Efficacy Of Different Regimens For Eradication Of Helicobacter Pylori

Objective Helicobacter pylori(H.pylori)is a pathogen parasitizing in the gastric mucosa.It is closely associated with many sotmach-related diseases.Epidemiological data have shown that more than half of the the world's population was infected with H.pylori.The prevalence rate of H.pylori infection varied in different global locations,and the rate was found to be 58.07% in China.Inappropriate and widespread use of antibiotics in the treatment of infectious diseases has become the main reason of declining response to the standard triple drug therapy used in treating H.pylori.This is due to increasing resistance rate of H.pylori to antibiotics used in the H.Pylori eradication regimen.Clarithromycin-based triple therapies are no longer recommended as clinical empirical therapy when the local resistance to this antibiotic is high(>10%-20%).Due to the emergence of high resistance rate to standard antibiotics used in H.pylori eradication,it is of upmost importance to search fo new possibilities of treatment of H.pylori infection.In this study,we aim to analyze the therapeutic effects of different eradication therapies of H.pylori infection.By comparing the eradication rate of H.pylori infection,the remission of clinical symptoms and the rate of adverse reactions,we aim to find the best therapeutic regimen.MethodsPatients enrollment:Patients enrolled in this study were those who gave positive results to the14C-urea breath test(14C-UBT)and rapid urease test of gastric mucosa biopsy(RUT)in the department of gastoenrerolofy of the First affiliated hospital of Dalian Medical University,during the period of March 2016 to December 2016.120 cases were selected.They were randomly divided into groups A,B and C.Each group consisted of 40 patients.Patients of group A were given drug treatment rabeprazole,levofloxacin and metronidazole.Patients of group B were given therapy of rabeprazole,metronidazole,levofloxacin and colloidal bismuth pectin.Patients of group C usedrabeprazole,clarithromycin,levofloxacin and colloidal bismuth pectin.The whole course of drug treatment was provided 10 days in the groups A,B and C.Successful eradication therapy for H.pylori infection was defined as a negative14C-UBT after 4 to 6 weeks of H.pylori eradication treatment.Methods of examination:Diagnosis of H.pylori infection was established by14C-urea breath test(14C-UBT)and rapid urease test of gastric mucosa biopsy(RUT)in First affiliated hospital of Dalian Medical University in 2016.Patients were treated with three different drug regimens,and the status of H.pylori infection reassessed by14C-UBT after stopping the drugs 4 to 6 weeks later.Statistical analysis:The statistical analysis was carried out using Excel 2013 and the statistical software of SPSS 20.0.The counting data was analysed with Mean±SD and t test.Statistical analysis on enumeration datawas expressed as percentage through Chi-sqare analysis.P<0.05 indicates statistical significance.Results120 patients accepted H.pylori eradication therapy and 114 patients completed the whole treatment course.The H.pylori eradication rate was analyzed according to the per-protocol(PP)and intention-to-treat(ITT).Helicobacter pylori eradication rate: The overall PP eradication rate was 86.0%(98/114).Final group A PP eradication rate was 70.3%(26/37),group B PP eradication rate was 92.3%(36/39),and group C eradication rate was 94.7%(36/38).The difference of PP eradication rate between Group A and group B was statistically significant(p=0.013<0.05)and similarly the difference of PP eradication rates between group A and group C showed statistical significance(p=0.005<0.05).The difference between PP eradication rates of group B and group C showed no statistical significance(P > 0.05).The overall ITT eradication rate of the 120 patients was 81.7 %(98/120).The final group A ITT eradication rate was 65.0%(26/40),group B ITT eradication rate was 90.0%(36/40)and group C ITT eradication rate was 90.0%(36/40).The difference of ITT eradication rate between group A and group B had statistical significance(p=0.007<0.05)and the difference between group A and group C ITT eradication rateshowed statistical significance(p=0.007<0.05).The difference of eradication rates of group B and group C had no statistical significance(P>0.05).The end results of PP analysis and ITT analysis were the same.Improvement of symptoms:Effectiveness rate was calculated by recording improvement of symptoms after drug therapy.PP analysis:Total effectiveness rate of therapy in group A was 70.3%(26/37),total effectiveness rate of the treatment in group B was 89.7%(35/39)and total effectiveness rate of therapy in group C was 92.1%(35/38).The difference of the effectiveness rate of therapy between Group A and group B had statistical significance(p=0.033,<0.05),and similarly the difference of effectiveness rate of treatment in group A and group C showed statistical significance(p=0.015<0.05).The difference between effectiveness rates of therapy of group B and group C had no statistical significance(p=0.719> 0.05).ITT analysis:The total effectiveness rate of therapy in group A was 65%(26/40)?in group B was 87.5%(36/40)and the rate in group C was 87.5%(35/40).The difference of effectiveness rate of therapy between Group A and group B had statistical significance(p=0.018,<0.05),and similarly the difference of effectiveness rate of treatment between group A and group C showed statistical significance(p=0.018,<0.05).The difference of effectiveness rate of drug therapy in group B and group C had no statistical significance(p>0.05).The end results of analysis of effectiveness rates in PP analysis and ITT analysis were the same.Adverse effect rate:The adverse effect rates in group A,group B and group C showed no statistical significance(P>0.05)in PP analysis and ITT analysis.Conclusion1.Bismuth quadruple therapies have a higher eradication rate and a clinical effectiveness rate than Triple therapies'.It is recommended in this area for clinical treatment.2.H.pylori eradication rates of bismuth quadruple therapies with metronidazole or clarithromycin were greater than 90%,but the difference between them is insignificant.Both metronidazole and clarithromycin can use for eradication of H.pyloriin the region.