Jaspersen D, Koerner T, Schorr W, Brennenstuhl M, Raschka C, Hammar C H
Department of Medicine, Academic Medical Hospital, Fulda, Germany.
Gastrointest Endosc. 1995 Jan;41(1):5-7. doi: 10.1016/s0016-5107(95)70267-9.
To evaluate whether eradication with omeprazole and amoxicillin results in a reduction of ulcer recurrence and rebleeding in patients with Helicobacter pylori-associated duodenal ulcer hemorrhage, patients with upper gastrointestinal hemorrhage from duodenal ulcers with stigmata of recent hemorrhage, a drop in hemoglobin level of more than 2 g/dL, and documented H. pylori infection (by rapid urease test and histologic findings) were randomly assigned to receive omeprazole, 40 mg every day, and amoxicillin, 1 g twice a day, (Group A) or omeprazole alone, 40 mg every day, (Group B) for 2 weeks. No maintenance antiulcer therapy was given. Patients underwent a second endoscopy 4 weeks after completion of therapy and were followed for 1 year. Endoscopy was performed again at the end of 1 year. All patients showed ulcer healing 4 weeks after completion of therapy. H. pylori eradication rates were 83% (Group A) and 5% (Group B) (p < .001). Ulcer recurrences were significantly lower in Group A (3/29 or 10%) than in Group B (9/22 or 41%; p < .05). Comparison of Group A patients with eradication and Group B patients without eradication also revealed a significant difference in rates of ulcer relapse (1/24 or 4% versus 9/21 or 43%; p < .01). Rebleeding occurred significantly less often in the dual therapy group than in the omeprazole group (0/29 versus 6/22 or 27%; p < .01). Eradication of H. pylori significantly reduces the rates of ulcer recurrence and rebleeding in patients with duodenal ulcer bleeding. Dual therapy with omeprazole and amoxicillin should be considered in all H. pylori-positive patients with hemorrhage from duodenal ulcers.
为评估奥美拉唑与阿莫西林联合根除治疗是否能降低幽门螺杆菌相关性十二指肠溃疡出血患者的溃疡复发率及再出血率，将近期有出血征象、血红蛋白水平下降超过2 g/dL且经快速尿素酶试验和组织学检查证实有幽门螺杆菌感染的十二指肠溃疡所致上消化道出血患者，随机分为两组，A组每天服用40 mg奥美拉唑及每天2次每次1 g阿莫西林，B组每天仅服用40 mg奥美拉唑，疗程均为2周。未给予维持性抗溃疡治疗。治疗结束4周后患者接受第二次内镜检查，并随访1年。1年后再次进行内镜检查。所有患者治疗结束4周后溃疡均愈合。A组幽门螺杆菌根除率为83%，B组为5%（p<0.001）。A组溃疡复发率（3/29或10%）显著低于B组（9/22或41%；p<0.05）。A组根除幽门螺杆菌患者与B组未根除患者的溃疡复发率比较也有显著差异（1/24或4%对9/21或43%；p<0.01）。双联治疗组再出血发生率显著低于奥美拉唑组（0/29对6/22或27%；p<0.01）。根除幽门螺杆菌可显著降低十二指肠溃疡出血患者的溃疡复发率及再出血率。对于所有幽门螺杆菌阳性的十二指肠溃疡出血患者，应考虑采用奥美拉唑与阿莫西林双联治疗。
