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Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection

World Journal of Gastroenterology 2012年第33期18卷 4542-4548页

作者： Giuliana Sereni Francesco Azzolini Lorenzo Camellini Debora Formisano Francesco Decembrino Veronica Iori Cristiana Tioli maurizio cavina Francesco Di Mario Giuliano Bedogni Romano Sassatelli Unit of Gastroenterology and Digestive Endoscopy Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico 42123 Reggio Emilia Italy Statistics and Clinical Epidemiology Unit Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico 42123 Reggio Emilia Italy Unit of Gastroenterology Ospedale S. Maria di Ca' Foncello 31100 Treviso Italy

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.

关键词： Helicobacter pylori Eradication treatment Rescue therapy Eradication rate Triple therapy Firstline therapy Second-line therapy

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