Efficiency Of Eradication Therapy In Chinese Children With Helicobacter Pylori Infection

Background and Aims:Helicobacter pylori is not only an important pathogenic factor of chronic gastritis,duodenal ulcer,gastric cancer,gastric mucosa associated lymphoid tissue tumor,but also closely related to the development of chronic gastritis,duodenal ulcer and peptic ulcer in children,also lead to iron deficiency anemia,growth disorder,asthma,allergic diseases,and so on in children.Helicobacter pylori infection is a global problem,and the infection rate is 50%in the whole world.As known,eradication of H.pyori has been proved to reduce the incidence of gastric cancer,and thus improve ulcer healing.But the eradication rate of H.pyori has dropped to less than 80%in the traditional standard triple therapy.There are many reasons for the failure of eradication,including the factors of the strain itself,the host factor,the environmental factors,the different clinical diseases,and the treatment scheme.However,the resistance of H.pyori to antibiotics is the main reason of the failure of eradication.The main purpose of this article is to understand the eradication of H.pyori infection in children in the region,so as to provide reference for clinicians to choose H.pyori eradication treatment scheme.Method:H.pyori eradication therapy for 10 or 14 days was accepted by 301 cases of children,who were diagnosed with H.pyori infection,in the Children' s Hospital of Zhejiang University School of Medicine from January,2012 to October,2015.At least 4 weeks after the end of the course of treatment,the 13C-UBT was used to evaluate whether the H.pyori was eradicated.If the initial treatment failed,the rescue therapy was treated and assessed again.Finally,the eradication rate of H.pyori was judged.Determination of 119 cases of culture positive H.pyori strains to clarithromycin,amoxicillin and metronidazole sensitivity using K-B susceptibility test.Results:(1)In initial treatment the eradication rate of OAC program(omeprazole,amoxicillin and clarithromycin)was 42.3%(95%confidence interval[CI]35.8%-48.8%),the eradication rate of non OAC program(bismuth-based regimens;triple therapy with furaxone;omeprazole,amoxicillin and metronidazole;omeprazole,metronidazole and clarithromyci)was 56.7%(95%CI 44.7%-68.7%),there were statistically significant differences between the two groups(P<0.05).(2)In initial treatment the eradication rate of bismuth-based regimens was 50.0%(95%CI 33.2%?66.8%),the eradication rate of standard triple therapy(PPI,clarithromyci and amoxicillin;PPI,clarithromyci and metronidazole)was 41.2%(95%CI 34.4%?48.0%),there were no statistically significant differences between the two groups(P>0.05).(3)The rescue therapy was treated when 56 cases of OAC program failed.The eradication rate of bismuth-based quadruple therapy(PPI,amoxicillin,clarithromyci and Colloidal bismmth pectin;PPI,amoxicillin,furaxone and Colloidal bismmth pectin;PPI,furaxone,clarithromyci and Colloidal bismmth pectin)was 58.3%(95%CI 42.0%?74.6%),The eradication rate of triple therapy with furaxone(PPI,amoxicillin and furaxone;PPI,furaxone and clarithromyci)was 55.0%(95%CI 33.4%-76.6%),there were no statistically significant differences between the two groups(P>0.05).(4)119 strains of H.pyori culture and drug sensitive test positive strains indicated,on metronidazole resistance rate was 63.9%,of clarithromycin resistant rate was 27.7%,amoxicillin resistant rate was 0.In 80 cases of drug sensitive test,the non drug resistance scheme was used in the initial treatment of drug resistant children,In 11 cases of clarithromycin and metronidazole resistant,the rate of eradication was 81.8%(95%CI 48.0%?98.0%)after the treatment of non drug resistance regimen,In 61 cases of metronidazole resistance,the rate of eradication was 55.7%(95%CI 43.2%?68.2%),In 8 cases of clarithromycin resistance,the rate of eradication was 100%(95%CI 63.0%?100.0%).Coincidence rate between H.pyori eradication results of 85 cases of OAC program and results of drug sensitivity test of clarithromycin in vitro was 50.6%.Conclusion:In the clinical treatment of Helicobacter pylori infection in children,The eradication rates(95%CI)of the initial treatment plan and the rescue treatment plan for 10 or 14 days both failed to achieve the target eradication rate of 80%.The eradication effect of bismuth-based regimens has no obvious advantage.Mainly related to the increase of antibiotic resistance..Drug sensitivity test is still the first choice for treatment of Helicobacter pylori infection in children.