替普瑞酮治疗慢性萎缩性胃炎100例

Clarithromycin-based triple therapy for treatment of peptic ulcer in Helicobacter pylori-positive children

AIM: To observe the clinical efficacy of triple therapy with clarithromycin, metronidazole and omeprazole in the treatment of Helicobacter pylori (H. pylori) infection-related peptic ulcer in children.

METHODS: A retrospective analysis of 96 children with peptic ulcer associated with H. pylori infection treated at our hospital from July 2011 to July 2013 was performed. Depending on the treatment, the patients were divided into either a treatment group or a control group (n = 48 for each). The treatment group received triple therapy with clarithromycin, metronidazole and omeprazole, while the control group was treated with amoxicillin, metronidazole and omeprazole. After treatment, children in both groups underwent gastroscopy and H. pylori examination to compare clinical efficacy, rate of H. pylori eradication and adverse reactions.

RESULTS: The clinical efficacy was better in the treatment group than in the control group. The overall effective rate was significantly higher in the treatment group than in the control group (95.83% vs 70.83%, P < 0.05). Five weeks after treatment, the rate of H. pylori eradication was significantly higher in the treatment group than in the control group (87.50% vs 62.5%, P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups.

CONCLUSION: Triple therapy with clarithromycin, metronidazole and omeprazole is associated with a higher rate of H. pylori eradication and a lower rate of adverse reactions in the treatment of H. pylori infection-associated peptic ulcer in children.

Therapeutic effects of folic acid against precancerous lesions in patients with chronic atrophic gastritis

AIM: To evaluate the therapeutic effect of folic acid against intestinal metaplasia (IM) and atypical hyperplasia (ATP).

METHODS: One hundred and one patients with chronic atrophic gastritis (accompanied with IM and ATP) were randomly divided into either a trial group or a control group. Before treatment, Helicobacter pylori (H. pylori) carriers received eradication treatment with routine quadruple chemotherapy for ten days. Patients of the trial group received treatment with folic acid and traditional Chinese medicine Weifuchun, while patients of the control group were treated with Weifuchun only. The treatment duration was 6 mo in both groups. The improvement in clinical symptoms and histological findings was compared between the two groups.

RESULTS: Compared to the control group, the trail group had significantly improved clinical symptoms and histological findings for IM and ATP (84.91% vs 41.67%, 70.27% vs 45.45%, 68.75% vs 33.33%; P < 0.001, P < 0.05, P < 0.05).

CONCLUSION: Combination therapy with folic acid and Weifuchun is safer and more effective than Weifuchun alone in the treatment of precancerous gastric lesions IM and ATP.

Furazolidone-based quadruple therapy as first-line treatment for Helicobacter pylori infection

AIM: To observe the rates of symptom remission, adverse reactions, and Helicobacter pylori (H. pylori) eradication of furazolidone-based quadruple therapy as first-line treatment for patients with H. pylori infection.

METHODS: One hundred and fifty-two patients who were diagnosed with H. pylori-positive chronic gastritis or duodenal ulcer were randomly divided into three groups: control group (esomeprazole + bismuth potassium critrate + amoxicillin + clarithromycin), 7-day furazolidone-based quadruple therapy group (esomeprazole + bismuth potassium critrate + amoxicillin + furazolidone), and 10-day furazolidone-based quadruple therapy group (esomeprazole + bismuth potassium critrate + amoxicillin + furazolidone). Patients were followed to observe symptom remission and adverse reactions. After at least 4 wk of treatment and 2 wk of non-use of PPIs, H. pylori status was assessed using the urea breath test. H. pylori eradication rate was assessed by PP and ITT analysis. Cost-effectiveness ratio and incremental cost-effectiveness ratio were used to evaluate the three treatments.

RESULTS: On PP analysis, the rates of H. pylori eradication in the three groups were 87.50%, 88.89% and 93.62%. On ITT analysis, the rates of H. pylori eradication in the three groups were 79.25%, 83.33% and 86.27%. There were no significant differences in the rates of H. pylori eradication among the three groups either on PP analysis or on ITT analysis. The rates of symptom remission and adverse reactions in the three groups also showed no significant difference (all P > 0.05). The cost-effectiveness ratios of the three groups were 3.69, 2.48 and 3.37. The incremental cost-effectiveness ratios of the 7-day and 10-day furazolidone-based quadruple therapy groups relative to the control group were -73.22 and -1.17.

CONCLUSION: Furazolidone-based quadruple therapy is associated with a high rate of H. pylori eradication and few slight side effects and can reduce the costs of quadruple treatment.

Effect of Astragalus, Panax notoginseng and their compatibility on expression of the heat shock protein 70 gene in rats with atrophic gastritis

AIM: To evaluate the effect of Astragalus, Panax notoginseng and their compatibility on expression of the heat shock protein 70 (Hsp70) gene in rats with atrophic gastritis.

METHODS: Sixty-four male healthy Wistar rats were randomized into seven groups: control group (n = 9), sham operation group (n = 10), model group (n = 9), teprenone group (n = 9), Astragalus group (n = 9), Panax notoginseng group (n = 9), and Astragalus plus Panax notoginseng group (n = 9). Atrophic gastritis was induced by implanting a pylorus spring and intragastrically administering hot salty starch paste. In the one-month therapeutic phase, the control, sham operation and model groups were given normal saline 2 mL daily. The Astragalus group was given water decoction of Astragalus containing crude drug 3.5 g/(kg• d). The Panax notoginseng group was infused with Panax notoginseng powder containing crude drug 0.7 g/(kg• d). The Astragalus plus Panax notoginseng group was given both Panax notoginseng powder and Astragalus water decoction. The teprenone group was given teprenone water suspension containing teprenone 200 mg/(kg• d). All drugs were given by gavage for one month. Three rats of each group were randomly selected for real-time PCR detection of Hsp70 mRNA and Western blot analysis of Hsp70/72 protein. The remaining rats were used for pathological assessment of stomach mucosa by hematoxylin and eosin staining method.

RESULTS: Gastric mucosal volume constituent ratio (GMVR) in the model group decreased compared to that in the sham operation group (P < 0.01). The GMVR in the teprenone group increased compared to that in the model group (P < 0.01). The GMVR in the Astragalus, Panax notoginseng, and Astragalus plus Panax notoginseng groups increased compared to the model group, but showed no statistical difference with that in the teprenone group (P > 0.05). Hsp70 mRNA expression in gastric mucosa of rats in the Astragalus group and Panax notoginseng group was higher than that in the model group (both P < 0.01). The expression of Hsp70/72 protein in all groups showed no statistical differences (all P > 0.05).

CONCLUSION: Astragalus, Panax and their combination can improve mucosal atrophy in rats with atrophic gastritis. Inducing Hsp70 gene expression may be one of therapeutic mechanisms for Astragalus and Panax notoginseng in treating atrophic gastritis.