根除幽门螺杆菌对功能性消化不良的影响

Eradication of Helicobacter pylori in functional dyspepsia: a long term follow-up study

目的 通过长期随访观察根除幽门螺杆菌 (Helicobacterpylori,Hp)后功能性消化不良(FD)者的症状能否得到缓解 ,阐明Hp与FD的关系。 方法 6 0例Hp感染的FD患者参加本次研究。运用改良的Glasgow评分表对患者的症状进行评分 (范围 :0～ 10分 )。所有病例随机分为三组抗Hp治疗。A组口服RBC(雷尼替丁枸橼酸铋 ) 4 0 0mg、阿莫西林 1g和呋喃唑酮 10 0mg各每日 2次。B组口服阿莫西林 1g和呋喃唑酮 10 0mg各每日 2次。C组口服RBC 40 0mg、克拉霉素 2 5 0mg和甲硝唑 40 0mg各每日 2次。总疗程均为 7d ,治疗后随访 2年。在治疗后第 4周及随访 2年后行13 C 尿素呼气试验 ,并于随访末再次对症状评分。结果 全部患者完成治疗。 42例Hp得以根除 ,18例抗Hp治疗失败。 2年后 5 4例完成复查 ,6例失访。其中 39例为Hp根除者 (39/ 5 4)。另 15例为抗Hp治疗失败者 ,其中 7例在 2年中曾自行接受追加的抗Hp治疗后为阴性 ,8例仍Hp阳性。 39例根除者中未发现复发病例。大部分的患者症状评分均有改善 ,但持续感染者评分高于根除者。在根除者中 ,平均症状评分从4.90减为 2 .38,差异有显著性 (P <0 .0 5 )。而持续感染者从 5 .0 0减至 3.0 0 ,差异无显著性 (P >0 .0 5 )。结论 通过长期随访 ,我们发现根除Hp可在较长时间内仍改?

Objective The relationship between Helicobacter pylori(H.pylori) infection and functional dyspepsia(FD) is uncertain. The aim of the study was to determine whether eradication of H.pylori would relieve the symptoms in dyspepsia. Methods Sixty cases of FD with H.pylori infection were recruited. The severity of symptoms was scored according to modified Glasgow method (range from 0 to 10). All patients were randomly enrolled into either group A(RBC 400 mg b.d, amoxycillin 1 g b.d and furazolidone 100 mg b.d for 7 days), group B (amoxycilin 1 g b.d and furazolidong 100 mg b.d for 7 days), or group C(RBC 400 mg b.d, clarithromycin 250 mg b.d and metronidazole 400 mg b.d for 7 days). Follow up study was carried out for up to 2 years. The status of H.pylori infection was determined by 13 C urea breath test at 4th week and 24th month after the eradication therapy. Results H.pylori was eradicated in 42 cases and remained positive in 18 cases. At 2 years after therapy, 54 cases were followed up (39 cases from eradicated group vs. 15 cases from remaining positive group). No recurrence was found in eradicated patients. Seven H.pylori positive cases turned to negative because of additional anti H.pylori rescue therapy during follow up period. Most of eradicated patients showed improvement in symptomatic score, and the patients with persistent H.pylori infection had a high score than those who were eradicated. Although the mean symptom score reduced in both groups, the difference was statistically significant only in eradicating group( P <0.05). Conclusions Eradication of H.pylori in functional dyspepsia improves symptoms after two years. Our results indicate that eradication therapy for patients with H.pylori positive functional dyspepsia is effective, since it improves symptoms and decreases health care costs by reducing the number of subsequent visit to doctors and treatment.