I. Introduction
Helicobacter pylori (
HP) is a Gram-negative bacterium that mainly lives in human stomach and duodenum. It is closely related to the occurrence and development of many gastric diseases, such as chronic gastritis, peptic ulcer, and even gastric cancer. Therefore, anti-HP therapy is of vital importance in clinical practice. According to statistics, about half of the world’s population is infected with Helicobacter pylori, and in developing countries, the infection rate may be even higher, which makes anti-HP therapy one of the focuses of global public health.
2. Harm
of Helicobacter pylori
(1) Chronic gastritis
Helicobacter pylori can stably colonize on the surface of gastric mucosa by virtue of its spiral structure and flagella. The urease it produces can decompose urea to produce ammonia, which can neutralize gastric acid, so that Helicobacter pylori can survive in acidic environment, while ammonia has a direct toxic effect on gastric mucosal cells. Long-term infection can lead to repeated inflammation of gastric mucosa, stomach pain, stomach distension, nausea, vomiting and other discomfort symptoms, affecting the quality of life of patients.
(2) Peptic ulcer
Helicobacter pylori (Hp) infection is one of the important causes of morbidity in peptic ulcer. By destroying the defensive barrier of gastric mucosa, gastric acid and pepsin are more likely to invade gastric and duodenal mucosa, leading to ulcer formation. Patients with gastric ulcer and duodenal ulcer often experience periodic attacks of epigastric pain, severe bleeding, perforation and other complications, life-threatening.
(3) Gastric cancer
Helicobacter pylori is classified as a class I carcinogen by the World Health Organization. Although not all people infected with Helicobacter pylori will develop gastric cancer, it increases the risk of gastric cancer. It can cause chronic inflammation of gastric mucosa and proliferation of epithelial cells. In this process, the genes of cells may mutate and gradually develop into gastric cancer.
Indications
for anti-HP therapy
(1) Peptic ulcer
Whether gastric or duodenal ulcer, as long as the diagnosis of Helicobacter pylori infection, the need for anti-HP therapy. Successful eradication of Helicobacter pylori can promote ulcer healing and significantly reduce the recurrence rate of ulcer.
(2) Chronic gastritis
For chronic gastritis patients with dyspepsia symptoms such as abdominal distension, abdominal pain and belching, if Helicobacter pylori is found to be positive, anti-HP treatment can help alleviate symptoms and improve gastric mucosal inflammation.
(3) Postoperative early gastric
cancer In patients with
early gastric cancer after surgery, if Helicobacter pylori infection is found, anti-HP therapy can reduce the risk of recurrence of gastric cancer.
(4) Family history
of gastric cancer Anti-HP therapy is also recommended for H. pylori-infected individuals
with a family history of gastric cancer because of their relatively high risk of gastric cancer.
4. Anti-HP treatment plan
(1) Classic triple therapy
The original triple therapy was based on a proton pump inhibitor (PPI) or bismuth, plus two antibiotics. Commonly used proton pump inhibitors such as omeprazole, lansoprazole, bismuth agents such as bismuth potassium citrate. Antibiotics such as amoxicillin, clarithromycin and metronidazole are commonly used. For example, omeprazole + amoxicillin + clarithromycin regimen, the course of treatment is generally 7-14 days. However, the eradication rate of classical triple therapy gradually decreased with the increase of drug resistance rate of Helicobacter pylori.
(2) Bismuth quadruple therapy
Bismuth quadruple therapy is currently the first-line treatment. That is, proton pump inhibitors + bismuth + two antibiotics. Bismuth can form a protective film on the surface of gastric mucosa and inhibit Helicobacter pylori. The choice of antibiotics should be based on the local drug resistance. Generally, the combination of amoxicillin + clarithromycin or amoxicillin + furazolidone is more commonly used. Proton pump inhibitors can choose rabeprazole, bismuth potassium citrate, and the course of treatment is usually 10-14 days. This program can improve the eradication rate of Helicobacter pylori. (3) Sequential therapy Sequential therapy is a new treatment strategy. Generally, proton pump inhibitors + amoxicillin are used first for 5-7 days, and then proton pump inhibitors + clarithromycin + metronidazole or tinidazole are used for 5-7 days. Sequential therapy has also shown better efficacy in some areas, especially for clarithromycin-resistant strains.
5. Precautions
for anti-HP treatment
(1) Patient compliance The compliance of patients with anti-HP treatment is very important. Patients need to take medicine on time and in accordance with the medical supervision, and can not stop or change the dosage by themselves. If the compliance is poor, it is easy to lead to treatment failure and increase the risk of Helicobacter pylori resistance.
(2) Adverse drug reactions In the course of anti-HP treatment, patients may have some adverse drug reactions. For example, antibiotics may cause gastrointestinal reactions, such as nausea and diarrhea, and bismuth may cause bad breath and black stool. Long-term use of proton pump inhibitors may also have some potential adverse reactions, such as osteoporosis. Therefore, in the course of treatment, we should pay close attention to the reaction of patients, and adjust the treatment plan in time for patients with serious adverse reactions.
(3) Review after treatment After the end of anti-HP treatment, it is generally necessary to review after 4 weeks of drug withdrawal. Breath tests, such as carbon-13 or carbon-14 breath tests, are used to determine whether Helicobacter pylori has been successfully eradicated. If the reexamination results are still positive, it is necessary to consider adjusting the treatment plan for re-treatment according to the specific situation.
VI. Conclusion
Anti-HP treatment is a complex but very important medical intervention. With the in-depth study of Helicobacter pylori and the accumulation of treatment experience, the treatment plan is also constantly optimized. It is of great significance to improve the eradication rate of Helicobacter pylori, reduce the incidence of gastric diseases and improve the health status of patients by accurately grasping the treatment indications, reasonably choosing the treatment plan, paying attention to patient compliance and adverse drug reactions, and doing a good job of reexamination after treatment. In the future, it is necessary to further study the mechanism of drug resistance of Helicobacter pylori and develop new therapeutic drugs and methods to better cope with the global public health problem of Helicobacter pylori infection.
