Clinical Study Of Anti-Helicobacter Pylori Therapy In Patients With Peptic Ulcer

Peptic ulcer (PU) is a common worldwide disease. Duodenal ulcer (DU) occurs more often than gastric ulcer (GU), and it happens more in male. GU has no gender preference. The etiology of PU is quite complicated and not well understood yet. A general concept is that the balance is lost between harming factors to the lining of the stomach and the duodenum and self-protective mechanisms of the lining. A typical symptom is upper abdominal pain, accompanied by acid reflux, heartburn, gas, flatulence, fatigue, anorexia et al. Since Australian researchers, Warren and Marshall, first found the existence of Helicobacter pylori (HP) by gastric biopsy in 1983, studies focusing on the relationship of HP and PU have been intensified. After eradication of HP by antibiotics, severe PU can be cured quite well, and recurrence rate lowers to less than 10%. Once HP is eradicated, re-infection rate is about 1%. We use three medicines-combined regimens based on Bismuth or proton pump inhibitor (PPI) achieved very satisfying results. We reviewed and divided 139 PU cases into 3 groups based gender, age and severity of PU. We investigated the following factors. 1,Epidemiological factors: age, gender, profession, and seasonal distribution. 2,Average abdominal relief time, abdominal pain relief rate on 3-day base, abdominal pain relief rate on 7-day base, and relief of other symptoms (abdominal pain, acid reflux, gas, heartburn, flatulence, fatigue, anorexia et al.). 3,Changes in gastric endoscopical features in the site of PU, eradication rate of HP, and complication. 4,Curing rate of PU, eradication rate of HP, and side effects of medicines. 5,Expenses. Our results are as follows. 1,PU peak falls on middle age (56% of patients are 36 to 55 years old), and DU occurs more than GU. 2,PU has a seasonal preference, and positive rate changes seasonally. Spring and summer have higher rates than fall and winter, and this change follows changes in weather. 3,Irregular diet and stress leading to gastrointestinal dysfunction may contribute to PU. 4,Psychiatric state may not contribute to PU, but we can not rule out that other factors such as family, marriage, health beliefs may affect patient's psychiatric state. Due to our limitation on sampling size, further epidemiological investigations are required to further understand the relationship between them. 5,Alcohol and cigarette use is one etiology to PU. We think that smoking may increase the secretion of gastric acid and pepsin, inhibit the secretion of sodium bicarbonate by pancreas, lower the tension of sphincter of pylorus, and affect the production of prostaglandin in gastric lining; alcohol use, especially high concentrated liquors, can direct damage gastric lining. 6,Endoscopical findings: 73.2% of GUs occur in lesser curve and pylorus, and 83.1% of DUs occur in the anterior wall of the first segment of duodenum. 7,No unique symptoms are found in PU patients, and common symptoms include abdominal pain (89.9%), acid reflux (69%), heartburn (61%), gas (78.9%), flatulence (71%), anorexia (56%), and fatigue (53%). 76.69% of cases have two or morethan two above symptoms. Upper abdominal pain is most commonly seen and its severity is not related to PU itself. 8,The key point is to eradicate HP infection to treat PU. HP directly affects healing and recurrence of PU, and Curing rate of HP-eradicated cases is obviously higher than HP-uneradicated cases. Our data shows that curing rate of PU is 99.2% in 120 HP-eradicated cases while 63.1% in 19 HP-uneradicated cases, and the difference is significant. We think treating HP infection is important to cure PU. 9,We applied three medicine-combined regimens based on Bismuth or PPI to 139 PUs and achieved satisfying results. The curing rate and HP-eradication rate are obviously improved (table 7 and 8), and these results are similar to foreign publications. There are no differences among group A, B, and C. The mechanism of Livzon WenSanLian in treating PU is that Bismuth Potassium Citrate (BPC) precipitates under low PH<5, forming a lining to cover ulcers. As a result, the new covering promotes repairment of the destroyed gastrointestinal lining. BPC itself is not an antacid. BPC has bactericidal effect to HP. The activity of tinidazole is 2-4 times higher than metronidazole, and clarithromycin is the most effective one in treating HP infection, and combination of clarithromycin with tinidazole will tremendously improve the eradication rate of HP. The regimen based on PPI achieved similar satisfying results. Omeprazole has anti-HP effects but cannot eradicate HP, it inhibits ATP enzymes in HP and thus its growth, and clarithromycin maintains a high concentration in gastric wall and...