O'Connor H J
Dept. of Medicine, General Hospital, Tullamore, Ireland.
Scand J Gastroenterol Suppl. 1994;201:11-5.
There is now a persuasive body of evidence linking Helicobacter pylori infection and peptic ulcer disease. Over 90% of duodenal ulcer and 70% of gastric ulcer patients are infected with H. pylori. Only a minority of infected patients develop ulcers, however, and host cofactors, rather than H. pylori strain, are probably critical to the development of peptic ulcer in infected individuals. Conversely, not all ulcers are associated with H. pylori, and in these cases enterogastric reflux and non-steroidal anti-inflammatory drug ingestion may be important. Eradication of H. pylori dramatically reduces ulcer relapse, effectively curing the disease. Eradication may also accelerate duodenal ulcer healing. Triple therapy with bismuth and antibiotics is effective against H. pylori, but there are problems with side effects, compliance and antibiotic resistance. Encouraging results are emerging on the efficacy and safety of omeprazole/antibiotic combination therapy, and this novel approach to H. pylori eradication is an exciting development. H. pylori has established itself as a pivotal factor in peptic ulcer disease and an effective helicobactericidal regimen is now the most rational and cost-effective treatment.
目前有大量有说服力的证据表明幽门螺杆菌感染与消化性溃疡病有关。超过90%的十二指肠溃疡患者和70%的胃溃疡患者感染了幽门螺杆菌。然而，只有少数受感染患者会患上溃疡，对于受感染个体而言，宿主辅助因子而非幽门螺杆菌菌株可能对消化性溃疡的发生至关重要。相反，并非所有溃疡都与幽门螺杆菌有关，在这些情况下，肠胃反流和服用非甾体抗炎药可能是重要因素。根除幽门螺杆菌可显著降低溃疡复发率，有效治愈该疾病。根除幽门螺杆菌还可能加速十二指肠溃疡的愈合。铋剂和抗生素的三联疗法对幽门螺杆菌有效，但存在副作用、依从性和抗生素耐药性等问题。关于奥美拉唑/抗生素联合疗法的疗效和安全性正在出现令人鼓舞的结果，这种根除幽门螺杆菌的新方法是一个令人兴奋的进展。幽门螺杆菌已成为消化性溃疡病的关键因素，有效的杀幽门螺杆菌方案现在是最合理且最具成本效益的治疗方法。
