Graham D Y, Hepps K S, Ramirez F C, Lew G M, Saeed Z A
Dept. of Medicine, Baylor College of Medicine, Houston, Texas.
Scand J Gastroenterol. 1993 Nov;28(11):939-42. doi: 10.3109/00365529309098288.
We evaluated whether therapy designed to eradicate Helicobacter pylori infection resulted in a reduction in rebleeding in patients with peptic ulcer disease. Patients presenting because of major upper gastrointestinal hemorrhage from peptic ulcer and whose ulcers healed in a study in which they were randomized to receive ranitidine alone or triple therapy plus ranitidine were followed up regularly with endoscopy. No maintenance anti-ulcer therapy was given after ulcer healing.
Patients received ranitidine, 300 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2 g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet), and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given. Development of ulcer recurrence with or without recurrent upper gastrointestinal bleeding was evaluated.
Thirty-one patients with major upper gastrointestinal bleeding from peptic ulcer were studied; 17 received triple therapy and 14 ranitidine alone. Major rebleeding occurred significantly (p = 0.031) more often in those in the ranitidine group (28.6%), compared with none (0%) in the triple therapy group.
Eradication of H. pylori infection reduces the rate of ulcer recurrence and rebleeding in complicated ulcer disease.
我们评估了旨在根除幽门螺杆菌感染的治疗是否能降低消化性溃疡病患者的再出血率。因消化性溃疡导致上消化道大出血前来就诊且溃疡愈合的患者，在一项随机接受单独雷尼替丁治疗或三联疗法加雷尼替丁的研究中，接受定期内镜随访。溃疡愈合后未给予维持性抗溃疡治疗。
患者接受300毫克雷尼替丁治疗，或雷尼替丁加三联疗法。三联疗法包括2克四环素、750毫克甲硝唑和5或8片次水杨酸铋（每片含151毫克铋），在治疗的前2周给药；雷尼替丁治疗持续至溃疡愈合或16周结束。溃疡愈合后，未给予维持性抗溃疡治疗。评估有无复发性上消化道出血的溃疡复发情况。
研究了31例因消化性溃疡导致上消化道大出血的患者；17例接受三联疗法，14例单独接受雷尼替丁治疗。雷尼替丁组患者的严重再出血发生率（28.6%）显著高于三联疗法组（0%）（p = 0.031）。
根除幽门螺杆菌感染可降低复杂性溃疡病的溃疡复发率和再出血率。
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