| Objective : Chronic atrophic gastritis is a common disease in clinic,which was developed from the superficial gastritis, the main pathological changes of this disease are decrease of gastric mucosa gland(atrophy), and in very severe patiens, even disappearance of these gland from the mucosa membrane. In addition to these changes, intestinal gland metaplasia, intestinal epithelial dysplasia can occur that are usually recognized as precancerous lesion of gastric cancer. It have been indicated in 1978 by WHO that CAG is related to gastric cancer. The mechanisms have not been understood fully.Clinical researches indicate that Hp infection may be a impotent cause of CAG,statistics analysis showed that,antibodies of Hp can be detected in 80%CAG patients。Secretion of gastric acid in these patients was reduced. Clinical research has confirmed that is closely related to chronic atrophic gastritis caused by Hp infection. Standard triple therapy has been recommend to treat Helicobacter pylori infection, that is PPI plus 2 antibiotics, but in Asian countries, Helicobacter pylori eradication rates are low generally by this way.The possible reasons were increasing of primary and acquired antibiotics resistance. As the developing of drug resistant strains, Hp eradication rate of traditional first-line drugs decreased gradually. The time of treatment cycle of Antibiotics is longer, and brought a large number of side reactions. Sequential therapy is a new therapy method, that is reported superior to the traditional triple therapy. Sequential therapy can overcome Hp resistance to clarithromycin and metronidazole in a certain extent. However, multi-center study carried out in our country showed no advantage. To explore more effective Hp eradication therapy scheme, this study observed the clinical curative effect of a new sequential therapy method and compared withstandard triple therapy in the treatment of Hp related atrophic gastritis, clinical efficacy the of a 14 day azithromycin participated sequential therapy were compared with standard triple therapy for Helicobacter related chronic atrophic gastritis in order to found an economic, efficient, less adverse side reactions of novel treatment method.Methods: Patients of with chronic atrophic gastritis were selected and confirmed by after gastroscopy pathological examination, breath test and serum Hp antibody detection. All of the patients were grouped by age and sex,and compared the extent of their illness. Then the patients were divided into two group, the Standard triple therapy group and new sequential therapy group 。 The symptoms indexes, endoscopy and pathology indicators index were analysed statistically and evaluated by scores. The new sequential therapy group were treated by 14 day sequential therapy: Rabeprazole 10 mg twice a day levofloxacin 0.2g twice a day were given orally for seven days at the beginning, in the following seven days rabeprazole 10 mg was took twice a day, azithromycin 0.5g once a day, and tinidazole 0. 5g once a day; The Standard triple therapy were used for the treatment for the control group:rabeprazole 10 mg twice a day, tinidazole tablets 0.5g twice a day and clarithromycin tablets 0.25 g twice a day were given for 7 days. All of the patients in the two groups were treated by taking rabeprazole 10 mg once a day to four weeks. 8 weeks after treatment mentioned above, evaluation was carried out by 14C-urea breath test and endoscopy examination, comprehensive analysis of the symptoms index. The results of both groups were analyzed statistically. H. pylori eradication rate, adverse reactions, repair extent of chronic inflammation of gastric mucosa were observed and compared. SPSS version 13.0 software package was used for statistical analysis. All of the data were presented as mean ± standard deviation(X ± S). multiple sets of data were analyzed using ANOVA, pairwise comparisons using q test; count data were expressed as percentage(%); and compared using the chi-square test(x2); related factors analysis using partial correlation analysis, the data results are P <0.05 defined as the difference was significant.Results: the score difference between the scores before and after treatment by New sequential therapy of Hp associated chronic atrophic gastritis patients were significant(P<0.05), endoscopy scores was significant(P<0.05), and so is the histopathological scores(P<0.05); when compared with standard triple therapy patients, there are significant differences between the two groups in symptoms(P <0.05), and endoscopy examination(P<0.05) and so is the Pathological test(P<0.05); The total effective rate of New sequential therapy group was 90%, Hp eradication rate was 90%, when compared with the standard triple therapy group, the differences were significant(P<0.05). No significant adverse reaction. The difference of adverse side effects between the two groups was significant statisticallyConclusion: when the patients were treated by New sequential therapy,in which levofloxacin and azithromycin were used for 14 days, the eradication rate of Hp was significantly better than that of the standard triple therapy. At the same time, the application of a new generation of proton pump inhibitors are powerful, makes the Hp eradication rate further increased. This scenario can be considered as the first-line drugs for the treatment of of chronic atrophic gastritis and eradication of Hp. |
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