Problems in the treatment of Helicobacter pylori infection
At present, there are still some problems in research on Helicobacter pylori (HP) infection treatment, and it is necessary to discuss more deeply.
1 HP eradication standard problem
There are currently two concepts in HP Clear (EraDication). The former is a review of HP negative at the end of the treatment. The latter refers to the treatment of HP negative after the treatment of 1 month. Clearance is just HP temporary suppression, HP infection is quickly recurred after stopping the drug; and the eradication means that 85% does not recurmer within 1A, which has played the role of treatment. At present, the International Conference recommends that the roots are referred to as cure as an indicator of the evaluation of HP infection.
There are many diagnostic methods for HP infections, and traditional so-called "gold standard" includes fast urea test, Warthin-starry silver and bacterial culture, the common disadvantages of these methods are not sufficient sensitivity to determine if HP is truly eradicate. We have been examined by patients with conventional methods (ie, gold standard) after treatment with different programs (Polymerase Chain Reaction, RCR), and 4 cases of HP is found, so we have ever The patient who did not detect with a conventional method and actually had HP, and the HP was mistakenly considered to be eradicated and waived. This is a major reason for our treatment failure. Due to the difference between the criteria that the HP is eradicated, it is one of the possible reasons why the results of each studies are different.
Effect of 2 gastric HP on therapeutic effect of antibacterial drug
The antibacterial activity in the in vitro concentration of antibacterial drugs is not completely consistent. Regarding whether antibacterial drugs can maintain its stable antibacterial activity in the gastrointestinal acid environment will directly affect the effect of HP infection. The study found that penicillin, amoxicillin, cyclopropoxia antibacterial activity decreased by 10 times in acidic environment, cephalakine reduction 16 times, erythromycin decreased by 100 times, which explained why some antibiotics are sensitive to in vivo in vitro The efficacy is not good or even invalid. Metronidazole and colloidal bismuth agents are not affected by internal pH. The influence of phosphobic drugs in the stomach is another important reason for anti-HP infection. Therefore, it should be avoided when choosing antibacterial drugs should avoid the use of drugs that can easily lose antibacterial activity in an acidic environment.
3 resistance problems of antibacterial drugs
The resistance of HP against microorganisms is also one of the important causes of HP infection treatment failure. About 15% to 50% of HP strains are resistant to nitromazole. GOODWIN and other reports HP-resistant strains have increased from 17% by 17% by heimenia and diazoxazine. The results show that the obtained drug resistance is more common than primary resistance. Bell et al. A group of patients with columns tetracene metronidazole were found to be 90.5% for metronidazole-sensitive strains, while a strain of metronidazole resistance was 31.6%. Therefore, it is recommended that the drug-sensitive test of HP to metronidazole before treatment, and drug-resistant uses other solutions. Nitromidazole and colloidal bismuth agents or colloidal bismuths amoxicillin metronidazole trialatherapy not only reduce the production of drug resistant strains, but also increase HP eradication rate. With regard to quinolone drugs, there were two groups of treatment failures, and MIC increased from 0.25 mg / l to 1 mg / L before treatment to 16 mg / l to 32 mg / L after treatment, an increase of 16 to 64 times. The drug is different from nitromidazole drugs, and a quinolone drug and another antibiotic merge cannot significantly improve the therapeutic effect, so it is considered that quinolone drugs are not suitable for HP treatment.
4 selection of HP treatment plans
An ideal treatment plan should include: 1HP eradication rate ≥90%; 2 short courses; 3 side effects; 4 patients have good compliance; 5 treatment is simple; 6 effect continues, not easy to recover. Due to the good effect of single-drug or two antibacterial pharmaceuticals, trixtherapy is currently used, ie colloidal bismuth agent (CBS) metronidazole amoxicillin, its eradication rate is 85% -95%, and the effect is satisfactory. But there are many problems: 1 more side effects, the incidence is more than 30%; 2 patient compliance is poor; 3HP is easily resistant to metronidazole, so it is not the most ideal treatment plan. The so-called "new two", which means Omemirazole amoxicillin (or cluster), which has been shown to have antibacterial activity in vitro, and the mechanism of action may be lowered, and it may reduce the acidity in the stomach. Increase the antibacterial activity of antibiotics in the gastric pH. The two use not only increase the HP eradication rate (up to 85% to 90%), but also make the symptoms rapidly, the ulcer is rapidly healing, the side reaction is small, and the patient has good compliance. So currently considers that "New Qian" is an ideal treatment plan for HP-related ulcer disease.
5 other factors affecting the treatment
Some troubles also affect the therapeutic effect of anti-HP infection: such as taking the time, the number of medications, and the time of drug dosage forms are related to the time of contact with bacteria. Increasing the number of medications, administration during an empty stomach and suspensions can increase or extend the time of contact with bacteria. The colloidal ruthenium suspension is better than the tablet effect, and the gentamicin is made into a floating piece or to extend the efficacy in the stomach residence time. Recent studies have recently been found that HP can be implanted, so HP can be replanted with the gastric mucosa after anti-HP treatment, so anti-HP therapy also includes removing HP in the tartar.
6 About drug side effects
The adverse reactions of the drug mainly occur in the application of antibiotics, and the general digestive tract response is common, and the use of antibiotics can cause the flora disorder, mold infection, and even the abnormal changes of liver and kidney function. Therefore, in the treatment of anti-HP infection, the occurrence of poisonous side reactions should be prevented or reduced.
