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dual therapy for Helicobacter pylori infection

Chinese Medical Journal 2023年第1期136卷 13-23页

作者： Miao Duan Jing Liu Xiuli Zuo Department of Gastroenterology Qilu Hospital of Shandong UniversityJinanShandong 250012China Laboratory of Translational Gastroenterology Qilu Hospital of Shandong UniversityJinanShandong 250012China Robot Engineering Laboratory for Precise Diagnosis and therapy of Gastrointestinal Tumor Qilu Hospital of Shandong UniversityJinanShandong 250012China

Bismuth-containing quadruple therapy(BQT)has long been recommended for Helicobacter pylori(H.pylori)eradication in China.Meanwhile,in the latest national consensus in China,dual therapy(DT)comprising an acid suppressor and amoxicillin has also been recommended.In recent years,the eradication rate of H.pylori has reached>90%using DT,which has been used not only as a first-line treatment but also as a rescue treatment.Compared with BQT,DT has great potential for H.pylori eradication;however,it has some limitations.This review summarizes the development of DT and its application in H.pylori eradication.The H.pylori eradication rates of DT were comparable to or even higher than those of BQT or standard triple therapy,especially in the first-line treatment.The incidence of adverse events associated with DT was lower than that with other therapies.Furthermore,there were no significant differences in the effects of dual and quadruple therapies on gastrointestinal microecology.In the short term,H.pylori eradication causes certain fluctuations in the gastrointestinal microbiota;however,in the long term,the gastrointestinal microbiota eventually returns to its normal state.In the penicillin-naïve population,patients receiving DT have a high eradiation rate,better compliance,lower incidence of adverse reactions,and lower primary and secondary resistance to amoxicillin.These findings suggest the safety,efficacy,and potential of DT for H.pylori eradication.

关键词： dual therapy Gastrointestinal microbiome Helicobacter pylori Quadruple therapy

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Is dual therapy the correct strategy in frail elderly patients with atrial fibrillation and acute coronary syndrome?

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Journal of Geriatric Cardiology 2020年第1期17卷 51-57页

作者： Alessio Menditto Roberto Antonicelli Cardiology Unit Italian National Research Centre on Aging

Atrial fibrillation(AF)is a very common arrhythmia in clinical practice.Its incidence and prevalence are age-related and are growing in the last years.Age is a risk factor also for coronary artery disease(CAD),and with the evolution of preventive care,the first event(acute coronary syndrome(ACS)or percutaneous coronary intervention(PCI))takes place at a later age.If elderly patients with AF and CAD undergo ACS or PCI,they have indication to assume triple therapy.Triple therapy(oral anticoagulation(OAC)plus dual antiplatelet therapy(DAPT))exposes patients to high bleeding risk.In the last 10 years,several clinical trials have tested dual therapy(OAC plus single antiplatelet therapy)in AF patients who undergo ACS or elective PCI.WOEST trial has tested warfarin+clopidogrel against triple therapy.PIONEER AF-PCI trial has tested low-dose rivaroxaban+P2Y12 inhibitor or very low-dose rivaroxaban+DAPT against standard triple therapy with warfarin.RE-dual PCI trial has tested two doses of dabigatran+P2Y12 inhibitor against standard triple therapy with Warfarin.AUGUSTUS trial has tested apixaban against warfarin both in dual therapy with P2Y12 inhibitor and in triple therapy with a P2Y12 inhibitor and aspirin.ENTRUST-AF PCI,last published study,has tested edoxaban+P2Y12 inhibitor against triple therapy.All these trials show dual therapy reduces significantly bleeding risk than triple therapy.In this paper,we analyze these clinical trials to understand if dual therapy results can be applied to elderly patients and what is probably the better approach in elderly AF patients undergo to ACS or PCI.

关键词： Acute coronary syndrome Atrial fibrillation dual therapy Oral anticoagulation The elderly

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