Hp根除在消化不良病人使用中治疗作用有限
早前的有些关于非溃疡性消化不良病人，施以根除幽门螺旋杆菌的方法收效甚微。近来的两项研究结果如下：
一项多中心临床研究，加拿大研究者共收集了157例病人的资料。病人的入选标准为（1）慢性或急性腹痛，（2）胃镜检查无消化性溃疡，（3）Hp检测尿素呼气试验阳性。病人被随机纳入接受Hp根除治疗组或安慰剂治疗组。Hp活动治疗组幽门螺旋杆菌灭菌治疗根除率为82%。经过一年的随访，两组消化不良指数、症状改善病人比例以及抑酸药的使用均无明显差异。
另一项研究，西雅图研究者共收集了432例病人的资料。病人使用H2受体拮抗剂或质子泵抑制剂；Hp阳性；既往有消化不良或消化性溃疡史，但无食道反流史。所有病人均接受Hp灭菌治疗。结果表明，在灭菌治疗后，与前一年比较，患者使用胃肠道疾病相关的药品及治疗总费用并没有明显下降。然而，以前患有消化性溃疡但无食道反流以及早先使用过长期抑酸药物小样本亚群组病人，其灭菌治疗却降低了使用药物的成本。
评价：这些研究印证了此前的结论，即Hp灭菌治疗不会缓解消化内镜已排除的消化性溃疡引起的消化不良症状。然而，对于Hp阳性既往有溃疡病史或Hp处在活动期但非溃疡的病人，可能从Hp灭菌治疗中获益。
资料来源：
1． Veldhuyzen van Zanten S et al. Absence of symptomatic benefit of lansoprazole, clarithromycin, and amoxicillin triple therapy in eradication of Helicobacter pylori positive, functional (nonulcer) dyspepsia. Am J Gastroenterol 2003 Sep; 98:1963-9.
2． Kearney DJ et al. The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia. Am J Gastroenterol 2003 Sep; 98:1952-62.
（风雪来 译）
Limited Effect of H. pylori Eradication in Dyspeptic Patients
In several studies of patients with nonulcer dyspepsia, eradication of Helicobacter pylori has yielded little benefit. Results of 2 new studies add to the literature.
In a multicenter study, Canadian researchers enrolled 157 patients with chronic or frequent epigastric pain, no endoscopic evidence of peptic ulcer, and positive urease and breath tests for H. pylori infection. Patients were randomized to receive either H. pylori eradication therapy or placebo; the eradication rate was 82% in the actively treated group. During 1 year of follow-up, no significant differences between groups were noted in dyspepsia scores, proportions of patients with improved symptoms, or use of acid-reducing medications.
In another study, Seattle researchers enrolled 432 patients who used H2-blockers or proton-pump inhibitors (according to a pharmacy database), tested positive (serologically) for H. pylori infection, and reported histories of dyspepsia or previous peptic ulcer but not reflux alone. All patients received H. pylori eradication therapy. During the year after eradication, medication costs and total costs related to gastrointestinal disease were not reduced significantly compared with those during the previous year. However, in a small subgroup of patients who had previously documented peptic ulcer and no reflux symptoms and who had received chronic acid-suppressive therapy, eradication therapy reduced medication costs.
Comment: These findings reinforce previous research that suggested that H. pylori eradication did not relieve dyspepsia if peptic ulcer had been excluded by endoscopy. However, some uninvestigated patients who are H. pylori positive have previously documented ulcers or active but undiagnosed ulcers: Eradication therapy could be beneficial in such patients.
— Allan S. Brett, MD
Source
Veldhuyzen van Zanten S et al. Absence of symptomatic benefit of lansoprazole, clarithromycin, and amoxicillin triple therapy in eradication of Helicobacter pylori positive, functional (nonulcer) dyspepsia. Am J Gastroenterol 2003 Sep; 98:1963-9. [Medline abstract][Download citation]
Kearney DJ et al. The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia. Am J Gastroenterol 2003 Sep; 98:1952-62. [Medline abstract][Download citation]
