| ObjectiveTo compare the therapeutic effect on H.pylori eradication rate by different regimen of bismuth quadruple;To delineate the characteristics of antibiotic resistance by Helicobacter pylori from Chongqing area;To explore the impact factor of the further consultation rate of patients who received the H.pylori eradication therapy.Methods240 patients were included who were diagnosed as peptic ulcer or chronic gastritis with endoscopy and were confirmed H.pylori infection by rapid urease test(RUT)or 13 C urea breath test(13C UBT).The patients were randomly divided into two groups: treated with esomeprazole + bismuth + clarithromycin + amoxicillin for 10 days and 14 days.At least 4 weeks after the end of treatment,the 13 C UBT or RUT was used to evaluate the efficacy.The eradication rate of H.pylori was statistically analyzed between the groups.215 patients with positive rapid urease test(RUT)in our hospital were brought into our study,gastric mucosal tissues were collected by endoscopy for H.pylori isolated and cultured and the susceptibility test.From January 2016 to June 2017,10628 patients were involved in the retrospective study,who were diagnosed as H.pylori infection and subsequently received PPI + bismuth potassium citrate + amoxicillin + furazolidone or PPI + clarithromycin/bismuth potassium citrate /tinidazole treatment in our outpatient service.The basic data of each patient were collected.Doctors completed the questionnaire of H.pylori,a part of the content with the questionnaire were collected.The risk factors for patients' further consultation were analyzed.ResultsComparison of efficacy of different regimen on bismuth quadruple therapy: A total of 21 patients were missed of two groups due to irregular medication,loss and not-reviewing,missing rate was 8.8%.The intention-to-treat(ITT)analysis of eradication rates in two groups were 77.8% and 76.4% respectively,there was no significant difference between the two groups(P> 0.05).The per-protocol(PP)analysis of eradication rates in two groups were 85.8% and 83.2% respectively,there was no significant difference between the two groups(P> 0.05).There were no significant differences in the incidence of adverse reactions between the 10-day course and the 14-day course of treatment with bismuth-treated regimens(7.7% and 9.8%,P> 0.05).The eradication rate was 84.5% in the 10-day course of chronic gastritis,(P <0.05).The eradication rate of the patients with chronic gastritis and peptic ulcer in 10-day course group were 84.5%and 95.2% respectively(P> 0.05).The eradication rate of the patients with chronic gastritis and peptic ulcer in 14-day course group were 83.7% and 84.6% respectively(P> 0.05).Antibiotic resistance of H pylori: 55 strains were isolated and cultured from 215 patients.Metronidazole,levofloxacin,clarithromycin resistance rates were 98.2%,20%(11/55),5.5%(3 / 55)respectively.The double resistance rate of metronidazole + levofloxacin was 16.4%(9/55),metronidazole + clarithromycin was 1.8%(1/55),metronidazole + levofloxacin + clarithromycin Triple drug resistance was 3.6%(2/55).Investigation of patients' further consultation: A total of 10628 outpatients were included.1,237 cases(22.3%)of PPI + citrate potassium bismuth potassium + amoxicillin + furazolidone program and 8253 cases(77.7%)of PPI + clarithromycin / potassium bismuth citrate / tinidazole.patients' further consultation rate was 13.9%(1472/10628).The further consultation rate of PPI + bismuth potassium citrate + amoxicillin + furazolidone and PPI + clarithromycin / bismuth potassium citrate / tinidazole regimen were respectively 16.9% and 13.0%,(P <0.05).The further consultation rate of male and female patients was 14.3% and 13.4% respectively(P = 0.211).The further consultation rate of Patients with chronic atrophic gastritis,atrophic gastritis,peptic ulcer patients,requiring H.pylori treatment,other diagnosed patients were 11.2%,24.9%,16.6%,14.6%,17.0% respectively(P <0.05).The further consultation rate of junior,intermediate,deputy high and high title doctor were 18.1%,17.3%,13.3% and 13.1% respectively(P <0.05).The further consultation rate of Bachelor,Master,Ph.D doctors were18.3%,13.6% and 13.9% respectively(P = 0.181).The further consultation rate of doctors' practitioner years 2-5 years,6-10 years,11-20 years,> 20 years were 16.0%,17.8%,15.2%,12.8% respectively(P <0.05).The further consultation rate of doctors routinely asked patients to referral and did not were 16.5% and 10.8% respectively(P <0.05).The treatment program,patient's age,whether the doctor routinely asked patients to referral,patients' diagnosis were the independent relevant factors of further consultation rate(P <0.05).ConclusionThe 10-day treatment showed satisfying efficacy to H.pylori eradication,for there were no significant difference compared with longer treatment by bismuth quadruple therapy.Thus the shorter treatment by 10 days makes a less burden to patients.The highest rate of antibiotics resistant in H.pylori was metronidazole(98.2%),followed by levofloxacin and clarithromycin,H.pylori showed no drug resistance to the furazolidone,tetracycline and amoxicillin.The further consultation rate of outpatients who received the H.pylori eradication therapy was very low(13.9%).In multivariate analysis,the treatment,age,doctor's advice and the disease progression were independent risk factors(P<0.05). |
PDF Full Text Request