Elta G H, Scheiman J M, Barnett J L, Nostrant T T, Behler E M, Crause I, Appelman H D
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
Am J Gastroenterol. 1995 Jul;90(7):1089-93.
BACKGROUND/AIMS: It remains controversial whether Helicobacter pylori infection causes symptoms in non-ulcer dyspepsia. One hundred non-ulcer dyspepsia patients were screened for H. pylori infection between November 1989 and February 1994. Forty patients entered a trial where both infected and uninfected patients were treated with H. pylori therapy, with the uninfected group serving as controls.
Non-ulcer dyspepsia was defined as unexplained epigastric discomfort lasting for at least 4 wk. From November 1989 until February 1992, all patients, regardless of H. pylori status, were treated with bismuth subsalicylate tablets (524 mg q.i.d.) for 4 wk and metronidazole (250 mg q.i.d.) for the first 2 of the 4 wk. From March 1992 until February 1994, only infected patients were treated in an attempt to obtain equal numbers in each group. H. pylori infection was diagnosed histologically at the index endoscopy and 1 month after completion of therapy. Symptoms were scored on a 0-5 scale for both frequency and severity.
Of 100 patients screened, 33 were infected with H. pylori (mean age, 42; 10 men, 23 women), and 67 were uninfected (mean age, 38; 16 men, 51 women). Thirty-six uninfected patients were not offered treatment during the latter part of the trial. Of the remaining 31 uninfected patients, 10 dropped out; of the 33 infected patients, 14 dropped out. Twenty-one uninfected patients and 19 H. pylori-infected patients completed treatment; in 13 of 19 patients (68%), H. pylori was eradicated. Symptoms improved in eight of 13 (61%) H. pylori-eradicated patients and in four of six (66%) H. pylori-persistent patients, compared with 14 of 21 (66%) uninfected patients. Long-term follow-up (mean, 34 months) showed similar symptom outcome in the two treatment groups.
Thirty-three percent of our non-ulcer dyspepsia patients were infected with H. pylori, a number similar to the percentage of infected age-matched controls in the U.S. Treatment with bismuth subsalicylate and metronidazole resulted in symptomatic improvement in 61-66% of non-ulcer dyspepsia patients regardless of initial or post-treatment H. pylori status. Long-term symptom follow-up in both the control and infected groups gave similar results. H. pylori infection is not related to the symptoms of non-ulcer dyspepsia.
背景/目的：幽门螺杆菌感染是否会导致非溃疡性消化不良的症状仍存在争议。1989年11月至1994年2月期间，对100例非溃疡性消化不良患者进行了幽门螺杆菌感染筛查。40例患者进入一项试验，其中感染和未感染幽门螺杆菌的患者均接受幽门螺杆菌治疗，未感染组作为对照组。
非溃疡性消化不良定义为不明原因的上腹部不适持续至少4周。从1989年11月至1992年2月，所有患者，无论幽门螺杆菌感染状况如何，均接受碱式水杨酸铋片（524毫克，每日4次）治疗4周，并在前2周接受甲硝唑（250毫克，每日4次）治疗。从1992年3月至1994年2月，仅对感染患者进行治疗，以使每组人数相等。在初次内镜检查时及治疗结束后1个月通过组织学诊断幽门螺杆菌感染。症状根据频率和严重程度按0至5分进行评分。
在筛查的100例患者中，33例感染幽门螺杆菌（平均年龄42岁；男性10例，女性23例），67例未感染（平均年龄38岁；男性16例，女性51例）。在试验后期，36例未感染患者未接受治疗。在其余31例未感染患者中，10例退出；在33例感染患者中，14例退出。21例未感染患者和19例感染幽门螺杆菌患者完成治疗；19例患者中有13例（68%）幽门螺杆菌被根除。与21例未感染患者中的14例（66%）相比，13例幽门螺杆菌被根除的患者中有8例（61%）症状改善，6例幽门螺杆菌持续存在的患者中有4例（66%）症状改善。长期随访（平均34个月）显示两个治疗组的症状结果相似。
我们的非溃疡性消化不良患者中有33%感染了幽门螺杆菌，这一比例与美国年龄匹配的感染对照组的比例相似。无论初始或治疗后幽门螺杆菌感染状况如何，使用碱式水杨酸铋和甲硝唑治疗可使61%至66%的非溃疡性消化不良患者症状改善。对照组和感染组的长期症状随访结果相似。幽门螺杆菌感染与非溃疡性消化不良的症状无关。
