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The long-term reinfection rate and the course of duodenal ulcer disease after eradication of Helicobacter pylori in a developing country

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第1期95卷 50-56页

作者： Rollan, A Giancaspero, R Fuster, F Acevedo, C Figueroa, C Hola, K Schulz, M Duarte, I Hosp Naval Almirante Nef Dept Gastroenterol Vina Del Mar Chile Pontificia Univ Catolica Chile Fac Med Dept Gastroenterol & Pathol Santiago Chile

OBJECTIVE: The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) eradication on the natural history of duodenal ulcer disease and the reinfection rate after treatment in a developing country. METHODS: A total of 111 H. pylori-infected patients with duodenal ulcer were treated with either omeprazole or famotidine plus two antibiotics for 2 wk. Those failed to respond to treatment were retreated with bismuth-based triple therapy. RESULTS: The radication rate was 76% (95% CI: 67-83%). Eventually, H. pylori was eradicated in 96 of the 111 patients (86%), who were followed-up clinically and endoscopically for a mean of 37.2 months. The cumulative reinfection rate after eradication (Kaplan-Meier) was 8% +/- 3% in yr 1, 11% +/- 4% in yr 2, and 13% +/- 4% in yr 3. Nine of the 12 reinfections occurred during yr 1. Recurrence of duodenal ulcer was detected in five patients (5.2%), all of them during yr 1 of follow-up. Histologically, gastritis scores (according to the Sydney system) improved significantly after eradication. CONCLUSIONS: In a high prevalence setting, H. pylori eradication and early reinfection rates after treatment are similar to rates observed in a low prevalence environment, whereas the late reinfection rate seems to be higher. However, up to 3 yr after treatment, most treated patients are free of H. pylori infection and/or ulcer activity. Even longer follow-up studies are necessary to determine whether specific retreatment policies are necessary to maintain long term eradication in developing countries.

关键词：阿莫西林/投药和剂量抗溃疡病药/治疗应用智利发展中国家药物疗法联合/投药和剂量十二指肠溃疡/诊断十二指肠溃疡/药物疗法十二指肠溃疡/微生物学法莫替丁/治疗应用随访研究胃炎/诊断胃炎/微生物学螺杆菌感染/并发症螺杆菌感染/诊断螺杆菌感染/药物疗法螺杆菌幽门甲硝唑/投药和剂量奥美拉唑/治疗应用复发替硝唑/投药和剂量青少年成年人老年人女(雌)性人类男(雄)性中年人

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Influence of Helicobacter pylori eradication therapy on ¹³C aminopyrine breath test:: Comparison among omeprazole-, lansoprazole-, or pantoprazole-containing regimens

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第10期95卷 2762-2767页

作者： Giannini, E Romagnoli, P Fasoli, A Chiarbonello, B Malfatti, F Botta, F Risso, D Lantieri, PB Savarino, V Testa, R Univ Genoa Dept Internal Med Gastroenterol Unit I-16132 Genoa Italy Univ Genoa Dept Hlth Sci I-16132 Genoa Italy

OBJECTIVE: Proton pump inhibitors and antimicrobial agents are widely used to eradicate Helicobacter pylori (H. pylori) infection. In the general population the prevalence of infection and of polypharmacy increases the possibility of drug-drug interactions during H. pylori eradication therapy. The purpose of the present study was to assess the prevalence, degree, and clinical relevance of metabolic interference with the cytochrome P450 enzymatic system occurring during 1 wk of administration of omeprazole, lansoprazole, or pantoprazole followed by the association of clarithromycin and metronidazole for another week. The C-13 aminopyrine breath test (ABT) was chosen to screen for possible interactions. METHODS: We studied 30 patients referred to our Unit for H. pylori eradication therapy. They were randomized to receive either omeprazole (20 mg b.i.d.), lansoprazole (30 mg b.i.d.), or pantoprazole (40 mg b.i.d.) for 2 wk. During the second week clarithromycin (250 mg b.i.d.) and metronidazole (500 mg b.i.d.) were added. ABT was performed before, and at the end of the first and second week of therapy. Percentage of the administered dose of C-13 recovered per hour at the peak (percent C-13 dose/h at the peak) and cumulative percentage of administered dose of C-13 recovered over time at 120 min (percent C-13 dose cum(120)) were the ABT evaluated parameters. RESULTS: At baseline all patients showed a normal liver function. In individual patients during treatment we observed various liver metabolic interactions both as inhibition and induction, as well as after the first and the second week of therapy. However, mean modifications of the ABT parameters during the 2 weeks of therapy were not statistically significant compared to baseline values. None of the patients who had ABT variations complained of side effects. CONCLUSIONS: H. pylori eradication therapy interferes with cytochrome P450-dependent liver metabolic activity. However, the clinical relevance of these metaboli

关键词： 2-吡啶甲基亚硫酰苯咪唑类氨基比林/诊断应用抗溃疡病药/投药和剂量苯咪唑类/投药和剂量呼吸试验碳放射性同位素/诊断应用克拉霉素/投药和剂量细胞色素P450酶系统/拮抗剂和抑制剂药物疗法联合胃炎/诊断胃炎/药物疗法螺杆菌感染/诊断螺杆菌感染/药物疗法螺杆菌幽门/药物作用甲硝唑/投药和剂量奥美拉唑/投药和剂量奥美拉唑/类似物和衍生物消化性溃疡/诊断消化性溃疡/药物疗法质子泵/拮抗剂和抑制剂亚砜类/投药和剂量成年人老年人女(雌)性人类男(雄)性中年人

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Risk of stomach cancer in patients with peptic ulcer disease

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WORLD JOURNAL OF SURGERY 2000年第3期24卷 315-320页

作者： Hansson, LE Mora Hosp Dept Surg S-79285 Mora Sweden

The relation between peptic ulcer and stomach cancer has long been disputed, but there is accumulating evidence that gastric ulcer disease is positively associated and duodenal ulcerations negatively associated with the risk of developing stomach cancer. As Helicobacter pylori infection is associated with both types of ulceration and stomach cancer. the varying outcomes of the infection indicate that factors other than the infection must be of importance. At present, there is no convincing evidence that pharmacologic inhibition of acid secretion for treatment of peptic ulcer increases the risk of stomach cancer. However, some recent studies indicate that prolonged treatment with proton pump inhibitors may accelerate the development of atrophic gastritis, a risk factor for stomach cancer, in individuals infected with H. pylori. It has repeatedly been shown that there is an at least twofold increased risk of stomach cancer 15 gears after gastric resection for peptic ulcer disease, and that the risk increases with the passage of time. Whether vagotomy has the same risk-increasing effect is still unclear.

关键词：抗溃疡病药/副作用胃切除术/副作用螺杆菌感染/并发症螺杆菌感染/药物疗法幽门螺杆菌消化性溃疡/并发症消化性溃疡/微生物学消化性溃疡/治疗危险因素胃肿瘤/病因学胃肿瘤/微生物学迷走神经切断术/副作用人类

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Studies on anti-Helicobacter pylori agents.: Part 1:: Benzyloxyisoquinoline derivatives

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BIOORGANIC & MEDICINAL CHEMISTRY 1999年第11期7卷 2647-2666页

作者： Yoshida, Y Barrett, D Azami, H Morinaga, C Matsumoto, S Matsumoto, Y Takasugi, H Fujisawa Pharmaceut Co Ltd Intellectual Property Div Med Chem Res Labs Yodogawa Ku Osaka 5328514 Japan Fujisawa Pharmaceut Co Ltd Med Biol Res Labs Yodogawa Ku Osaka 5328514 Japan

The synthesis and optimization of the anti-Helicobacter pylori activity of a novel series of benzyloxyisoquinoline derivatives that was discovered by a random screening process, are described. In the in vitro assay, compound 10c containing a 3-acetamido-2,6-dichlorobenzyl substituent was found to have extremely potent activity against H. pylori and no activity against other common bacteria. The anti-H. pylori activity of 10c was superior to that of amoxicillin (AMPC) (1) and clarithromycin (CAM) (2), However, 10c did not show in vivo efficacy in a mouse infection model;a feature attributed to the lack of strong bactericidal activity at short contact times. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：阿莫西林/药理学抗菌药/化学合成抗菌药/化学抗菌药/药理学抗菌药/治疗应用疾病模型动物螺杆菌感染/药物疗法幽门螺杆菌/药物作用幽门螺杆菌/生理学异喹啉类/化学合成异喹啉类/化学异喹啉类/药理学小鼠近交ICR 微生物敏感性试验青霉素类/药理学构效关系动物小鼠

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Management of peptic ulcers: Emerging issues

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WORLD JOURNAL OF SURGERY 2000年第3期24卷 250-255页

作者： Freston, JW Univ Connecticut Ctr Hlth Off Clin Res Farmington CT 06030 USA

Most peptic ulcers are caused by Helicobacter pylori infection. The infection is best diagnosed by a radiolabeled carbon urea breath test, which also can prove that eradication therapy was successful. Serologic testing is useful for establishing prior or present infection but not to determine if the infection has been eradicated. Endoscopic tests usually are not needed to establish a diagnosis. Modern ulcer treatment consists of H. pylori eradication in infected patients. A combination of a proton pump inhibitor plus clarithromycin and amoxicillin or a proton pump inhibitor plus bismuth, metronidazole, and tetracycline are the most effective regimens. Reinfection is Less than 2% per year in developed countries. Evidence suggests that H. pylori eradication may foster the development of erosive esophagitis, but confirmatory studies are needed. Studies also suggest an interaction between H. pylori infection and peptic ulcers related to the use of nonsteroidal antiinflammatory drugs (NSAIDs). However, the studies are conflicting: One shows that H. pylori eradication protects against NSAID-related ulcers;another suggests protection afforded by the infection. Non-H. pylori peptic ulcers remain a challenge, especially in the United States, where one study showed that 42% of peptic ulcers were not due to the infection. Some non-H. pylori ulcers are refractory to usual doses of antisecretory drugs.

关键词：抗菌药/治疗应用消炎药非甾类/副作用抗溃疡病药/治疗应用药物疗法联合胃食管反流/微生物学螺杆菌感染/并发症螺杆菌感染/诊断螺杆菌感染/药物疗法幽门螺杆菌消化性溃疡/药物疗法消化性溃疡/微生物学复发危险因素治疗失败人类

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Treatment of Helicobacter pylori in patients with duodenal ulcer hemorrhage -: A long-term randomized, controlled study

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第9期95卷 2225-2232页

作者： Lai, KC Hui, WM Wong, WM Wong, BCY Hu, WHC Ching, CK Lam, SK Univ Hong Kong Queen Mary Hosp Dept Med Div Gastroenterol Hong Kong Hong Kong Peoples R China

OBJECTIVE: Eradication of Helicobacter pylori (H. pylori) in patients with uncomplicated duodenal ulcers prevents longterm recurrence of ulcers. We aimed to study whether treatment of H. pylori prevents the long-term recurrence of duodenal ulcer hemorrhage. METHODS: Patients with duodenal ulcer bleeding and confirmed H. pylori infection were recruited. A total of 120 patients were randomly assigned to triple therapy (DeNoltab 120 mg, amoxycillin 500 mg, and metronidazole 300 mg four times daily) or DeNoltab 120 mg four times daily alone. No maintenance therapy was given during the follow-up period. The endpoints were the cumulative rates of symptomatic and bleeding duodenal ulcer recurrences. RESULTS: Of the patients receiving the triple regimen, 85.1% had H. pylori eradicated as compared to 2.0% of patients receiving DeNoltab (p < 0.05). More patients in the DeNoltab group than those in the Triple group had recurrence of ulcer bleeding, but this did not reach statistical significance (12/60 vs 6/60, p = 0.20). Logistic regression analysis on clinical, personal, and endoscopic characteristics identified persistent H. pylori infection as the only independent predictor of recurrence of duodenal ulcer bleeding. CONCLUSIONS: Treatment of H. pylori alone with the present bismuth-based triple therapy in patients with duodenal ulcer hemorrhage did not result in significant reduction in further bleeding episodes, although a trend was seen for the group that was given triple therapy. On the other hand, posttreatment H. pylori status was found to be an independent predictor of bleeding recurrence. (Am J Gastroenterol 2000;95:2225-2232. (C) 2000 by Am. Cell. of Gastroenterology).

关键词：阿莫西林/治疗应用抗酸剂/治疗应用抗菌药/治疗应用铋药物疗法联合/治疗应用十二指肠溃疡/并发症十二指肠溃疡/药物疗法十二指肠溃疡/病理学内窥镜检查消化系统随访研究螺杆菌感染/并发症螺杆菌感染/药物疗法螺杆菌感染/病理学螺杆菌幽门/药物作用螺杆菌幽门/分离和提纯肠黏膜/微生物学肠黏膜/病理学甲硝唑/治疗应用消化性溃疡出血/药物疗法消化性溃疡出血/病因学消化性溃疡出血/病理学预后复发/预防和控制青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Treatment advances in acid secretory disorders: The promise of rapid symptom relief with disease resolution

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第11期94卷 S17-S24页

作者： Earnest, DL Robinson, M Univ Arizona Hlth Sci Ctr Gastroenterol Sect Tucson AZ 85724 USA Univ Oklahoma Coll Med Oklahoma City OK 73190 USA Oklahoma Fdn Digest Res Oklahoma City OK 73190 USA

Gastric acid-related disorders are common clinical problems associated with a wide range of symptoms. Important advances have occurred over the last 20 yr that have improved our understanding of these disorders as well as our approach to treatment. Today, control of gastric acid secretion represents the cornerstone of effective management of both peptic ulcer disease and gastroesophageal reflux disease (GERD). A variety of acid-reducing strategies are now available to clinicians to manage symptoms and control or resolve disease. Antacids offer rapid symptomatic relief but probably have little effect on overall disease progression. Histamine-2 receptor antagonists can also provide good initial symptomatic treatment in peptic ulcer disease and in mild to moderate GERD. However, problems with postmeal acid control and tachyphylaxis may detract from their longterm usefulness. The availability of proton pump inhibitors (PPIs), which block the final process in H+ ion secretion, has revolutionized our approach to the management of patients with acid secretory disorders. The currently available PPIs, omeprazole and lansoprazole, enable us to control symptoms effectively and safely, hasten healing, and minimize disease recurrence. New PPIs, such as rabeprazole and pantoprazole, will further expand our treatment options and may offer even greater possibilities with regard to rapid symptomatic relief and disease resolution. (Am J Gastroenterol 1999;94(Suppl.):S17-S24. (C) 1999 by Am. Cell. of Gastroenterology).

关键词：胃酸/分泌胃食管反流/药物疗法螺杆菌感染/药物疗法螺杆菌幽门组胺H2拮抗剂/治疗应用消化性溃疡/药物疗法消化性溃疡/微生物学质子泵/拮抗剂和抑制剂人类

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A survey of internal medicine residents' knowledge about Helicobacter pylori infection

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第8期95卷 1914-1919页

作者： Sharma, VK Bailey, DM Raufman, JP Elraie, K Metz, DC Go, MF Schoenfeld, P Smoot, DT Howden, CW Univ Arkansas Med Sci Div Digest Dis Little Rock AR 72205 USA Univ S Carolina Sch Med Columbia SC 29208 USA Univ Penn Philadelphia PA 19104 USA Baylor Coll Med Vet Affairs Med Ctr Houston TX 77030 USA Natl Naval Med Ctr Bethesda MD USA Howard Univ Washington DC 20059 USA Rush Univ Chicago IL 60612 USA Rush Presbyterian St Lukes Med Ctr Chicago IL 60612 USA

OBJECTIVE: Despite recently published national guidelines, many physicians have only limited knowledge about Helicobacter pylori infection. We conducted this study to assess internal medicine residents' knowledge about H. pylori. METHODS: Two hundred and nineteen residents in seven accredited internal medicine training programs completed a self-administered questionnaire on personal demographics and practices related to testing for-and treating-H. pylori infection. RESULTS: Noon conferences (82%), ward teaching (66%), journals (70%), and sponsored symposia (27%) were their major sources of H. pylori-related information. Forty-eight percent had used office-based tests for the infection. Testing for (and treatment of) Helicobacter pylori infection was recommended by 97% (97%) for newly diagnosed duodenal ulcer, but by only 61% (63%) for a past history of duodenal ulcer. Many recommended testing in unproven conditions and might not have offered treatment to an infected patient. A proton pump inhibitor-based triple-drug regimen was the treatment of first choice of 55%;20% recommended proton pump inhibitor-based dual regimens. Sixty-six percent and 80%, respectively, underestimated the rates of resistance to clarithromycin and metronidazole. In the absence of gastrointestinal symptoms, 22% would have ordered Helicobacter pylori testing but only 33% of these would undergo treatment if positive. CONCLUSIONS: Internal medicine residents usually test for Helicobacter pylori infection in appropriate conditions, but may not always treat the infection when the result is positive. Most use efficacious treatment regimens although many have inaccurate knowledge of resistance rates, which may adversely influence prescribing. Education should focus on practical issues surrounding Helicobacter pylori testing and treatment such as those contained in the American College of Gastroenterology's 1998 practice guidelines. (C) 2000 by Am. Cell. of Gastroenterology.

关键词：数据收集抗药性微生物药物疗法联合健康知识态度实践螺杆菌感染/诊断螺杆菌感染/药物疗法螺杆菌幽门/生理学内科学/教育实习医师和住院医师职务质子泵/拮抗剂和抑制剂成年人人类男(雄)性中年人

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A survey of gastroenterologists' perceptions and practices related to Helicobacter pylori infection

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第11期94卷 3170-3174页

作者： Sharma, VK Vasudeva, R Howden, CW Univ S Carolina Sch Med Div Digest Dis & Nutr Dept Internal Med Columbia SC USA

OBJECTIVE: The aim of this study was to assess the current practice of gastroenterologists in the United States concerning Helicobacter pylori (H. pylori) infection. METHODS: We mailed a structured questionnaire to 1000 gastroenterologists chosen at random from a national database. We asked about personal and practice demographics and practices relating to testing for, and treating, H. pylori infection. RESULTS: A total of 922 questionnaires were delivered, from which we received 286 responses (31%). Respondents used many different tests for H. pylori infection, but only 10% each had used either the C-13- Or C-14-urea breath test. Testing for II. pylori infection was usually for appropriate reasons, although 21% indicated that they might not treat a patient with a positive test result. Different multiple treatment regimens were used;the most frequent were combinations of a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole. Estimates of the prevalence of antibiotic resistance were highly variable and often inaccurate. Most respondents would not check asymptomatic individuals for the infection;however, in the absence of symptoms, 38% would personally undergo testing and treatment if positive. CONCLUSIONS: Gastroenterologists usually test for Ii. pylori infection in appropriate conditions, but may not always treat the infection based on a positive test result. Most use efficacious regimens to treat the infection although many have inaccurate information on resistance rates, which may adversely influence prescribing. Many would have testing and, if positive, treatment in the absence of symptoms or a specific diagnosis, but do not recommend this for their patients. (C) 1999 by Am. Coil. of Gastroenterology.

关键词：阿莫西林/治疗应用抗菌药/治疗应用医务工作者的态度呼吸试验碳同位素碳放射性同位素/诊断应用克拉霉素/治疗应用抗药性微生物酶抑制剂/治疗应用胃肠病学螺杆菌感染/诊断螺杆菌感染/药物疗法螺杆菌幽门甲硝唑/治疗应用青霉素类/治疗应用医师诊疗模式质子泵/拮抗剂和抑制剂问卷调查放射性药物/诊断应用尿素/分析人类

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Accuracy of an enzyme immunoassay for the detection of Helicobacter pylori in stool specimens in the diagnosis of infection and posttreatment check-up

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第9期95卷 2200-2205页

作者： Forné, M Domínguez, J Fernández-Bañares, F Lite, J Esteve, M Galí, N Espinós, JC Quintana, S Viver, JM Hosp Univ Mutua de Terrassa Dept Gastroenterol Barcelona 08021 Spain Hosp Univ Mutua de Terrassa Dept Internal Med Barcelona 08021 Spain Hosp Univ Mutua de Terrassa Dept Microbiol Barcelona 08021 Spain Hosp Univ Germans Trias I Pujol Dept Microbiol Barcelona Spain

OBJECTIVE: The aim of this study was to assess the reliability of a newly developed enzyme immunoassay for Helicobacter pylori-specific antigen detection in stools (HpSA) compared to other standardized diagnostic techniques such as histology (H), rapid urease test (RUT) and C-13-urea breath test (UBT) to diagnose H. pylori infection and to evaluate its usefulness in determining H. pylori status after treatment. METHODS: One hundred eighty-eight patients referred to our department for upper gastrointestinal endoscopy were included. H. pylori infection was confirmed in all patients by HpSA test in stools, RUT, UBT, and H. Patients were defined as positive for H. pylori if RUT and UBT or H were positive. A total of 142 symptomatic patients received eradication treatment and were reassessed 6 wk after therapy;for 70 of these patients, stool samples were also collected at 24 h and 6 months after finishing eradication treatment. In the posttreatment follow-up, UBT was used as gold standard. RESULTS: The sensitivity of HpSA test for the diagnosis of H. pylori infection using a cut-off value of 0.130 was 89.5% and its specificity 77.8%. This specificity was lower than that obtained with UBT, H, and RUT. In the early follow-up the sensitivity of HpSA test was null. At 6 weeks and at 6 months post-treatment its sensitivity was 70.4% and 50% and its specificity was 81.6% and 79.3%, respectively. CONCLUSIONS: The HpSA stool test, using a cut-off value of 0.130, may be useful for the primary diagnosis of H. pylori infection, with sensitivity similar to that obtained with other standard tests, but with less specificity. HpSA test is not useful for early monitoring of treatment efficacy. At 6 wk and at 6 months posttreatment, HpSA test lacks accuracy as compared to UBT for evaluating the outcome of the eradication treatment. (Am J Gastroenterol 2000;95:2200-2205. (C) 2000 by Am. Cell. of Gastroenterology).

关键词：抗菌药抗体细菌/分析抗原细菌/分析诊断鉴别药物疗法联合/治疗应用消化不良/诊断消化不良/药物疗法消化不良/病因学消化不良/微生物学粪便/微生物学胃炎/并发症胃炎/药物疗法胃炎/微生物学胃炎/病理学螺杆菌感染/并发症螺杆菌感染/诊断螺杆菌感染/药物疗法螺杆菌感染/微生物学螺杆菌幽门/免疫学螺杆菌幽门/分离和提纯免疫酶技术/标准观察者偏差可重复性结果回顾性研究敏感性与特异性女(雌)性人类男(雄)性中年人

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