One year follow-up of patients after successful helicobacter pylori eradication therapy.

The aim of this study was to investigate the Helicobacter pylori (Hp) status of patients who underwent successful eradication therapy 1 year prior to the study and to evaluate their current symptoms. METHODS: all of the patients were initially evaluated by oesophago-gastro-bulboscopy and the Hp status was determined by at least two different methods [rapid urease test, histology or urea breath test (UBT)]. The Hp infection was treated with a 1-week triple therapy protocol, and the UBT was repeated 4-6 weeks later. We invited back 110 patients who had negative post-eradication UBT results 12+/-3 months prior to the study period. UBT was repeated and a questionnaire was completed about the previous and present complaints and medication. RESULTS: 80 of the 110 patients (73%) came back for the follow-up. Twenty five patients had peptic ulcer disease, 36 patients had gastritis or duodenitis without erosive lesions, and 19 patients had erosive form of gastritis or duodenitis initially. All of the patients except one in the erosive gastritis group had negative control UBT 1 year after the eradication, which means 1.25% recurrence rate within 1 year. The eradication therapy completely revealed the symptoms of 16 patients in the ulcer group (64%), 13 patients in the gastroduodenitis group (36%, P=0.03 vs. ulcer patients), 10 patients with erosive gastroduodenitis (52%), but this was only temporary. One year after the eradication therapy seven of the ulcer patients (28%), 11 patients with gastroduodenitis (31%) and seven patients with erosive gastroduodenitis (37%) were symptom-free. Most of the patients had epigastric pain (44%), heartburn (43%) and/or abdominal distension (33%). Nine ulcer patients (36%), 10 patients with gastroduodenitis (28%) and five patients with erosive gastroduodenitis (26%) were taking H(2)-blockers regularly. CONCLUSION: the 1-month post-eradication UBT was probable true negative in all of the evaluated cases, since 79 patients (98.75%) were also negative after 1 year. The Hp recurrence rate is very low (1.25%) in a 1-year period. The symptoms were relieved shortly after eradication therapy in the majority of patients with ulcer disease or erosive lesions. However, significantly smaller portion of the patients with gastroduodenitis became symptom-free. Only about one third of the treated patients remained symptom-free 1 year after the eradication.     

Eradication of Helicobacter pylori has no effect on gastric acidity in duodenal ulcer patients—evaluation of 24-h pH monitoring

It is accepted that eradication of Helicobacter pylori leads to healing of chronic active gastritis facilitates ulcer healing and prevents ulcer recurrence in duodenal ulcer (DU) patients. However, it is not entirely known whether the eradication of the bacteria normalizes gastric acid secretion and abolishes dyspeptic symptoms after ulcer healing. This study was aimed to evaluate the intragastric acidity and dyspeptic complaints before, and 3 months after, eradication in 18 endoscopically proven H. pylori positive DU patients. Gastric pH was measured by 24-h continuous intraluminal recording, serum gastrin measurements and Congo-red tests were also performed. Dyspeptic complaints and antacid consumptions were recorded in diary cards, antisecretory therapy was not allowed after the cessation of eradication therapy. Endoscopy, H. pylori status and Congo-red tests were controlled at the 6th and 12th week, while pH measurements and serum gastrin tests were performed at inclusion and 3 months later. Three patients dropped out and in 14 out of the remaining subjects healing of DUs and successful eradications were achieved by the 6th and 12th week controls. The 24-h median pH and the percentage of 24-h pH readings under pH 3 were not changing significantly by the 3-month controls (from 1.9±0.5 to 1.8±0.4 and from 52.6±5.5% to 58.6±5%, respectively). Similary, no significant changes were observed in serum gastrin levels and dyspeptic symptom scores (from 72±7 pg/ml to 56.7±8 pg/ml and from 2.69±0.4 to 1.26±0.3, respectively). The antacid consumption was almost stable when compared with the pre- and post-eradication periods. It was concluded that despite successful H. pylori eradication and healing of DU, intragastric acidity does not change significantly at least 3 months after the therapy. The persisting dyspeptic symptoms and the need for antacid consumption suggest that some healed ulcer patients require antisecretory therapy in the post-eradication period.     

益生菌抑制幽门螺杆菌的作用机制及研究进展

幽门螺杆菌在胃部疾病的发病过程中起着重要作用,是导致胃炎、胃溃疡,甚至胃癌的关键因素之一。随着胃部疾病患者幽门螺杆菌阳性检出率的不断升高,人们对于胃病和幽门螺杆菌的相关性研究也有了一定进展。如今,对于幽门螺杆菌阳性患者根除治疗的必要性,以及抗生素治疗耐药性等问题已引起广泛关注。在这种情况下,益生菌作为相对安全的天然微生物,在抑制幽门螺杆菌并促进胃部健康的益生功能方面具有重要的研究潜力。本综述对幽门螺杆菌的致病机理、不同基因分型的致病程度等方面进行了总结,并对益生菌抑制幽门螺杆菌的机制进行了探讨。建议在治疗幽门螺杆菌感染时,应与常规的治疗手段结合应用,不仅会增加幽门螺杆菌的根除率,还能减少治疗相关的副作用。     

四联疗法和序贯疗法治疗服用非甾体类消炎药人群幽门螺杆菌感染的临 床对照研究

目的:对比四联疗法和序贯疗法对根除服用非甾体类消炎药(NSAID)人群幽门螺杆菌(Hp),改善其消化道不良症状及促进消化性溃疡愈合的临床效果。方法:对有消化不良症状的服用非甾体类消炎药物患者行胃镜检查、快速尿激酶及13C呼气试验检查,将155例幽门螺杆菌阳性合并有慢性胃炎或消化性溃疡患者作为研究对象,随机分为两组,A组采用四联疗法,B组采用序贯疗法。A组予雷贝拉唑+克拉霉素+阿莫西林+枸橼酸铋钾治疗10天;B组前5天予雷贝拉唑+阿莫西林,后5天予雷贝拉唑+克拉霉素+甲硝唑。治疗结束后,予雷贝拉唑和胃黏膜保护剂治疗8周。停药4周后,复查胃镜、13C呼气试验,观察和比较两组Hp根除率、消化不良症状缓解率及溃疡愈合率。结果:A、B两组Hp根除率分别为(ITT分析:86.7%和81.9%;PP分析:87.8%和84.3%);症状缓解率为(81.9%对79.2%);胃溃疡愈合率为(68.8%对66.7%),十二指肠球部溃疡的愈合率为(68.2%对70.0%),两组患者间Hp根除率、症状缓解率及溃疡愈合率比较均未见明显统计学差异(P>0.05)。四联疗法组和序贯疗法组不良反应的发生率分别为4.9%和4.3%。两组比较无明显差异(P>0.05)。结论:四联疗法和序贯疗法对长期服用非甾体类消炎药物人群的Hp根除疗效、消化不良症状的缓解及促进溃疡愈合的治疗作用均无明显差异。     

Eradication of Helicobacter pylori has no effect on gastric acidity in duodenal ulcer patients--evaluation of 24-h pH monitoring.

It is accepted that eradication of Helicobacter pylori leads to healing of chronic active gastritis facilitates ulcer healing and prevents ulcer recurrence in duodenal ulcer (DU) patients. However, it is not entirely known whether the eradication of the bacteria normalizes gastric acid secretion and abolishes dyspeptic symptoms after ulcer healing. This study was aimed to evaluate the intragastric acidity and dyspeptic complaints before, and 3 months after, eradication in 18 endoscopically proven H. pylori positive DU patients. Gastric pH was measured by 24-h continuous intraluminal recording, serum gastrin measurements and Congo-red tests were also performed. Dyspeptic complaints and antacid consumptions were recorded in diary cards, antisecretory therapy was not allowed after the cessation of eradication therapy. Endoscopy, H. pylori status and Congo-red tests were controlled at the 6th and 12th week, while pH measurements and serum gastrin tests were performed at inclusion and 3 months later. Three patients dropped out and in 14 out of the remaining subjects healing of DUs and successful eradication was achieved by the 6th and 12th week controls. The 24-h median pH and the percentage of 24-h pH readings under pH 3 were not changing significantly by the 3-month controls (from 1.9+/-0.5 to 1.8+/-0.4 and from 52.6+/-5.5% to 58.6+/-5%, respectively). Similarly, no significant changes were observed in serum gastrin levels and dyspeptic symptom scores (from 72+/-7 pg/ml to 56.7+/-8 pg/ml and from 2.69+/-0.4 to 1.26+/-0.3, respectively). The antacid consumption was almost stable when compared with the pre- and post-eradication periods. It was concluded that despite successful H. pylori eradication and healing of DU, intragastric acidity does not change significantly at least 3 months after the therapy. The persisting dyspeptic symptoms and the need for antacid consumption suggest that some healed ulcer patients require antisecretory therapy in the post-eradication period.     

Oxidative damage of the gastric mucosa in Helicobacter pylori positive chronic atrophic and nonatrophic gastritis, before and after eradication

Background. Helicobacter pylori is the main cause of gastritis and a primary carcinogen. The aim of this study was to assess oxidative damage in mucosal compartments of gastric mucosa in H. pylori positive and negative atrophic and nonatrophic gastritis. Materials and methods. Five groups of 10 patients each were identified according to H. pylori positive or negative chronic atrophic (Hp‐CAG and CAG, respectively) and nonatrophic gastritis (Hp‐CG and CG, respectively), and H. pylori negative normal mucosa (controls). Oxidative damage was evaluated by nitrotyrosine immunohistochemistry in the whole mucosa and in each compartment at baseline and at 2 and 12 months after eradication. Types of intestinal metaplasia were classified by histochemistry. Results. Total nitrotyrosine levels appeared significantly higher in H. pylori positive than in negative patients, and in Hp‐CAG than in Hp‐CG (p < .001); no differences were found between H. pylori negative gastritis and normal mucosa. Nitrotyrosine were found in foveolae and intestinal metaplasia only in Hp‐CAG. At 12 months after H. pylori eradication, total nitrotyrosine levels showed a trend toward a decrease in Hp‐CG and decreased significantly in Hp‐CAG (p = .002), disappearing from the foveolae (p = .002), but remaining unchanged in intestinal metaplasia. Type I and II of intestinal metaplasia were present with the same prevalence in Hp‐CAG and CAG, and did not change after H. pylori eradication. Conclusions. Oxidative damage of the gastric mucosa increases from Hp‐CG to Hp‐CAG, involving the foveolae and intestinal metaplasia. H. pylori eradication induces a complete healing of foveolae but not of intestinal metaplasia, reducing the overall oxidative damage in the mucosa.     

Characteristics of Helicobacter pylori-induced gastritis and the effect of H. pylori eradication in patients with chronic idiopathic thrombocytopenic purpura

BACKGROUND: The association between Helicobacter pylori infection and idiopathic thrombocytopenic purpura (ITP) has been reported widely. We investigated the prevalence of H. pylori infection, its virulence profile and the effectiveness of its eradication in patients with ITP. MATERIALS AND METHODS: Twenty patients with ITP, 20 with peptic ulcer (10 gastric ulcer (GU), 10 duodenal ulcer (DU)) and 20 with NUD were studied. The virulence profile of the strains was assessed by genotyping for cagA, vacA, iceA, and hpyIIIR/hrgA and by assaying for IL-8 and DNA fragmentation after incubation with AGS cells. Infected patients and two uninfected ITP patients received triple therapy and platelets were counted before and 1 month, 6 months, 1 year, and 2 years after eradication therapy. RESULTS: H. pylori infection was found in 17 ITP (85%), 20 ulcer (100%) and 13 NUD (65%) patients. Biopsies and strains were collected from five ITP, 20 ulcer and 13 NUD patients. The ITP patients had a pangastritis or corpus-predominant gastritis pattern. All H. pylori isolates, from ITP, ulcer and NUD patients, were cagA(+) and vacA s1/m1, and did not differ in levels of IL-8 induction or DNA fragmentation. Fifteen ITP (88%) and 17 ulcer (85%) patients had successful eradication of H. pylori. Ten of these 15 (67%) H. pylori-eradicated ITP patients had platelet recovery. There was no significant change in platelet count in the two ITP patients in whom eradication failed or in the two originally H. pylori-uninfected ITP patients, or in the treated ulcer patients. Age at onset of ITP was the main determinant of platelet recovery: 100% of patients diagnosed after the age of 60 recovered compared with only 22% of those diagnosed before 50. CONCLUSIONS: H. pylori-infected ITP patients have a corpus-predominant pattern of gastritis but the virulence profile of their strains does not differ from that of ulcer or NUD patients. Eradication of H. pylori infection is a good therapeutic option for some patients with chronic ITP, especially for those who develop ITP in older age.     

Helicobacter pylori eradication in patients on long-term H2 receptor antagonists. Economic and symptomatic benefits. A large prospective study in primary care

Background. A large proportion of patients in primary care are still being maintained on long‐term acid suppression, without any attempts to identify Helicobacter pylori status and to treat those that test positive. Objectives. To assess the prevalence and economic and symptomatic benefits of H. pylori eradication in patients maintained on long‐term H₂ receptor antagonists (H₂RA) in primary care. Patients and Methods. Patients on long‐term (i.e. 6 months or longer) H₂RA were identified from the computerised records of six practices in north England. Helicobacter pylori status was identified using serology and H. pylori positive patients were then offered standard 7‐day proton pump based triple therapy, followed by a urea breath test (UBT) to confirm H. pylori eradication. Those who had a positive UBT were offered a second line course of H. pylori eradication therapy. Follow up period was 1 year. The main outcome measures were improvement in dyspepsia symptom scores, amount of H₂RA being consumed, and economic benefits after H. pylori eradication. Results. One thousand and seven patients (1.5%) were identified on long‐term H₂RA, of whom 471 (46%) ultimately had their H. pylori serology assessed. Sixty‐three (297) percent of the patients tested had a positive serology for H. pylori, the majority of whom (58%, 172) had prior evidence of peptic ulcer disease. The mean duration of therapy and mean time since endoscopy/barium studies was significantly longer in patients with peptic ulcer disease compared to their counterparts with nonulcer dyspepsia and gastro‐oesophageal reflux disease, p= .0002 and .0001, respectively. After successful H. pylori eradication (which was possible in 84% of the patients), at the end of the 1‐year study period, on an intention to treat basis 62% of the patients could either stop or significantly reduce dosage of their H₂RA. There was also significant reduction in the mean dose of H₂RA being consumed and severity of symptoms at the end of the study period (p < .00001). Conclusion. Almost two‐thirds of patients on long‐term H₂RA in primary care will have a positive serology for H. pylori; the majority of these will have peptic ulcer disease. In over 60% of cases H. pylori eradication led to significant improvement in symptom scores and reduction in dosage of H₂RA being consumed. Cessation or reduction in long‐term H₂RA prescribing is cost effective.     

Helicobacter pylori and its eradication in rosacea.

Rosacea is a common condition of unknown etiology usually accompanied by gastrointestinal symptoms and favorably responding to the treatment with antibiotics. This study was designed to examine the prevalence of gastric Helicobacter pylori (Hp) infection verified by 13C-UTB-test, CLO, Hp culture and serology (IgG) in patients with rosacea. Gastroduodenoscopy was combined with pentagastrin secretory test and antral and fundic biopsy samples were taken for histological evaluation (the Sydney system). Blood samples were also taken for the determination of plasma gastrin using RIA and plasma interleukin (IL)-8 and tumor necrosis factor alpha (TNFalpha) using ELISA. This study was performed in 60 patients, 31-72 year old, with visible papules and pustules associated with erythema and flushing on the face and on 60 age- and gender-matched patients without any skin diseases but with similar as in rosacea gastrointestinal symptoms but without endoscopic changes in gastroduodenal mucosa (non-ulcer dyspepsia - NUD). The Hp prevalence in rosacea patients was about 88 % as compared to 65% in control NUD patients. Among rosacea patients, 67% were cytotoxin associated gene A (CagA) positive, while in NUD patients only 32% were CagA positive. Rosacea patients showed gastritis with activity of about 2.1 in antrum and 0.9 in the corpus of the stomach while those with NUD only mild gastritis with activity of approximately 1.0) confined to the antrum only. Following initial examination, typical 1 wk anti-Hp therapy including omeprazole (20 mg bd.), clarithromycin (500 mg bd.) and metronidazol (500 mg bd.) was carried out. After eradication, 51 out of 53 treated rosacea patients became Hp negative. Within 2-4 weeks, the symptoms of rosacea disappeared in 51 patients, markedly declined in 1 and remained unchanged in 1 other subject. A dramatic reduction in activity of gastritis (to 0.3 in antrum and to 0.1 in corpus) was observed. Basal plasma gastrin decreased from 48 +/- 5 pM before to 17+/-3 pM after eradication, while pentagastrin-induced maximal (MAO) declined, respectively, from about 16.6 +/- 4.2 to 8.5 +/- 1.8 mmol/h. Plasma TNFalpha and IL-8 were reduced after the therapy by 72% and 65%, respectively. We conclude that: 1) Rosacea is a disorder with various gastrointestinal symptoms closely related to gastritis, especially involving the antrum mucosa, with Hp expressing cagA in the majority of cases and elevated plasma levels of TNFalpha and IL-8; 2) The eradication of Hp leads to a dramatic improvement of symptoms of rosacea and reduction in related gastrointestinal symptoms, gastritis, hypergastrinemia and gastric acid secretion; and 3) Rosacea could be considered as one of the major extragastric symptoms of Hp infection probably mediated by Hp-related cytotoxins and cytokines.     

影响幽门螺杆菌根除疗效相关因素

幽门螺杆菌（Hp）是慢性活动性胃炎和消化性溃疡的主要病因,并与胃癌、MALT淋巴瘤的发生密切相关,其根除治疗在临床上具有重要的意义。大量研究显示Hp的根除疗效在下降,本文就有关影响Hp根除疗效的相关因素做一简要概述。     

Systematic review and meta-analysis: Helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer

Background: The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and Helicobacter pylori eradication. Aim: To perform a systematic review and meta‐analysis to ask whether this change in practice is in fact justified. Materials and Methods: A search on the Cochrane Controlled Trials Register, Medline, and Embase was made for controlled trials of duodenal ulcer perforation patients using simple closure method plus postoperative H. pylori eradication therapy versus simple closure plus antisecretory non‐eradication therapy. The long‐term results for prevention of ulcer recurrence were compared. Results: The pooled incidence of 1‐year ulcer recurrence in H. pylori eradication group was 5.2% [95% confidence interval (CI) of 0.7 and 9.7], which is significantly lower than that of the control group (35.2%) with 95% CI of 0.25 and 0.45. The pooled relative risk was 0.15 with 95% CI of 0.06 and 0.37. Conclusions: Helicobacter pylori eradication after simple closure of duodenal ulcer perforation gives better result than the operation plus antisecretory non‐eradication therapy for prevention of ulcer recurrence. All duodenal ulcer perforation patients should be tested for H. pylori infection, and eradication therapy is required in all infected patients.     

Effect of Helicobacter pylori eradication on gastric precancerous lesions: A systematic review and meta-analysis

Background

The question of whether eradication of Helicobacter pylori (Hp) can reverse gastric precancerous lesions, including intestinal metaplasia, remains uncertain, leading to ongoing debate. Therefore, a meta-analysis was performed to evaluate the effect of Hp eradication on gastric precancerous lesions.

Materials and Methods

PubMed, Embase, Cochrane Library, Web of Science, Scopus database, and ClinicalTrials.gov were systematically searched from inception to April 2023 for studies that explored the impact of Hp eradication on gastric precancerous lesions. Risk ratios (RRs) and their 95% confidence intervals (95% CIs) were selected as the effect size. We used the random-effects model to assess pooled data. We also performed quality assessments, subgroup analyses, and sensitivity analyses.

Results

Fifteen studies were included. Compared with placebo, Hp eradication could significantly prevent the progression of gastric precancerous lesions (RR = 0.87, 95% CI: 0.81–0.94, p < 0.01) and reverse them (RR = 1.32, 95% CI: 1.17–1.50, p < 0.01). Then, specific precancerous lesions were further explored. The progression of intestinal metaplasia was significantly prevented by Hp eradication compared to placebo or no treatment (RR = 0.80, 95% CI: 0.69–0.94, p < 0.01). Moreover, compared with placebo or no treatment, Hp eradication also improved chronic atrophic gastritis (RR = 1.84, 95% CI: 1.30–2.61, p < 0.01) and intestinal metaplasia (RR = 1.41, 95% CI: 1.15–1.73, p < 0.01). However, in terms of preventing dysplasia progression (RR = 0.86, 95% CI: 0.37–2.00) and improving dysplasia (RR = 0.89, 95% CI: 0.47–1.70), Hp eradication had no advantage compared to placebo or no treatment.

Conclusions

Hp eradication therapy could prevent the progression of gastric precancerous lesions and reverse them. Notably, intestinal metaplasia can be reversed, but this may only be appropriate for patients with epigenetic alterations and milder lesions.     

Helicobacter pylori Reinfection in Brazilian Patients with Peptic Ulcer Disease: A 5-Year Follow-Up

Background:  The Helicobacter pylori reinfection seems to be higher in developing countries, than in developed ones. The aim of the study was to determine the annual recurrence rate of H. pylori , in Brazilian patients with peptic ulcer disease, in a 5-year follow-up.
Methods:  Patients, with peptic ulcer disease diagnosed by upper digestive endoscopy (UDE) and H. pylori infection verified by histological analysis, rapid urease test, polymerase chain reaction, and urea breath test (UBT), were treated for bacterial eradication. The cure of the infection was verified using the same tests, 3 months after. Clinical evaluation and UBT were performed after sixth and ninth month. After 1 year of follow-up, UBT and UDE were repeated. Up to the fifth year, patients were assessed twice a year and an UBT was performed annually. The patients included and all the reinfected were tested for 15 different genes of the H. pylori .
Results:  One hundred and forty-seven patients were followed: 19 for 1 year, eight for 2 years, four for 3 years, five for 4 years, and 98 for 5 years, totaling 557 patients/years. Recurrence did not occur in the first year. In the second year, two patients were reinfected; in the third, four patients; in the fourth, three patients; and in the fifth, one patient. The total of reinfected patients was 10. The annual reinfection rate was 1.8%.
Conclusion:  Brazil presents a low prevalence of H. pylori reinfection, similar to the developed countries.     

13C-urea breath test during hospitalization for the diagnosis of Helicobacter pylori infection in peptic ulcer bleeding

Objective: To evaluate the accuracy of ¹³C‐urea breath test (UBT) to detect Helicobacter pylori infection in patients hospitalized with peptic ulcer bleeding and treated with proton pump inhibitors (PPIs). Methods: Patients hospitalized with peptic ulcer bleeding, and treated with omeprazole, had a first UBT performed the day after resuming oral feeding. Patients with a negative UBT during hospitalization underwent a repeated UBT 15 days after stopping PPIs. Results: The first UBT during hospitalization was positive in 86% of 131 patients. Time between admission and performance of the test was longer in patients with negative versus positive UBT (5.2 ± 0.7 versus 4.3 ± 0.5 days; p < .001). The repeated UBT became positive in 15 of 18 (83%) patients with a negative first UBT. In the multivariate analysis, the only variable associated with a negative first UBT was the time elapsed between admission and performance of the test (odds ratio = 6.6; 95%CI = 2.9–15.1). Conclusion: Most H. pylori‐positive patients with ulcer bleeding have a positive UBT (performed just after resuming oral feeding) despite previous treatment with high‐dose PPIs. Nevertheless, to preclude false‐negative results due to PPI therapy, the UBT should be performed as early as possible. If the infection cannot be demonstrated with this first UBT, H. pylori still needs to be definitively excluded with a second UBT performed after stopping PPIs.     

三联疗法与胃复春联合治疗幽门螺杆菌阳性胃溃疡的疗效评估

目的:探讨三联疗法与胃复春联合治疗幽门螺杆菌(Hp)阳性胃溃疡的临床疗效。方法:选择2011年11月到2014年11月在我院就诊的240例Hp阳性胃溃疡患者,随机分为实验组(n=120)和对照组(n=120)。对照组采用三联疗法,实验组在对照组基础上加服胃复春。比较两组患者的临床疗效、Hp根除率、胃泌素、胃动素水平。结果:实验组患者的总有效率和Hp根除率均明显高于对照组,具有显著性差异(均P0.05)。实验组治疗后胃泌素水平低于治疗前,亦低于对照组治疗后,具有显著性差异(均P0.05),胃动素变化无显著性差异。结论:三联疗法联合胃复春治疗Hp阳性胃溃疡能有效根除Hp,降低胃泌素水平,治疗效果良好。     

13C-Urea breath test is superior in sensitivity to detect Helicobacter pylori infection than either antral histology or rapid urease test.

There is no single technique which fulfils the criterion for a reference method to detect Helicobacter pylori (Hp) infection. The aim was to compare the results of antral histology (H), rapid urease test (U) and urea breath test (UBT) from antral biopsy samples in patients having gastric or duodenal lesions during upper GI endoscopy. We used the following methods: 1) biopsy specimens for histology (Warthin-Starry staining); 2) rapid urease test; and 3) 13C-urea breath test with infrared spectrometry. The total number of patients was 166 examined by H, U, and UBT. H, U and UBT were negative (-) in 64 patients and positive (+) in 51. The true positivity and false negativity (%, number of patients in parentheses) of each method based upon the positivity of the other two tests were: H+, U+ (54): UBT+, 94.4% (51) and UBT-, 5.6% (3); H+, UBT+ (57): U+, 89.5% (51) and U-, 10.5% (6); U+, UBT+ (65): H+, 78.5% (51) and H-, 21.5% (14). If Hp infection is considered to be positive when at least two tests detect the presence of Hp, UBT shows the highest sensitivity in comparison to histology of biopsy specimens and urease test. UBT is highly recommended as a screening test for Hp infection in patients presenting upper GI endoscopic alterations.     

奥美拉唑与呋喃唑酮及阿莫西林联用治疗幽门螺杆菌阳性十二指肠肠溃疡的疗效观察

目的：观察奥美拉联用呋喃唑酮及阿莫西林治疗幽门螺杆菌(Hp)阳性十二指肠溃疡的临床疗效。方法：对45例经胃镜活检证实的Hp阳性十二指肠溃疡应用奥美拉唑20mg Bid 呋喃唑酮0．2g Bid 阿莫西林1．0g Bid,疗程1w。结果：45例病例中,42例愈合,40例根除,7d疼痛缓解率为87％。结论：呋喃唑酮三联疗法能有效地根除Hp,且不良反应少,疗效高,病人依从性好,价格适中,是较理想的方案,值得进一步尝试。     

淮南地区幽门螺杆菌感染个体菌株基因多态性与感染结局的影响

目的:探讨淮南地区幽门螺杆菌感染个体菌株基因多态性及其与感染结局的影响。方法:选取125例幽门螺杆菌(H.pylori,HP)感染的慢性胃炎、消化性溃疡患者,常规获取胃窦、胃体部粘膜,进行HP分离、培养,提取HP基因组DNA,采用随机扩增多态性DNA(RAPD)指纹分析法检测菌株基因多态性;125例患者均给予质子泵抑制、H2受体拮抗剂、铋剂为基础的三联或四联疗法治疗,治疗后4~6周进行14C-尿素呼气试验评估Hp根除情况;获取HP根除失败患者的胃窦、胃体黏膜进行HP分离、培养、鉴定,并采用RAPD指纹分析法检测菌株来源,评估HP基因多态性对治疗结局的影响。结果:cagA、iceA1、iceA2、vacAs1、vacAm1、babA2阳性率分别为92.80%、36.00%、93.60%、93.60%、29.50%、53.50%,cagA、iceA2、vacAs阳性率均高于其他基因类型阳性率(P0.05或P0.01),其他基因类型阳性率比较差异无统计学意义(P0.05)。经治疗后HP根除率为86.4%(107/125),14.4%(18/125)根除失败;18例根除失败患者中,15例患者治疗前后的菌株具有相同的指纹图谱,证实为原菌株复发,其中cagA、iceA1、iceA2、vacAs1、vacAm1、babA2阳性率分别为93.33%、13.33%、86.67%、93.33%、6.67%、20.00%,cagA、iceA2、vacAs阳性率均高于其他基因类型阳性率(P0.05或P0.01)。结论:cagA+、vacAs+、iceA2+为淮南地区HP感染的优势基因型,该基因型易导致HP根除失败;未发现babA2与HP感染结局存在相关性。     

Eradicating Helicobacter pylori in Peptic Ulcer Disease Reduces Medical Costs in the Community

Background: Eradicating Helicobacter pylori markedly reduces ulcer recurrence in patients with peptic ulcer disease (PUD). Many decision analysis studies have concluded that eradicating H. pylori in PUD patients is more cost‐effective than maintaining antisecretory therapy. In 1995, we introduced an H. pylori eradication program into a large transportation company that experienced increased incidences of PUD among its employees along with increased medical costs, and we performed trend analysis of the actual medical costs of PUD in this cohort. Methods: In this cohort, there were approximately 8500 employees. H. pylori‐positive PUD patients were identified at the annual health check up. The patients received eradication therapy with lansoprazole, amoxicillin, and clarithromycin. After eradication, the patients were followed up by a yearly health check up. The annual number of patients who received eradication was recorded, and the annual direct medical costs of PUD therapy were analyzed. Results: A total of 440 H. pylori‐positive PUD patients received eradication therapy in a 7‐year period. Based on an intention‐to‐treat analysis, the eradication rate was 84.5% (372 of 440). The largest number of patients who received eradication therapy was found in 1995 (n = 115), and from 1995 to 2001 this number decreased yearly by 12.5 (95% confidence interval (CI): 5 to 20). Between 1989 and 1995, the annual medical costs arising of PUD therapy increased by ¥2.25 million (95% CI: 1.19 to 3.31) per year, being highest (¥22.75 million) in 1995. Between 1995 and 2001, the costs decreased by ¥3.88 million (95% CI: 3.16 to 4.59) per year. The cost in 2001 was 5.7% of the cost in 1995. The eradication program was terminated in 2001 because the prevalence of PUD diminished markedly, and the associated medical costs decreased as well. Conclusions: H. pylori eradication could reduce the number of PUD patients and associated medical costs in the workplace setting.     

An evaluation of a serologic test with a current infection marker of Helicobacter pylori before and after eradication therapy in Chinese

Background and Aims: Development of an accurate and less cumbersome noninvasive method to detect current Helicobacter pylori infection is essential in clinic. The aim of this study was to evaluate the performance of the CIM test, also known as the Assure®H. pylori Rapid Test (Genelabs Diagnostics Pty. Ltd., Singapore), for the diagnosis of current H. pylori infection before and after eradication therapy in Chinese population. Methods: A total of 452 eligible people were recruited for this study in Jiangsu Province, China. Each individual underwent a ¹³C urea breath test (¹³C‐UBT). For the evaluation of CIM test after eradication, 115 H. pylori‐positive outpatients were treated with 1‐week triple therapy. One month after the end of therapy, the patients underwent ¹³C‐UBT again, and the CIM‐test was performed 1, 3, and 6 months after the end of therapy. Its performance (sensitivity, specificity, positive and negative predictive values, and accuracy) were determined using the ¹³C‐UBT as a gold standard for H. pylori diagnosis. Results: H. pylori was detected in 221 (65.6%) of the 337 people by ¹³C‐UBT. The sensitivity, specificity, positive and negative predictive values, and accuracy of the CIM test were 93.2%, 90.5%, 94.9%, 87.5%, and 92.3%, respectively, using ¹³C‐UBT as a gold standard. One month after eradication therapy, the sensitivity, specificity of CIM test were only 50% and 66.7%, 66.7% and 84.6% 3‐month after eradication therapy and the sensitivity, specificity increased to 85.7% and 96.9%, respectively, when CIM test was used 6 months after the end of anti‐H. pylori therapy. Conclusions: The CIM test is a simple, rapid, accurate, cheap, and near‐people test. It may be satisfactory for detecting H. pylori infection in cases without eradication therapy, but it could not differentiate the past or current infection correctly within 6 months after anti‐H. pylori therapy.