Clinical Study On Curative Effect Of Different Treatment Regimens On Helicobacter Pylori In Some Areas Of Sichuan Province

Background Objective:As a developing country,China has a high incidence of H.pylori infection which is closely related to upper gastrointestinal diseases,especially gastric cancer.In addition,H.pylori infection is closely associated with Parenteral disease,so eradication treatment of H.pylori is a key and difficult topic in the field of H.pylori worldwide.The study was aimed to evaluate the drug resistance of H pylori through the efficacy of three different eradication regimens of H pylori in some areas of Sichuan province.At the same time,combined with the incidence of adverse reactions,it is expected to find a suitable empirical therapeutic regimen for the eradication of H.pylori in Sichuan,and to conduct the cultures and drug sensitization of H.pylori in patients with poor efficacy,so as to obtain personalized treatment regimens.Methods:From September 1,2018 to September 1,2019,a total of 300cases of H.pylori positive patients were detected by ¹⁴C or ¹³C urea breath test(¹⁴C-UBT or ¹³C)or rapid urease test in three third class A hospitals of Sichuan province.The regimens were follows:esomeprazole（AstraZeneca）20 mg 2times/d,colloidal bismuth pectin（Datong Dayuan）200 mg 3 times/day,amoxicillin（Shandong Lukang）1000 mg 2 times/d,antibiotic 2:group A（n=100）:furazolidone（Beijing Ocean）100 mg 2 times/d,group B（n=100）:clarithromycin（Kangmei Pharmaceutical Industry）500 mg 2 times/d,group C（n=100）:tetracycline（Zhejiang Dadong）500 mg 3 times/d.Acceptance of eradication H.pylori was treated for 14 days and stopped for 4 weeks after the end of all treatment regimens.¹⁴C or¹³C Urine breath Test(¹⁴C-UBT or¹³C)was used to detect the eradication of H.pylori and to record the adverse reactions of the patients.In the patients with poor efficacy of the above three treatment regimens,the gastric mucosal tissues of gastric antrum and the stomach body were taken for H pylori culture and drug sensitization,and the drug was guided according to the drug sensitization,and the radical treatment effect of H.pylori was evaluated.The obtained data were statistically analyzed foreradication rate,symptom relief rate,incidence of adverse reactions,cost-effectiveness,and the results of H.pylori culture drug sensitivity in patients with poor efficacy among group A,B,and C,with SPSS software.Results:The comparison of general data of the three regimens:the age,sex and gastroscopy results of the patients among group A,B and C were not statistically significant（P>0.05）.A comparative analysis of eradication rates in three regimens:295 of the300 patients were finally treated and followed up,and 5 patients were lost to follow up.The eradication rate of patients in group A,B and C was93.0%,77.0%and 92.0%by ITT analysis.There was significant difference in eradication rate among the three groups.There was a significant difference in the eradication rate between the two groups of patients with A and B and two groups of B and C（P<0.05）.However,there was no significant difference in eradication rate between group A and group C（P>0.05）.The eradication rate of patients in group A,B and C was 93.94%,78.57%and 93.88%by PP analysis.There was a significant difference in the eradication rate between the two groups of patients with A and B and two groups of B and C（P<0.05）.However,there was no significant difference in eradication rate between group A and group C（P>0.05）.The comparative analysis of Symptom relief rate in three regimens:according to PP analysis,60 cases in group A showed significant effect,35cases were effective,4 cases were ineffective,and the symptom remission rate was 95.95%.In group B,59 cases showed significant effect,29 cases were effective,10 cases were ineffective,and the symptom remission rate was89.97%.In group C,there were 61 cases with obvious effect,32 cases with effective effect and 5 cases with ineffective effect,and the symptom remission rate was 94.89%.There was no significant difference in symptom remission rate among the three groups（P>0.05）.The Comparative analysis of incidence of adverse reactions in the three regimens the incidence of adverse reactions in the three groups was 23.2%,29.5%and 28.5%.There was no significant difference among the three groups（P>0.05）.A comparative analysis of the cost-effect in the three groups:group A277.76 yuan,group B 414.96 yuan,group C 280.84 yuan.It could be seen from above results that group A has the lowest cost to improve the unit treatment efficacy.The results of culture and drug susceptibility test of H.pylori in patients with poor efficacy:The gastric antrum and gastric mucosa were used in33 patients with poor curative effect.Among the 33 positive gastric mucosa specimens,12 were positive,with a culture positive rate of 36.36%.Among the12 positive H.pylori specimens,after the drug sensitive test,the sensitive rate to amoxicillin rate was 75.0%,the sensitivity to furazolidone rate was 83.3%,sensitive to tetracycline rate was 83.3%,the sensitivity to clarithromycin rate was 25.0%,the sensitivity to levofloxacin rate was 33.3%,the sensitivity to metronidazole rate was 25.0%.According to the results of drug susceptibility test,H.pylori was again eradicated in 11 patients,with the eradication rate of91.66%.Conclusion:Quadruple regimens containing Amoxicillin,furazolone and Amoxicillin,tetracycline in eradication therapy of H.pylori are more effective than clarithromycin-containing quadruple regimen,and the cost of the quadruple regimens containing Amoxicillin,furazolone and Amoxicillin,tetracycline are the lowest in terms of improving the effectiveness of unit therapy.Therefore in the clinical practice of empirical treatment of H.pylori in Sichuan,especially in the south of sichuan where drug resistance rate is high,the two quadruple regimens containing amoxicillin and furazolidone,amoxicillin and tetracycline should be taken as the first choice for the empirical eradication of H.pylori.The culture and drug susceptibility test of H.pylori is safe and effective for the remedial treatment of H.pylori,and can make the selection of antibiotics more targeted in clinical practice,significantly improve the eradication rate,and provide a certain basis for the extensive application of H.pylori drug susceptibility test in clinical practice.