Labenz J, Tillenburg B, Peitz U, Börsch G, Idström J P, Verdú E, Stolte M, Blum A L
Department of Internal Medicine and Gastroenterology, Elisabeth Hospital Essen, Germany.
Am J Gastroenterol. 1997 Apr;92(4):576-81.
We have previously shown that, in duodenal ulcer patients, pH control by omeprazole is less pronounced after cure of Helicobacter pylori infection. The present study was designed to test the hypothesis that this response to omeprazole persists 1 yr after cure of H. pylori infection.
In 12 duodenal ulcer patients, intragastric acidity was measured with a glass electrode during treatment with omeprazole (20 mg) once daily before, and 4-6 wk and 1 yr after, cure of H. pylori infection. H. pylori infection was assessed by [13C]urea breath test, culture, histology (Warthin Starry stain), and rapid urease test.
Cure of H. pylori infection resulted in a lowered pH during omeprazole treatment. This effect persisted after 1 yr. Median 24-h gastric pH before H. pylori treatment was 5.6; 4-6 wk after cure of the infection it was 2.9 (p = 0.003), and 1 yr after cure of the infection it remained unchanged (pH = 2.5; p = 0.5). Accordingly, twice as much time was spent above pH 3 and pH 4 before H. pylori treatment than 1 or 12 months after cure (percent of time > or = pH 3: 82.7 vs. 49.7 vs. 43.1; percent of time > or = pH 4: 72.7 vs. 38.3 vs. 26.4).
In duodenal ulcer patients, cure of H. pylori infection resulted in a marked rapid and persistent decrease of the pH increasing effect of omeprazole. Therefore, H. pylori is a determinant of the pH achieved in response to omeprazole treatment in duodenal ulcer patients.
我们之前已经表明，在十二指肠溃疡患者中，幽门螺杆菌感染治愈后，奥美拉唑对pH的控制作用减弱。本研究旨在验证以下假设：幽门螺杆菌感染治愈1年后，对奥美拉唑的这种反应依然存在。
选取12例十二指肠溃疡患者，在幽门螺杆菌感染治愈前、治愈后4 - 6周以及1年后，每天服用一次奥美拉唑（20毫克）期间，用玻璃电极测量胃内酸度。通过[13C]尿素呼气试验、培养、组织学检查（沃辛 - 斯塔瑞染色）和快速尿素酶试验评估幽门螺杆菌感染情况。
幽门螺杆菌感染治愈后，奥美拉唑治疗期间的pH值降低。这种效应在1年后仍然存在。幽门螺杆菌治疗前胃内pH值的中位数为5.6；感染治愈后4 - 6周为2.9（p = 0.003），感染治愈1年后保持不变（pH = 2.5；p = 0.5）。因此，幽门螺杆菌治疗前pH值高于3和pH值高于4的时间是治愈后1个月或12个月的两倍（pH值≥3的时间百分比：82.7对49.7对43.1；pH值≥4的时间百分比：72.7对38.3对26.4）。
在十二指肠溃疡患者中，幽门螺杆菌感染治愈导致奥美拉唑升高pH值的作用迅速且持续显著降低。因此，幽门螺杆菌是十二指肠溃疡患者对奥美拉唑治疗反应中pH值变化的一个决定因素。
