Eradication of 'ooHelicobacter pylori'ox : an objective assessment of current therapies

The purpose of the present review was to determine objectively the optimal treatment for the eradication of H. pylori amongst the currently used regimens. A comprehensive literature search provided a data-base relating to the following treatments: dual therapy with an anti-secretory drug plus either amoxycillin or clarithromycin; standard triple therapy, with or without additional anti-secretory drugs; proton pump inhibitor triple therapy; and H₂-receptor antagonist triple therapy. Emphasis was placed on intention-to-treat analyses of eradication rates using all of the available evidence. The criteria used to select the optimal treatment were efficacy (eradication rates), frequency of side-effects, simplicity of the regimen (number of tablets per day and duration of treatment) and cost. The analysis showed that proton pump inhibitor triple therapy (that is, a proton pump inhibitor plus any two of amoxycillin, clarithromycin or a nitroimidazole) was the preferred treatment for the eradication of H. pylori . In particular, the 1-week, low-dose regimen with omeprazole plus clarithromycin plus tinidazole produced the highest eradication rates (>90%) with the lowest frequency of side-effects and at only modest cost.     

Change in apoptosis in the gastric surface epithelium and glands after eradication of Helicobacter pylori

BACKGROUND: Change in apoptosis in gastric glands after eradication of Helicobacter pylori has never been reported. AIMS: The purpose of this paper is to investigate the change in apoptosis in gastric glands after eradication of Heliobacter pylori. PATIENTS AND METHODS: We studied 23 Heliobacter pylori-positive patients with duodenal and gastric ulcers, who were monitored for 6-12 months after eradication, and eight controls. Biopsies were taken from the antrum and body. Apoptosis was evaluated immunohistochemically using anti-single stranded DNA antibody. Apoptotic index was calculated by counting immunostained cells in surface epithelial and glandular cells. RESULTS: In the surface epithelium, Apoptotic indexes were significantly higher in patients than in controls. In the upper portion of fundic glands, apoptotic indexes were significantly higher in patients with gastric ulcers (14.2% (9.3, 17.8)) (median (1st quartile, 3rd quartile)) than in controls (8.0% (2.0, 9.0), p < 0.01) and decreased significantly after eradication (3.4% (2.0, 5.3)), p < 0.01). In pyloric glands, apoptotic indexes were no different between patients and controls. In the lower portion of fundic glands, apoptotic indexes were very low, both in patients and in controls. CONCLUSIONS: Our results showed that apoptosis, not only of surface epithelial cells but also of glandular cells in the upper portion of fundic glands, increased in Heliobacter pylori-positive patients with gastric ulcers and decreased to normal levels after eradication of Heliobacter pylori.     

用PCR—RFLP和16SrDNA指纹图法分析幽门螺杆菌基因型

本文建立了PCR－RFLP和16srDNA指纹图法．对19株幽门螺杆菌（HP）进行基因型分析：HP尿素酶C基因的PCR扩增产物．分别用HindⅢ、HaeⅢ、AluⅠ酶切，结果显示：每个酶均将19株HP分为3种RFLP图谱．综合HindⅢ，HaeⅢ和AluⅠ酶切结果，19株HP分为10个酶切带型；PCR扩增HP标准株16SrRNA基因，地高辛标记制备550bp探针，19株HPDNA分别经HaeⅢ和EcoRⅠ酶切、电泳后，通过Southern杂交获16SrDNA指纹图，结果显示：HaeⅢ酶切分为14个杂交带型，EcoRⅠ酶切19株HP杂交带型均不同。本实验表明：上述两种方法重复性好，分群力高，可准确有效地对HP作出鉴定并将其分型。19株HP株间存在基因型差异。     

埃索美拉唑三联与奥美拉唑三联疗法治疗Hp阳性十二指肠溃疡对比研究

目的比较埃索美拉唑三联与奥美拉唑三联疗法治疗幽门螺杆菌（Hp）阳性十二指肠球部溃疡的临床疗效。方法将104例经内镜诊断并检测证实Hp阳性的十二指肠球部溃疡患者随机分为两组。埃索美拉唑组（52例）：埃索美托唑20mg＋阿莫西林1g＋克托霉素500mg，每日2次，共7d；奥美拉唑组（52例）：奥美拉唑20mg＋阿莫西林1g＋克拉霉素500mg，每日2次，共7d。疗程结束4周后复查胃镜并检测Hp，观察腹痛缓解率、溃疡愈合率、Hp根除率及用药后的不良反应等。结果埃索美拉唑组第1天和第2天腹痛缓解率分别为34．6％和59、6％，高于奥美托唑组的17.3％和38．5％（P〈0．05）。埃索美托唑组和奥美拉唑组溃疡愈合率分别为92.3％和88．5％，Hp根除率分别为88．5％和82．7％，差异无显著性（P〉0．05）。两组用药后不良反应少，有较好的安全性。结论埃索美拉唑三联疗法治疗Hp阳性的十二指肠溃疡安全有效．腹痛缓解速度优于奥美拉唑三联疗法。     

Whole CanA Gene Amplification of Helicobacter pylori and Its Fingerprinting by Restriction Fragment Length Polymorphism

To set up a method of amplification for the whole CagA gene of Helicobacter pylori and its fingerprinting by restriction fragment length polymorphism(RFLP),nested PCR was employed in combination with TD-PCR to amplify the gene and EcoRI and Hind Ⅲ were used to generate the RFLP fingerprinting.Target DNA fragments from 13 of 20 samples were successfully amplified and the relevant RFLP fingerprintings were obtained.It is concluded that the method can be used to amplify the whole CagA gene and CagA gene has apparent diversity of RFLP profile.     

Effect of Helicobacter pylori on ectopic gastric mucosa of Meckel's diverticulum in children after meckelectomy

Ninety-two children underwent meckelectomy in our department over the 10-year period 1981–1990. All histologic speciments of Meckel's diverticula were studied, most of them retrospectively, for evidence of active inflammation or ulceration in any ectopic gastric mucosa present and specifically searching for Helicobacter pylori (HP). Thirty-eight (group A) were excised as being responsible for the main clinical symptoms while 54 (group B) were resected incidentally. Ectopic gastric mucosa was found in 19 cases, 18 in the symptomatic group and 1 in the incidental group. In the 18 cases belonging to group A histologic findings indicating gastritis due to HP were present. Combined operative and laboratory findings in all 92 cases indicated that HP colonizes gastric mucosa electively and leads to infection, which seems to be responsible for the clinical symptoms of meckelitis.Presented at the 15th Annual International Meeting of Greek Association of Pediatric Surgeons, Porto Hydra, Greece, 27–30 September 1990     

三联疗法根除幽门螺杆菌治疗对肠道微生态的影响

目的 探讨抗幽门螺杆菌(Hp)治疗对患者肠道菌群状态(肠道微生态)及耐药性的影响。方法 分别称取60例患者治疗前后新鲜粪便0．5g，选择肠道菌群中具代表性的4种需氧菌和6种厌氧菌分别进行需氧和厌氧培养，从培养出的菌落中挑选相同的菌株进行治疗前后药敏试验。结果 (1)治疗后肠道菌群中肠杆菌、葡萄球菌、拟杆菌、双歧杆菌、消化球菌、梭菌、乳杆菌、真杆菌均较治疗前明显降低(P＜0．05)；(2)治疗后肠道菌群中大肠埃希氏菌、消化链球菌、赛氏葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、产气真杆菌等对庆大霉素、红霉素、环丙沙星、特美丁、头孢噻肟钠等药耐药率明显增加，且存在多重耐药(P＜0．05)；(3)治疗后超广谱β—内酰氨酶阳性的消化链球菌、表皮葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、赛氏葡萄球菌等较治疗前分别增加26．2％、33．3％、28．6％、35．3％、28．6％。结论 三联抗Hp治疗后肠道菌群失调、耐药菌株的增加、传播与扩散对广大人群存在潜在危险。     

Helicobacter pylori infection and gastric emptying of solids in humans

Helicobacter pylori has been implicated in a number of upper gastrointestinal illnesses. In a controlled study, we have investigated the relationship between H. pylori infection and gastric emptying of solids in two groups of patients with chronic symptoms of dyspepsia. In the first group, 19 patients with non-ulcer dyspepsia and H. pylori infection underwent a standard test of gastric emptying after ingestion of 500 μCi of Tc-labelled chicken liver. The results were compared to a control group of 16 uninfected volunteers. We also studied a second group of 20 patients with previously diagnosed idiopathic gastroparesis for the prevalence of H. pylori infection and its relationship to symptom severity and rates of gastric emptying. In the first group of patients, the half-time of gastric emptying was significantly less among the infected patients compared to the uninfected volunteers (108 ± 9 vs. 142 ± 14 min, P < 0.05). In the second group of patients with gastroparesis, the prevalence of H. pylori was not significantly different among these patients than among 21 age and sex matched controls (20% vs. 38%, P = 0.32). Gastric emptying was markedly slow in all 20 patients in the second group but less so among the four with H. pylori infection. Symptom scores were no different between infected and uninfected patients. We conclude that H. pylori infection is not associated with abnormally slow gastric emptying. On the contrary, gastric H. pylori infection appears to be associated with mildly accelerated emptying of solids compared to normal controls. Idiopathic gastroparesis and dyspepsia related H. pylori infection are separate but sometimes overlapping disorders.     

拉萨地区冠心病与幽门螺杆菌感染相关性研究

目的探讨西藏拉萨地区幽门螺杆菌（Helicobacter pyloric，Hp）感染与冠心病及多种危险因素的关系。为该地区冠心病的防治提供依据。方法分为冠心病组46例和非冠心病组51例，应用检测血抗HpIgG及-C-尿素呼气试验方法检测Hp感染情况，并分别测定各组血脂、血糖、餐后2h血糖、C反应蛋白、纤维蛋白原、白细胞总数。结果冠心病组患者血清抗HpIgG阳性率为50．0％（23／46），明显高于非冠心病组的23．5％（12／51），P〈0．05；冠心病患者Hp现症感染率为54．3％（25／46），明显高于非冠心病组的31．3％（27／51），P〈0．05；冠心病组Hp感染患者血脂、空腹及餐后2h血糖、C反应蛋白、纤维蛋白原较非感染患者明显升高（P〈0．05）。结论Hp感染与冠心病相关，可能是拉萨地区冠心病发病的独立危险因素。     

检测幽门螺旋杆菌感染的几种方法的比较

目的 :评价几种诊断幽门螺杆菌 (Hp)感染的检测方法 .方法 :对 386例患者行胃镜钳取胃窦粘膜 ,分别经改良Giemsa染色、快速尿素酶 (RUT)试验、14 C 尿素呼气试验 (14 C UBT)检查及HpIgG血清学检查 ,与细菌培养结果对照 ,用 χ2检验进行对比评价 .结果 :RUT ,14 C UBT和改良Giemsa染色的敏感性、特异性较高 ,与细胞培养的符合率相近 ,其中14 C UBT和改良Giemsa染色联合检测的符合率更相近 (99.7% ) ;HpIgG血清学检查的敏感度虽和其余检测方法无差别 ,但其特异度较低 ,尤其是复诊组的特异度 ,与其他检测方法有显著差异 (P <0 .0 1) ,而且与初诊组相比也有差异 (χ2 =35 .18,P <0 .0 1) .结论 :HpIgG血清学检查可用于Hp感染的筛查 ,而不能作为疗效判断的指标 ,14 C UBT和改良Giemsa染色联合检测是较可靠的Hp检测方法