Miehlke S, Bayerdörffer E, Lehn N, Mannes G A, Höchter W, Weingart J, Sommer A, Heldwein W, Müller-Lissner S, Bästlein E
Department of Internal Medicine II, Klinikum Grosshadern, University of Munich, Germany.
Eur J Gastroenterol Hepatol. 1995 Oct;7(10):975-8. doi: 10.1097/00042737-199510000-00012.
Chronic Helicobacter pylori-associated gastritis is now widely accepted as one of the most important pathogenic factors in duodenal ulcer disease. However, little is known about for how long patients remain free of duodenal ulcer relapses after H. pylori infection has been cured. In the present study, we investigated remission time during a 5-year follow-up period after anti-H. pylori treatment.
The patients were randomly allocated to treatment with either a combination of 3 x 600 mg bismuth subsalicylate and 2 x 1000 mg amoxycillin or 3 x 600 mg bismuth subsalicylate monotherapy. Endoscopy, including histological and microbiological examination of biopsies, was performed 4 weeks after termination of treatment and after 1 and 2 years. During the third, fourth and fifth years of the follow-up period, patients were monitored twice a year for symptoms compatible with ulcer relapse and for their use of anti-ulcer medication. Endoscopic and histological examinations were carried out whenever symptoms occurred.
Of 56 evaluated patients, 47 showed healing of ulcers after bismuth subsalicylate plus amoxycillin compared with 44 of 57 after bismuth subsalicylate monotherapy. H. pylori infection was cured in 52% (29 of 56) of the patients after combined therapy and in 4% (2 of 57) after the monotherapy. The cumulative duodenal ulcer relapse rates after 5 years were 38% (18 of 47) after the combined therapy and 75% (33 of 44) after the monotherapy. In patients who were cured of H. pylori infection, the cumulative duodenal ulcer relapse rate after 5 years was 9.7% (3 of 31), compared with 81.7% (49 of 60) in those patients who remained H. pylori-positive after treatment (P < 0.001). In two of the three patients who suffered duodenal ulcer relapse after being cured of H. pylori infection, H. pylori was present again at the time of relapse.
The data suggest that curing H. pylori infection results in long-term cure of duodenal ulcer disease and that duodenal ulcer relapses in successfully treated patients are most often associated with H. pylori reinfection.
慢性幽门螺杆菌相关性胃炎现已被广泛认为是十二指肠溃疡疾病最重要的致病因素之一。然而，对于幽门螺杆菌感染治愈后患者多长时间不会出现十二指肠溃疡复发，人们了解甚少。在本研究中，我们调查了抗幽门螺杆菌治疗后5年随访期内的缓解时间。
将患者随机分配接受3×600mg次水杨酸铋和2×1000mg阿莫西林联合治疗或3×600mg次水杨酸铋单药治疗。治疗结束后4周以及1年和2年后进行内镜检查，包括活检组织的组织学和微生物学检查。在随访期的第3、4和5年，每年对患者进行两次监测，观察是否有与溃疡复发相符的症状以及他们使用抗溃疡药物的情况。每当出现症状时进行内镜和组织学检查。
在56例接受评估的患者中，次水杨酸铋加阿莫西林治疗后47例溃疡愈合，而次水杨酸铋单药治疗的57例中有44例溃疡愈合。联合治疗后52%（56例中的29例）的患者幽门螺杆菌感染治愈，单药治疗后为4%（57例中的2例）。联合治疗后5年十二指肠溃疡累积复发率为38%（47例中的18例），单药治疗后为75%（44例中的33例）。在幽门螺杆菌感染治愈的患者中，5年后十二指肠溃疡累积复发率为9.7%（31例中的3例），而治疗后仍为幽门螺杆菌阳性的患者中这一比例为81.7%（60例中的49例）（P<0.001）。在3例幽门螺杆菌感染治愈后出现十二指肠溃疡复发的患者中，有2例在复发时幽门螺杆菌再次出现。
数据表明，治愈幽门螺杆菌感染可导致十二指肠溃疡疾病的长期治愈，并且成功治疗的患者中十二指肠溃疡复发最常与幽门螺杆菌再次感染有关。
