Helicobacter pylori infection as a cause of gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia: a systematic overview.

OBJECTIVE: To develop a predictive index for length of stay in the intensive care unit (ICU) following cardiac surgery. DESIGN: Univariate and multivariate logistic regression analysis of a cohort of 1404 patients divided into a derivation set of 713 patients and a validation set of 691 patients. SETTING: St. Michael's Hospital, Toronto, a tertiary care cardiovascular centre. PATIENTS: A consecutive sample of all patients undergoing cardiac surgery between Jan. 1 and Dec. 31, 1990 (derivation set), and Jan. 1 and Dec. 31, 1991 (validation set). MAIN OUTCOME MEASURE: A long ICU stay (more than 2 days). Other outcomes analysed were ICU stays over 4, 7 and 10 days, and death. RESULTS: In the derivation set increasing age, female sex, left ventricular function, type of surgery, and urgency of surgery were found to be independent risk factors for a long ICU stay in a multivariate logistic regression analysis. A predictive index was created by assigning risk scores based on the odds ratios of the significant variables in the logistic regression analysis. The predictive index was found to predict lengths of ICU stay greater than 2, 4, 7 and 10 days, and patient death in the validation set. CONCLUSIONS: Length of ICU stay and death following cardiac surgery can be predicted with a multivariate predictive index. The index has potential application as a means of stratifying cardiac surgical risk as well as in optimizing ICU resource planning when resources are limited.     

幽门螺杆菌粪便抗原诊断方法的系统评价

目的评价幽门螺杆菌(Hp)粪便抗原诊断Hp感染的价值。方法电子检索以中国生物医学文献数据库、中国生物医学期刊文献数据库、中国学术期刊全文数据库与中文科技期刊全文数据库为主进行文献检索,再根据已发表文献中的参考文献追溯进行手工检索。发表时间截止至2004年3月1日。按确定的纳入标准筛选文献,对纳入的文献进行质量评价,运用Coehrane协作网诊断与筛查小组推荐的SROC曲线法,以敏感性、特异性、准确性、阳性预测值、阴性预测值及似然比等指标行Meta分析。结果19篇文献、3123例符合纳入标准。Hp粪便抗原诊断Hp感染的敏感度及特异度为94％和93％。结论Hp粪便抗原诊断Hp感染简便、无创、准确度高。     

Helicobacter pylori. Basics and clinical overview

The discovery of Helicobacter pylori (H. pylori) has greatly changed the approach to the management of peptic ulcer disease and gastric cancer. A sound knowledge of the basics of H. pylori is an important aid in the diagnosis and treatment of clinical conditions associated with this infection. Gastric carcinoma is estimated to be the world's second most common cancer as a cause of death. It is hoped that gastric cancer can be prevented by H. pylori eradication; however, this issue is still under investigation. Active research is ongoing to highlight the mechanisms by which H. pylori leads to severe gastric diseases as well as finding associations with extra-gastric diseases.     

Helicobacter pylori infection: an overview in 2013, focus on therapy

Objective This article aimed to review the incidence of Helicobacterpylori （H.pylon） infection and its therapy.Data sources Relevant articles published in English were identified by searching in PubMed from 2000 to 2013,with keywords ＂H.pylori＂.Important references from selected articles were also retrieved from Elsevier,Wiley,EBSCO,and SPRINGER.The Chinese articles published were searched from China National Knowledge Infrastructure （CNKI）.Study selection Articles about ＂prevalence＂,＂gastric carcinoma＂,＂peptic ulcer＂,＂gastroesophageal reflux disease＂,＂functional dyspepsia＂,＂pathogenic mechanism＂,＂therapy＂,＂eradication rate＂,＂antibiotic resistance＂,and ＂gene polymorphisms＂ were selected.Results The decreased infection rates of H.pylori could also be linked to the changed disease spectrum,such as the decreased morbidity and recurrence rate of H.pylori-related peptic ulcer,and the increased morbidity of gastroesophageal reflux.Although different treatment regimens have been used for H.pylori infection,the H.pylori eradication rate declined gradually.Due to primary resistance to antibiotics,the gene polymorphism of host and infected strain,and the therapy regimes,H.pylori eradication became even more difficult.Conclusions The prevalence of H.py/ori infection had been decreasing,but the rate of eradication failure has dramatically risen in many countries due to resistance to antibiotic.H.pylori therapy in clinical practice is becoming proqressively more difficult.     

幽门螺杆菌感染治疗的进展

幽门螺杆菌是公认的慢性活动性胃炎、胃十二指肠溃疡、胃黏膜相关淋巴组织淋巴瘤、胃癌等消化系统 疾病的主要致病因素,根除幽门螺杆菌是防治这些疾病的重要措施。近年来,随着克拉霉素及甲硝唑耐药率逐渐上 升,标准三联疗法根除率已小于80%,远远达不到临床要求。在原有传统三联疗法基础上联合益生菌、胃黏膜保护 剂、口腔洁治、中药,可提高胃内幽门螺杆菌根除率。     

Cigarette smoking and Helicobacter pylori infection.

The direct urease test was used in 462 patients with normal upper digestive tracts, 108 with duodenal ulcers and 43 with gastric ulcers who attended for upper digestive endoscopy in a prospective study. There was a strong association between Helicobacter pylori infection and current cigarette smoking in patients with normal endoscopy (49.6% vs 35.5%, P < 0.01). The associations of peptic ulcer both with H. pylori infection and cigarette smoking were also confirmed. The excess of peptic ulcer disease in cigarette smokers may be explained by their increased susceptibility to H. pylori infection.     

幽门螺力感染的治疗

幽门螺杆菌在儿童时期就可以感染胃 ,并引起终生的慢性胃炎 ,而后者可以引起消化性溃疡病。根治幽门螺杆菌的感染就可以根治消化性溃疡1 5。由于在成年人中幽门螺杆菌的再感染非常罕见6 ,因此这种过去呈慢性复发性的严重疾病在经过了充分的治疗后 ,是可以永久根治的。如果溃疡没有复发 ,也没有溃疡穿孔或出血 ,病人的生命质量可以提高7,病假减少 ,因看病和购买药物导致的花费也会减少。在设计幽门螺杆菌的治疗方案时 ,抗生素的耐药问题需要加以考虑8。过去的10多年里 ,人们提出了多种不同的治疗方法和建议。变化之快 ,使许多医生迷失了方向 …     

含铋剂四联一线治疗方案根除幽门螺杆菌疗效观察

目的:评价含铋剂四联方案(耐信+克拉霉素+阿莫西林+丽珠得乐)治疗消化性溃疡或慢性胃炎Hp感染患者的疗效,寻找高效、经济的一线Hp根除方案.方法:①136例消化性渍疡或慢性胃炎Hp感染初治患者,随机分为四联组(67例)和三联组(69例);四联组采用埃索美拉唑20 mg+克拉霉素缓释0.5 g+阿莫西林1.0 g+枸橼酸铋钾胶囊220 mg/d,三联组采用埃索美拉唑20 mg+克拉霉素缓释片0.5 g+阿莫西林1.0 g/d,7 d为1疗程.②采用14C-UBT检测Hp根除率.③按ITT和PP分析,计算成本-效果比(C/E)及增量成本-效果比(△C/AE).结果:四联组Hp根除率为88.71%,三联组Hp根除率为73.02%,两组比较差异有统计学意义(P<0.05).四联组和三联组成本.效果比分别为4.15和4.82,含铋荆四联相对于标准三联方案增量成本-效果比为1.02.结论:Hp根除率含铋荆四联方案较标准三联方案高,可推荐为经济、高效的一线治疗方案.     

幽门螺杆菌感染治疗现状与挑战

幽门螺杆菌(Helicobaeler pylori,Hp)的发现已超过27年,由于Hp感染不仅与胃肠道疾病还与某些胃肠道外疾病关系密切,所以被人们广泛关注,而Hp感染治疗的研究则成为了该领域中的热点,也是临床医生最关注和最感兴趣的临床问题.     

Novel agent for Helicobacter pylori infection management

Tto the editor： We read with interest several papers discussing the role of Helicobacter pylori （H. pylori） in gastric disease.This infecting organism is so important due to its etiological and pathogenetic role in gastroduodenal ulcer disease, gastric carcinoma, MALT lymphoma, and other diseases of the stomach and other organs. Complex, expensive and not convenient for use in many parts that the infection is endemic, resistance to common antibiotics has made numerous lifelong H. pylori infections complicating the management of them. This is also due to the lack of effective therapeutic interventions or vaccines.     

Kang wei granules in treatment of gastropathy related to Helicobacter pylori infection.

Kang Wei Granules, a granular preparation for strengthening the spleen and replenishing Qi and for clearing away heat and resolving dampness, was used in the treatment of 288 cases of gastropathy related to Helicobacter pylori infection. The effects were compared with De Nol triple therapy in the control group of 74 cases. The therapeutic results showed that Kang Wei Granules was superior to the western drugs in improving the principal symptoms of deficiency of the spleen and stomach, and retention of damp-heat in the interior (P < 0.05).     

Carbohydrates in Helicobacter pylori infection

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胃癌前病变与幽门螺杆菌感染

目的了解胃癌前病变组织Hp感染状况.方法采用美蓝染色检测126例慢性浅表性胃炎(CSG)、88例慢性萎缩性胃炎(CAG)、73例肠上皮化生(IM)、32例不典型增生(Dys)胃粘膜Hp感染状况.观察胃粘膜炎症反应程度.结果Hp感染率在CAG(65.9%)、IM(63.0%)、Dys(62.5%)组显著高于CSG(42.1%)组(P＜0.05;P＜0.01,P＜0.01)轻度及中度CAG(78.9%,70.4%)显著高于重度CAG组(39.1%)(I＜0.01,P＜0.05);轻度及中度IM(80%,69.6%)显著高于重度IM组(30%)(P＜0.01).胃粘膜单个核细胞、分叶核细胞浸润程度Hp阳性组较Hp阴性组显著增多(I＜0.01).结论Hp感染引起胃粘膜炎症反应,在胃癌前病变的发生中起着重要作用.随着胃粘膜萎缩和肠化的加重.Hp难于生存,其致病性减弱.     

Helicobacter pylori: a Jordanian study.

The prevalence of Helicobacter pylori in patients with upper gastrointestinal symptoms in the north of Jordan was studied prospectively. The occurrence of H. pylori was documented histologically and bacteriologically in 169 patients attending endoscopy for upper gastrointestinal symptoms. Our results showed that H. pylori was present in 70% of patients with acute gastritis, 73% of patients with chronic gastritis, 68% of patients with acute on chronic gastritis, 83% of patients with duodenal ulceration, 75% of the patients with gastric ulceration, 64% of patients with no pathology, and 68% of patients regardless of the pathology found. There was a sharp rise in the prevalence of H. pylori with age, up to the age of 40 years with an annual increase in the prevalence of 2%. This study shows that the prevalence of H. pylori in Jordan is similar to that seen in other developing countries with infections occurring at a lower age and with the annual infection rate being double that seen in developed countries.     

防治幽门螺杆菌感染是预防胃癌的必经之路

我国是消化道肿瘤高发国家,也是胃癌发病率和幽门螺杆菌感染率的双高国家。H. pylori是胃癌的明确致癌物,同时也是胃癌最重要的可控危险因素。根除H. pylori的时机选择越早越好,对于已发生肠化生的患者通过根除H. pylori也可获益。H. pylori感染的管理策略已经从“检测和治疗”、“筛查和治疗”向“以家庭为单位防控”转变。筛查并根除H. pylori是降低我国胃癌发生率的可行途径。     

Diagnosis of Helicobacter pylori infection： A meta-analysis

Objective： To evaluate effects of diagnostic tests for Helicobacter pylori （H. pylori） infection. Methods ： A meta-analysis was conducted in 22 identified studies through Chinese literature searching which were published after 1995 and evaluated diagnostic tests for Helicobacter pylori （H. pylori） infection. Results： Polymerase chain reaction （PCR） had the best performance with diagnostic odds ratio （DOR） of 6.7 （5. 5-7. 8）, followed by ^13C urea breath test and Enzyme-linked immunosorbent assay （ELISA） quantitative serological test, with DOR being 6.4 （5.4-7. 4） and 4.5 （3. 8-5.2）, respectively. Conclusion： Non-invasive tests are the appropriate methods for screening H. pylori infection, whereas invasive tests are the best methods for ascertaining the suspected patients.