The Clinical Efficacy Of Sequential Therapy And Typical Triple Therapy In The Treatment Of Helicobacter Pylori Peptic Ulcer

Objective:Peptic ulcer is one of the most common digestive system disease, with the popularity of digestive endoscopic examination,H2-receptor antagonist (H2RA) and proton pump inhibitors (PPIs) came out, non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and on Helicobacter pylori (Helicobacter pylori, H.pylori) understanding role in the pathogenesis of peptic ulcer in the recent twenty years, diagnosis, treatment of peptic ulcer disease has undergone tremendous changes, especially the proton pump inhibitor eradication of Helicobacter pylori and the application in the treatment of peptic ulcer disease, greatly reduced the incidence of disease and complications of peptic ulcer disease occurrence rate, make the patient’s quality of life has been greatly improved. Among them, the eradication of Helicobacter pylori (H.pylori) has become a priority among priorities in the treatment of peptic ulcer and prevention of ulcer recurrence. Helicobacter pylori (H.pylori) infection is an important cause of chronic active gastritis and peptic ulcer, it also associated with gastric cancer, gastric mucosa associated lymphoma. Therefore, to eradicate H.pylori to relieve the clinical symptoms of peptic ulcer, healing, prevention of ulcer recurrence, and has important significance to prevent canceration. For H.pylori related peptic ulcer, first-line therapy in our country is used PPIs plus clarithromycin plus amoxicillin or metronidazole in the treatment for7-14days of standard triple therapy. But with the H.pylori treatment for extensive development, highlighted the problem of drug resistance, Hp eradication rate decreased gradually, the traditional triple therapy effect is obviously reduced. Sequential therapy proposed by Italy scholars De Francesco etc. obtain higher eradication rate of Hp, the clinical results are satisfactory. Sequential therapy which is compositived by a proton pump inhibitor, amoxicillin, clarithromycin and Tinidazole and traditional triple therapy on the treatment of Helicobacter pylori infection in patients with peptic ulcer is mainly studied in this paper, and we observe the clinical effect of the two methods.Materials and Methods:2013May to2014May in the choice of50patients admitted to the Department of digestive system of Qilu Hospital of Shandong University by gastroscopy and C13-Breath test confirmed Helicobacter pylori infection in patients with peptic ulcer, according to the different treatments, were randomly divided into treatment group and control group,25cases in each group; the treatment group according to the sequential therapy of the first-fifth days to give the Esomeprazole+amoxicillin oral treatment, sixth-tenth days given esomeprazole+clarithromycin+Tinidazole oral therapy; the control group according to the standard triple therapy in first-tenth days were given esomeprazole+amoxicillin+clarithromycin oral therapy. The end of the two set of10d after treatment to continue taking esomeprazole4weeks, ending all course.4weeks after the cessation, rechecking gastroscope and C13breath test to observe the ulcer healing and Helicobacter pylori eradication, follow-up of oral drug adverse reaction during treatment. Using SPSS19statistical software in computer data processing, between group comparisons using X2, P< 0.05as the difference had statistical significance.Results:The treatment group of25patients with clinical symptoms and signs were improved evidently in24cases, endoscopic performance at least as good as the healing of ulcer, ulcer area reduced50%or scar period,1patients with endoscopic performance for the ulcer area reduced to less than50%, but the clinical symptoms were improved, the total effect rate was96%; the control group of25patients with clinical symptoms and signs were improved evidently in19cases, endoscopic performance at least as good as the healing of ulcer, ulcer area reduced50%or scar period,4patients with endoscopic performance for the ulcer area reduced to less than50%, but the clinical symptoms were improved, and the clinical symptoms of2patients endoscopic features were not significantly better clinical curative effect, the total efficiency is76%. The patients in the treatment group the total clinical effective rate was significantly better than the control group. The treatment group of25patients with H.pylori eradication in23cases, eradication rate was92%; the control group of25patients with H.pylori eradication in20cases, eradication rate was80%, statistically significant differences between groups (P<0.05). Two groups of patients with adverse reaction rate were12%in treatment group,16%in the control group, no significant difference.Conclusion:According to the treatment in two groups of a total of50cases of patients can be seen, Helicobacter pylori infection is one of the leading factors of peptic ulcer disease, root for Helicobacter pylori infection is the main method for the treatment of peptic ulcer. Complete removal of Helicobacter pylori in patients with peptic ulcer (gastric ulcer and duodenal ulcer), endoscopic features of total efficiency of up to96%. The traditional triple therapy with a proton pump inhibitor+ amoxicillin+clarithromycin10day course can better removal of Helicobacter pylori (clearance rate of80%). The10day sequential therapy is better than the traditional triple therapy for Helicobacter pylori has higher removal rate, have obvious effect on promoting the healing of peptic ulcer, there is no obvious difference comparing safety adverse drug reaction etc.. For the drug method is simple, one time use less species, little adverse reaction, Hp eradication rate higher characteristic, high compliance of patients with sequential therapy for Helicobacter pylori infection.