| BackgroundHelicobacter pylori(H.pylori)infection was associated with both digestive diseases and extra-digestive diseases,including chronic active gastritis,peptic ulcer,gastric mucosa-associated lymphoid tissue(MALT)lymphoma,immune thrombocytopenic purpura(ITP)and gastric cancer.Eradicating H.pylori infection is demonstrated as the most beneficial approach to reduce the risk of gastric malignancy.Antibiotic resistance and poor compliance with therapy are two major reasons for inadequate eradication of H.pylori.Mounting resistance to antibiotics has hindered the effectiveness of traditional recommended therapy in recent years.The eradication rate has dropped below 80%in many countries,some of which even below 60%.Apart from antibiotics resistance,poor compliance with therapy is also an indispensable reason for eradication failure.To tackle this problem,some compliance reinforcement measures were evaluated in previous studies.However,the results are inconsistent.As exceedingly growing numbers of individuals use mobile phones around the world,mobile phone based interventions are applied in various medical settings.Compared with telephone education,short message consumes fewer time and human resources,and can be easily integrated into patients' lives without interrupting routine life.Thus,short message may be more suitable in the H.pylori eradication process.AimWe conducted a prospective randomized controlled study to evaluate the effect of short-message-based re-education(SMRE)on the eradication rate of H.pylori.The compliance,adverse events,and patient satisfaction were also assessed.MethodsThe H.pylori positive patients who had not received prior eradication therapy were recruited consecutively from July 2016 to December 2017 at Qilu Hospital of Shandong University in China.H.pylori infection was confirmed by the 13C-urea breath test(UBT).Patients were randomly allocated to SMRE group or control group.All participants received a 14-day quadruple regimen comprising lansoprazole 30 mg,colloidal bismuth pectin 200 mg,amoxicillin 1 g,and clarithromycin 500 mg twice daily.They were required to take lansoprazole and bismuth 30 minutes before meal and antibiotics 30 minutes after meal.Patients in control group received oral and written instructions at outpatient clinic.Patients in the SMRE group received extra short messages including dosage and time of administration twice daily.Successful H.pylori eradication was assessed using the 13C-urea breath test 6 weeks after treatment.The compliance,adverse events,and patient satisfaction were also analyzed.ResultsTotal of 310 H.pylori-infected outpatients were randomly assigned to SMRE group and control group.The subjects were all included in the ITT analysis,140 of the SMRE group and 143 of the control group completed the eradication.The indications for eradication of H.pylori including chronic gastritis and duodenitis,gastric atrophy,intestinal metaplasia,peptic ulcer and others such as ITP,MALT lymphoma and urticaria.In the ITT analysis,the H.pylori eradication frequencies were 74.2%for SMRE group and 67.7%(P = 0.211)for control group,respectively.In the PP analysis,the frequencies were 82.1%for SMRE group and 73.4%(P = 0.078)for control group,respectively.In subgroup analysis,the eradication rates in SMRE group were significantly higher than those in control group for patients?40 years in PP analysis(88.6%vs 71.2%,P = 0.036).Compliance in SMRE group was significantly better than that in control group(84.8%vs 72.8%,P = 0.011).Also,patient satisfaction of the SMRE group was significantly higher than that of the control group(P = 0.015).Totally around 89.6%patients considered SMRE approach acceptable.The rate of overall adverse events was 30.7%(43/140)in SMRE group and 42.0%(60/143)in control group(P = 0.049).ConclusionOur prospective randomized study demonstrated that the twice daily SMRE improved the H.pylori eradication rate in young patients,increased total compliance with treatment in all population,and alleviated adverse reactions. |
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