Bell G D, Powell K U
Dept. of Medicine, Ipswich Hospital, UK.
Scand J Gastroenterol Suppl. 1996;215:96-104.
The reported rate of Helicobacter pylori reinfection following eradication therapy is highly variable. In Ipswich, the 14C-urea breath test (UBT) has been used since 1986 as a tool to study H. pylori eradication and reinfection. Updated results from 1182 patients in whom the organism had apparently been successfully eradicated, following a number of different eradication regimens between October 1986 and 31 March 1995, are presented. During this period, 57 "reinfections' were observed, of which 45 had occurred within 6 months of treatment. After the first year, the 'reinfection' rate was less than 0.6% per year. The criterion for eradication of the infection was a UBT (2-hour area under curve) of less than 40 at least 1 month after treatment. The treatment regimens were arbitrarily divided into five groups with eradication rates of: less than 20%, 20-39%, 40-59%, 60-79% and over 80%. In these groups, the 6-month 'reinfection' rates were 28.0%, 15.8%, 16.4%, 4.6% and 1.7%, respectively (p < 0.001). These and other data presented in the paper strongly suggest that, in Westernized countries, most so-called reinfections in adults are in fact the late recrudescence of a suppressed infection rather than a true reinfection. Our data also suggest that the true reinfection rate is particularly low if the eradication therapy chosen has an efficacy of more than 85%. Several effective and well-tolerated 1-week triple H. pylori eradication regimens are now available, and we would advocate their use in preference to the less effective dual regimens where initial eradication rates are lower and there is consequently a higher risk of 'reinfection'. We would predict that even in developing countries with a high prevalence of metronidazole-resistant H. pylori, the 'reinfection' rate would be low if a combination of omeprazole, amoxycillin and clarithromycin were to be used.
据报道，根除治疗后幽门螺杆菌再感染率差异很大。在伊普斯威奇，自1986年以来，14C-尿素呼气试验（UBT）一直被用作研究幽门螺杆菌根除和再感染的工具。本文给出了1986年10月至1995年3月期间，1182例经多种不同根除方案治疗后幽门螺杆菌明显被成功根除患者的最新结果。在此期间，观察到57例“再感染”，其中45例发生在治疗后6个月内。1年后，“再感染”率低于每年0.6%。根除感染的标准是治疗后至少1个月的UBT（2小时曲线下面积）小于40。治疗方案被任意分为五组，根除率分别为：低于20%、20%-39%、40%-59%、60%-79%和超过80%。在这些组中，6个月的“再感染”率分别为28.0%、15.8%、16.4%、4.6%和1.7%（p<0.001）。本文给出的这些及其他数据有力地表明，在西方国家，成人中大多数所谓的再感染实际上是潜伏感染的晚期复发，而非真正的再感染。我们的数据还表明，如果所选的根除治疗有效率超过85%，真正的再感染率会特别低。目前有几种有效的、耐受性良好的1周三联幽门螺杆菌根除方案，我们提倡使用这些方案，而不是使用效果较差的双联方案，因为后者初始根除率较低，因此“再感染”风险更高。我们预计，即使在甲硝唑耐药幽门螺杆菌高流行的发展中国家，如果使用奥美拉唑、阿莫西林和克拉霉素联合治疗，“再感染”率也会很低。
