Hentschel E
I. Medizinische Abteilung, Hanusch-Krankenhaus, Wein.
Wien Klin Wochenschr. 1994;106(17):543-6.
Helicobacter pylori (H.p.) induced chronic gastritis cannot at present be considered as an absolute indication for eradication therapy of H.p. Clinical trials with antimicrobial compounds, mainly bismuth, have not convincingly demonstrated appreciable symptomatic benefit for patients with H.p.-positive gastritis and non-ulcer dyspepsia. However, new results indicate that possibly a longer follow-up period may be necessary to prove a symptomatic improvement after H.p. eradication in patients with chronic gastritis. In contrast, eradication of H.p. reduces the relapse rates of recurrent non-iatrogenic peptic ulcer to virtually zero. Antimicrobial treatment of H.p. infection is, therefore, clearly indicated in chronic duodenal and gastric ulcers. In the case of success, drug maintenance therapy or operation becomes superfluous. The combination of amoxicillin plus metronidazole with ranitidine or of omeprazole with amoxicillin or clarithromycin results in eradication rates of about 85%. Triple therapy with bismuth, metronidazole, and amoxicillin or tetracycline is successful in about 90% of patients but the incidence of side effects is higher.
目前，幽门螺杆菌（H.p.）引起的慢性胃炎不能被视为根除幽门螺杆菌治疗的绝对指征。使用抗菌化合物（主要是铋剂）进行的临床试验，并未令人信服地证明对幽门螺杆菌阳性胃炎和非溃疡性消化不良患者有明显的症状改善。然而，新的结果表明，可能需要更长的随访期来证明慢性胃炎患者根除幽门螺杆菌后症状有所改善。相比之下，根除幽门螺杆菌可将复发性非医源性消化性溃疡的复发率降至几乎为零。因此，对于慢性十二指肠溃疡和胃溃疡，明确需要进行幽门螺杆菌感染的抗菌治疗。如果治疗成功，药物维持治疗或手术就变得多余了。阿莫西林加甲硝唑与雷尼替丁联合使用，或奥美拉唑与阿莫西林或克拉霉素联合使用，根除率约为85%。铋剂、甲硝唑和阿莫西林或四环素的三联疗法在约90%的患者中取得成功，但副作用发生率较高。
