幽门螺杆菌对抗生素耐药研究进展

Effect of probiotics in treatment of Helicobacter pylori associated peptic ulcer

AIM: To observe the effect of probiotics in the treatment of Helicobacter pylori (H. pylori) associated peptic ulcer (PU).

METHODS: One hundred and thirty-two patients with H. pylori associated PU treated at our hospital from May 2013 to May 2014 were randomly divided into two groups: an observation group (n = 66) and a control group (n = 66). The observation group was given probiotics plus triple therapy, while the control group was given triple therapy alone. After one month of therapy, all patients underwent ¹⁴C urea breath test to assess H. pylori infection status, and endoscopy was performed to assess ulcer healing. Clinical effects and improvement of gastrointestinal symptoms were compared between the two groups.

RESULTS: After treatment, although the rate of symptom remission had no significant difference between the two groups (97% vs 93.9%, P > 0.05), ¹⁴C urea breath test value (95.15 dpm/mmol ± 8.34 dpm/mmol vs 100.32 dpm/mmol ± 10.34 dpm/mmol), the rate of H. pylori eradication (87.9% vs 63.6%), the rate of adverse reactions (4.5% vs 18.2%), and the total effective rate (97% vs 83.3%) were significantly better in the observation group than in the control group (P < 0.05).

CONCLUSION: Probiotics combined with triple therapy can significantly improve the rate of H. pylori eradication, reduce adverse reactions, and increase the cure rate in patients with H. pylori associated PU.

Sequential therapy versus standard triple therapy for Helicobacter pylori eradication

AIM: To assess the efficacy and safety of a new sequential treatment regimen versus standard triple therapy for Helicobacter pylori (H. pylori) infection.

METHODS: One hundred and two H. pylori-infected patients with chronic gastritis or peptic ulcer were randomized to receive a 10-day sequential therapy [esomeprazole (20 mg, twice daily) plus amoxicillin (1000 mg, twice daily) for the first 5 d, followed by esomeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the remaining 5 d] or a 14-day standard triple therapy [esomeprazole (20mg), clarithromycin (500 mg) and amoxicillin 1000 mg, twice daily]. H. pylori status was evaluated by ¹³C-urea breath test or endoscopy four weeks after completion of treatment.

RESULTS: There were no significant differences in the eradication rate of H. pylori infection (90.4% vs 90.2%, P = 1.000) and the incidence of side effects (23.5 % vs 35.3%, P = 0.172) between the 10-day sequential regimen group and 14-day standard regimen group. The treatment cost was significantly lower for the 10-day sequential therapy than for the 14-day standard triple therapy (380.6 yuan vs 677.88 yuan, P < 0.05).

CONCLUSION: The 10-day sequential treatment regimen has similar eradication rate of H. pylori infection and incidence of side effects but higher cost-efficiency compared to the 14-day standard triple therapy.

Sequential therapy versus standard triple therapy for Helicobacter pylori eradication in Chinese patients: a meta-analysis

AIM: To systematically review the differences in efficacy and incidence of adverse reactions between sequential therapy and standard triple therapy for the eradication of Helicobacter pylori (H pylori) infection in Chinese patients.

METHODS: A search of Chinese databases was conducted by two independent reviewers to identify randomized controlled trials (RCT) comparing sequential therapy with standard 7-day and 10-day triple therapies in the treatment of H pylori infection. The patients' clinical data, study quality, H pylori eradication rate and the incidence rate of adverse reactions were compared between sequential therapy and standard 7-day and 10-day standard triple therapies in the treatment of H pylori infection. The relative risk ratio (RR) with 95% confidence intervals (CI) was calculated. The funnel plots was used to estimate publication bias.

RESULTS: A total of 9 studies involving 835 subjects were identified. The eradication rates of sequential therapy and standard 7-day and 10-day triple therapies were 92.0%, 73.7% and 84.5%, respectively. Pooled estimates showed superiority of sequential therapy over 7-day triple regimen with RR of 1.23 (95%CI: 1.14-1.33), and over 10-day triple regimen with RR of 1.12 (95%CI: 1.02-1.23). The incidence rate of adverse reactions was comparable between the two therapies.

CONCLUSION: Sequential therapy appears superior to standard triple therapy for eradication of H pylori infection in Chinese patients. No significant difference is noted in the incidence rate of adverse reactions between the two therapies.

A 10-day sequential therapy for Helicobacter pylori-infected patients: an analysis of 39 cases

AIM: To determine whether the sequential therapy is better than the standard triple-drug therapy in treatment of H pyloriinfection for adults with chronic gastritis and peptic ulcer.

METHODS: Seventy-nine patients with H pylori positive were randomly divided two groups. Thirty nine patients received a 10-day sequential therapy [esomeprazole (20 mg, twice daily) plus amoxicillin (1000 mg, twice daily) for the first 5 days, followed by esomeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the remaining 5 days]. Forty patients received a 7-day triple therapy [esomeprazole (20 mg), clarithromycin (500 mg) and amoxicillin 1000 mg, twice daily]. H pylorieradication was checked four weeks after treatment using 13C-urea breath test.

RESULTS: The eradication rate of the 10-day sequential therapy was 94.87%, and merely 77.50% for the control group. The difference between the two groups was significant (χ² = 4.97, P < 0.05). There was no difference in incidence of side effects between the two groups (χ² = 0.05, P > 0.05).

CONCLUSION: The 10-day sequential therapy achieves a higher eradication rate than the standard triple therapy for the first time in adults. It is an effective, safe and economical option for patients and possesses great potential.