Huang J Q, Hunt R H
Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada.
J Gastroenterol Hepatol. 1997 Aug;12(8):590-8. doi: 10.1111/j.1440-1746.1997.tb00491.x.
The successful isolation of Helicobacter pylori from stomachs of patients with gastritis and peptic ulcer has revolutionized our concepts of the pathogenesis of gastritis, peptic ulcer, gastric cancer and gastric B cell lymphoma. Eradication of H. pylori heals gastritis and H. pylori-related peptic ulcer. After a successful cure of H. pylori infection, virtually no recurrence of duodenal ulcer is seen. However, treatment to cure the infection has proved difficult. Numerous clinical trials have been attempted, but as yet no ideal regimen has been identified. Monotherapies have many drawbacks and should be avoided. Dual therapies combining a proton pump inhibitor (PPI) and an antimicrobial agent provide higher eradication rates than those involving two antimicrobial agents. Bismuth-based triple therapies are more effective than dual therapies in eradicating H. pylori infections. However, poor compliance and frequent adverse effects have made these combinations less favourable in clinical practice. Proton pump inhibitor-based triple therapies have shown more consistent and higher eradication rates with a short duration of treatment, good patient compliance, fewer side effects, prompt symptom relief and fast ulcer healing. Results from PPI-based quadruple therapies are promising; however, large multicentre clinical trials are needed to confirm the effect and the complex regimen again may compromise compliance outside of the clinical trial setting. Eradication of H. pylori infection is cost-effective in the long-term management of peptic ulcer disease compared with maintenance therapy with antisecretory drugs.
从胃炎和消化性溃疡患者的胃中成功分离出幽门螺杆菌，彻底改变了我们对胃炎、消化性溃疡、胃癌和胃B细胞淋巴瘤发病机制的认识。根除幽门螺杆菌可治愈胃炎和与幽门螺杆菌相关的消化性溃疡。成功治愈幽门螺杆菌感染后，十二指肠溃疡几乎不会复发。然而，事实证明治愈这种感染的治疗很困难。已经尝试了大量临床试验，但尚未确定理想的治疗方案。单一疗法有许多缺点，应避免使用。将质子泵抑制剂（PPI）与抗菌剂联合使用的双重疗法比使用两种抗菌剂的疗法具有更高的根除率。基于铋剂的三联疗法在根除幽门螺杆菌感染方面比双重疗法更有效。然而，依从性差和频繁的不良反应使这些联合疗法在临床实践中不太受欢迎。基于质子泵抑制剂的三联疗法在短疗程治疗中显示出更一致和更高的根除率，患者依从性好，副作用少，症状缓解迅速，溃疡愈合快。基于PPI的四联疗法的结果很有前景；然而，需要大型多中心临床试验来证实其效果，而且复杂的治疗方案在临床试验环境之外可能再次影响依从性。与使用抗分泌药物进行维持治疗相比，根除幽门螺杆菌感染在消化性溃疡疾病的长期管理中具有成本效益。
