| Objective: Helicobacter pylori(Hp)is a Gram-negative bent aerobic bacterium,mainly distributed in the gastric mucosa,and widely distributed in human body.Its infection can cause a variety of gastric and external diseases.The infection rate of Hp in China is 47% to 66% respectively,and the infection rate of Hp is still severe.Hp has been listed by the International Agency for Research on Cancer(IARC)as a Class I carcinogen for gastric cancer.Numerous studies have shown that the elimination of Hp can not only reduce the recurrence rate of gastric ulcer and duodenal bulbar ulcer,but also reduce the incidence of gastric cancer.Recent studies have shown that Hp infection and clearance can lead to intestinal microecological imbalance,and the addition of probiotics can alleviate the imbalance.However,there is no consensus on the efficacy of probiotics in Hp salvage therapy and the regulation of intestinal flora.Therefore,we plan to add probiotics into the bismuth quadruple regimen to observe its effect on Helicobacter pylori infection,so as to lay a foundation for its clinical application.To observe the effect of standard quadruple therapy combined with probiotics in initial treatment of Hp.Two bismuth agent quadruple therapy group was used as the standard group to observe the eradication rate,adverse reactions and clinical symptoms of Hp,in order to obtain the best treatment plan for Hp,laying the foundation for the subsequent eradication of Hp clinical application.Methods:From December 2021 to January 2023,320 newly enrolled patients were observed under gastroscopy and/or pathology in case No.2,Department of Gastroenterology,East Central Hospital of Handan City.14 C urea breath test(14C-UBT)detected Hp positive.Two bismuth agents were used in quadruple therapy(group A and group B),160 cases in each group.Group A: Rabeprazole + amoxicillin + clarithromycin + bismuth potassium citrate quadruple therapy;Group B: Rabeprazole + amoxicillin +furazolidone + bismuth potassium citrate quadruple therapy.The two control groups were divided into eight groups according to standard group,combined group Ⅰ,combined group Ⅱ and combined group Ⅲ,which were recorded as group A1,group A2,group A3,group A4,group B1,group B2,group B3 and group B4,with 40 cases in each group.Group A1 and group B1 were treated with two standard bismuth quadruple therapy for 2 weeks,respectively.Group A2 and B2: bifidobacterium tetrad tablet1.5g,3 times a day,2 weeks after taking the medicine,standard group was used for 2 weeks;Group A3 and B3: on the basis of standard group,bifidobacterium quadruplet viable tablet 1.5g was added,3 times a day,for2 weeks;Group A4 and B4: After 2 weeks of treatment in standard group,1.5 g bifidobacterium tetrad tablets were added,3 times a day,for 2 weeks.The subjects in eight groups were given 14 C urea exhalation test(14C-UBT)4 weeks after drug withdrawal.The result was negative,indicating successful Hp clearance,while the result was positive,indicating failure of Hp clearance.To observe the effects of two traditional bismuth quadruple therapy methods combined with probiotics in different periods on the eradication rate,the incidence of adverse reactions and the remission rate of clinical symptoms.Results: 1.Eradication of Helicobacter pylori: 320 patients,306 patients completed the test,268 patients were eradicated.The total Hp eradication rate of the eight groups was 83.75% according to ITT analysis,and 87.58%according to PP analysis.ITT analysis showed that all strains had good scavenging effect on Hp.A1,A2,A3,A4,B1,B2 and B3 are 80.00%,80.00% and 85.00% respectively.B4,95.00%.There was no significant difference in the clearance of H.pylori between group An and group B,but there was significant difference in the clearance of Hp between the two groups.Results: A1,A2,84.21%,85.00%,A4,A3 89.47%,B1,B2,94.12%,and B3,94.44%,B4 95.00%.There was no significant difference in Hp clearance between group A and group B.There was no significant difference in Hp clearance between groups in group A and between groups in group B.By PP analysis,the results were as follows: Group A1 80.00%,A2 84.21%,A3 85.00%,A4 89.47%,B1 80.00%,B2 94.12%,B3 94.44%and B4 95.00%.There was no significant difference in the Hp clearance rate between group A and group B.There was no significant difference in Hp clearance between groups in group A and between groups in group B.2.What happens to ADR: what happens to all ADR is as follows: Group A125.00%,group A2 15.79%,group A3 5.00%,group A4 21.05%,group B130.00%,group B 17.65%,group B3 5.56% and group B4 15.00%.Chi-square cutting analysis was conducted on the incidence of adverse reactions among groups A,and the results showed that the incidence of adverse reactions in group A3 was significantly different from that in the standard group,while the incidence of adverse reactions in groups A2 and A4 was less than that in the standard group,but there was no significant difference.There was no statistical significance in the incidence of adverse reactions among group B1,B2,B3 and B4.Through chi-square cutting analysis of the incidence of adverse reactions in group B,the results showed that the incidence of adverse reactions in group B3 was significantly lower than that in the standard group,with statistical significance,while the incidence of adverse reactions in group B2 and group B4 was lower than that in the standard group,but did not show significant statistical significance.3.Remission of clinical symptoms: the remission rates of clinical symptoms in groups A1,A2,A3 and A4 were 82.50%,84.21%,85.00% and92.11%,respectively;the remission rates of clinical symptoms in groups B1,B2,B3 and B4 were 85.00%,85.29%,83.33% and 90.00%,respectively.There was no significant difference between group A and group B in the comparison of the curative effect of the two methods.Conclusions:1.Probiotics combined with bismuth quadruple therapy could improve the H.pylori eradication rate compared with bismuth quadruple therapy,but the difference was not statistically significant.With the help of probiotics,there was no significant difference in the clearance rate of two different bismuth quadruple therapy regimens.Probiotics were applied in different periods,and the group A4 and group B4 group had higher eradication rates,but there was no significant difference compared with group A1,group B1,group A2,group B2,group A3 and group B3.2.Compared with the conventional quadruple therapy regimen,probiotics combined with bismuth quadrupletherapy at different time points could reduce the adverse reactions to eradicate Hp,and the simultaneous application of probiotics in group A3 and group B3 had the least adverse reactions.There was no significant difference in ADR between group A and group B treatment regimens.3.In the case of the combination of conventional bismuth and probiotics,the clinical effective rate was higher than that of conventional bismuth for 2weeks followed by the combination of conventional bismuth for 2 weeks followed by the combination of probiotics for 2 weeks,but there was no significant difference among the 8 groups.4.Preoperative health education and intraoperative telephone and wechat tracking can effectively improve patients’ medication compliance.Whether it can be used as a non-drug treatment to increase the success rate of initial treatment of Hp needs to be further discussed. |
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