Common Therapies For The Eradication Of Helicobacter Pylori And Analysis Of Drug Resistance

BACKGROUND AND AIMSHelicobacter is one of the helicobacter pylori,it can secrete adhesion to get theepithelial cells,get through the mucous layer using its flagellum,then give offurease to keep itself in the neutral environment and damages the cells ofparasitifers’ at the same time.Cell related gene protein will cause a stronginflammatory reaction.The cytoderm of Helicobacter pylori which contains LewisX and Lewis Y can act as one kind of antigen.In addition to these,Helicobacterpylori can promote the release of inflammatory mediators from epithelialcells.More than half of the World’s population were infected.Helicobacter pylorihas been proved to be related to many diseases of the digestive system,for exampleChronic gastritis,Peptic ulcer,Gastritis MALT lymphadenoma and gastric cancer.Recently,quadruple therapies combining a PPI,two kinds of antibiotics andbismuth has been proposed to as the first-line anti-H.pyloritherapies.Antimicrobial resistance rates varies from regions toregions.However,the drug resistance rate of Ningxia is unknown.This studyobserved the therapeutic effects of different treatments and the courses of thetreatment by comparing the eradications of three conventional treatments.We alsoanalysed the Cost-Effectiveness Analysis of every treatment.Finally,we can provide basis for clinical diagnosis and treatment.METHODS180people with upper gastrointestinal symptoms who came to NingxiaMedical University affiliated hospital were involved in this study.They werediagnosed as having chronic gastritis or peptic ulcer after underwent electronicgastroscope,both RUT and UBT tests were positive.They were randomly dividedinto six groups: group one: rabeprazole40mg once a day,amoxicillin1000mgtwice a day,clarithromycin500mg twice a day,bismuth1000mg three times a dayfor7days;group two:rabeprazole40mg once a day,levofloxacin200mg twice aday,furazolidone100mg twice a day,bismuth1000mg three times a day for7days;group three:rabeprazole40mg once a day,clarithromycin250mg twice aday,tinidazole500mg twice a day,bimuth potassium citrate600mg three times aday for7days;group four: rabeprazole40mg once a day,amoxicillin1000mg twicea day,clarithromycin500mg twice a day,bismuth1000mg three times a day for14days;group five:rabeprazole40mg once a day,levofloxacin200mg twice aday,furazolidone100mg twice a day,bismuth1000mg three times a day for14days;group six:rabeprazole40mg once a day,clarithromycin250mg twice aday,tinidazole500mg twice a day,bimuth potassium citrate600mg three times aday for14days.Check the eradication rate by UBT tests after they finished theircourses of treatment and4weeks of nonuse of any drug.Followed up and recorderadication rates and adverse reactions.In addition to analysis of eradicationrates,we have campared the CEA of each therapy.RESULTS1.170patients finished their courses of treatment.The eradication oftherapeutic schedule C for7days(14.9%) is obviously lower than that oftherapeutic schedule A(39.3%) and B(53.3%).The eradication of therapeutic schedule A for7days(39.3%) is lower than the etadication of therapeutic scheduleB.But there is no significant difference between the eradication rates of these twoschedules.2.The eradication rate of therapeutic schedule C for14days(40.0%) isobviously lower than that of therapeutic schedule A (79.3%) and B (83.9%).Theeradication of therapeutic schedule A for14days(79.3%) is lower than theeradication rate of therapeutic schedule B(83.9%)， but there is no significantdifference between the eradication rates of these two schedules.3.No statistical difference was proved between the rates of adverse reactions ofthe three therapeutic schedules for7days(21.4%,23.2%and14.85).The rates ofadverse reactions of the three therapeutic schedules for14days are34.5%,25.8%and24.0%,and there’s no significant difference between these three groups.4.The Cost-Effectiveness Analysis of the three therapeutic schedules for7days are5.05,2.96and18.83.5.The Cost-Effectiveness Analysis of the three therapeutic schedules for14days are5.01,3.76and13.93.CONCLUSION1.Among all the three therapies for7days,therapy withrabeprazole,clarithromycin， tinidazole and bismuth has the lowest eradicationrate(14.8%),and the therapy with rabeprazole,levofloxacin,furazolidone andbismuth has the highest eradication rate(53.3%).The results among the groups for14days are similar to this.Therapy with rabeprazole,clarithromycin，tinidazole andbismuth has the lowest eradication rate(40.0%),and the therapy withrabeprazole,levofloxacin,furazolidone and bismuth has the highest eradicationrate(83.9%).2.There may have been drug-resistant strains in our region.The resistance rate of tinidazole might be the highest,and there may have been drug-resistant toamoxicillin,clarithromycin,Levofloxacin or furazolidone,but the treatment effectscan be improved by increasing the duration of treatment,but moreantibiotic-resistance in vitro experiment is needed.3.The lowest Cost-Effectiveness Analysis of the three therapies for7days istherapeutic schedule B,it means that therapeutic schedule B takes least costs underthe same treatment effect.The conclusion from the groups for14days is the same.4.The therapeutic schedule with rabeprazole,clarithromycin,tinidazole andbimuth potassium citrate is not appropriate to eradicate Helicobacter pylori in thisregion. Both the therapeutic schedule with rabeprazole,amoxicillin,clarithromycinand bismuth for14days and the therapeutic schedule withrabeprazole,levofloxacin,furazolidone and bismuth for14days can be used asoptions to eradicate Helicobacter pylori.