Reilly T G, Ayres R C, Poxon V, Walt R P
Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Aliment Pharmacol Ther. 1995 Oct;9(5):483-90. doi: 10.1111/j.1365-2036.1995.tb00410.x.
Helicobacter pylori eradication for peptic ulcer has been widely taken up. Evidence for the efficacy of different regimens is often derived from small series in clinical trials but there is little reporting of everyday practice with unselected patients. Freedom from ulcer relapse has been demonstrated, but not whether this equates with clinical success.
We report on a series of 706 patients with H. pylori infection who, between January 1991 and April 1995, received eradication therapy followed by assessment of H. pylori status. Two-hundred and seven of these patients were followed-up by postal questionnaire, validated by parallel questionnaires to their general practitioners, covering clinical outcome measures.
The overall eradication rate was 81.7%, and a 1-week course of omeprazole plus two antibiotics was significantly better than a 2-week course of standard triple therapy (85.0% vs. 78.0%, P < 0.05). Amongst 21 first-time failures, a 7-day course of a clarithromycin-containing triple therapy succeeded in 18. The questionnaire replies indicate that, following successful H. pylori eradication, ulcer patients are less likely to consult with ulcer symptoms (P < 0.0005), take medication (P < 0.0005), require further prescription (P < 0.0005), or lose work-time because of their ulcer (P < 0.005). They are more likely to have a subjective sense of ulcer cure (P < 0.0005).
In addition to clear cost savings, social benefits are now demonstrated when H. pylori is eradicated. A well-tolerated 1 week regimen is genuinely effective in everyday practice.
幽门螺杆菌根除治疗已广泛应用于消化性溃疡。不同治疗方案疗效的证据通常来自临床试验中的小样本系列研究，但对于未选择患者的日常实践报道较少。已证实溃疡复发率降低，但这是否等同于临床成功尚不清楚。
我们报告了1991年1月至1995年4月期间接受根除治疗并随后评估幽门螺杆菌感染状况的706例幽门螺杆菌感染患者。其中207例患者通过邮寄问卷进行随访，并通过向其全科医生发放平行问卷进行验证，问卷涵盖临床结局指标。
总体根除率为81.7%，奥美拉唑加两种抗生素的1周疗程明显优于标准三联疗法的2周疗程（85.0%对78.0%，P<0.05）。在21例初次治疗失败的患者中，含克拉霉素的三联疗法7天疗程有18例成功。问卷回复表明，幽门螺杆菌根除成功后，溃疡患者因溃疡症状就诊的可能性降低（P<0.0005），用药的可能性降低（P<0.0005），需要进一步开处方的可能性降低（P<0.0005），因溃疡而误工的可能性降低（P<0.005）。他们更有可能主观感觉溃疡已治愈（P<0.0005）。
除了明显节省成本外，现在还证明了根除幽门螺杆菌的社会效益。一种耐受性良好的1周疗程在日常实践中确实有效。
