根除幽门螺杆菌会损害非甾体抗炎药相关性出血性消化性溃疡的愈合吗？一项前瞻性随机研究。
Does eradication of Helicobacter pylori impair healing of nonsteroidal anti-inflammatory drug associated bleeding peptic ulcers? A prospective randomized study.
作者信息
Chan F K, Sung J J, Suen R, Lee Y T, Wu J C, Leung W K, Chan H L, Lai A C, Lau J Y, Ng E K, Chung S C
机构信息
Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
出版信息
Aliment Pharmacol Ther. 1998 Dec;12(12):1201-5. doi: 10.1046/j.1365-2036.1998.00434.x.
BACKGROUND
Despite the widely accepted view that Helicobacter pylori is the most important cause of peptic ulcer disease, recent studies have suggested that the microbe protects against nonsteroidal anti-inflammatory drug (NSAID)-associated gastroduodenal lesions and promotes ulcer healing. We investigated the effects of H. pylori eradication on the healing of NSAID-associated bleeding peptic ulcers.
METHODS
Chronic NSAID users presenting with peptic ulcer haemorrhage underwent endoscopy to secure haemostasis and to document H. pylori infection by rapid urease test and culture. They were prospectively randomized to receive either omeprazole (20 mg once daily) for 8 weeks or a 1-week course of triple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg, metronidazole 400 mg, all given four times daily) plus omeprazole (20 mg once daily) for 8 weeks. Endoscopy was repeated after 8 weeks. Final H. pylori status was determined by a 13C-urea breath test that was performed at least 4 weeks after discontinuation of omeprazole.
RESULTS
195 H. pylori-infected NSAID users, complicated by bleeding ulcers, were randomized to receive omeprazole alone (102) or triple therapy plus omeprazole (93). 174 patients returned for second endoscopy at 8 weeks (91 in the omeprazole group, 83 in the triple therapy group). Urea breath test was negative in 14% in the omeprazole group vs. 92% in the triple therapy group (P < 0.001). Complete ulcer healing was achieved in 88 (97%) patients in the omeprazole group and 77 (93%) in the triple therapy group (P=0. 31). On intention-to-treat analysis, ulcers were healed in 86% of the omeprazole group and 83% of the triple therapy group (P=0.50). There was no significant difference in the healing rates of gastric or duodenal ulcers between the two groups.
CONCLUSION
Eradication of H. pylori did not impair the healing of NSAID-associated bleeding peptic ulcers.
背景
尽管幽门螺杆菌是消化性溃疡疾病最重要病因这一观点已被广泛接受，但近期研究表明，该微生物可预防非甾体抗炎药（NSAID）相关的胃十二指肠病变，并促进溃疡愈合。我们研究了根除幽门螺杆菌对NSAID相关出血性消化性溃疡愈合的影响。
方法
患有消化性溃疡出血的慢性NSAID使用者接受内镜检查以确保止血，并通过快速尿素酶试验和培养记录幽门螺杆菌感染情况。他们被前瞻性随机分组，分别接受8周的奥美拉唑（每日一次，每次20mg）治疗，或接受为期1周的三联疗法（枸橼酸铋钾120mg、四环素500mg、甲硝唑400mg，均每日四次给药）加8周的奥美拉唑（每日一次，每次20mg）治疗。8周后重复进行内镜检查。最终的幽门螺杆菌状态通过在停用奥美拉唑至少4周后进行的13C尿素呼气试验确定。
结果
195例感染幽门螺杆菌的NSAID使用者，并发出血性溃疡，被随机分组，分别单独接受奥美拉唑治疗（102例）或三联疗法加奥美拉唑治疗（93例）。174例患者在8周时返回接受第二次内镜检查（奥美拉唑组91例，三联疗法组83例）。奥美拉唑组14%的患者尿素呼气试验为阴性，而三联疗法组为92%（P<0.001）。奥美拉唑组88例（97%）患者和三联疗法组77例（93%）患者实现了溃疡完全愈合（P=0.31）。在意向性分析中，奥美拉唑组86%的溃疡和三联疗法组83%的溃疡愈合（P=
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