A Curative Effect Analysis Of Concomitant,Sequential And Bismuth-based Quadruple Therapy As Initial Treatment For Chronic Gastritis With Helicobacter Pylori Infection

Objectives Give the patients who have helicobacter pylori chronic gastritis 10 days concomitant,sequential and bismuth-based quadruple therapy as the primary treatment,compare three groups' difference on eradication rate,symptoms,adverse reactions and accomplish the cost-effect analysis.And then provide a reference for clinical to choose the best eradication project.Methods Choose 150 cases who come to the internal medicine department of gastroenterology in North China University of Science and Technology Affiliated Hospital during March 2016 to September 2016.All of the cases have been diagnosed helicobacter pylori chronic gastritis by gastroscope and 14C-urea breath test.The group of bismuthbased quadruple therapy(rabeprazole sodium enteric coated tablets 10 mg,oral 30 minutes before a meal,2/d;bismuth potassium citrate capsules 0.6g,contain bismuth 220 mg,oral 30 minutes before a meal,2/d;amoxicillin capsules 1g,oral after a meal,2/d;clarithromycin dispersible tablet 0.5g,oral after a meal,2/d.treatment for 10 days)has 53 patients.The group of sequential therapy(for the first 5 days: rabeprazole sodium enteric coated tablets 10 mg,oral 30 minutes before a meal,2/d;amoxicillin capsules 1g,oral after a meal,2/d.for the later 5 days: rabeprazole sodium enteric coated tablets 10 mg,oral 30 minutes before a meal,2/d;clarithromycin dispersible tablet 0.5g,oral after a meal,2/d;levofloxacin capsules 0.2g,oral after a meal,2/d.treatment for 10 days)has 50 patients.The group of concomitant therapy(rabeprazole sodium enteric coated tablets 10 mg,oral 30 minutes before a meal,2/d;amoxicillin capsules 1g,oral after a meal,2/d;clarithromycin dispersible tablet 0.5g,oral after a meal,2/d;levofloxacin capsules 0.2g,oral after a meal,2/d.treatment for 10 days)has 47 patients.Take a respective follow-up to the cases before treatment,discontinuation of treatment and 4 weeks after stopping treatment.Record the patients' clinical symptoms and give a mark according to the symptom rating scale.Record adverse reactions at the discontinuation of treatment and 4 weeks after stopping treatment.The cases of the 3 groups review 14C-UBT after discontinuation drugs for 4 weeks and record test results.Compare the eradication rate,symptoms and the incidence of adverse reactions.Take statistical analysis by SPSS17.0 software.Compare count data by chi-square test.Measurement data was expressed by x ±s.Compare among groups by using analysis of variance and compare between two groups by using SNK-q test.There is statistical difference when P?0.05.Results 1 ITT analysis: the group of bismuth-based quadruple therapy 79.2%,the group of sequential therapy 68.0%,the group of concomitant therapy 87.2%.The eradication rates of the 3 groups have no statistical difference(P=0.071).PP analysis: the group of bismuth-based quadruple therapy 89.4%,the group of sequential therapy 72.3%,the group of concomitant therapy 93.2%.The eradication rate of the group of bismuth-based quadruple therapy has statistical difference compared with the group of sequential therapy(P<0.05);the group of sequential therapy also has statistical difference compared with the group of concomitant therapy(P<0.05);while the group of bismuth-based quadruple therapy has no statistical difference compared with the group of concomitant therapy(P=0.288).2 The symptoms score before and after treatment with three groups is gradual decline(the group of bismuth-based quadruple therapy: 3.20±2.16vs0.82±1.11vs0.27±0.53;the group of sequential therapy: 3.51±2.28vs0.55±1.00vs0.23±0.56;the group of concomitant therapy: 3.28±2.11vs0.74±1.13vs0.26±0.53)and is statistically significant(P?0.01),while there is no statistical difference(P=0.999)among three groups at the same time point(before treatment: 3.20±2.16vs3.51±2.28vs3.28±2.11;discontinuation of treatment: 0.82±1.11vs0.55±1.00vs0.74±1.13;4 weeks after stopping treatment: 0.27±0.53vs0.23±0.56vs0.26±0.53).3 Incidence of adverse reactions: the group of bismuth-based quadruple therapy 17.0%(9/53),the group of sequential therapy 16.0%(8/50),the group of concomitant therapy 36.2%(17/47).There is no statistical difference compared the group of bismuth-based quadruple therapy with the group of sequential therapy(P=0.893);but there is statistical difference between the group of sequential therapy and the group of concomitant therapy(P<0.05);there is statistical difference between the group of bismuth-based quadruple therapy and the group of concomitant therapy too(P<0.05).The adverse reactions are slight among the 3 groups and are disappeared 4 weeks after stopping drugs.4 The comparison of cost-effect of three groups: the bismuth-based quadruple therapy is 2.59,the sequential therapy is 2.28,the concomitant therapy is 2.62;comparing the group of bismuth-based quadruple therapy with the group of sequential therapy,the former increased 1% eradication when its cost increased 3.90 yuan;comparing the group of concomitant therapy with the group of sequential therapy,the former increased 1% eradication when its cost increased 3.77 yuan;comparing the group of concomitant therapy with the group of bismuth-based quadruple therapy,the former increased 1% eradication when its cost increased 3.19 yuan.Conclusions 1 10 days bismuth-based quadruple therapy and concomitant therapy have a higher eradication rate than sequential therapy on the primary treatment of Hp chronic gastritis.2 10 days concomitant,sequential and bismuth-based quadruple therapy have no difference on relieving clinical symptoms.3 10 days bismuth-based quadruple therapy and sequential therapy have a lower incidence of adverse reactions than concomitant therapy.4 The cost-effect of 10 days sequential therapy is better than the bismuth-based quadruple therapy,and the cost-effect of the bismuth-based quadruple therapy is better than the concomitant therapy.