Study On Optimization Of Eradication Of Helicobacter Pylori With Probiotics Combined With Quadruple Therapy

Background:Helicobacter pylori（Hp）is a Gram-negative microaerobic bacterium colonizing in the curved gastric mucosa and is one of the most common human pathogens.At present,more than 50%of the world’s population is infected with Hp.In China,the infection rate of Helicobacter pylori in the rural population is 66%,and that in the urban population is47%.In 1994,the International Agency for Research on Cancer（IARC）listed Hp as a carcinogen like carcinogen of gastric cancer.According to statistics,about 90%of the occurrence of non-cardiac gastric cancer is related to Hp infection.Hp infection is the most important controllable risk factor for cancer prevention at present,and should be used as a primary preventive measure for gastric cancer.Eradicating Hp has become a global concern.With the deepening of researches on Hp eradication at home and abroad,treatment regimens have been continuously optimized.At present,bismuth agent quadruple therapy has been the preferred treatment for HP eradication in China.However,with the abuse of antibiotics,the increase of drug resistance and the occurrence of adverse drug reactions,the eradication rate of Hp is not optimistic.We need to continue to explore new therapies to eradicate Hp in order to find the best treatment options.Objective:The purpose of this study was to investigate the effect of probiotics combined with quadruple therapy on the eradication of Helicobacter pylori.The standard group was treated with bismuth compound therapy,To explore the effect of probiotics at different times on the incidence of adverse reactions in the eradication rate of Helicobacter pylori and the degree of clinical symptom remission,so as to obtain the optimal treatment plan.To provide the basis for the clinical use of probiotics in the later stage.Method:In this study,160 first-time treatment patients who were tested positive for HP by ¹³C urea breath test(¹³C-UBT)in a tertiary hospital in Xi’an from November 2019 to December 2020 were selected.They were randomly divided into four groups:standard group and combined groupⅠ、Ⅱ、Ⅲ.The standard group received bismuth quadruple therapy（Rabeprazole sodium enteric capsules 20mg、Amoxicillin capsule 1000mg、Clarithromycin tablet 500mg、Colloidal pectin bismuth capsule 200mg,2 times per day,2weeks）.Combined groupⅠ:Bifidum Triple Live Bacteria Tablets 2g（3 times per day）were pretreated for 2 weeks,and then the standard group was treated for 2 weeks;Combined groupⅡ:on the basis of standard group regimen,bifidum triplet live tablet 2g（3 times per day）was additionally treated for 2 weeks;Combination groupⅢ:Standard group was treated with bifidum triplet live tablet 2g（3 times per day）for 2 weeks after eradication.All patients in the four groups were tested by ¹³C urea breath test(¹³C-UBT)4 weeks after drug withdrawal.To compare the effect of conventional bismuth agent quadruple therapy and different time combined with probiotics on the incidence of adverse reactions in Hp eradication rate and the remission of clinical symptoms.All patients were followed up by telephone,the occurrence of adverse reactions and the remission of clinical symptoms were recorded,good communication was conducted with patients in time,the medication status of patients was understood,correct medication guidance was given,adverse psychological reactions during treatment were eliminated,and medication compliance of patients was improved from the perspective of humanistic care.Result:1.General condition of the four groups:A total of 160 patients were included in this study,and 5 patients were lost to follow-up or discontinued treatment due to drug side effects.Standard group:17 males and 21 females;average age:42.68±11.2;Combined groupⅠ,there were 14 males and 25 females,average age 39.94±13.60;Combined groupⅡ:There were 20 males and 20 females,average age 43.5±11.819;Combined groupⅢ,there were 21 males and 17 females,average age 44.7±11.7.There was no significant difference in smoking and drinking、body mass index among the four groups（p>0.05）.2.Eradication rate:In 160 patients,¹³C urea breath test(¹³C-UBT)were reexamined4 weeks after drug withdrawal.A total of 155 patients completed the treatment according to the protocol,with a completion rate of 96.87%,among which 139 cases were successfully eliminated,with an eradication rate of 89.68%.The Hp eradication rates of the standard group and the combination groupⅠ、Ⅱ、Ⅲwere 80.0%、87.5%、90.0%、90.0%according to intentionality analysis（ITT）,respectively,and there was no significant difference（p>0.05）.According to the protocol set analysis（PP）,the eradication rates were 84.2%,89.7%,90.0%and 94.7%,respectively,without significant difference（p>0.05）.According to ITT and PP analysis,the probiotic-assisted bismuth agent quadruple therapy could improve the Hp eradication rate,and the Hp eradication rate was the highest with the conventional quadruple therapy followed by probiotics treatment for 2 weeks,but there was no significant statistical difference between the four groups.3.Incidence of adverse reactions:After the treatment,standard,Combined groupⅠⅡⅢ,the incidence of adverse reactions were 31.58%,12.8%,7.5%,13.16%.The incidence of adverse reactions in the standard group was significantly higher than that in the combined group.（p<0.05）.There was no significant difference in the incidence of adverse reactions among the three groups in the combination group（p>0.05）.4.Clinical symptom remission:This research standard,combination groupⅠ、Ⅱ、Ⅲclinical symptom remission rate were 86.4%,84.6%,85.0%,89.47%,the probiotics treatment for 2 weeks after the eradication of the conventional quadruple therapy had a higher improvement rate in patients with clinical symptoms,but no significant difference（p>0.05）.Conclusion:1.Compared with conventional quadruple therapy,probiotic-assisted bismuth agent quadruple therapy could increase the eradication rate of Hp,in which the eradication rate of Hp was the highest when the conventional quadruple therapy was followed by probiotics for 2 weeks.2.Compared with conventional quadruple therapy,probiotics combined with quadruple therapy significantly reduced the incidence of adverse reactions during the Hp eradication process,and the incidence of adverse reactions was the lowest under the conventional quadruple therapy with probiotics at the same time.3.In the conventional bismuth agent quadruple therapy and its probiotics combination regimen,the probiotics treatment for 2 weeks after the eradication of the conventional quadruple therapy had a higher improvement rate in patients with clinical symptoms.4.Health education before treatment and telephone follow-up during treatment are beneficial to improve patients’medication compliance,and it is worth further study whether it can be an important measure to improve the success rate of initial treatment of HP besides.