Clinical Study Of Probiotics Combined With Quadruple Therapy In The Treatment Of Helicobacter Pylori Positive Gastric Ulcer

BackgroundGastric ulcers can cause abdominal pain,bleeding,etc.70%of gastric ulcers are associated with Helicobacter pylori（H.pylori）infection.At present,bismuth quadruple therapy is recommended to cure H.pylori infection,but the eradication rate of H.pylori decreases year by year due to antibiotic resistance.Studies have shown that probiotics can competitively inhibit the growth of H.pylori and restore the ecological environment of gastric microorganisms and mucosal barrier,which is expected to improve the effect of H.pylori eradication therapy and promote the healing of gastric ulcers.The purpose of this study is to study the clinical application of probiotics combined with bismuth quadruple therapy in patients with H.pylori positive gastric ulcer.ObjectivesTo investigate the efficacy of probiotics combined with quadruple therapy in the treatment of patients with H.pylori positive gastric ulcer,the eradication rate of H.pylori and the effects on intestinal flora distribution and serum inflammatory factors.MethodsA total of 181 patients with H.pylori positive gastric ulcer admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2018 to October 2019 were selected and divided into observation group（91 cases）and control group（90 cases）according to random number table method.The two groups were treated with quadruple therapy for 14 days,in which the observation group was additively treated with bifidobacterium and Lactobacillus triple live tablets.After 14 days of treatment,patients in the two groups still needed to take rabeprazole sodium enteric capsules for 14 days.Gastroendoscopy was used to compare the healing of gastric ulcer before treatment and 4weeks after treatment.Four weeks after treatment,the eradication of H.pylori was determined by ¹³C breath test.Fresh feces were collected from patients before treatment and 4 weeks after treatment,and were diluted and inoculated in MRS medium and TPY medium for culture.After the completion of culture,bacterial colonies were counted,and the logarithm value was used to calculate the number of bacterial communities（lgn/g wet stool）and compared.Before treatment and 4 weeks after treatment,serum C-reactive protein（CRP）and serum amyloid A（SAA）levels were measured by immunoturbidimetry,and serum procalcitonin（PCT）levels were detected by electrochemiluminescence.The adverse reactions during treatment were accurately recorded and compared.ResultsA total of 170 patients completed treatment,among which 6 patients in the observation group withdrew due to midway interruption or automatic withdrawal,and 5 patients in the control group withdrew due to midway interruption or automatic withdrawal.1.In the observation group,37 cases were cured,21 cases were significantly effective,and 20 cases were effective;in the control group,25 cases were cured,19 cases were significantly effective,and 25 cases were effective.Compared with the control group,the clinical efficacy and effective rate of the observation group were significantly improved（91.76 vs.81.18%,P<0.05）.2.There were 9 cases of H.pylori positive patients in the observation group,and 76 cases were successfully eradicated;there were 21 cases of H.pylori positive patients in the control group,and 64 cases were successfully eradicated.Compared with the control group,the eradication rate of H.pylori in the observation group was significantly increased（89.41%vs.75.29%,P<0.05）.3.There was no significant difference in the number of intestinal bifidobacteria and Lactobacillus between the two groups before treatment（P>0.05）.The number of intestinal bifidobacteria and Lactobacillus flora in 2 groups at 4 weeks after treatment was significantly higher than that before treatment（P<0.05）.The number of intestinal bifidobacteria and lactobacillus in observation group was significantly higher than that in control group（P<0.05）.4.There was no significant difference in serum CRP,SAA and PCT levels between the two groups before treatment（P>0.05）.At 4 weeks after the completion of treatment,the serum CRP and SAA in both groups were significantly lower than before treatment（P<0.05）,and the serum CRP and SAA in observation group were significantly lower than those in control group（P<0.05）.Serum PCT in 2 groups was lower than that before treatment（P>0.05）,and there was no significant difference between the observation group and the control group（P>0.05）.5.Among the adverse reactions,there was 1 case of nausea,1 case of abdominal distension,1 case of dysphoria,2 cases of constipation and 3 cases of rash in the observation group.In the control group,there were 3 cases of nausea,1 case of abdominal distension,2 cases of taste disturbance,1 case of constipation,and 3 cases of rash.There was no significant difference between the observation group and the control group（9.41%vs.11.76%,P>0.05）.ConclusionProbiotics combined with quadruple therapy can improve the clinical efficacy of H.pylori positive gastric ulcer patients and increase the eradication rate of H.pylori.The mechanism is related to improving intestinal flora and alleviating inflammatory response.