Efficacy Of Furazolidone-containing Quadruple Therapy For Refractory H.pylori Infection And Correlation With Gastrointestinal Flora

Objective:Infection with Helicobacter pylori（H.pylori）leads to the development of both intragastric and extragastric diseases.Numerous studies have confirmed that Hp eradication not only reduces the recurrence rate of peptic ulcers but also reduces the risk of gastric cancer.China is a developing country with high prevalence of H.pylori infection and gastric cancer.Although guidelines and consensus recommend eradication regimens such as bismuth quadruple therapy and sequential therapy,eradication still fails in some patients due to various reasons such as antibiotic resistance and compliance.H.pylori infection and eradication can induce homeostatic imbalance of intestinal and oral flora,so this study analyzed the efficacy of bismuth quadruple therapy containing furazolidone on refractory H.pylori,and explored the correlation between the efficacy and GI flora to provide a reference basis for clinical diagnosis and treatment.Methods:Fifty-nine patients with positive ¹⁴C-urea breath test from October 2021 to July 2022 who attended Hospital were selected for the study.Patients who underwent eradication therapy for the first time entered the control group and were treated with bismuth quadruple therapy of clarithromycin+amoxicillin,and patients who failed previous eradication therapy entered the experimental group and were treated with bismuth quadruple therapy of furazolidone+amoxicillin.Stool and oral samples of patients before treatment,at the end of eradication treatment and 4 weeks after eradication treatment were retained and subjected to 16S r RNA high-throughput sequencing by Biotechnology Company.Results:A total of 59 patients were included,divided into 35 cases in the control group and 24 cases in the experimental group.The eradication rate of the control group was91%;the eradication rate of the experimental group was 96%.Observed species,Chao1,and shannon index of intestinal and oral flora had a decreasing trend at the end of eradication treatment in both control and experimental in groups compared with the previous ones,and had a rebound trend 4 weeks after eradication.Species composition analysis showed that the structure of the intestinal flora was altered at the end of eradication in both groups,and usually recovered after 4 weeks of eradication,but the recovery time to pre-eradication levels was shorter in the experimental group.Conclusion:Bismuth quadruple therapy with furazolidone has good efficacy and safety in the remedial treatment of H.pylori and facilitates a more rapid return of intestinal flora to pre-eradication levels.