Hp根除在消化不良病人使用中治療作用有限
早前的有些關(guān)于非潰瘍性消化不良病人,，施以根除幽門螺旋桿菌的方法收效甚微。近來的兩項研究結(jié)果如下：
一項多中心臨床研究,，加拿大研究者共收集了157例病人的資料,。病人的入選標準為（1）慢性或急性腹痛，（2）胃鏡檢查無消化性潰瘍,，（3）Hp檢測尿素呼氣試驗陽性,。病人被隨機納入接受Hp根除治療組或安慰劑治療組。Hp活動治療組幽門螺旋桿菌滅菌治療根除率為82%,。經(jīng)過一年的隨訪,，兩組消化不良指數(shù)、癥狀改善病人比例以及抑酸藥的使用均無明顯差異,。
另一項研究,，西雅圖研究者共收集了432例病人的資料。病人使用H2受體拮抗劑或質(zhì)子泵抑制劑,；Hp陽性,；既往有消化不良或消化性潰瘍史，但無食道反流史,。所有病人均接受Hp滅菌治療。結(jié)果表明,，在滅菌治療后,，與前一年比較，患者使用胃腸道疾病相關(guān)的藥品及治療總費用并沒有明顯下降,。然而,，以前患有消化性潰瘍但無食道反流以及早先使用過長期抑酸藥物小樣本亞群組病人，其滅菌治療卻降低了使用藥物的成本,。
評價：這些研究印證了此前的結(jié)論,，即Hp滅菌治療不會緩解消化內(nèi)鏡已排除的消化性潰瘍引起的消化不良癥狀。然而,，對于Hp陽性既往有潰瘍病史或Hp處在活動期但非潰瘍的病人,，可能從Hp滅菌治療中獲益。
資料來源：
1． Veldhuyzen van Zanten S et al. Absence of symptomatic benefit of lansoprazole, clarithromycin, and amoxicillin triple therapy in eradication of Helicobacter pylori positive, functional (nonulcer) dyspepsia. Am J Gastroenterol 2003 Sep; 98:1963-9.
2． Kearney DJ et al. The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia. Am J Gastroenterol 2003 Sep; 98:1952-62.
（風(fēng)雪來 譯）
Limited Effect of H. pylori Eradication in Dyspeptic Patients
In several studies of patients with nonulcer dyspepsia, eradication of Helicobacter pylori has yielded little benefit. Results of 2 new studies add to the literature.
In a multicenter study, Canadian researchers enrolled 157 patients with chronic or frequent epigastric pain, no endoscopic evidence of peptic ulcer, and positive urease and breath tests for H. pylori infection. Patients were randomized to receive either H. pylori eradication therapy or placebo; the eradication rate was 82% in the actively treated group. During 1 year of follow-up, no significant differences between groups were noted in dyspepsia scores, proportions of patients with improved symptoms, or use of acid-reducing medications.
In another study, Seattle researchers enrolled 432 patients who used H2-blockers or proton-pump inhibitors (according to a pharmacy database), tested positive (serologically) for H. pylori infection, and reported histories of dyspepsia or previous peptic ulcer but not reflux alone. All patients received H. pylori eradication therapy. During the year after eradication, medication costs and total costs related to gastrointestinal disease were not reduced significantly compared with those during the previous year. However, in a small subgroup of patients who had previously documented peptic ulcer and no reflux symptoms and who had received chronic acid-suppressive therapy, eradication therapy reduced medication costs.
Comment: These findings reinforce previous research that suggested that H. pylori eradication did not relieve dyspepsia if peptic ulcer had been excluded by endoscopy. However, some uninvestigated patients who are H. pylori positive have previously documented ulcers or active but undiagnosed ulcers: Eradication therapy could be beneficial in such patients.
— Allan S. Brett, MD
Source
Veldhuyzen van Zanten S et al. Absence of symptomatic benefit of lansoprazole, clarithromycin, and amoxicillin triple therapy in eradication of Helicobacter pylori positive, functional (nonulcer) dyspepsia. Am J Gastroenterol 2003 Sep; 98:1963-9. [Medline abstract][Download citation]
Kearney DJ et al. The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia. Am J Gastroenterol 2003 Sep; 98:1952-62. [Medline abstract][Download citation]
