Labenz J, Börsch G
Department of Internal Medicine, Elisabeth Hospital, University of Essen, Germany.
Am J Gastroenterol. 1994 Oct;89(10):1785-8.
The aim of the present study was to compare the rates of peptic ulcer recurrence and of complications in a cohort of 190 patients, before and up to 4 yr after eradication of Helicobacter pylori infection.
190 patients with recurrent and/or complicated H. pylori-positive peptic ulcer disease (duodenal ulcer, n = 124; gastric ulcer, n = 59; gastroduodenal double ulcer, n = 2; anastomotic ulcer after partial gastric resection, n = 5) were prospectively followed up to 4 yr after eradication of H. pylori. Patients were investigated clinically and endoscopically, including the assessment of H. pylori infection before treatment, 4 wk after cessation of the eradication therapy, in 1-yr intervals and when symptoms of the ulcer disease recurred.
Cure of H. pylori infection was obtained by either omeprazole plus amoxicillin (n = 157) or oral triple therapy (n = 33). The overall ulcer relapse rate was 0.9% per patient year. Comparing the pre- and postherapeutical course of the disease, the 1-yr ulcer recurrence rate decreased from 67.9% to 1.1% (P < 0.0001), and the 2-yr relapse rate decreased from 91.1% to approximately 3.0% (calculation: 0.9% ulcer recurrences per patient year x 329 patient years) (P < 0.0001) without relevant differences between the two major groups of patients with either duodenal or gastric manifestation of their ulcer disease. Ulcer complications did not occur. The H. pylori recurrence rate was 2.6% in the 1st and 1.2% in the 2nd yr after eradication. In the 3rd and 4th yr, no H. pylori reinfections were detected.
Cure of H. pylori infection was associated with a highly significant change of the disease history in this large group of patients with formerly relapsing and/or complicated peptic ulcers. In addition, H. pylori eradication is a stable phenomenon at least during the first 4 yr after treatment. Thus, H. pylori eradication should be considered in those patients with peptic ulcer disease severe enough to require avoidance of ulcer recurrence or its complications.
本研究旨在比较190例患者在根除幽门螺杆菌感染之前及之后长达4年期间的消化性溃疡复发率和并发症发生率。
对190例复发和/或并发幽门螺杆菌阳性消化性溃疡疾病的患者（十二指肠溃疡124例、胃溃疡59例、胃十二指肠复合溃疡2例、胃部分切除术后吻合口溃疡5例）在根除幽门螺杆菌后进行了长达4年的前瞻性随访。对患者进行临床和内镜检查，包括在治疗前、根除治疗停止后4周、每年以及溃疡病症状复发时评估幽门螺杆菌感染情况。
通过奥美拉唑加阿莫西林（157例）或口服三联疗法（33例）实现了幽门螺杆菌感染的治愈。总体溃疡复发率为每年0.9%/患者。比较治疗前后的病程，1年溃疡复发率从67.9%降至1.1%（P<0.0001），2年复发率从91.1%降至约3.0%（计算：每年0.9%溃疡复发率×329患者年）（P<0.0001），溃疡病表现为十二指肠或胃的两大组患者之间无显著差异。未发生溃疡并发症。根除幽门螺杆菌后第1年复发率为2.6%，第2年为1.2%。在第3年和第4年，未检测到幽门螺杆菌再次感染。
在这一大组既往有复发性和/或复杂性消化性溃疡的患者中，幽门螺杆菌感染的治愈与疾病史的高度显著变化相关。此外，至少在治疗后的前4年，根除幽门螺杆菌是一个稳定的现象。因此，对于那些患有严重到需要避免溃疡复发或其并发症的消化性溃疡疾病患者，应考虑根除幽门螺杆菌。
