The Study On The Timing Of Remedial Treatment For Helicobacter Pylori Infection

BackgroundHelicobacter pylori(H.pylori),a gram-negative bacterium,was first discovered by Marshall and Warren in 1983.H.pylori was defined in the Kyoto Global Consensus Report as a common infection source,whose transmission modes including mouth-to-mouth,fecal-to-mouth and stomach-to-mouth.Although infected patients are asymptomatic in most cases,H.pylori infection is directly associated with chronic gastritis,peptic ulcer,non-ulcerative dyspepsia,gastric mucosa-associated lymphoid tissue(MALT)lymphoma,and gastric cancer.A large number of studies have shown that eradication of H.pylori can reduce the incidence rate of gastric cancer.At present,due to the non-standard H.pylori eradication program,high antibiotic resistance rate,poor patient compliance and other reasons in clinical work,the failure of H.pylori eradication treatment is becoming more and more common.However,there is still no conclusion on the most appropriate time for rescue treatment for patients with H.pylori eradication failure.AimWe conducted a prospective,open cohort observational study to explore the optimal timing for rescue treatment of H.pylori,so as to guide clinical treatment and improve the eradication rate.MethodsPatients with positive H.pylori infection requiring rescue treatment were prospectively recruited.Their basic information,previous times of eradication,last eradication time and medication regimen were collected.If the patients had no quinolone antibiotic medication history,they were given esomeprazole 40mg bid,bismuth potassium citrate granule 2g bid,amoxicillin 1000mg bid and levofloxacin 500mg qd for 14 days.If the patients had a history of quinolone antibiotic use,they were given esomeprazole 40mg bid,bismuth potassium citrate granule 2g bid,amoxicillin 1000mg bid and furazolidone 100mg bid,with a course of 14 days.Patients were followed up for adverse reactions and compliance after 14 days,and urease breath test was repeated 8 weeks after withdrawal to evaluate the eradication rate.The main evaluation index was the eradication rate of H.pylori,while the secondary evaluation index was compliance and safety.ResultsFrom December 2018 to March 2021,a total of 394 patients with positive H.pylori infection requiring rescue treatment were enrolled in the trial.In the intention-to-treat analysis(ITT),the total eradication rate of H.pylori was 79.9%(315/394)(95%CI,76.0-83.9%).In the per-protocol analysis(PP),the total eradication rate of H.pylori was 82.9%(315/380)(95%CI,79.1-86.7%).In the intention-to-treat analysis(ITT),the eradication rate of H.pylori was 79.7%(118/148)in patients with an interval of 0 to 3 months,78.0%(64/82)in patients with an interval of 3 to 6 months,and 78.2%(68/87)in patients with an interval of 6 to 12 months.The eradication rate of H.pylori was 84.4%(65/77)in patients with an interval longer than 12 months.There was no statistical difference in the eradication rate of H.pylori among all groups.In the per-protocol analysis(PP),the eradication rate of H.pylori was 81.4%(118/145)in patients with an interval of 0 to 3 months,81.0%(64/79)in patients with an interval of 3 to 6 months,and 81.9%(68/83)in patients with an interval of 6 to 12 months.The eradication rate of H.pylori was 89.0%(65/73)in patients with an interval longer than 12 months.There was no statistical difference in the eradication rate of H.pylori among all groups.Since previous eradication times and medication regimens may affect the eradication rate of H.pylori,subgroup analysis was performed.Although there was statistically significant difference in the eradication rate of H.pylori between the two groups according to the previous eradication times(88.2%VS 76.9%,P=0.004),there was no statistically significant difference in the eradication rate of H.pylori between different remedial treatment duration within the groups.However,there was no statistical difference in the eradication rate of H.pylori between different eradication regiments,i.e.,the EBAF group and the EBAL group(83.1%VS 82.3%,P=0.979).Moreover,there was no statistical difference in the eradication rate of H.pylori between different remedial treatment duration within the groups.ConclusionDifferent duration of rescue treatment has no effect on the eradication rate of H.pylori.The previous eradication times have a significant impact on the eradication rate of Helicobacter pylori.In the remedial treatment of Helicobacter pylori,there was no significant difference in the eradication rate between the four regimens of bismuth agent containing levofloxacin and that containing furazolidone.