Clinical Effect Of Bismuth-Containing Quadruple Therapy Against Helicobacter Pylori And Changes Of Intestinal Flora Before And After Treatment

Objective:To study the clinical efficacy of anti-Helicobacter pylori quadruple therapy with bismuth-containing agent and the changes of intestinal flora before and after treatment,and to find out the flora that lead to treatment failure.Methods:Patients with Helicobacter pylori infection were treated with anti-Helicobacter pylori bismuth-containing quadruple regimen for 14 days,and stool samples were collected before treatment,2 weeks after treatment and 1 month after drug withdrawal for 16 Sr DNA sequencing.According to the treatment time,they were divided into pre-treatment group,2-week treatment group and 1-month discontinuation group.Breath test was reviewed after treatment,and patients were divided into successful group and failed group according to the review results.The change of microflora before and after treatment and the difference of microflora between successful and unsuccessful treatment groups were analyzed.Results:In the course of treatment against Helicobacter pylori infection,the differences of intestinal flora α diversity index(Chao1 index,Simpson index,Shannon index)were statistically significant(P< 0.05).There was no significant difference in α diversity index(Chao1 index,Simpson index and Shannon index)between successful and failed treatment groups(P > 0.05).The dominant Phylum in Helicobacter pylori infection patients were Firmicutes,Bacteroidetes,Proteobacteria and Actinobacteria,and the dominant Genus were Bacteroidetes,Blautia,Faecalibacterium and Ruminococcus.The relative abundance of Firmicutes,Proteobacteria,Actinobacteria,TM7 and Fusobacteria changed before Helicobacter pylori eradication treatment,2 weeks of treatment and 1 month of drug withdrawal,and the difference was statistically significant(P < 0.05).The relative abundance of Blautia,Shigella,Faecalibacterium,Prevotella,Oscillospira and Clostridium were changed,and the difference was statistically significant(P <0.05).The relative abundance of Dorea in treatment failure group was increased,while that of Bifidobacterium in treatment failure group was decreased,with statistical significance(P < 0.05).Conclusion:In the process of Helicobacter pylori eradication,the diversity and dominant flora of intestinal flora are changed,and the flora disorders occur in the process of treatment.The abundance of pathogenic bacteria in the intestinal tract is relatively increased and the abundance of beneficial bacteria producing short chain fatty acids is relatively decreased,leading to the weakening of intestinal barrier,the increase of pro-inflammatory factors,and the increase of inflammation level,which may affect the eradication effect of Helicobacter pylori.Ultimately,eradication therapy fails.