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OBJECTIVE To evaluate the cost-effectiveness of ivabradine in the treatment of chronic heart failure （CHF） in the context of “Quadruple Therapy” from the perspective of the health system. METHODS Based on real-world cohort data， the Markov model was constructed according to the natural progression of CHF， with a cycle time of 3 months， a study timeframe of 20 years， and a discount rate of 5%. Using quality-adjusted life year （QALY） and incremental cost-effectiveness ratios （ICER） as the output indexes， the cost-utility analysis was used to evaluate the cost-effectiveness of ivabradine in combination with the “Quadruple Therapy” regimen， compared with the “Quadruple Therapy” regimen for the treatment of CHF， and the robustness of the results of the base analysis was verified by univariate sensitivity analysis and probabilistic sensitivity analysis. RESULTS The results of the base analysis showed that the ICER of ivabradine combined with the “Quadruple Therapy” regimen was 165 065.54 yuan/QALY， compared with the “Quadruple Therapy” regimen， which was lower than the willingness-to-pay （WTP） threshold （257 094 yuan/QALY） based on 3 times of China’s gross domestic product （GDP） per capita in 2022. The results of the univariate sensitivity analysis showed that the discount rate had the greatest impact on the robustness of the model. The probabilistic sensitivity analysis showed that the probability that the ivabradine combined with the “Quadruple Therapy” regimen was cost-effective under the WTP threshold in this study was 59.50%. CONCLUSIONS When using 3 times China’s 2022 GDP per capita （257 094 yuan/ QALY） as the WTP threshold， the combination of ivabradine and the “Quadruple Therapy” regimen for treating CHF is cost- effective.
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OBJECTIVE To explore the efficacy， safety and economics of a dual therapy consisting of conventional dose of vonoprazan combined with conventional dose of amoxicillin in patients with primary treatment of Helicobacter pylori （HP） infection. METHODS Using a prospective cohort study， the patients diagnosed with HP infection and receiving initial treatment in Chengdu Xinhua Hospital from July 2021 to July 2022 were collected according to inclusion and exclusion criteria. The patients were given vonoprazan/amoxicillin dual therapy （i.e. VA group， Vonoprazan fumarate tablets 20 mg， once a day+Amoxicillin capsules 1.0 g， twice a day， 14 days） and bismuth-containing quadruple therapy （i.e. LJAF group， Rabeprazole sodium enteric- coated tablets 20 mg， twice a day+Colloidal bismuth pectin capsules 200 mg， twice a day+Amoxicillin capsules 1.0 g， twice a day+ Furazolidone tablets 100 mg， twice a day， for 14 days） according to the patient’s medication willingness. Four weeks after the end of the treatment， HP eradication rates of the two groups were compared by using intention-to-treat （ITT）， modified intention-to- treat （MITT） and per-protocol （PP） analysis. The occurrence of adverse drug reactions （ADR） was recorded， and an economic evaluation was performed for them. RESULTS Among the 58 patients in VA group， 55 completed the trial， 2 were lost to follow- up and one withdrew due to rash； among the 62 patients in LJAF group， 57 completed the trial， 3 were lost to follow-up and 2 withdrew due to rash. Results of ITT， MITT and PP analysis showed that HP eradication rates of VA group were 86.2%， 89.3% and 90.9%， and those of LJAF group were 87.1%，91.5% and 94.7%， respectively； there was no statistical significance among different groups （P＞0.05）. The incidences of ADR in VA group and LJAF group were 6.9% and 14.5%，which were not significantly different （P＞0.05）. The result of cost minimization analysis showed that the treatment cost of VA group was 340.9 yuan， which was lower than 373.5 yuan of LJAF group. CONCLUSIONS In patients with primary treatment of HP infection， the efficacy and safety of dual therapy of conventional dose of vonoprazan combined with conventional dose of amoxicillin is equivalent to the bismuth-containing quadruplex therapy with low cost.
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Objective:To explore the effects of different courses of Bifidobacterium combined with bismuth on the eradication rate, ulcer healing rate and adverse reactions in the initial eradication treatment of Helicobacter pylori positive gastric ulcer patients.Methods:From September 2018 to September 2021, 219 patients with gastric ulcer were selected from the outpatient department of gastroenterology department of Kailuan General Hospital Affiliated,all of whom were positive for 13C or 14C-urea breath test and were not treated with Helicobacter pylori eradication. Group A, B and C were randomly divided by Excel, Group A was the control group (73 patients): 14-day bismuth quadruple therapy (Eprazole + colloidal bismuth pectin + amoxicillin + furazolidone); group B (73 patients): 7 days Bifidobacterium tetravaccine tablets (live) was given in the second week of treatment in group A; group C (73 patients): Bifidobacterium tetravaccine tablets (live) was given 14 days on the basis of treatment in group A. 13C or 14C-urea breath test and gastroscope were reexamined after all treatments, to compare the eradication rate, ulcer healing rate and the incidence of adverse reactions.Results:The eradication rates in three groups were 90.8%(59/65), 91.2% (62/68)and 91.0%(61/67) respectively, there was no significant difference among the three groups (χ 2=0.01, P=0.997). The ulcer healing rate in three groups were 93.8%(61/65), 94.1%(64/68) and 95.5%(64/67) respectively, group B and group C were compared with group A, and the difference was not statistically significant(group B: group A P=1.000, group C: group A P=0.716).The incidence of adverse reactions in three groups was 21.4%(15/70), 7.1%(5/70) and 7.0%(5/71) respectively, the difference was statistically significant (χ 2=9.21, P=0.010). The incidence of adverse reactions in group B and C was significantly lower than that in group A (group B: group A χ 2=5.83, P=0.016; group C: groups A χ 2=5.99, P=0.014). Compare means of measurement data among the three groups use analysis of variance. Chi square test, Fisher exact probability method and split chi square test were used to compare the three groups of counting data. Conclusion:14-day Bifidobacterium tetravaccine tablets (live) and the second half of the treatment lasted for 7-day Bifidobacterium Bifidobacterium tetravaccine tablets (live), they are combined separately with bismuth quadruple therapy in the first eradication of Helicobacter pylori positive gastric ulcer patients can significantly reduce adverse reactions, but Bifidobacterium tetravaccine tablets (live) could not significantly improve the eradication rate, and had no promoting effect on the healing of gastric ulcer.
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Absence of adequate treatment for Helicobacter pylori (H. pylori) infection leads to prolonged life time colonization which is responsible for complications. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency and tolerability of standard triple therapy vs. quadruple regimen therapy in H. pylori eradication in Egypt.
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Helicobacter pylori , Clarithromycin , Amoxicillin , Therapeutics , Anti-Bacterial AgentsABSTRACT
As the awareness of the harmfulness of Helicobacter pylori (Hp) infection increases, the indications for Hp eradication continue to expand. "Kyoto Global Consensus Report on Helicobacter pylori Gastritis" puts forward "Hp infected individuals should be offered eradication therapy, unless there are competing considerations" and the statement has been accepted by more and more scholars. In our country, "the confirmed Hp infection" has been listed as an indication for eradication. However, as the antibiotic resistance rate of Hp increases, the eradication rate of Hp is gradually decreasing, and the proportion of people who has failed multiple treatments is increasing. This article was specially written for helping the clinicians to improve the eradication rate of Hp infection.
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OBJECTIVE: To compare the eradication rate, adverse reactions and compliance of the two 14-day bismuth-containing quadruple therapies in Liaoning Province as the first-line Helicobacter pylori(HP) eradication programs. METHODS: We collected222 eligible HP-infected patients who were admitted to the First Affiliated Hospital of China Medical University from March 2017 to October 2018 and treated with either of the following two programs:(1) EBLA group: esomeprazole(20 mg, twice a day), bismuth(200 mg, twice a day), levofloxacin(200 mg, twice a day) and amoxicillin(1 g, twice a day), 111 cases in total;(2) EBCA group:esomeprazole(20 mg, twice a day), bismuth(200 mg, twice a day), clarithromycin(500 mg, twice a day) and amoxicillin(1 g, twice a day), 111 cases in total. The patients in both groups were given medicines for 14 days, and the 13 C breath test was performed after4 weeks of withdrawal. RESULTS: The eradication rate of EBLA group was 87.34%(95%CI 80.9%-93.9%), and that of EBCA group was 83.33%(95%CI 76%-90.7%).There was no significant difference between the two groups(P=0.413). The incidence of adverse reactions was 10.8% in EBLA group and 26.13% in EBCA group. The difference was statistically significant(P=0.003). The compliance of patients in EBLA group was 99.10%, and that of EBCA group was 98.20%. The difference was not statistically significant(P=0.561).CONCLUSION: Both EBLA program and EBCA program can achieve good eradication rate and compliance in Liaoning province. The incidence of adverse reactions in EBLA group is lower than that in EBCA group, which is the preferred first-line HP eradication program.
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Objective To evaluate the effect of Weisu granule combined with conventional therapy in treatment of chronic atrophic gastritis (CAG). Methods A total of 99 CAG patients who met the inclusion criteria were randomly divided into control group (49 cases) and observation group (50 cases) according to random number table method. The control group was treated with quadruple therapy, while the observation group was treated with Weisu granule on the basis of the control group. Both groups were treated for 90 days. Interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) were detected by ELISA. The scores of TCM symptoms between the two groups before and after treatment were compared. Adverse reactions during treatment were observed and recorded. The eradication rate of H.pylori was measured by 14C urea breath test, and the clinical efficacy was evaluated. Results The total effective rate was 92.0% (46/50) in the observation group and 73.5% (36/49) in the control group. There were significant differences between the two groups (χ2=5.975, P=0.015). After treatment, the level of serum IL-6, hs-CRP and TNF-α in the observation group was significantly lower than those in the control group (t=7.112, 7.753, 9.310, respectively, all P<0.01). After treatment, the scores of symptoms such as abdominal distension and pain, emotional disturbance, hypochondrium pain and belching in both groups decreased (P<0.01), and those in the observation group was significantly lower than those in the control group (t=12.892, 12.451, 10.596, respectively, P<0.01). The eradication rate of H.pylori was 90.0% (45/50) in the observation group and 24.5% (12/49) in the control group. There was a significant difference between the two groups (χ2=43.381, P<0.01). Conclusions The Weisu granule combined with quadruple therapy has a definite theraputic effect. It can improve the clinical symptoms of patients, improve the clearance rate of H.pylori, and alleviate inflammation.
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Objective To evaluate the efficacy of Anzhong-Fuyuan decoction combined with western routine therapy in the treatment of helicobacter pyiori(H.pylori)-positive chronic atrophic gastritis (CAG).Methods A total of 110 H.pylori positive CAG patients who met the inclusion criteria were divided into two groups according to random number table method,55 in each group.The control group was treated with quadruple therapy.On the basis of the control group,the study group was treated with Anzhong-Fuyuan decoction.Both groups were treated continuously for 40 days.The serum level of pepsinogen Ⅰ (Pepsinogen Ⅰ,PG Ⅰ),pepsinogen Ⅱ (PG Ⅱ),gastrin (GAS),endothelin (ET),CRP,IL-6 and TNF-α were detected by ELISA.The eradication rate of H.pylori was measured by 14C urea breath test,and the clinical efficacy was evaluated.Results The total effective rate was 92.7％ (51/55) in the study group and 78.2％ (43/55) in the control group.There were significant differences between the two groups (x2=4.681,P=0.031).The eradication rate of H.pylori was 89.1％ (49/55) in the study group and 76.4％ (42/55) in the control group.There was significant difference between the two groups (x2=3.911,P=-0.048).After treatment,the level of serum PG Ⅰ (84.87 ± 13.95 g/L vs.78.05 ± 12.69 g/L,t=3.434) and PG Ⅰ/PG Ⅱ (6.71 ± 1.26 vs.5.86 ± 1.13,t=2.861) in the study group was significantly higher than those in the control group (P＜0.05),and PG Ⅱ (12.64 ± 1.94 g/L vs.13.31 ± 2.10 g/L,t=3.725) was significantly lower than those in the control group (P＜0.01).The serum level of gastrin (10.76 ± 3.06 mmol/L vs.8.11 ± 2.84 mmol/L,t=4.707) was higher than that of control group (P＜0.01),endothelin (56.64 ± 4.42 ng/L vs.60.42 ± 5.13 ng/L,t=4.140) was significantly lower than that of control group (P＜0.01).After treatment,the level of CRP,IL-6 and TNF-α in the study group was significantly lower than those in the control group (t=11.100,9.571 and 8.687,respectively,all Ps＜ 0.001).Conclusions The Anzhong-Fuyuan decoction combined with routine therapy can significantly enhance the gastric mucosal secretion ability of H.pylori positive CAG patients,increase the ratio of PG Ⅰ/PG Ⅱ,promote the repair and regeneration of gastric mucosa,reduce the level of inflammatory cytokines.
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Objective To investigate the effect of combination therapy with cognitive behavior on the quality of life of patients with gastroduodenal ulcer.Methods The patients with gastroduodenal ulcer treated in our hospital from April 2015 to April 2017 were randomly divided into intervention group and control group according to the order of treatment.Both groups were treated with bismuth-containing quadruple therapy and routine nursing was performed.The intervention group received cognitive behavior on this basis.SF-36 scale was used to evaluate the quality of life of the two groups of patients, and the prognosis of the patients was evaluated.The patient satisfaction was investigated by the self-designed questionnaire of patient satisfaction questionnaire.The clinical efficacy, treatment compliance, quality of life improvement, prognosis and satisfaction were compared between the two groups.Results The total effective rate was 96.67%(58/60) in the intervention group and 81.67%(49/60) in the control group.The total effective rate of the intervention group was significantly higher than that of the control group(P<0.05).The scores of SF-36 scale in the intervention group were higher than those in the control group(P<0.05).The incidence of complications in the intervention group was lower than that in the control group, and the satisfaction rate was higher than that of the control group(P<0.05).Conclusion Cognitive behavioral intervention combined with bismuth quadruple therapy for gastroduodenal ulcer can improve the patient's compliance and efficacy, significantly improve the quality of life of patients, improve patient satisfaction, with clinical application value.
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Objective To investigate the correlation of traditional Chinese medicine (TCM) syndrome types of chronic gastritis with Helicobacter pylori (Hp) eradication rate after anti-Hp treatment. Methods A total of 180 chronic gastritis patients with Hp infection were differentiated into spleen-stomach insufficiency syndrome, spleen-stomach dampness-heat syndrome, and liver depression and qi stagnation syndrome, and each syndrome group had 60 cases. Patients in each group were evenly divided into two subtypes, and were treated with triple therapy or quadruple therapy for 10 days respectively. After treatment, the Hp eradication rate in each group was compared. Results (1) The overall Hp eradication rate was 78.3%. No matter after triple therapy or quadruple therapy, patients with spleen-stomach insufficiency syndrome had the lowest Hp eradication rate (61.7%), which was lower than that of the patients with spleen-stomach damp-heat syndrome (88.3%) and the patients with liver depression and qi stagnation syndrome (85.0%), the difference being statistical significance (P 0.05). (2) A total of 10 cases had adverse reaction such as nausea and vomiting, stomachache, and gastric distention, 8 cases from spleen-stomach insufficiency group, one from spleen-stomach dampness-heat group, and one from liver depression and qi stagnation group. Spleen-stomach insufficiency group had higher incidence of adverse reaction than the other two groups (P < 0.05). Conclusion The Hp eradication rate after anti-Hp treatment varied in chronic gastritis patients with different TCM syndrome types, and the rate in patients with spleen-stomach insufficiency syndrome was lower than that of the patients with spleen-stomach damp-heat syndrome and the patients with liver depression and qi stagnation syndrome no matter after triple therapy or quadruple therapy.
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Objective To observe the effect of eradication of helicobacter pylori (Hp) combined with comprehensive rehabilitation treat-ment on patients with non-alcoholic fatty liver disease (NAFLD). Methods From December, 2015 to April, 2016, 219 patients diagnosed as NAFLD with Hp infection were enrolled, in which 119 patients (observation group) were treated with anti Hp quadruple therapy. They were tested with 13C urea breath test one month after drug withdrawal. The other 100 patients were as control group. The severity of NAFLD was observed with abdominal ultrasound after six months. Results After treatment, Hp was eradicated in 107 cases (90.68%) in the observation group, one dropped out for pulmonary infection. After six months, the severity of NAFLD improved better in the patients eradicated Hp in the observation group than in the control group (χ2=8.397, P<0.05). Conclusion Eradication of Hp combined with comprehensive rehabilita-tion treatment can improve the severity of NAFLD.
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Objective To study the resistance status of helicobacter pylori (HP) to commonly used antibacterial drugs as well as clinical effects of quadruple therapy in the patients with chronic obstructive pulmonary disease (COPD) infected by Hp.Methods A total of 180 cases of patients with Hp infection in the inpatient department and outpatient department of our hospital from August 2012 to December 2014 were collected,including 90 cases of COPD (COPD group) and 90 cases of non-COPD (control group).The gastric antrum mucosal tissues in all cases were taken for conducting Hp culture and identification.The resistance situation to clarithromycin,metronidazole,amoxicillin,levofloxacin and furazolidone in each group was observed.In addition,the two groups were equally divided into subgroup A,B and C according to different medication schemes:which were given 3 kinds of quadruple medication scheme containing amoxicillin and clarithromycin (group A),amoxicillin and levofloxacin (group B) and amoxicillin and furazolidone (group C).Then the clinical effects were compared.Results The resistance rate of infected Hp strains to clarithromycin in the control group was 21.11%;which to metronidazole was 55.56%;which to amoxicillin was 3.33%;which to levofloxacin was 5.56%,while which in the COPD group were in turn 26.67%,57.78%,7.78% and 16.67% respectively.No strain was found to be resistant to furazolidone in the two groups.There was statistically significant difference in the resistance to levofloxacin and double antibiotic resistance between the two groups (P<0.05).The eradication rates for using 3 kinds of quadruple therapy in 3 subgroups of control group were 90.0% in the group A,96.7% in the group B and 100.0% in the group C,while which in the COPD group were 86.7%,80.0% and 96.7% respectively;the Hp eradication rate for adopting the group B scheme had statistical difference between the two groups (P<0.05).Conclusion The resistance rate of COPD patient affected by Hp to levofloxacin has an increasing trend,so its use should be cautious.The quadruple scheme containing amoxicillin+furazolidone can serve as the preferred scheme for the initial Hp eradication therapy in COPD patients affected by Hp.
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Objective To compare the efficacy and the risk of adverse effect of drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter (H.) pylori infection.Methods Literature retrieval was conducted by using major databases.Related papers published up to June 2015 were considered eligible if they were randomized control trials comparing different pharmacological formulations for H.pylori infection and used in a network Meta-analysis and a single rate Meta-analysis to evaluate the relative and absolute rates of H.pylori eradication and the risk of adverse effect.The Jadad score was used to evaluate the methodological quality.Funnel plot was constructed to evaluate the risk of publication bias.Begg's rank correlation test or Egger's regression intercept test was done for the asymmetry of funnel plot.Results Twenty randomized control trials for the treatment of 6 753 initial treated patients with H.pylori infection were included.Drug susceptibility test guided therapy was significantly superior to concomitant therapy,hybrid therapy,sequential therapy and bismuth quadruple therapy.The culture-based therapy had the highest likelihood of improving clinical efficacy,with lowest risk of adverse effect.Concomitant therapy had the highest probability of causing adverse effect despite its effectiveness.Hybrid therapy and bismuth quadruple therapy were associated with lower risk of adverse effect and higher effectiveness.Conclusion Drug susceptibility test guided therapy showed superiority to other 4 interventions for H.pylori eradication mentioned above.Hybrid therapy and bismuth quadruple therapy might be applied in the settings where the culture-based strategy is not available.
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Objective To compare the efficacy and the risk of adverse effect of drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter (H.) pylori infection.Methods Literature retrieval was conducted by using major databases.Related papers published up to June 2015 were considered eligible if they were randomized control trials comparing different pharmacological formulations for H.pylori infection and used in a network Meta-analysis and a single rate Meta-analysis to evaluate the relative and absolute rates of H.pylori eradication and the risk of adverse effect.The Jadad score was used to evaluate the methodological quality.Funnel plot was constructed to evaluate the risk of publication bias.Begg's rank correlation test or Egger's regression intercept test was done for the asymmetry of funnel plot.Results Twenty randomized control trials for the treatment of 6 753 initial treated patients with H.pylori infection were included.Drug susceptibility test guided therapy was significantly superior to concomitant therapy,hybrid therapy,sequential therapy and bismuth quadruple therapy.The culture-based therapy had the highest likelihood of improving clinical efficacy,with lowest risk of adverse effect.Concomitant therapy had the highest probability of causing adverse effect despite its effectiveness.Hybrid therapy and bismuth quadruple therapy were associated with lower risk of adverse effect and higher effectiveness.Conclusion Drug susceptibility test guided therapy showed superiority to other 4 interventions for H.pylori eradication mentioned above.Hybrid therapy and bismuth quadruple therapy might be applied in the settings where the culture-based strategy is not available.
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Objective To assess the efficacy and safety of berberine, amoxicillin, lansoprazole, bismuth quadruple therapy for Helicobacter pylori (H.pylori)eradication.Methods From December 2015 to April 2016,566 patients with initial treatment of H.pylori infection were prospectively enrolled.Patients were divided into observation group (berberine, amoxicillin, lansoprazole, bismuth) and control group (clarithromycin, amoxicillin, lansoprazole, bismuth), 283 cases in each group, and the treatment courses in two groups were both 14 days.Four weeks after completion of the treatment, the eradication rate of H.pylori and adverse effect rate of the two groups were compared.Student t test and Chi square test were performed for comparison between the two groups.Results There was no statistically significant difference in the baseline demographic data including gender,age, body mass index (BMI), symptom score between patients of the two groups (all P>0.05).Four weeks after completion of the treatment, the eradication rates of observation group and control group were 87.5%(244/279) and 87.1%(242/278) according to per-protocol analysis, and which were 86.2%(244/283) and 85.5 %(242/283) according to intention-to-treat analysis.There was no statistically significant difference between the two groups (x2=0.021,0.058;both P>0.05).The adverse effect rates of the two groups were 12.5%(35/279) and 16.5%(46/278), and there was no statistically significant difference (x2=1.795,P=0.180).Conclusions Both the new quadruple regimen containing berberine, amoxicillin and bismuth, and the standard quadruple regimen containing clarithromycin, amoxicillin and bismuth both can effectively eradicate H.pylori infection.The new regimen might be recommended as first-line eradication regimen in Xi′an district or area with high clarithromycin resistance.
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Objective To compare the efficacy of different doses of esomeprazole based quadruple therapy on Helicobacter pylori(H.pylori) eradication in Uygur population, and to study the relationship between H.pylori eradication and dyspepsia symptoms in H.pylori caused gastritis.Methods From August 2015 to May 2016, Uygur patients diagnosed with H.pylori positive superficial gastritis in Xinjiang Uygur Autonomous Region Kashgar Prefecture were recruited.According to random number table, patients were divided into single-dose group, standard-dose group and high-dose group.In single-dose group patients received esomeprazole 40 mg, once per day;in standard-dose group patients received esomeprazole 20 mg, twice per day;and in high-dose group patients received esomeprazole 40 mg, twice per day;besides esomeprazole the treatment of three groups were all combination of amoxicillin, clarithromycin and bismuth, magnesium compound granules.The treatment course of all three groups was 14 days.The H.pylori eradication rate, clinical efficacy, symptom score and adverse drug reaction were compared.The H.pylori eradication rate was evaluated with intention to treat analysis (ITT) and per-protocol sets (PP).Chi square test, t test and one-way analysis of vaiance were used for statistical comparison.Results A total of 248 patients were enrolled,82 cases in single-dose group, 83 cases in standard-dose group and 83 cases in high-dose group.There were five, five and six cases lose to follow-up or dropped out respectively in single-dose, standard-dose and high-dose group.The results of ITT analysis showed that the eradication rates of H.pylori in single-dose group, standard-dose group and high-dose group were 62.2%(51/82),77.1%(64/83) and 89.2%(74/83),respectively;the differences between each two groups were statistically significant (x2=4.34,16.33 and 4.30, all P0.05).Conclusions High dose of esomeprazole based quadruple therapy can increase the eradication rate of H.pylori in Uygur population, and H.pylori eradication therapy can significantly improve the dyspepsia symptoms of H.pylori caused gastritis in Uygur.High dose of esomeprazole may improve the clinical efficacy of H.pylori caused gastritis with dyspeptic symptoms in Uygur with safety.
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Objective To evaluate the efficacy of levofloxacin-based triple therapy and bismuthbased quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens.Methods Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed,Cochrane Library,SPRINGER,VIP database,WanFang database and CKNI database.The literature quality was evaluated by the improved Jadad criterion.RevMan5.3 sofeware was applied to data analysis.The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis.Publication bias assessed with funnel plots.Results Ultimately seventeen literatures were included for meta-analysis,the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant (77.0％ vs 68.7％,OR =1.52,95％ CI 0.96-2.42,P =0.34).In European countries,levofloxacin-based triple therapy was more effective than quadruple therapy(80.6％ vs 68.5％,OR =2.18,95％ CI 1.25-3.81,P ＜ 0.05),while eradication rates of two groups in Asian countries were similar.The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy,whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy (87.7％ vs 61.3％,OR =4.92,95％ CI 3.09-7.82,P ＜ 0.05).The efficacy was not influenced by the dose of levofloxacin.The adverse effects were significantly lesser(19.1％ vs 29.5％,OR =0.47,95％ CI 0.26-0.82,P ＜ 0.05),whereas the compliance rate was significantly higher in levofloxacin group (96.0％ vs 89.9％,OR =2.27,95％ CI 1.33-3.87,P ＜ 0.05).Conclusions Comparing with bismuth-based quadruple therapy,levofloxacinbased triple therapy has higher eradication rate,compliance rate and lesser side effects,so we recommend it as a second-line rescue therapy after front-line Hp eradication failure.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
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Objective To discuss whether Saccharomyces boulardii sachets can improve the eradication rate and reduce some untoward effects of gastrointestinal tract when adding in the Helicobacter pylori (Hp) standard quadruple therapy.Methods 249 cases infected with Hp were randomly divided into control group(124 cases) and treatment group (125 cases).The control group was treated with standard quadruple therapy:colloidal bismuth pectin capsules,100 mg,tid,po;furazolidone tablets,0.1 g,bid,po;amoxil capsule,1 g,bid,po;rabeprazole sodium enteric-coated capsules,20 mg,qd,po.The treatment group was treated with Saccharomyces boulardii sachets(0.25 g,bid,po)besides.Both groups were treated for 4 weeks.Evaluate the effect of Hp eradication rate by using the method of intent of treatment (ITT) analysis and consistent scenario set (PP)analysis.Results According to the ITT analysis,the eradication rate of control group was 89.52%,and that of treatment group was 96.00%.According to the PP analysis,the eradication rate of control group was 90.00%,and the rate of treatment group was 97.39%.Both analysis results showed the eradication rate of Hp in treatment group was significantly higher than control group(P<0.05).As for reducing the untoward effects such as nausea,inappetence,diarrhea,astriction and erythra,control group was obviously lower than treatment group (P<0.05).Conclusion Compared with standard quadruple therapy only,adding Saccharomyces boulardii sachets can significantly improve the eradication rate of Hp and obviously reduce the untoward effects such as nausea,inappetence,diarrhea,astriction and erythra.It is worth to be generalized and applied in clinical practice.
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Objective To evaluate the effect and adverse drug reaction of Boulardii yeast combined with triple and quadruple therapy on eradication helicobacter pylori (H.pylori).Methods240 cases of peptic ulcer patients of H.pylori positive were selected in our hospital from January 2014 to December 2015, according to different treatment were divided into the triple threapy group(n=60), the triple therapy union group (n=60), the quadruple therapy group (n=60) and the quadruple therapy union group (n=60).The triple threapy group were given clarithromycin and amoxicillin and pantoraazole;on the basis of this, the triple therapy union group were given Boulardiiyeast.the quadruple therapy group were given clarithromycin and amoxicillin and pantoraazole and CBS capsule, on the basis of this, the quadruple therapy union group were given Boulardiiyeast.The four groups were treated continuously for 14 days.14C-UBT, H.pylori eradication rate and adverse drug reaction in the four groups were evaluated five weeks after treatment.ResultsCompared with the triple threapy group and the quadruple therapy group, H.pylori eradication rate in the triple therapy union group(91.2%) and the quadruple therapy union group(94.7%) were improved obviously, and the adverse drug reactions (31.6%、29.8%) decreased significantly, the cumulative recurrence rate of H.pylori were significantly decreased, and the differences were statistically significant (P< 0.05).ConclusionBoulardii yeast combined with triple and quadruple therapy can obviously increase the H.pylori eradication rate, reduce the incidence of adverse drug reactions and the risk of recurrence.The reasonable treatment plan should be selected according to the actual situation.
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Objective To observe the effect of self-assembling Atractylodes Rhizome Decoction combined with quadruple therapy on Helicobacter pylori (Hp)-positive peptic ulcer and its effect on wound healing, gastric acid secretion and recurrence.MethodsThis study was based on 70 patients with Hp-positive peptic ulcer treated in our hospital from March 2012 to May 2014.The patients were divided into study group and control group according to the order of admission.(BAO), the maximum gastric acid secretion (MAO), the peak gastric acid secretion (P<0.05).The treatment group is divided into two groups according to the treatment group.(PAO), Hp eradication and recurrence were observed and compared.ResultsAfter treatment, the total effective rate of wound healing study group was 80.00% higher than that 57.14% of the control group (χ2=4.242, P<0.05).The levels of BAO, MAO and PAO in the two groups were significantly lower than those before treatment (P<0.05).The eradication rates of Hp in the study group were significantly higher than those in the control group at 6 months and 1 year follow-up.The recurrence rate was significantly lower in the study group than in the control group (P<0.05),There was no significant difference between the two groups.ConclusionThe clinical effect of self-made Baishui Yipi Decoction combined with quadruple therapy on Hp-positive peptic ulcer patients is effective in promoting wound healing and Hp eradication, and inhibiting gastric acid secretion and reducing the recurrence rate.It is a kind of medicine worthy of clinical application Program.