Clinical Effect Of Sequential Regimen And The Standard Triple Therapy For Peptic Ulcer With Helicobacter Pylori

Objective:To compare the effect of sequential regimen and the standard triple therapy for Helicobacter pylori eradication. The aim is to find out an effective therapy for patients with Helicobacter pylori infection,and to explore factors affecting the rate of H.pylori eradication.Methods:Totally 90 Helicobacter pylori-infected patients with peptic ulcer diagnosed by endoscopy were enrolled. The patients were randomized divided into three groups, A group(n=30) who received sequential regimen,esomeprazole 20mg plus amoxicillin 1.0g for the first 5days,and followed by esomeprazole 20mg,clarithromycin 500mg and tinidazole 500mg,for the last 5day;and B group(n=30) who received sequential regimen,esomeprazole 40mg plus amoxicillin 1.0g for the first 5days,and followed by esomeprazole 40mg,clarithromycin 500mg and tinidazole 500mg, for the last 5day;C group(n=30) who received standard triple regimen, esomeprazole 20mg, clarithromycin 500mg and amoxicillin 1g,for 10days.All drugs were given twice daily. After finishing of H.pylori therapy at least four weeks later, and after withdrawal of esomeprazole at least two weeks later,we compared the H.pylori status,ulcer healing,clinical symptoms and side-effects among three groups by inquisition,endoscopy and 14C-urea breath test(14C-UBT). Three regimens were evaluated by cost effectiveness analysis and factors affecting the rate of H.pylori eradication were filtered by logistic regression analysis.Results:1.The rates of H.pylori eradication in A group,B group and C group were 83.33%,86.67% and 60% respectively. The rates of A group and B group were significantly greater than that of the C group (P<0.05;difference),and the differences had no statistical significance between the A group and B group (P>0.05).2. The peptic ulcer healing rates in A group,B group and C group were 90%,96.67% and 73.33% respectively. The rates of A group and B group were significantly greater than that of the C group (P<0.05;difference),and the differences had no statistical significance between the A group and B group (P>0.05); the rates of ulcer treatment efficiency in A, B, C three groups of patients were 93.33%,96.67% and 80.00% respectively, among the three groups no significant difference(P>0.05);three sets of clinical symptom score and the incidence of adverse reactions were not different significantly between three groups(P>0.05).3.The cost effectiveness analysis showed that the C/E value of the A group was lowest in the three groups.4.Multiple regression analysis identified that the H.pylori eradication rate correlated to age, the past history of peptic ulcer,treatment group,the site of ulcers,as well as gastric mucosa RUT results,,but not to sex,height, weight, and smoking, drinking habit. Overall eradication rate was higher in older patients, and RUT results that were weak positive,duodenal ulcer, but without a history of PU.Conclusion:1.Sequential regimen can achieve a higher rate of H.pylori eradication and ulcer healing rate. The C/E value of the A group was lowest in the three groups.2.The eradication rate of H.pylori is higher in older duodenal ulcer patients without a history of PU and with RUT results that were weak positive before primary treatment.