Tytgat G N
Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Scand J Gastroenterol Suppl. 1996;215:70-3.
Two questions need to be answered before the eradication of Helicobacter pylori infection can be discussed. Firstly, can the infection be cured, and if so, is the cure permanent or transient? Secondly, what is the long-term clinical outcome of H. pylori infection? Current indications for the eradication of H. pylori infection can be divided into three categories: well-established, equivocal and experimental. Peptic ulcer disease in patients positive for H. pylori is a well-established indication for eradication of the organism. H. pylori-positive dyspepsia and the need for prolonged treatment with non-steroidal anti-inflammatory drugs are equivocal indications. MALT (mucosa-associated lymphoid tissue)-lymphoma, hypertrophic/hyperplastic gastritis, atrophic gastritis with or without premalignant mucosal alterations, and the need for prolonged powerful acid-suppressive therapy, in patients positive for H. pylori are all experimental indications. The decision to recommend H. pylori eradication therapy should not be taken lightly. Despite the risks associated with antimicrobial therapy, however, the benefits from cure of the infection are such that antimicrobial therapy is being increasingly favoured, and the reasoning behind withholding eradication therapy is becoming more difficult to understand in the light of current knowledge.
在讨论根除幽门螺杆菌感染之前，需要回答两个问题。首先，这种感染能被治愈吗？如果能，治愈是永久性的还是短暂的？其次，幽门螺杆菌感染的长期临床后果是什么？目前根除幽门螺杆菌感染的指征可分为三类：明确的、不明确的和试验性的。幽门螺杆菌阳性患者的消化性溃疡病是根除该菌的明确指征。幽门螺杆菌阳性的消化不良以及需要长期使用非甾体抗炎药治疗属于不明确指征。幽门螺杆菌阳性患者的黏膜相关淋巴组织（MALT）淋巴瘤、肥厚性/增生性胃炎、伴有或不伴有癌前黏膜改变的萎缩性胃炎，以及需要长期强力抑酸治疗，均为试验性指征。推荐幽门螺杆菌根除治疗的决定不应轻易做出。然而，尽管抗菌治疗存在风险，但感染治愈带来的益处使得抗菌治疗越来越受到青睐，鉴于目前的知识，不进行根除治疗的理由越来越难以理解。
