Rollán A
Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica, Santiago de Chile.
Rev Med Chil. 1997 Aug;125(8):939-49.
A NIH Consensus Conference recommended Helicobacter pylori eradication to all ulcer patients, based mainly on information coming from countries with a low prevalence of infection in general population. The epidemiological situation is different in developing countries, where a pandemic of H. pylori goes unchecked, and most people become infected at young age. It is possible that response to eradication therapies and reinfection rate were to be included among the differences between developed and developing countries, raising doubts about the worldwide applicability of NIH recommendations. Limited published evidence and our experience suggest that eradication therapies have a lower efficacy and reinfection rate is significantly higher in developing compared to developed countries. In spite of this, the risk of ulcer recurrence after H. pylori eradication is substantially reduced compared to antisecretory therapy. Model analysis to evaluate the cost-effectiveness of H. pylori eradication, using figures that probably include the clinical and costs situation of developing countries, suggests that also from an economic perspective H. pylori eradication should be the standard treatment for peptic ulcer disease in developing countries. Local studies must determine the best eradication therapy for a particular geographical location, and longer follow-up of eradicated patients is needed to determine the true reinfection rate.
美国国立卫生研究院（NIH）的一次共识会议建议，对所有溃疡患者进行幽门螺杆菌根除治疗，这主要是基于来自普通人群感染率较低国家的信息。在发展中国家，流行病学情况有所不同，幽门螺杆菌大流行未得到控制，大多数人在年轻时就被感染。发达国家和发展中国家之间的差异可能包括对根除治疗的反应和再感染率，这使得人们对NIH建议在全球的适用性产生怀疑。有限的已发表证据和我们的经验表明，与发达国家相比，发展中国家的根除治疗效果较低，而再感染率则显著较高。尽管如此，与抗分泌治疗相比，幽门螺杆菌根除后溃疡复发的风险大幅降低。使用可能包括发展中国家临床和成本情况的数据进行的模型分析，以评估幽门螺杆菌根除的成本效益，结果表明，从经济角度来看，幽门螺杆菌根除也应成为发展中国家消化性溃疡疾病的标准治疗方法。当地研究必须确定特定地理位置的最佳根除治疗方法，并且需要对根除患者进行更长时间的随访，以确定真正的再感染率。
