van der Hulst R W, Weel J F, van der Ende A, ten Kate F J, Dankert J, Tytgat G N
Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Am J Gastroenterol. 1996 Nov;91(11):2333-7.
Many of the currently used Helicobacter pylori eradication regimens fail to cure 5-20% of the patients. Those patients will remain at risk of developing a potentially fatal complication of peptic ulcer disease. Therefore, a new attempt to cure H. pylori infection after initial failure of therapy is indicated. We studied the efficacy of three retreatment regimens after initial failure of omeprazole-amoxicillin dual therapy.
Fifty-three patients whose treatment failed were randomly assigned to receive retreatment with the same regimen of omeprazole 20 mg b.i.d. (group I) or omeprazole 40 mg t.i.d. (group II) plus amoxicillin 750 mg t.i.d. for 14 days. Forty patients in whom the omeprazole-amoxicillin retreatment failed were assigned to receive omeprazole 20 mg b.i.d., amoxicillin 750 mg t.i.d., and metronidazole 500 mg t.i.d. for 14 days (group III) or omeprazole 20 mg b.i.d. plus clarithromycin 500 mg t.i.d. for 14 days (group IV). H. pylori infection was assessed by culture and histology of gastric biopsies before and 4-6 wk after cessation of therapy. Susceptibility of H. pylori to amoxicillin, clarithromycin, and metronidazole was determined by the E test.
In groups I (n = 28) and II (n = 25), cure of H. pylori infection was achieved in 21% and 28% of patients, respectively (not significant). In groups III (n = 20) and IV (n = 20), H. pylori infection was cured in 75% and 70%, respectively.
Retreatment with an identical omeprazole-amoxicillin dual regimen is of limited benefit, a result that is independent of the omeprazole dose. In contrast, a third H. pylori eradication attempt with omeprazole-clarithromycin dual therapy or omeprazole-amoxicillin-metronidazole triple therapy provides reasonable cure rates after failure of omeprazole-amoxicillin dual therapy.
目前使用的许多幽门螺杆菌根除方案无法治愈5% - 20%的患者。这些患者仍有发生消化性溃疡疾病潜在致命并发症的风险。因此，有必要在初始治疗失败后尝试新的方法来治愈幽门螺杆菌感染。我们研究了奥美拉唑 - 阿莫西林双联疗法初始失败后三种再治疗方案的疗效。
53例治疗失败的患者被随机分配接受再治疗，一组为每日两次服用20毫克奥美拉唑的相同方案（第一组），或每日三次服用40毫克奥美拉唑（第二组）加每日三次服用750毫克阿莫西林，疗程14天。40例奥美拉唑 - 阿莫西林再治疗失败的患者被分配接受每日两次服用20毫克奥美拉唑、每日三次服用750毫克阿莫西林和每日三次服用500毫克甲硝唑，疗程14天（第三组），或每日两次服用20毫克奥美拉唑加每日三次服用500毫克克拉霉素，疗程14天（第四组）。在治疗前及治疗停止后4 - 6周，通过胃活检的培养和组织学评估幽门螺杆菌感染情况。通过E试验测定幽门螺杆菌对阿莫西林、克拉霉素和甲硝唑的敏感性。
在第一组（n = 28）和第二组（n = 25）中，分别有21%和28%的患者实现了幽门螺杆菌感染的治愈（无显著差异）。在第三组（n = 20）和第四组（n = 20）中，幽门螺杆菌感染的治愈率分别为75%和70%。
相同的奥美拉唑 - 阿莫西林双联方案再治疗的益处有限，这一结果与奥美拉唑剂量无关。相比之下，在奥美拉唑 - 阿莫西林双联疗法失败后，用奥美拉唑 - 克拉霉素双联疗法或奥美拉唑 - 阿莫西林 - 甲硝唑三联疗法进行第三次幽门螺杆菌根除尝试可提供合理的治愈率。
