根除幽门螺旋杆菌治疗对消化性溃疡患者胃泌素表达的影响

目的探究根除幽门螺旋杆菌治疗对消化性溃疡患者胃泌素表达的影响。方法选取2019年9月至2020年9月锦州市第二医院收治的120例消化性溃疡患者作为研究对象,随机分为根除组(n=65)与对照组(n=55)。对照组予以常规的抑酸、降酸、胃黏膜保护等治疗措施,根除组在对照组治疗基础上予以根除幽门螺旋杆菌治疗,比较两组临床疗效、幽门螺旋杆菌根除情况、治疗前后胃泌素水平、胃泌素基因表达。结果根除组治疗总有效率为92.31%,高于对照组的78.18%,差异有统计学意义(P<0.05)。根除组幽门螺旋杆菌根除率为75.38%,高于对照组的56.36%,差异有统计学意义(P<0.05)。治疗前,两组胃泌素水平比较差异无统计学意义;治疗后,两组胃泌素水平均低于治疗前,且根除组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组胃泌素基因表达比较差异无统计学意义;治疗后,两组胃泌素基因表达均低于治疗前,且根除组低于对照组,差异有统计学意义(P<0.05)。结论根除幽门螺旋杆菌治疗消化性溃疡疗效确切,能显著提高根除幽门螺旋杆菌根除率,降低胃泌素水平及其基因表达,值得临床推广应用。

探讨小建中汤联合抗幽门螺旋杆菌治疗脾胃虚寒型消化性溃疡的临床疗效

探究在脾胃虚寒型消化性溃疡患者治疗过程中采用小建中汤与抗幽门螺旋杆菌治疗对患者临床疗效的影响。方法:在2018年1月~2019年1月期间医院收治的脾胃虚寒型消化性溃疡患者中选取150例分两组,其中,对照组行西药治疗,研究组对对照组基础上采用小建中汤进行联合治疗,对比临床效果。结果:研究组有效率高于对照组;在幽门螺旋杆菌(Helicobacter pylori, Hp)清除效果方面,研究组优于对照组;在复发情况方面,研究组复发率低于对照组。结论:在脾胃虚寒型消化性溃疡患者治疗过程中,采用小建中汤与抗幽门螺旋杆菌治疗进行联合治疗,有利于提升患者治疗效果,值得推广。

胃黏膜相关淋巴组织淋巴瘤bcl-10核表达与抗幽门螺旋杆菌治疗的长期随访研究

目的探讨抗幽门螺旋杆菌(Hp)治疗胃黏膜相关淋巴组织(MALT)淋巴瘤的远期效果及bcl-10在肿瘤对抗Hp治疗的反应性判断中的意义。方法选择12例Hp阳性胃MALT淋巴瘤,用免疫组化的方法检测肿瘤细胞bcl-10表达的情况,给予规范抗Hp治疗,并密切进行内窥镜随访。结果在单纯抗Hp治疗后6例获得完全缓解(CR),无一例检测到bcl-10核表达。余6例未达CR的病例中4例检测到bcl-10核表达。提示瘤细胞存在bcl-10的核表达,证明肿瘤的发展已与Hp作用无关,也提示临床,目前抗Hp治疗并非此类患者的首选治疗方案。这12例单纯抗Hp治疗CR率为50%(6/12),中位随访时间13.5个月。抗Hp后获得CR中位时间1.5个月,最长为6个月。至今,CR持续中位时间为14个月,最长达2年。结论抗Hp治疗可以使相当一部分胃MALT淋巴瘤患者获得CR,bcl-10核表达可能与肿瘤对抗Hp治疗不反应密切相关,但需进一步扩大样本量及延长随访时间证实。

碳14呼吸试验阳性患者与家庭成员同期抗幽门螺旋杆菌治疗必要性研究

研究碳14呼吸试验阳性患者与家庭成员同期抗幽门螺旋杆菌治疗的必要性。方法:随机数字表法将上海市浦东新区三林康德社区卫生服务中心于2021年筛查的62例碳14呼吸试验阳性患者分为同期组38例和非同期组24例,对比两组受试患者与家庭成员是否同期进行抗幽门螺旋杆菌诊治后幽门螺旋杆菌的根除情况。结果:同期组幽门螺旋杆菌转阴率明显高于非同期组,非同期组复阳率明显高于同期组,同期组与非同期组组间对比差异统计学意义存在(P<0.05)。结论:对碳14呼吸试验阳性患者与家庭成员同期抗幽门螺旋杆菌治疗及其必要,可以有效治疗患者的幽门螺旋杆菌,提高患者治疗率,减少患者复阳率发生,对预防和治疗幽门螺旋杆菌感染有积极意义。

影响幽门螺旋杆菌初治疗效的多因素分析

目的探讨年龄、性别、文化程度、病程等多种因素对初次治疗幽门螺旋杆菌的多因素分析。方法随机选取2014年7月至2016年8月432例初次抗HP治疗的患者作为研究对象,通过对年龄、性别、文化程度、服药疗程等多方面进行统计分析。结果HP根除情况:<40岁、40~59岁和≥60岁三个年龄段中,男性和女性的HP根除率比较,差异均无统计学意义(P>0.05)。男性和女性在不同年龄段的HP根除率比较,差异均有统计学意义(P<0.05),60岁及以上患者的HP根除率高于其他年龄段患者。治疗依从性:<40岁、40~59岁和≥60岁三个年龄段患者的抗HP治疗依从性比较结果显示,60岁及以上患者完全依从的比例高于其他年龄段患者,依从性较差的比例低于其他年龄段患者,差异有统计学意义(P<0.05)。结论年龄大、文化程度高的患者依从性更高。

消化内镜联合幽门螺杆菌治疗胃溃疡出血的临床疗效评价

探讨对胃溃疡出血患者,采纳消化内镜联合幽门螺旋杆菌治疗,观察评价其临床疗效。方法 研究时段设置在2022年3月-2023年3月,从绍兴市中心医院医共体马鞍分院内科随机性质选取临床以胃溃疡出血为诊断的患者共计入108例作为研究观察群体,将其按照治疗方式的不同分为2组,即对照组(n=54例,对其予以幽门螺旋杆菌四联疗法治疗)与观察组(n=54例,在对照组基础状况下实施消化内镜治疗)。结果 组别所开展的治疗有效率落实评估统计,观察组更高(P<0.05)。组别落实的不良反应事件率统计呈现数据,观察组更低(P<0.05)。予以对组别患者的病情改善情况实施观测,显示观察组的止血时间观测值、临床症状消失均为更低(P<0.05)。落实对两组的再出血发生率、抗幽门螺杆菌清除率开展统计工作,显示观察组前者为更低,后者的数据显示为更高(P<0.05)。结论 临床施以落实消化内镜+幽门螺旋杆菌四联疗法两种有效治疗方式,积极应用于胃溃疡出血病例,可助于提高疗效,不良反应事件率更低,病情症状利于改善,降低在出血率,提高抗幽门螺杆菌清除率,治疗作用显著。

两疗程法清除幽门螺旋杆菌感染对降低十二指肠溃疡远期复发率的效果观察

目的 :观察两疗程法清除幽门螺旋杆菌 (HP)对十二指肠溃疡远期复发率的效果。方法 :将 HP感染合并十二指肠溃疡的 1 1 1例患者随机分为 2组 ;A组 55例 ,用法莫替丁、阿莫西林、甲哨唑、维敏胶囊联合用药 ,疗程 2周 ;B组 56例 ,用药同前 ,半年后重复治疗 2周。完成治疗后 ,分别在 6、1 2、1 8和 2 4月复查胃镜及 HP PCR检测。结果 :A组四个时间段十二指肠溃疡复发率分别为 1 .9%、9.4%、3.8%、3.8% ,2 a总复发率 1 8.9% ;B组为 0 %、1 .8%、1 .8%、1 .8% ,2 a总复发率 5.4%。两组比较 ,B组复发率明显低于 A组 (P<0 .0 5)。结论 :两疗程法清除 HP能明显降低十二指肠溃疡的远期复发率。

Trends in the eradication rates of Helicobacter pylori infection for eleven years

AIM:To evaluate the trends in the eradication rate of Helicobacter pylori(H.pylori) over the past 11 years in a single center.METHODS:This retrospective study covered the period from January 2000 to December 2010.We evaluated 5746 patients diagnosed with gastric ulcers(GU),duodenal ulcers(DU),GU + DU,or nonpeptic ulcers associated with an H.pylori infection.We treated them annually with the 2 wk standard first-line triple regimen,proton pump inhibitor(PPI) + amoxicilin + clarithromycin(PAC;PPI,clarithromycin 500 mg,and amoxicillin 1 g,all twice a day).The follow-up test was performed at least 4 wk after the completion of the 2 wk standard H.pylori eradication using the PAC regimen.We also assessed the eradication rates of 1 wk second-line therapy with a quadruple standard regimen(PPI b.i.d.,tripotassium dicitrate bismuthate 300 mg q.i.d.,metronidazole 500 mg t.i.d.,and tetracycline 500 mg q.i.d.) after the failure of the first-line therapy.Statistical analysis was performed with 95%CI for the differences in the annual eradication rates.RESULTS:A total of 5746 patients [2333 males(58.8%),1636 females(41.2%);mean age of males vs females 51.31 ± 13.1 years vs 52.76 ± 13.6 years,P < 0.05,total mean age 51.9 ± 13.3 years(mean ± SD)] were investigated.Among these patients,1674 patients were excluded:35 patients refused treatment;18 patients ceased H.pylori eradication due to side effects;1211 patients had inappropriate indications for H.pylori eradication,having undergone stomach cancer operation or chemotherapy;and 410 patients did not undergo the follow-up.We also excluded 103 patients who wanted to stop eradication treatment after only 1 wk due to poor compliance or the side effects mentioned above.Finally,we evaluated the annual eradication success rates in a total of 3969 patients who received 2 wk first-line PAC therapy.The endoscopic and clinical findings in patients who received the 2 wk PAC were as follows:gastric ulcer in 855(21.5%);duodenal ulcer in 878(22.1%);gastric and duodenal ulcer in 124(3.1%),erosive,atrophic gastritis and functional dyspepsia in 2055(51.8%);and other findings(e.g.,MALToma,patients who wanted to receive the therapy even though they had no abnormal endoscopic finding) in 57(0.5%).The overall eradication rate of the 2 wk standard firstline triple regimen was 86.5%.The annual eradication rates from 2000 to 2010 were 86.7%,85.4%,86.5%,83.3%,89.9%,90.5%,88.4%,84.5%,89.1%,85.8%,and 88.3%,sequentially(P = 0.06).No definite evidence of a significant change in the eradication rate was seen during the past eleven years.The eradication rates of second-line therapy were 88.9%,82.4%,85%,83.9%,77.3%,85.7%,84.4%,87.3%,83.3%,88.9%,and 84%(P = 0.77).The overall eradication rate of 1 wk quadruple second-line therapy was 84.7%.There was no significant difference in the eradication rate according to the H.pylori associated diseases.CONCLUSION:This study showed that there was no trend change in the H.pylori eradication rate over the most recent 11 years in our institution.

InIncidence and clinical features of endoscopic ulcers developing after gastrectomy

AIM： To determine the precise incidence and clinica features of endoscopic ulcers following gastrectomy. METHODS： A consecutive series of patients who un- derwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed. A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled. We analyzed differences in patient age, sex, size of the le- sions, method of operation, indications for gastric resec- tion, and infection rates of Helicobacterpylor/（H. pylor/~ between the nonulcer and ulcer groups. RESULTS： The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%. Ulcers were more common in patients with Billroth l] anastomosis and pre-existing conditions forpeptic ulcer disease （PUD）. Infection rates of H. pylori- did not differ significantly between the two groups. The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission. CONCLUSION： H. pylori was not an important factor in ulcerogenesis following gastrectomy. For patients who underwent surgery for PUD, clinical course of mar- ginal ulcers was more severe.

Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection

AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication. METHODS: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test(UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d. RESULTS: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and thirdline therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate. CONCLUSION: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and secondline treatment can still be triple therapy with amoxicillin and tinidazole.

Gastroenterostoma after Billroth antrectomy as a premalignant condition

Gastric stump carcinoma （GSC） following remote gastric surgery is widely recognized as a separate entity within the group of various types of gastric cancer. Gastrecto- my is a well established risk factor for the development of GSC at a long time after the initial surgery. Both exo- as well as endogenous factors appear to be involved in the etiopathogenesis of GSC, such as achlorhydria, hypergastrinemia and biliary reflux, Epstein-Barr virus and Helicobacter pylori infection, atrophic gastritis, and also some polymorphisms in interleukin-l~ and maybe cyclo-oxygenase-2. This review summarizes the litera- ture of GSC, with special reference to reliable early di- agnostics. In particular, dysplasia can be considered as a dependable morphological marker. Therefore, close endoscopic surveillance with multiple biopsies of the gastroenterostomy is recommended. Screening start- ing at 15 years after the initial ulcer surgery can detect tumors at a curable stage. This approach can be ofspecial interest in Eastern European countries, where surgery for benign gastroduodenal ulcers has remained a practice for a much longer time than in Western Eu- rope, and therefore GSC is found with higher frequency.

Quadruple therapy with moxifloxacin and bismuth for first-line treatment ofHelicobacter pylori

AIM:To compare triple therapy vs quadruple therapy for 10 d as first-line treatment ofHelicobacter pylori(H.pylori) infection.METHODS:Consecutive H.pylori positive patients never treated in the past for this infection were randomly treated with triple therapy of pantoprazole(PAN) 20 mg bid,amoxicillin(AMO) 1 g bid and moxifloxacin(MOX) 400 mg bid for 10 d(PAM) or with quadruple therapy of PAN 20 mg bid,AMO 1 g bid,MOX 400 mg bid and bismuth subcitrate 240 mg bid for 10 d(PAMB).All patients were found positive at 13 C-Urea breath test(UBT) performed within ten days prior to the start of the study.A successful outcome was confirmed with an UBT performed 8 wk after the end of treatment.χ 2 analysis was used for statistical comparison.Per protocol(PP) and intention-to-treat(ITT) values were also calculated.RESULTS:Fifty-seven patients were enrolled in the PAM group and 50 in the PAMB group.One patient in each group did not return for further assessment.Eradication was higher in the PAMB group(negative:46 and positive:3) vs the PAM group(negative:44 and positive:12).The H.pylori eradication rate was statistically significantly higher in the PAMB group vs the PAM group,both with the PP and ITT analyses(PP:PAMB 93.8%,PAM 78.5%,P < 0.02;ITT:PAMB 92%,PAM 77.1 %,P <0.03).CONCLUSION:The addition of bismuth subcitrate can be considered a valuable adjuvant to triple therapy in those areas where H.pylori shows a high resistance to fluoroquinolones.