性溃疡疾病且需要长期服用H2拮抗剂药物的患者中使用根除治疗，这基于临床益处和成本效益两方面的理由。在为根除幽门螺杆菌而提出的众多方案中，最有力的证据支持铋剂、甲硝唑和四环素的三联组合。使用质子泵抑制剂的方案可能更容易被患者接受，但缺乏来自试验的有力证据。使用血清幽门螺杆菌抗体酶联免疫吸附测定阳性作为内镜检查的标准已被证明可使内镜检查工作量减少23%。进一步的研究应回答对全科医生很重要的问题，例如根除治疗在非溃疡性消化不良患者中的作用以及根除幽门螺杆菌在预防胃癌方面的有效性。
