老年人幽门螺旋杆菌感染与反流性食管炎的相关性临床观察

Clinical observation on a correlation between Helicobacter pylori infection and reflux esophagitis in the elderly

目的通过根除幽门螺杆菌，观察幽门螺杆菌感染与老年反流性食管炎的临床相关性。方法前瞻性研究，连续入选2010-2016年在我院临床诊断反流性食管炎老年患者180例，其中无幽门螺杆菌感染组（未感染组）78例，幽门螺杆菌感染组（感染组）102例；感染组数字抽签随机分成两组（各51例）。单药组给予艾司奥美拉唑20mg，3次／d口服，疗程为8周；多药组在艾司奥美拉唑20mg，3次／d口服基础上加用阿莫西林1000mg，3次／d口服，克拉霉素500mg／次，3次／d口服或甲硝唑400mg，3次／d口服（3种抗生素选2种），同时联合应用胶体铋剂，200mg3次／d，餐前口服，应用2周。治疗前和治疗后行内镜、检测幽门螺杆菌及24h食管pH抗监测检查。结果治疗后3组患者症状改善总有效率均达95．0％以上（P〈0．05）；内镜下3组反流性食管炎患者总有效率均84．6％、80．4％、82．4％（66／78、41／51、42／51）以上（P〈0．05）；3组患者24h食管pH监测有显著改善（P〈0．05），但3组间差异无统计学意义（P〉0．05）。多药组根除幽门螺杆菌治疗后幽门螺杆菌转阴率为90．2％（46／51）。结论幽门螺杆菌感染的反流性食管炎老年患者，可进行抗幽门螺杆菌治疗但需同时进行抑制胃酸的系统治疗，可有效预防反流性食管炎进展。

Objectives To study a correlation between Helieobacter pylori Infection and reflux esophagitis in the elderly. Methods In a prospective study, 180 cases of elderly patients with confirmed diagnosis of reflux esophagitis were consecutively recruited in our hospital from 2010-2016 years. 180 reflux esophagitis patients were divided into three groups：non-HP infection group（group A, n： 78）,and 102 HP infection patients were subdivided into B1 group（n= 51）with single-drug therapy and B2 group（n= 51）with multiple drugs therapy. The groups A and B1 were treated with only esomeprazole 20 mg/bid for 8 weeks. The group B2 was treated with esomeprazole 20 mg/bid for 8 weeks,colloidal bismuth 200 rag/bid for 2 weeks plus two kinds of antibiotics（taking any 2 of the following 3：Amoxicillin 1 000 mg/bid, Clarithromycin 500 rag/bid and tinidazole 500 mg/bid）for 2 weeks. Gastroscope and cognate biopsy, helicobacter pylori detection, and 24 h esophagus pH monitoring was performed before and after the therapy. Results Group A,B1 and B2 showed that the total effective rate of symptoms improvement were more than 95.0% in post-versus pre-treatment （P〈0.05）, the gastro scope evidence-based total effective rate of reflux esophagitis were 84.6%. 80.4%.82.4% （66/78, 41/51, 42/51） after therapy （P〈 0.05）, and 24 h esophagus pH was significantly improved （P 〈 0.05 ）after therapy. But the differences in above indexes showed no statistical significance between three groups （P 〉 0.05 ）. After HP eradication therapy, HP negative rate was 90. 2%（46/51）in multiple drugs group. Conclusions Reflux esophagitis in elderly patients with Helicobacter pylori infection can be treated with anti-HP drugs, but the treatment should include drugs inhibiting gastric acid,so as to effectively prevent the progress of reflux esophagitis. There is no clear correlation between irritation of esophagus by reflux contents and Helicobacter pylori infection.