Kashifard M, Malekzadeh R, Siavoshi F, Mikaeli J, Massarrat S
Department of Gastroenterology and Digestive Disease, Research Center, Shariati Hospital, Tehran, Iran.
Eur J Gastroenterol Hepatol. 1998 Oct;10(10):847-50. doi: 10.1097/00042737-199810000-00006.
To determine the speed of the healing process of duodenal ulcers during eradication regimens with and without a high-dose anti-secretory drug.
An outpatient department of a university hospital as a community-based and referral centre.
A total of 101 patients with proven duodenal ulcer and a positive urease test were randomized into two groups: one group received the classic triple therapy (bismuth subnitrate 3 x 375 mg for 4 weeks + tetracycline 3 x 500 mg + metronidazole 3 x 250 mg daily, both for 2 weeks ), the other group received dual therapy comprising amoxicillin 2 x 1000 mg + omeprazole 2 x 20 mg daily, both for 2 weeks. All patients underwent a control endoscopy 2 and 6 weeks after the beginning of treatment. Eradication was assumed if a urease test and culture were negative in all specimens taken from antral and corpus mucosa.
In total, 93 patients completed all 6 weeks of the study (45 patients in the triple therapy group and 48 patients in the dual therapy group). The disappearance of ulcer pain was faster in the group under the regimen including omeprazole (dual therapy) than in the group with triple therapy (2.4+/-2.7 days versus 4.5+/-3.5 days; P< 0.01). The two-week healing rate was significantly higher in the patients treated with dual therapy than in the group treated with triple therapy (77% versus 33.3%; P< 0.01); however, 12 out of 37 patients with a healed ulcer in the dual therapy group had an ulcer relapse at 6 weeks (six became symptomatic). Only in one of these 12 patients was Helicobacter pylori eradicated. Fifteen of the 45 patients with triple therapy had healed ulcers at 2 weeks, and of these 14 remained healed at 6 weeks (H. pylori was eradicated in eight patients). The six-week healing rate with dual therapy was the same as with classic triple therapy (64.6% versus 77.6%); the eradication rate was lower in the former group than in the latter (30.4% versus 51.1% respectively; P=0.056).
A high dose of a proton pump inhibitor (PPI) combined with amoxicillin results in rapid ulcer healing and pain disappearance, but is associated with early ulcer relapse due to lack of eradication of H. pylori. Its addition to regimens with bismuth and antibiotics is not necessary to achieve ulcer healing.
确定在根除幽门螺杆菌治疗方案中，使用和不使用高剂量抗分泌药物时十二指肠溃疡的愈合速度。
一所大学医院的门诊部，作为社区型和转诊中心。
总共101例经证实患有十二指肠溃疡且尿素酶试验呈阳性的患者被随机分为两组：一组接受经典三联疗法（次硝酸铋3×375mg，共4周；四环素3×500mg +甲硝唑3×250mg，均每日服用，共2周），另一组接受双重疗法，即阿莫西林2×1000mg +奥美拉唑2×20mg，均每日服用，共2周。所有患者在治疗开始后2周和6周接受对照内镜检查。如果从胃窦和胃体黏膜采集的所有标本的尿素酶试验和培养均为阴性，则认为幽门螺杆菌已被根除。
总共93例患者完成了为期6周的全部研究（三联疗法组45例患者，双重疗法组48例患者）。在包含奥美拉唑的治疗方案组（双重疗法）中，溃疡疼痛消失的速度比三联疗法组更快（2.4±2.7天对4.5±3.5天；P<0.01）。双重疗法治疗的患者两周愈合率显著高于三联疗法治疗的组（77%对33.3%；P<0.01）；然而，双重疗法组中37例溃疡愈合的患者中有12例在6周时溃疡复发（6例出现症状）。在这12例患者中只有1例幽门螺杆菌被根除。三联疗法组的45例患者中有15例在2周时溃疡愈合，其中14例在6周时仍愈合（8例患者幽门螺杆菌被根除）。双重疗法的六周愈合率与经典三联疗法相同（64.6%对77.6%）；前一组的根除率低于后一组（分别为30.4%对51.1%；P = 0.056）。
高剂量质子泵抑制剂（PPI）联合阿莫西林可使溃疡快速愈合且疼痛消失，但由于幽门螺杆菌未被根除，会导致溃疡早期复发。在铋剂和抗生素治疗方案中添加它对于实现溃疡愈合并非必要。
