背景:幽门螺杆菌根除治疗的情况一直在变化,由于抗菌素耐药菌株的增加,生活方式的改善,以及根除适应症的变化。在日本,在医疗保险制度下,根除疗法现在适用于所有幽门螺杆菌阳性患者,钾竞争性酸阻滞剂vonoprazan从2015年开始用于根除。最近,随着社会的老龄化,为老年患者提供根除治疗的机会正在增加,但目前老年患者根除治疗的现状和有效性尚不清楚.因此,我们旨在调查大都市地区根除幽门螺杆菌的趋势,以确定80岁以上老年患者成功根除幽门螺杆菌的相关因素.
方法:调查了2013年至2023年在东京都市区20家医院接受一线或二线根除的患者的根除率趋势。
结果:一线治疗(n=6481),符合方案分析的根除率为82.3%(95%置信区间[CI]:81.2%-83.2%),二线治疗占87.9%(86.9%-88.9%)(n=4899)。多因素分析表明,一线治疗成功根除的独立因素是年龄大于80岁(OR:0.606;95%CI:0.448-0.822),消化性溃疡(vs.萎缩性胃炎:3.817;3.286-4.433),和vonoprazan(vs.质子泵抑制剂(PPI),3.817;3.286-4.433),二线治疗年龄大于80岁(0.503;0.362-0.699)和vonoprazan(1.386;1.153-1.667)。
结论:在2015年之后,由于使用了vonoprazan,一线和二线治疗的根除率保持在高于2015年之前的水平。由于80岁以上患者的幽门螺杆菌根除率较低,未来需要为这些患者制定有效的策略.
BACKGROUND: The situation of Helicobacter pylori eradication therapy has been changing over time, owing to increases in antimicrobial-resistant strains, lifestyle improvements, and changes in indications for eradication. In Japan, eradication therapy is now available to all H. pylori-positive patients under the medical insurance system, and the potassium-competitive acid blocker vonoprazan has been used for eradication from 2015. Recently, with the aging of society, opportunities to provide eradication to elderly patients are increasing, but the current status and effectiveness of eradication in elderly patients remains unclear. Therefore, we aimed to investigate the trends of H. pylori eradication in a metropolitan area to determine the factors associated with successful H. pylori eradication in elderly patients older than 80 years.
METHODS: Trends in the eradication rates of patients who received first- or second-line eradication at 20 hospitals in the Tokyo metropolitan area from 2013 to 2023 were investigated.
RESULTS: The eradication rates in the per-protocol analysis were 82.3% (95% confidence interval [CI]: 81.2%-83.2%) for the first-line treatment (n = 6481), and 87.9% (86.9%-88.9%) for the second-line treatment (n = 4899). Multivariate analysis showed that independent factors for successful eradication in the first-line treatment were an age of older than 80 years (OR: 0.606; 95% CI: 0.448-0.822), peptic ulcers (vs. atrophic gastritis: 3.817; 3.286-4.433), and vonoprazan (vs. proton pump inhibiters (PPIs), 3.817; 3.286-4.433), and an age of older than 80 years (0.503; 0.362-0.699) and vonoprazan (1.386; 1.153-1.667) in the second-line treatment.
CONCLUSIONS: After 2015, the eradication rate of both first- and second-line therapies were maintained at a higher level than before 2015, owing to the use of vonoprazan. As the H. pylori eradication rate in patients older than 80 years was low, an effective strategy for these patients needs to be developed in the future.