Kato S, Ritsuno H, Ohnuma K, Iinuma K, Sugiyama T, Asaka M
Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
Helicobacter. 1998 Dec;3(4):278-82. doi: 10.1046/j.1523-5378.1998.08030.x-i1.
Proton pump inhibitor-based eradication therapy of Helicobacter pylori has been widely studied in adults, but there have been only a few reports about this therapy in children. The purpose of this study was to investigate the safety and efficacy of 1-week triple therapy for eradication of H. pylori and ulcer healing in children.
We prospectively studied 15 patients aged 2-17 years (5 with gastric ulcers, 8 with duodenal ulcers, and 2 with nodular gastritis alone). Three patients had H2 blocker-resistant duodenal ulcers. Patients received 0.75 mg/kg of lansoprazole b.i.d., 25 mg/kg of amoxicillin b.i.d., and 10 mg/kg of clarithromycin b.i.d. for 7 days. No additional therapy (including antisecretory drugs) was administered to any patients following eradication therapy. Patients underwent endoscopy to obtain antral biopsies (culture, urease test and histology) and to evaluate the mucosal status, and underwent a 13C-urea breath test before and 4-8 weeks after the completion of a 1-week course of therapy.
All patients received the full drug regimen. Endoscopy showed complete healing of ulcers in 12 of 13 patients with peptic ulcer disease (92%). H. pylori was eradicated in 13 of 15 patients (87%). Diarrhea and/or an altered taste sensation occurred in 5 patients (33%). There were no hematological or biochemical abnormalities related to therapy.
The 1-week triple therapy was safe and effective for eradicating H. pylori. The present study showed that ulcer healing in juveniles is closely associated with eradication of H. pylori, and that no additional therapy is required when H. pylori is eradicated. A shorter course of eradication therapy than 2 weeks may be suitable for children with H. pylori infection.
基于质子泵抑制剂的幽门螺杆菌根除疗法在成人中已得到广泛研究，但关于该疗法在儿童中的报道却很少。本研究的目的是调查为期1周的三联疗法根除儿童幽门螺杆菌及促进溃疡愈合的安全性和有效性。
我们前瞻性地研究了15例年龄在2至17岁的患者（5例胃溃疡、8例十二指肠溃疡、2例仅患有结节性胃炎）。3例患者患有对H2受体阻滞剂耐药的十二指肠溃疡。患者接受兰索拉唑0.75mg/kg，每日2次，阿莫西林25mg/kg，每日2次，克拉霉素10mg/kg，每日2次，疗程7天。根除治疗后未对任何患者给予额外治疗（包括抗分泌药物）。患者接受内镜检查以获取胃窦活检标本（培养、尿素酶试验和组织学检查）并评估黏膜状态，在为期1周的疗程结束前及结束后4至8周进行13C尿素呼气试验。
所有患者均完成了整个药物疗程。内镜检查显示，13例消化性溃疡疾病患者中有12例（92%）溃疡完全愈合。15例患者中有13例（87%）幽门螺杆菌被根除。5例患者（33%）出现腹泻和/或味觉改变。未发现与治疗相关的血液学或生化异常。
为期1周的三联疗法根除幽门螺杆菌安全有效。本研究表明，青少年溃疡愈合与幽门螺杆菌根除密切相关，根除幽门螺杆菌后无需额外治疗。短于2周的根除疗程可能适用于幽门螺杆菌感染的儿童。
