目的 分析幽门螺杆菌(Helicobacter pylori, HP)根除治疗失败相关因素，为有效根除Hp提供建议和决策。 方法 对2005年5月-2008年12月经胃镜检查确诊的慢性胃炎或消化性溃疡，且Hp检测阳性并行含质子泵抑制剂三联或四联治疗的患者103例进行研究。治疗结束至少4周后，用14C呼气试验评估Hp是否成功根除，根据测试结果分为治疗失败组33例及治疗成功组70例。运用统一标准的调查表对每位患者进行相关因素调查，就调查表所涉及的因素在根除失败组与成功组间采用单因素及多因素Logistic回归进行分析。 结果 通过单因素分析依从性和饮酒在两组之间有统计学意义(P＜0.05)。Logistic多因素分析发现，依从性差是根除失败的独立危险因素。 结论 依从性差是治疗失败十分重要的影响因素。
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
Objective To review the eradication rate for Helicobacter Pylori (H. pylori) eradication therapy with Ranitidine bismuth citrate (RBC). Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed according to International Cochrane Collaboration. Data Source RCTs were identified from specialized trials register of Cochrane U GDP Group, the Cochrane library, additional electronic search (including MEDLINE and CBM), handsearching, and personal contact with pharmaceutical companies. Data Selection Randomized clinical trials comparing RBC or RBC in combination with other antibiotics such as proton pump inhibitor, H2-receptor antagonist, other bismuth or placebo were included. No language and blinding limitations were applied. Inclusion criteria Data were extracted independently by two reviewers. The methodological quality of trials was assessed by the Jadad-scale plus allocation concealment. Statistics analysis was managed by using RevMan 4. 1. Results Fifteen randomized clinical trials including 3 638 patients were included, with eight trials of high methodological quality. Meta-analysis indicated that odds ratio was 3.06 (95%CI 2.62 to 3. 58, P lt; 0. 000 01) comparing RBC to controls. But the heterogeneity was significant (P lt; 0. 000 01), so we choose random effects model. Then the odds ratio was 2.05 (95%CI 1. 29 to 3. 25, P=0.002). No serious adverse effects were found. Sensitivity analysis showed that the specimens and the quality of RCT haven’t affected researching result. Conclusion RBC is more effective in Helicobacter Pylori eradication therapy than others.
【摘要】 目的 观察根除幽门螺杆菌对糖尿病胃轻瘫（DGP）的治疗作用。 方法 选择2008年3月-2010年1月100例幽门螺杆菌阳性DGP患者。随机分为A、B两组。A组给予莫沙比利5 mg，3次/d，4周，及根除幽门螺杆菌治疗（埃索美拉唑 20 mg+克拉霉素 500 mg+阿莫西林1.0 g，12次/d）2周。B组采用莫沙比利5 mg，3次/d，4周。记录患者治疗前、治疗4周及停药4周时的症状积分。 结果 92例完成实验。A组症状积分治疗4周后明显下降（Plt;0.01），与停药4周后相比差异无统计学意义（Pgt;0.05），二者均明显低于B组同期（Plt;0.05、lt;0.01）。B组症状积分治疗4周后明显下降（Plt;0.01），停药4周后明显高于治疗4周后（Plt;0.05），但仍低于治疗前（Plt;0.05）。A组治疗4周及停药4周后显效率及总有效率分别为57.4%及91.5%、40.4%及83%，明显高于B组35.6%及75.6%、15.6%及53.3%（Plt;0.05）。 结论 对幽门螺杆菌阳性的DGP患者根除幽门螺杆菌可明显提高疗效，并有效防止停药后症状复发。【Abstract】 Objective To explore the therapeutic effect of helicobacter pylori (H.pylori) eradication on diabetic gastroparesis (DGP) patients. Methods A total of 100 DGP patients with H.pylori infection diagnosed between March 2008 and January 2010 were included and randomly divided into two groups. The patients in group A underwent the treatment with mosapride 5 mg (thrice per day) for four weeks and H.pylori eradication therapy (esomeprazole 20 mg, twice per day; clarithromycin 500 mg, twice per day; amoxicillin 1.0 g, twice per day for two weeks). The patients in group B was administered with mosapride 5 mg (thrice per day) for four weeks. The symptom scores (SS) were recorded pretreatment, 4 weeks later and 4 weeks after stopping treatment. Results Ninety-two patients finished the study. The SS in group A decreased significantly (Plt;0.01) 4 weeks after the treatment and didn’t differ much from that 4 weeks after stopping the treatment. Both of the SS were lower than those in group B at the same time. In group B, compared with that before the treatment, the SS were much lower than that 4 weeks after the treatment (Plt;0.01) and 4 weeks after stopping the treatment (Plt;0.05); the former was significantly lower than the latter (Plt;0.05). The marked efficacy rate and total efficacy rate in group A were higher than those in group B (4-week treatment: 57.4% and 91.5% vs. 35.6% and 75.6%, 4 weeks after stopping the treatment: 40.4% and 83% vs. 15.6% and 53.3%) (Plt;0.05). Conclusion H.pylori eradication can increase the therapeutic effect on H.pylori positive patients with DGP and reduce the recurrence of the symptoms remarkably.
ObjectiveTo determine the level of CDH1 gene promoter hypermethylation in human gastric carcinoma by establishing MS-PCR method, and analyze retrospectively the possible statistical relationship between CDH1 gene promoter hypermethylation in human gastric carcinoma and HP infection, tumor differentiation, invasion, lymph nodal and distant metastasis, respectively. MethodsThe bisulfite conversion MS-PCR method was adopted to examine the level of CDH1 gene promoter hypermethylation in 40 cases of human gastric carcinoma tissue collected between January 2008 and December 2009. The statistical relationship between CDH1 gene promoter hypermethylation in human gastric carcinoma and HP infection, tumor differentiation, invasion, lymph nodal and distant metastasis were examined respectively with SPSS statistical tools. ResultsThe positive rate of CDH1 gene promoter hypermethylation in gastric carcinomas (67.5%) was higher than that in paired normal gastric mucosae (12.5%), and the difference was significant (P<0.05). In gastric carcinomas, the positive rate of CDH1 gene promoter hypermethylation in well differentiated or moderately differentiated groups (22.2%) was lower than that in poorly differentiated groups (80.6%), and the difference was significant (P<0.05). The positive rate of CDH1 gene promoter hypermethylation in HP positive groups (78.1%) was higher than that in HP negative groups (25.0%), and the difference was significant (P<0.05). ConclusionCDH1 gene promoter hypermethylation may play an important role in the process of tumor carcinogenesis in gastric carcinomas. Meanwhile, the CDH1 gene promoter hypermethylation may lead to poor differentiation in gastric carcinomas. CDH1 gene promoter hypermethylation is related to HP infection in the original gastric carcinomas, which shows that HP may get involved in the process of tumor suppressor gene methylation/inactivation and tumor development process.
Objective To investigate the efficacy of pantoprazole and omeprazole as part of triple therapy in treatment of duodenal ulcer. Methods Seventy-eight patients with duodenal ulcer and HP-positive were randomized to two groups. A random number table was used to generate random sequence. The sequence was not concealed. No blinding was used. Thirty-nine patients received pantoprazole 40 mg + amoxicillin 1.0 g + clarithromycin 0.5 g (PAC group) and 39 patients received omeprazole 20 mg + amoxicillin 1.0 g + clarithromycin 0.5 g (OAC group), twice daily with duration of 7 days. The follow-up time was 4 to 6 weeks. Results At the end of the treatment, 38 patients completed the study, and 1 patient lost to follow-up in the PAC group; thirty-seven patients completed the study, two patients lost to followup in the OAC group. The results of intention-to-treat analysis and per-protocol analysis showed that the HP eradication rates were 87.2%/89.5% in the PAC group and 87.2%/91.9% in the OAC group (P＞0.05); the clinical improvement rates were 79.4%/81.6% in the PAC group and 82.0%/86.5% in the OAC group (P＞0.05). The side effect rates were 10.6% in the PAC group and 8.1% in the OAC group (P＞0.05). No significant difference was found between the two groups (P＞0.05). Conclusions The PAC group is therapeutically effective for eradication of HP and improves symptoms and has an equivalent effect to OAC group for patients with HP-positive duodenal ulcer. Both drugs are well tolerated.
【摘要】目的探讨幽门螺杆菌(Hp)感染的根除与治疗糖尿病性胃轻瘫疗效的关系。方法 采用碳14呼气试验测定出67例糖尿病性胃轻瘫并Hp感染患者,经正规抗Hp治疗后进行疗效分析。结果67例中,Hp根除41例,症状明显改善33例,症状无明显改善8例;Hp未根除26例,症状明显改善17例,症状无明显改善9例。结论 糖尿病性胃轻瘫并Hp感染者经有效抗Hp治疗,对提高该病疗效有明显作用
目的:观察两种常用一线根除幽门螺杆菌(H.pylori)三联方案在本地区(成都市)的疗效。方法:纳入70例诊断为消化性溃疡、慢性糜烂性胃炎、慢性萎缩性胃炎伴H.pylori感染的患者。随机分为A、B两组。A组采用埃索美拉唑(E)20 mg bid+克拉霉素(C)500 mg bid+甲硝唑(M)400 mg bid,B组采用E 20 mg bid+ C 500 mg bid+阿莫西林(A)1.0g bid治疗,疗程7天。H.pylori根除失败者以1周四联方案:E 20 mg bid+胶体次枸櫞酸铋(B)220 mg bid+呋喃唑酮100 mg bid+ A1.0g bid治疗,观察疗效。结果:64例完成实验。三联方案H.pylori根除率:A组62.5%,B组84.4%,有显著差异(Plt;0.05)。二线四联方案根除率94.1%。结论:ECA方案H.pylori根除率明显高于ECM方案,可能更适合于本地区根除H.pylori的一线治疗,EBFA方案作为二线治疗具有较高疗效。
ObjectiveTo systematically review the association between Helicobacter pylori (HP) infection and Parkinson's disease (PD). MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies on the association between HP and PD from January 2000 to July 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 16 case-control studies involving 2 790 subjects were included. The results of meta-analysis showed that the HP infection rate was higher in PD patients than that in healthy patients (OR=1.87, 95%CI 1.38 to 2.54, P<0.000 1). The results of subgroup analysis showed that the infection rate of HP in PD group in Asia and Africa region was significantly higher than that in control group, but not in Europe region. Breath tests and other detection methods were used to detect HP infection, and the HP infection rate in PD group was significantly higher than that in the healthy control group. However, there was no significant difference in HP infection between the two groups by ELISA. UPDRS Ⅲ score of PD patients with HP infection was significantly higher than that of PD patients without HP infection. ConclusionsCurrent evidence shows that PD patients have a higher HP infection rate than the normal population, and the rates are affected by regions and HP detection methods. In addition, HP infection can aggravate the motor symptoms and motor complications of PD patients. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.