O'Connor H J
Department of Medicine, General Hospital, Tullamore, Co. Offaly, Eire.
Eur J Gastroenterol Hepatol. 1994 Dec;6 Suppl 1:S113-9.
To critically review current indications and therapies for Helicobacter pylori eradication.
Studies selected for this review were identified from Medline and a manual search of the literature.
The clearest indication for H. pylori eradication is in the treatment of H. pylori-positive duodenal and gastric ulcer since eradication of the infection prevents ulcer relapse, effectively curing the disease. The use of anti-H. pylori therapy in non-ulcer dyspepsia remains controversial and further studies are required. Despite strong circumstantial evidence linking H. pylori and gastric cancer, it is premature to advocate H. pylori therapy for primary prevention of neoplasia. Triple therapy (bismuth, metronidazole, tetracycline) can eradicate H. pylori in over 90% of cases but this multidrug regimen is not ideal because of side effects, possible non-compliance and doubtful efficacy against metronidazole-resistant infection. Proton-pump inhibitor-antibiotic combinations are a promising alternative to triple therapy with few side effects and good compliance, but there is uncertainty about the most effective combination. H. pylori reinfection after successful eradication is unusual (< 1% per year).
H. pylori eradication is now the treatment of choice in H. pylori-positive peptic ulcer disease. The search continues for the ideal H. pylori treatment regimen which will combine high efficacy, safety and patient acceptability, with low cost.
批判性地回顾当前根除幽门螺杆菌的适应证和治疗方法。
本综述所选研究通过医学文献数据库（Medline）及文献手工检索确定。
根除幽门螺杆菌最明确的适应证是治疗幽门螺杆菌阳性的十二指肠溃疡和胃溃疡，因为根除感染可预防溃疡复发，有效治愈疾病。在非溃疡性消化不良中使用抗幽门螺杆菌疗法仍存在争议，需要进一步研究。尽管有充分的间接证据表明幽门螺杆菌与胃癌有关，但主张用幽门螺杆菌疗法进行肿瘤一级预防还为时过早。三联疗法（铋剂、甲硝唑、四环素）可使90%以上的病例根除幽门螺杆菌，但这种多药方案并不理想，因为存在副作用、可能的依从性差以及对甲硝唑耐药感染的疗效存疑等问题。质子泵抑制剂 - 抗生素联合用药是三联疗法有前景的替代方案，副作用少且依从性好，但最有效的联合用药方案尚不确定。成功根除幽门螺杆菌后再感染的情况不常见（每年<1%）。
根除幽门螺杆菌现已成为幽门螺杆菌阳性消化性溃疡疾病的首选治疗方法。人们仍在继续寻找理想的幽门螺杆菌治疗方案，该方案应兼具高效、安全、患者可接受性及低成本等特点。
