| About half of the population is estimated to be infected with Helicobacter pylori in this world. H.pylori is more prevalent in low-income areas of the world and in the older. H. pylori injure gastric and duodenal mucosa by colonization, urease, virulent proteins and inducing immune inflammatory responses. Today, more and more studies evidence that H. pylori contributes to the development of upper gastrointestinal disease and gastric cancer.Antiplatelet drugs are widely used in prevention of thrombotic cerebrovascular or cardiovascular disease. Those drugs increase gastrointestinal adverse events, especially upper gastrointestinal hemorrhage when decrease the motality of erebrovascular or cardiovascular disease. Proton pump inhibitors were frequently used to prevent upper gastrointestinal bleeding in patients receiving dual-antiplatelet therapy with aspirin and clopidogrel. However, the concomitant therapy of PPI decreased effect of the antiplatelet drugs and an increased risk of major adverse cardiovascular events, so proton pump inhibitors should be taken deliberately.It was evidenced that aspirin inhibited the virulence of H pylori in vitro, including breaking the bacteria, inhibiting urease, inhibiting colonization, decreasing the virulence of toxin and inhibiting immune inflammatory responses. But there are large difference between in vitro study and clinical research.Antiplatelet drugs are very important to the patients with cerebrovascular or cardiovascular disease, and decrease the mortality. It is very important to improve the adherence of antiplatelet drugs, but those studies were limited in propaganda and education.There are various methods of Helicobacter Pylori's inspection methods, including noninvasive and invasive inspection. Those inspections depend on urease, microscopy method and immune response. Different methods have different advantages and disadvantages, we can take one in need.The rate of eradication of helicobacter depends on drug resistance, therapy time, bismuth, proton pump inhibitors and adherence of treatment. We need improve the rate of eradication of helicobacter though many methods.Emergency endoscopy was taken in clinical widely. But there are few studies concerning emergency endoscopy in patient with dual-antipaletel treatment. We need further study to evaluate the safety and efficiency of emergency endoscopy.Eradication of helicobacter accelerating mucosal repair in patient with long-term antiplatelet therapy is not clear. At the same time, Eradication of helicobacter enhancing the adherence of long-term antiplatelet therapy should be investigated.This study mainly included the following two parts:Part1: Effect of eradication of H.pylori on upper gastrointestinal rebleeding rate in patients with long-term therapy of combined aspirin and clopidogrel Objective:To investigate the effect of eradication of H.pylori on upper gastrointestinal rebleeding rate in patients with long-term (more than3months) therapy of combined aspirin and clopidogrel and to reduce rehemorrhage rate.Methods: Patients with upper gastrointestinal bleeding and receiving long-term aspirin and clopidogrel treatment were enrolled in this study. Gastroscopy and pathology test were taken to determine upper gastrointestinal bleeding etiology. Patients with H.pylori infection were divided into treatment group and control group. The patients in treatment group received esomeprazole, clarithromycin and amoxicillin. Upper gastrointestinal rebleeding rates of both groups were compared. The groups were compared with X2test.Results:There are5patients with active bleeding was found in emergency endoscopy,3cases accepted APC,1patient accepted submucous injection and1patient treated by endoscopic clips. All patients got hemostasis. The infection rate of H.pylori in patients with long-term therapy of combined aspirin and clopidogrel was70.51%(55/78). The upper gastrointestinal rebleeding rate in treatment group and control group were7.69%(2/26) and34.62%(9/26), there was significant between these two groups (X2=5.650, P=0.017),ITT (X2=5.893, P=0.015). there are no significant difference in H.pylori negative group and treatment group (X2=0.432, P=0.511), ITT (X2=0.568, P=0.451),and in H.pylori negative group and control group (X2=1.630, P=0.202), ITT (X2=1.428, P=0.232)Conclusion: In patients with long-term therapy of combined aspirin and clopidogrel, eradication of H.pylori can reduce the rate of upper gastrointestinal rebleeding. Part2: Study of the relationship between infection of H.pylori and adherence with long-term antiplatelet therapyObjective: To investigate the relationship between infection of H.pylori and adherence with long-term antiplatelet therapy. To evaluate the effect of eradication of H.pylori on adherence in patient with long-term antiplatet treatment.Methods: Patients with single antiplatelet aspirin therapy and dual antiplatelet treatment were enrolled in this study. All patients will accept carbon-14-urea breath test and will be divided into H.pylori infection positive group and H.pylori infection negative group. People infected with H.pylori were divided into treatment group and control group randomly. The patients in treatment group received eradication therapy for H.pylori by pantoprazole plus metronidazole and amoxicillin. After a month, people in treatment group were divided into eradication H.pylori group and no-eradication H.pylori group by carbon-14-urea breath test. All patients will be follow up, and the groups were compared with X2test.Results:295patients with single antiplatelet aspirin therapy were enrolled, including186H.pylori infection positive patients and109H.pylori infection negative patients. H.pylori were eradicated in82patients by eradication therapy by pantoprazole plus metronidazole and amoxicillin, and43patients still infect with H.pylori.266patients with both aspirin and clopidogrel therapy were enrolled, including173H.pylori infection positive patients and93H.pylori infection negative patients. H.pylori were eradicated in74patients by eradication therapy by pantoprazole plus metronidazole and amoxicillin, and45patients still infect with H.pylori. At follow up,93.90%patients maintained adherence to aspirin in eradication group,83.33%in no eradication group,83.61%in control group and93.46%in infection negative group. There was significant difference between control group and eradication group (X2=3.949> P=0.047),the significant difference also between control group and infection negative group (X2=4.146, P=0.042).At follow up,90.41%patients maintained adherence to both aspirin and clopidogrel in eradication group,77.78%in no eradication group,77.36%in control group and90.11%in infection negative group. There was significant difference between control group and eradication group (X2=4.085, P=0.043),the significant difference also between control group and infection negative group (X2=4.372, P=0.037).Conclusion: H.pylori infection has a negative effect on the adherence with antiplatele therapy. Eradication of H.pylori will improve adherence with antiplatele drug. |
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