Saita H, Murakami M, Takahashi Y, Sou Y, Kaitani K, Nishio K, Kita T
Department of Gastroenterology, Hyogo Prefectural Amagasaki Hospital, Japan.
J Gastroenterol Hepatol. 1998 Jul;13(7):725-31. doi: 10.1111/j.1440-1746.1998.tb00721.x.
In Japan, gastric ulcers are often accompanied by marked gastric mucosal atrophy. We evaluated the dual therapy of double-dose lansoprazole and amoxycillin for Helicobacter pylori eradication in Japanese ulcer patients and investigated the effects of intragastric distribution of H. pylori colonization and gastric mucosal atrophy on eradication with this combination therapy. Seventy-six H. pylori-positive ulcer patients received lansoprazole (30 mg) plus amoxycillin (500 mg) twice daily for 2 weeks (LA-60 group), lansoprazole (30 mg once daily) plus amoxycillin (500 mg twice daily) for 2 weeks (LA-30 group) or lansoprazole (30 mg once daily) for 6 or 8 weeks (LPZ group). Infection was evaluated by light microscopy, culture and biopsy urease tests. Helicobacter pylori colonization was classified as localized to the corpus (localized type) or involving the antrum and corpus (whole type). Fundic mucosal atrophy was graded according to endoscopic and histological features. Eradication was achieved in 67.6% in the LA-60 group, 31.6% in the LA-30 group, and 0% in the LPZ group, and moderate or severe histological gastritis was improved in the LA-60 group. Eradication was better in localized-type colonization (92%) than whole-type (56%), and better with fundic mucosal atrophy (84%) than without, but poor in both whole-type colonization and scanty mucosal atrophy (47%). The LA-60 therapy achieves better eradication in Japanese ulcer patients with localized H. pylori colonization and/or gastric mucosal atrophy, which are likely to be important predictors for the successful eradication with dual therapy.
在日本，胃溃疡常伴有明显的胃黏膜萎缩。我们评估了双倍剂量兰索拉唑和阿莫西林联合治疗对日本溃疡患者根除幽门螺杆菌的疗效，并研究了幽门螺杆菌在胃内定植分布及胃黏膜萎缩对该联合治疗根除效果的影响。76例幽门螺杆菌阳性的溃疡患者接受以下治疗：兰索拉唑（30毫克）加阿莫西林（500毫克），每日2次，共2周（LA - 60组）；兰索拉唑（每日30毫克）加阿莫西林（每日2次，500毫克），共2周（LA - 30组）；或兰索拉唑（每日30毫克），治疗6或8周（LPZ组）。通过光学显微镜、培养及活检尿素酶试验评估感染情况。幽门螺杆菌定植分为局限于胃体（局限型）或累及胃窦和胃体（全胃型）。根据内镜及组织学特征对胃底黏膜萎缩进行分级。LA - 60组的根除率为67.6%，LA - 30组为31.6%，LPZ组为0%，且LA - 60组中度或重度组织学胃炎有所改善。局限型定植的根除效果（92%）优于全胃型（56%），有胃底黏膜萎缩者的根除效果（84%）优于无萎缩者，但全胃型定植且黏膜萎缩轻微者的根除效果较差（47%）。LA - 60疗法对幽门螺杆菌局限型定植和/或胃黏膜萎缩的日本溃疡患者有更好的根除效果，而这可能是联合治疗成功根除的重要预测因素。
