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일차 제균요법 실패 후 이차 삼제 병합요법에 의한 헬리코박터 파이로리 감염 재치료
김나영 ( Kim Na Yeong ),임선희 ( Im Seon Hui ),이계희 ( Lee Gye Hui ),구명숙 ( Gu Myeong Sug ),김정목 ( Kim Jeong Mog ),황진혁 ( Hwang Jin Hyeog ),김진욱 ( Kim Jin Ug ),이동호 ( Lee Dong Ho ),정현채 ( Jeong Hyeon Chae ),송인성 ( S 대한소화기학회 2003 대한소화기학회지 Vol.42 No.3
Background/Aims: Helicobacter pylori (H. pylori) treatments fail at least in 10-20% of patients. However, retreatment strategies after failure of initial treatment have not been established. This study was conducted to evaluate the eradication rate of retreatment choices. Methods: Twenty-seven peptic ulcer patients who were retreated with OAC (omeprazole+amoxicillin+clarithromycin) or BMT (bismuth+metronidazole+tetracycline) after failure of BMT or OAC were included. Quadruple therapy (omeprazole+BMT) was also tried after failure of two successive triple therapies. Furthermore, the effect of resistance of metronidazole or clarithromycin on the eradication of H. pylori was evaluated. Results: Among 13 patients who were retreated with OAC after failure of BMT regimen, H. pylori was eradicated in 10 patients (76.9%). Among 14 patients retreated with BMT after failure of OAC regimen, H. pylori was eradicated in 11 patients (78.6%). Resistance of H. pylori to metronidazole or clarithromycin decreased the efficacy of BMT or OAC, respectively. Conclusions: Eradication regimen should be decided considering the resistance to H. pylori. However, in case of unknown state of resistance, OAC can be chosen if BMT fails. Similarly, BMT can be tried in cases that OAC therapy failed. After failures of both triple therapies, quadruple therapy can be tried as the next step. (Korean J Gastroenterol 2003;42:195-203)