Current Status of the Third-Line Helicobacter pylori Eradication.
Current Status of the Third-Line Helicobacter pylori Eradication.
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DOI：
10.1155/2018/6523653
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发表时间：
2018
影响因子：
2
通讯作者：
Baik GH
中科院分区：
文献类型：
--
作者：
Choi JH;Yang YJ;Bang CS;Lee JJ;Baik GH
全球范围内抗生素耐药性正在加剧，连续第一线和第二线幽门螺杆菌根除方案失败的患者也在增加。因此，细菌培养与抗生素药敏试验和分子药敏试验的作用对于避免使用无效抗生素具有重要意义。然而，抗生素敏感性测试指导的治疗并不一定能保证成功根除，并且三线救援治疗的有效性结果好坏参半。因此，为患者提供治疗前用药指导和教育非常重要。确定根除失败的原因也很重要，包括宿主相关因素（根除方案依从性差、吸烟和细胞色素 P450 2C19 基因多态性）或治疗相关因素（剂量或治疗持续时间不足以及胃酸度），因为这些因素可以根据定制治疗进行修改。尽管根除幽门螺杆菌的适应症已经扩大，但胃癌高风险患者可以通过三线甚至四线治疗获得明确的益处。
Antibiotic resistance is growing worldwide, and patients who have failed consecutive 1st- and 2nd-line H. pylori eradication regimens are increasing. Therefore, the role of the bacterial culture with antibiotic susceptibility testing and molecular susceptibility testing is important for avoiding the use of ineffective antibiotics. However, antibiotic susceptibility testing-guided treatment does not necessarily guarantee successful eradication, and there have been mixed results for the effectiveness of a 3rd-line rescue therapy. Therefore, providing patients with pretreatment medication instructions and education is important. It is also crucial to determine the reason of the eradication failure, including host-related factors (poor compliance to eradication regimen, smoking, and cytochrome P450 2C19 genetic polymorphism) or treatment-related factors (inadequate dosage or duration of therapy and gastric acidity), as such factors can be modified for a tailored therapy. Although the indications for H. pylori eradication have widened, patients at a high risk of gastric cancer can gain definitive benefits with a 3rd-line or even 4th-line therapy.
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