Adamek R J, Freitag M, Opferkuch W, Rühl G H, Wegener M
Dept. of Medicine, St. Josef-Hospital, Ruhr-University, Bochum, Germany.
Scand J Gastroenterol. 1994 Oct;29(10):880-3. doi: 10.3109/00365529409094857.
The aims of this study were to evaluate a Helicobacter pylori eradication schedule for H. pylori-positive gastroduodenal ulcer bleeding, which could be commenced intravenously after endoscopic diagnosis, and to assess the effect of omeprazole pretreatment on bacterial eradication.
In a prospective study 20 consecutive patients with H. pylori-positive acute peptide ulcer bleeding, who were managed conservatively including endoscopic injection therapy, were treated with a 2-week regimen consisting of either 40 mg omeprazole three times daily (with the exception of the loading dose of 80 mg) and 2 g amoxicillin three times daily intravenously for 3 days and 20 mg omeprazole twice daily and 1 g amoxicillin twice daily orally for 11 days (n = 10) or only with 40 mg omeprazole three times daily (with the exception of the loading dose of 80 mg) intravenously for 3 days and 20 mg omeprazole twice daily and 1 g amoxicillin twice daily orally for 11 days (n = 10). Subsequently, both groups received 20 mg omeprazole twice daily orally for 4 weeks.
H. pylori eradication, defined as negative bacterial findings in urease test, culture and histology, or 13C-urea breath test at least 4 weeks after cessation of omeprazole medication, was achieved in 100% (10/10) of patients in the first group but only in 30% (3/10) of patients in the second group (p < 0.01). Ulcer healing was endoscopically confirmed in all but one patient in the second group.
For the first time a promising concept for H. pylori eradication in H. pylori-positive ulcer bleeding is available by using a combined intravenous and oral omeprazole/amoxicillin therapy, which can be started intravenously immediately after an emergency upper GI endoscopy. In addition, these data imply that omeprazole pretreatment may not be wise when H. pylori eradication is attempted.
本研究旨在评估一种针对幽门螺杆菌阳性的胃十二指肠溃疡出血的根除方案，该方案可在内镜诊断后立即开始静脉给药，并评估奥美拉唑预处理对细菌根除的效果。
在一项前瞻性研究中，连续20例幽门螺杆菌阳性的急性肽溃疡出血患者，采用包括内镜注射治疗在内的保守治疗，接受为期2周的治疗方案，一组患者每日三次口服40mg奥美拉唑（首剂80mg除外），每日三次静脉注射2g阿莫西林，共3天，然后每日两次口服20mg奥美拉唑和每日两次口服1g阿莫西林，共11天（n = 10）；另一组患者仅每日三次静脉注射40mg奥美拉唑（首剂80mg除外），共3天，然后每日两次口服20mg奥美拉唑和每日两次口服1g阿莫西林，共11天（n = 10）。随后，两组患者均每日两次口服20mg奥美拉唑，持续4周。
在第一组患者中，100%（10/10）实现了幽门螺杆菌根除，定义为在奥美拉唑停药至少4周后，尿素酶试验、培养和组织学检查或13C尿素呼气试验细菌检测结果为阴性；而在第二组患者中，只有30%（3/10）实现了根除（p < 0.01）。除第二组一名患者外，所有患者内镜检查均证实溃疡愈合。
首次提出了一种有前景的幽门螺杆菌阳性溃疡出血的幽门螺杆菌根除方案，即采用静脉和口服联合的奥美拉唑/阿莫西林治疗，该方案可在急诊上消化道内镜检查后立即开始静脉给药。此外，这些数据表明，在尝试根除幽门螺杆菌时，奥美拉唑预处理可能并不明智。
