Gastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazole
Gastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazole
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DOI：
10.1016/s0016-5085(99)70544-5
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发表时间：
1999-07-01
期刊：
影响因子：
29.4
通讯作者：
Malfertheiner, P
中科院分区：
文献类型：
--
作者：
Holtmann, G;Cain, C;Malfertheiner, P
背景和目标：在先前的研究中，观察到质子泵抑制剂（PPI）对幽门螺杆菌感染患者胃内pH值的夸大作用。由于治疗期间胃食管反流病（GERD）患者症状的愈合和改善与胃内pH值升高直接相关，因此我们假设，在H. pylori感染患者的感染率高于无H.幽门感染方法：我们招募了971例经内镜证实的II级和III级（Savary/米勒）反流性食管炎患者。在研究入组时，H.通过C-13-尿素呼气试验评估幽门螺杆菌状态，并记录基线特征。在研究完成之前，医生和患者未被告知呼吸测试的结果。所有患者均接受泮托拉唑治疗，40 mg口服，每日一次，持续4周。治疗4或8周后通过内窥镜检查证实愈合。如果此时食管炎尚未完全愈合，则继续治疗4周。比较了有和没有Hi pylon感染的患者的愈合率和症状缓解。结果：H. pylori感染率为39.9%（95%可信区间[CI]，36.9 - 42.9），性别、吸烟和饮酒均与H. pylori感染（P> 0.4）。846例患者完成了试验，无方案违背。4周和8周后反流性食管炎的总体愈合率分别为80.4%（95%CI，77.7 - 83.1）和93.6%（95%CI，91.8 - 95.2）。in H.幽门螺杆菌阳性患者，4周（86.6% vs. 76.3%; P = 0.0005）和8周（96.4% vs. 91.8%; P <0.004）后的愈合率显著较高。治疗4周后症状缓解程度H组明显优于H组（P <0.05）。幽门螺杆菌感染的患者比未感染的患者。结论：反流性食管炎与H。pylori感染的疗效明显优于H. PPI泮托拉唑治疗幽门螺杆菌阴性患者。
Background & Aims: In previous studies an exaggerated effect of proton pump inhibitors (PPIs) on intragastric pH in Helicobacter pylori-infected patients was observed. Because healing and improvement of symptoms in patients with gastroesophageal reflux disease (GERD) is directly associated with an increase of intragastric pH during treatment, we hypothesized that the response to treatment with a PPI in patients with reflux esophagitis would be better in H. pylori-infected patients than in patients without H. pylori infection. Methods: We recruited 971 patients with endoscopically verified reflux esophagitis grades II and III (Savary/ Miller). At study entry, H. pylori status was assessed by a C-13-urea breath test and baseline characteristics were recorded. Physicians and patients were not notified about the results of the breath test until completion of the study. All patients underwent treatment with pantoprazole, 40 mg orally once daily for 4 weeks. Healing was verified by endoscopy after 4 or 8 weeks of treatment. If the esophagitis had not completely healed at this time, treatment was continued for a further 4-week period. Healing rates and symptom relief were compared for patients with and without Hi pylon infection. Results: The prevalence of H. pylori was 39.9% (95% confidence interval [CI], 36.9-42.9), and neither gender, smoking, nor alcohol consumption were associated with the H. pylori infection (P > 0.4). The trial was completed by 846 patients without protocol violation. Overall healing rates of reflux esophagitis were 80.4% (95% CI, 77.7-83.1) and 93.6% (95% CI, 91.8-95.2) after 4 and 8 weeks, respectively. in H. pylori-positive patients, healing rates were significantly higher after 4 (86.6% vs. 76.3%; P = 0.0005) and 8 weeks (96.4% vs. 91.8%; P < 0.004). Relief of symptoms after 4 weeks was also significantly (P < 0.05) better in H. pylori-infected patients than in uninfected patients. Conclusions: Patients with reflux esophagitis and H. pylori infection respond significantly better than H. pylori-negative patients to the PPI pantoprazole.