含铋剂四联疗法根除消化性溃疡幽门螺杆菌感染的疗效

The Efficacy and Safety of Regimens for Helicobacter pylori Eradication Treatment in China: A Systemic Review and Network Meta-Analysis

BACKGROUND

With Helicobacter pylori's increasing antibiotic resistance, evidence of more effective treatments is lacking in China, where H. pylori prevalence is nearly 50%. Thus, we performed a network meta-analysis to compare therapeutic regimens.

METHODS

Data extracted from eligible randomized controlled trials from January 2000 to September 2021 were entered into a Bayesian hierarchical random-effects model to evaluate the efficacy and safety of H. pylori eradication regimens.

RESULTS

This study included 101 trials involving 21,745 patients. Vonoprazan-bismuth-containing quadruple therapy (VBQT) ranked the highest [surfaces under cumulative ranking curve (SUCRA), 83.64%], followed by high-dose amoxicillin dual therapy (HDDT) [SUCRA, 79.70%, odds ratio (OR)=1.31, 95% credible interval (CrI) (0.36, 4.72)] and proton pump inhibitor-based bismuth-containing quadruple therapy (BQT) [SUCRA, 63.59%, OR=1.59, 95% CrI (0.48, 5.24)]. HDDT [OR=2.47, 95% CrI (1.51, 4.06)], BQT [OR=2.04, 95% CrI (1.69, 2.47)], concomitant quadruple nonbismuth therapy (CT) [OR=1.93, 95% CrI (1.19, 3.15)], and sequential therapy (ST) [OR=1.86, 95% CrI (1.50, 2.32)] had higher eradication rates than standard triple therapy (TT). ST (SUCRA, 82.52%) and VBQT (SUCRA, 83.89%) had the highest eradication rate before and after 2010 in the effectiveness ranking, respectively. Furthermore, the H. pylori eradication rate of patients receiving 14-day BQT treatment was higher than that of 10-day BQT regimen [OR=2.55, 95% CI (1.84, 3.53)] and 7-day BQT regimen [OR=3.64, 95% CI (2.64, 5.01)].

CONCLUSIONS

The TT regimen was not an optimal choice in China for H. pylori eradication; VBQT, HDDT, and BQT showed better efficacy. After 2010, there is a trend toward significance that VBQT provided a higher H. pylori eradication rate in China, but with only 1 randomized controlled trial. Thus, more supportive real-world data are needed to confirm its effectiveness.

Marzulene-S combined with standard triple therapy for treatment of children with Helicobacter pylori positive peptic ulcer: Efficacy and influence on serum pepsinogen and gastrointestinal hormones

AIM

To evaluate the efficacy of marzulene-S combined with standard triple therapy in the treatment of children with Helicobacter pylori (H. pylori) positive peptic ulcer (PU), and to observe the effect on serum pepsinogen (PG) and gastrointestinal hormones.

METHODS

A total of 144 children with H. pylori positive PU were randomly divided into either an observation group or a control group, with 72 cases in each group. Both groups were treated with standard triple therapy (omeprazole + clarithromycin + amoxicillin), and the observation group was additionally given marzulene-S. The clinical efficacy, eradication rate of H. pylori and adverse drug reaction rate were compared between the two groups. Serum levels of PG Ⅰ, PG Ⅱ, gastrin (GAS), and somatostatin (SS) were measured in all patients before and after treatment, and the results were compared with those of 30 healthy children who received physical examination at our hospital.

RESULTS

The total effective rate was significantly higher in the observation group than in the control group (97.22% vs 84.72%, P < 0.05). Compared with the healthy control group, serum levels of PG Ⅰ, PG Ⅱ, and SS were significantly higher, and that of SS was significantly lower in the two patient groups before treatment (P < 0.05). Serum levels of PG Ⅰ, PG Ⅱ, and SS significantly decreased, and that of SS significantly increased in the two patient groups after treatment compared with pretreatment levels (P < 0.05). Compared with the control group, serum levels of PG Ⅰ, PG Ⅱ, and SS were significantly lower, and that of SS was significantly higher in the observation group after treatment (P < 0.05). The incidence of adverse drug reactions was 4.17% in the observation group and 6.94% in the control group, which showed no statistical difference (P > 0.05).

CONCLUSION

Marzulene-S combined with standard triple therapy can regulate serum levels of PG and gastrointestinal hormones in children with H. pylori positive PU, improve the clinical curative effects, and has few adverse drug reactions.

Value of standardized treatment mode for peptic ulcer

AIM: To evaluate the effect of standardized treatment mode for peptic ulcer.

METHODS: One hundred and eighty-nine patients with peptic ulcer were divided into a standardized treatment group (n = 96) and a control group (n = 93). The standardized treatment group received standardized treatment regimen, and the control group was treated with conventional therapy. After treatment, the two groups were compared regarding Helicobacter pylori (H. pylori) eradication, ulcer healing, ulcer recurrence, patient compliance, satisfaction score, and rate of disease knowledge awareness.

RESULTS: The H. pylori eradication rate and ulcer cure rate were significantly higher in the standardized treatment group than in the control group (84.21% vs 58.89%, 42.11% vs 28.89%, P < 0.05). The rate of ulcer recurrence did not differ significantly between the standardized treatment group and the control group (12.63% vs 17.78%, P > 0.05). Average score of therapeutic compliance in the 185 patients was 6.69 ± 1.35, among which the score was significantly lower in the standardized treatment group than in the control group (7.22 ± 1.34 vs 6.17 ± 1.37, P < 0.05). The satisfaction degree was also significantly higher in the standardized treatment group than in the control group (4.31 ± 0.99 vs 3.06 ± 1.26, P < 0.05). The standardized treatment group presented higher rate of disease knowledge awareness than the control group (70.53% vs 46.67%, P < 0.05).

CONCLUSION: The standardized treatment mode for peptic ulcer could effectively increase the eradication rate of H. pylori, ulcer healing rate, patient's knowledge about the disease, medication compliance and patient treatment satisfaction, representing an effective strategy for prevention and treatment of peptic ulcer.