背景:目前,非幽门螺杆菌(NHPH)的根除方案尚未建立。我们调查了根除幽门螺杆菌的标准三药联合疗法和质子泵抑制剂(PPI)单药疗法根除NHPH的有效性。
方法:受试者是根据显微镜检查结果诊断为NHPH感染胃炎的患者,螺旋状生物明显大于幽门螺杆菌,在2010年11月至2021年9月期间在Kenwakai医院使用Giemsa染色的胃粘膜标本中,通过内镜活检样品中尿素酶基因的聚合酶链反应(PCR)分析鉴定了其NHPH物种,同意使用三联药联合治疗1周或PPI单药治疗6个月根除NHPH。根除完成六个月后,其结果是通过食管胃十二指肠镜检查确定的,显微镜检查,和PCR分析。如果根除不成功,建议患者使用其他疗法进行第二次根除。
结果:PCR分析在38例患者中检测到NHPH:其中36例为猪螺杆菌,2例为海姆氏螺杆菌/ailurogastricus。14名感染了猪螺杆菌的患者和1名感染了黑曼氏螺杆菌/幽门螺杆菌的患者要求根除治疗。三药联合治疗成功了五名患者中的四名,而PPI单药治疗10例患者中有5例成功。后一种治疗失败的五名患者中有三名要求三联药物联合治疗作为第二次根除,所有三名均成功。总的来说,三药联合治疗成功了八分之七(87.5%)的尝试病例,而PPI单药治疗在10例中有5例(50%)尝试过。
结论:在NHPH根除中,三药联合治疗被认为在一定程度上有效,并成为一线治疗.同时,虽然不太成功,PPI单一疗法似乎是一种潜在的有希望的选择,特别是对于过敏或对抗生素耐药的患者。PPI单一疗法的有效性可能归因于猪螺杆菌的高酸性环境偏好和PPI的抑酸作用。此外,NHPH感染的胃炎患者中男性占主导地位可能是由于胃酸分泌能力的性别差异。然而,需要积累进一步的证据。
背景:这项研究得到了肯瓦凯医院研究伦理委员会的批准(编号:2,017,024)。
BACKGROUND: At present, eradication regimens for non-Helicobacter pylori Helicobacter (NHPH) have not been established yet. We investigated effectiveness of the standard triple-drug combination therapy for Helicobacter pylori eradication and of a proton pump inhibitor (PPI) monotherapy in eradication of NHPH.
METHODS: Subjects were the patients who were diagnosed with NHPH-infected gastritis based on microscopic findings, helical-shaped organisms obviously larger than Helicobacter pylori, in the gastric mucosal specimens using Giemsa staining at Kenwakai Hospital between November 2010 and September 2021, whose NHPH species were identified by polymerase chain reaction (PCR) analysis of urease genes in endoscopically-biopsied samples, and who consented to NHPH eradication with either the triple-drug combination therapy for one week or a PPI monotherapy for six months. Six months after the completion of eradication, its result was determined with esophagogastroduodenoscopy, microscopic examination, and PCR analysis. In cases of unsuccessful eradication, a second eradication with the other therapy was suggested to the patient.
RESULTS: PCR analysis detected NHPH in 38 patients: 36 as Helicobacter suis and two as Helicobacter heilmannii/Helicobacter ailurogastricus. Fourteen Helicobacter suis-infected and one Helicobacter heilmannii/Helicobacter ailurogastricus-infected patients requested eradication therapy. The triple-drug combination therapy succeeded in four of five patients, while the PPI monotherapy succeeded in five of 10 patients. Three of five patients who had been unsuccessful with the latter therapy requested the triple-drug combination therapy as the second eradication and all three were successful. In total, the triple-drug combination therapy succeeded in seven out of eight (87.5%) attempted cases, while the PPI monotherapy in five out of 10 (50%) attempted cases.
CONCLUSIONS: In NHPH eradication, the triple-drug combination therapy was considered to be effective to some extent and to become the first-line therapy. While, although less successful, PPI monotherapy appeared to be a potentially promising option particularly for patients with allergy or resistance to antibiotics. Effectiveness of PPI monotherapy may be attributed to hyperacid environment preference of Helicobacter suis and PPI\'s acid-suppressive effect. Additionally, male predominance in NHPH-infected gastritis patients may be explained by gender difference in gastric acid secretory capacity. However, further evidence needs to be accumulated.
BACKGROUND: This study was approved by the Research Ethics Committee of Kenwakai Hospital (No. 2,017,024).