The Influence Of Pre-treatment With A Proton Pump Inhibitor On Eradication Of Helicobacter Pylori

Objective: There is much debate about the influence of pre-treatment with a proton pump inhibitor on Helicobacter pylori eradication.To determine the effects of pretreatment with pantoprazole alone, followed by an H. pylori eradication regimen, on the eradication rate.Proton pump inhibitors by blocking parietal cell H+-K+-ATP enzyme paly a role in inhibiting gastric acid secretion inhibitors and anti-ulcer drugs. The major indications of PPIs are acid-ralated diseases, such as peptic ulcer,gastro-esophageal reflux disease,and Zollinger Ellison syndrome. PPIs also used for the eradication of Helicobacter pylori with antibiotics such as amoxillin and clarithromycin. In recent years, Helicobacter pylori eradication rate showed a declining trend,the influence factors of the eradication rate decline is a hotspot. There is more relevant research for Helicobacter pylori strains resistant,and have a high degree of clinical importance,however the application times of PPIs and whether different types of PPIs affect the eradication rate of H. pylori is not clear.Studise have shown that the application of PPIs can produce multiple effects of Helicobacter pylori,PPIs application alone for a period of time can reduce the rate of its subsequent eradication.However, a common phenomenon in clinical practice is when the peptic ulcer, reflux disease go far, there are obvious symptoms or having clinical complications such as peptic ulcer bleeding, small perforation, and pyloric obstruction , intravenous PPIs are often the first to be given ,when the symptoms relief or disease controled in patients of H.pylori-positive and then given the eradication treatment. Besides the strains resistant ,the eradication rate of Helicobacter pylori decreased in recent years, may be related with the application of PPIs , therefor ,this to be confirmed by further studies.Material and Method: 1 Materials:the time was from December 2009, to January 2011 a total of 103 adults were collected for eradication sequentially from the patients with chronic gastritis erosive bleeding, peptic ulcer. They are all positive for H. pylori tested by rapid urease test(RUT) or 14C-urea breath test(14C-UBT). 2 patient lost to follow,and 2 patient can not complete the full course of treatment, the actual completion is 99 cases. These patients ranged in age from 20 to 70 years, including 51 males,and 48 females.2 Selection criteria: the following two terms must be met:⑴Patients have chronic gastritis erosive bleeding, peptic ulcer, first-degree relatives of the patients have gastric cancer, with functional dyspepsia by conventional therapy have no effection, willing to cooperate and can be followed-up of persons aged 20-70 years old;⑵H.pylori-positive: H. pylori infection in vivo was assessed by RUT or 14C-UBT. And the following conditions must be met:①In recently 4 weeks, have no use of proton pump inhibitors (PPIs), H2 receptor antagonists, bismuth agents and antibiotics;②Not allergic to the drugs used;③No serious heart, liver, lung, renal dysfunction;④Non-pregnant and lactating women;⑤Were able to correctly express their complaints,except to be suffering from mental illness,severe neurosis,and can not be partners;⑥All patients were treated by eradication of H.pylori for the first time.3 Methods: Patients were randomly divided into three groups for H.pylori eradication therapy, respectively, as follows:Treatment group A (P-EAKF group,n = 33): Application of pantoprazole 2-3weeks,and then given the treatment of H.pylori eradication; Control group B (EAKF-P group,n=36): directly given the treatment of H.pylori eradication;Control group C (P-1-EAKF group,n=34): given the treatment of H. pylori when it is 4 weeks after therapy of Helicobater pylori eradication.4 Therapy regimenAll the patients were given the same therapy regimen : the first 5 days, Esomeprazole 20 mg bid plus Amoxycillin 1g bid, for the last 5 days, Esomeprazole 20 mg bid, Clarithromycin 0.5g bid and Furazolidone 0.1g bid.5 EfficacyBacterial eradication was diagnosed by 14C-UBT when after 4 weeks the therapy had ended. And recorded the major side-effects accurately. SPSS 13.0 data statistical software was used for statistical analysis. The comparison of the rate analyzed byχ2 test. Statistical significance was defined as a P <0.05.Results:Treatment group A: 33cases were enrolled, 1 case lost to follow,1was removed from the 33 patients because they can not tolerate clarithromycin,31 cases have completed the whole course of treatment. The years ranged in age from 26 to 63 years with a average age of 48.13±9.65years; 22 cases succeded in eradication, the ITT eradication rate of group A was 66.67%,the PP eradication rate was 70.97%.Control group B : 36 cases were enrolled, 1 case lost to follow, 35 cases have completed the whole course of treatment. The years ranged in age from 26 to 70 years with a average age of 46.11±11.81 years; 26 cases succeded in eradication, the ITT eradication rate of group B was 72.22%, the PP eradication rate was 74.29%.Control group C : 34 cases were enrolled, 1 case have subconjunctival hemorrhage to remove from this group, 33 cases have completed the whole course of treatment. The years ranged in age from 22 to 63 years with a average age of 45.06±12.16 years; 27 cases succeded in eradication, the ITT eradication rate of group C was 79.41%, the PP eradication rate was 81.82%.The difference has no statistical significance on age,sex and disease classification between the three groups (P >0.05). (Table 1,2,3)The eradication rate of H.pylori of all the patients is 75.76%. There was no statistical significance of the difference of eradication rate between the three groups. (P>0.05).(Table4)Adverse drug reactions: Adverse reactions take place in 2 cases of the P-EAKF group,and 6 cases in the EAKF-P group, 2 cases in the P-1-EAKF group. The adverse effect rates of the 2 groups were 6.45% ,17.14% and 6.06 respectively.The difference was of no statistical significance between the 3 groups (P >0.05).(Table 5)The capital adverse effect are mouth pain, some abdominal pain,diarrhea, nausea, vomiting and other gastrointestinal reactions,headaches,palpitations, allergies.The adverse effects are mild,and do not need to be given special treatment. The symptoms all disappeared after the course of treatment. The three groups all completed the whole course of treatment.Conclusion:1 The eradication rate of H. pylori was not affected significantly by pretreatment with PPIs.2 The H.pylori eradication is not affected by gender ,age or clinical disease.