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십이지장궤양 환자에서 Helicobacer pylori 의 박멸이 궤양 재발에 미치는 영향에 관한 연구
김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Suk Cho),채봉남(Bong Nam Chae),최진용(Chin Yong Choi),이계희(Kye Heui Lee),손인(In Son),박성훈(Sung Hoon Park),구명숙(Myoung Sook Koo),최신은(Shin Eun Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.3
N/A Background: The recurrence rate of duodenal ulcer (DU) within 12 months after treatment is 70~90%. Since the identification of Helicobacter pylori (H. pylori) which has been confirmed to be the major causal agent of chronic antral gastritis, the close linkage between the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more than 90% of patients with DV have stimulated studies on the use of anti-H. pylori antimicrobial agents in DU. However, the definition of eradication related with the time at which assessment is made after the completion of therapy has not been unified, and moreover, there is no general agreement on how H. pylori should be eradicated. Methods: This study was performed for 190 DU patients and four different methods -culture, Gram stain of touch print, H&E stain, mucosal urease test-were taken for H. pylori test just before treating to identify the infection rate of H. pylori in DU patients, immediately after each 6 week ulcer therapy to assess the negative conversion rate of H. pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS), CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 months after therapy. Results : 1) The infection rate of H. pylori in DU patients in Korea was 94.2%. 2) The negative conversion rate of U. pylori immediately after the therapy in cimetidine group was 0%, and that of omeprazole group was 16.7% but one half of the negative converted cases was converted to be positive 4 weeks later after the completion of therapy, so the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1% which is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be negative, so the eradication rate was 88.5%, which is higher than that of double therapy group. 3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18 months later, respectively, and in omeprazole group that was 58.3% both in 1 year and 18 months later. In CBS group, that was 33.3% in 1 year and 44.4% in 1H months later. In double therapy group, that was 12.5% in 1 year and 18.8% in 18 months later, respectively. In triple therapy group, that was both 3.8% in 1 year and 18 months later. 4) When all of these patients were classified into two groups according to the eradication of H. pylori, the recurrence rate was 0% in the 32 patients with H. pylori eradicated, and that WBS 57.1% (24 patients) in the 42 patients with H. pylori not eradicated. Conclusion : From these results, we can conclude that in order to evaluate the eradication of H. pylori, it is more precise to assess the H. pylori 4 weeks later after the completion of therapy than immediately after the therapy, and the eradication of H. pylori in DU patients reduces the recurrence of DU.
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십이지장궤양 치료방법에 따른 Helicobacter pylori의 박멸에 관한 연구
최진용(Jin Yong Choi),김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Sook Cho),채봉남(Bong Nam Chae),이계희(Kye Heui Lee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1
N/A The recurrence rate of duodenal ulcer(DU) within 12 months after treatment has been re- duced to 0-27% with eradication of Helicobacter pylori(H. pylori) from 50-90% without eradi- cation. This study was conducted to find the ideal method of treatment in the aspects of erad- ication of H. pylori, symptom reduction, and side effect among the three treatment methods. This study was performed for 73 patients with DU, and four different methods, for identifying H. Pylori infection-Gram stain of touch print, culture, H&E stain, CLO test-were taken just be- fore treatment and taken 4 weeks later after the completion of ulcer therapy to find the eradi- cation rate of H. pylori in three treatment groups. The first treatment group consisted of col- loidal bismuth subcitrate(CBS) 240mg twice a day, metronidazole 250mg thrice, and amoxicillin 500mg thrice for 6 weeks(Group I, n=28), the second group omeprazole 20mg once a day for 6 weeks and amoxicillin 500mg thrice for the first two weeks(Group II, n=l3), and the third group ranitidine 150mg twice a day or omeprazole 20mg once for 4 weeks and thereafter CBS 120mg four times a day, metronidazole 500mg thrice and amoxicillin 500mg four times for 2 weeks(Group III, n=32). The degree of symptom reduction and frequency of side effect in each treatment group were evaluated during the treatment period. The eradication rate of H. pylori was 89.3% in Group I, 23.1% in Group II, and 87.5% in Group Ill, In Group I, more than 50% of symptom reduction within 1 week was 55.6%, within 2 weeks 22.2% and after 2 weeks 22.2%; in Group II, more than 50% of symptom reduction within 1 week was 100%; in Group III, the same rate of reduction within 1 week was 96.6% and within 2 weeks 3.4%. The frequency of side effect in Group I was 21.2% including 5 patients (15.2%) in whom the medication could not be completed due to major side effect; the frequen- cy of side effect in Group II was 0%; that in Group lIl was 21.9/, in all of whom the side effect was minor so the medication could be completed. From these results, we concluded that in the aspect of eradication of H. pylori, the triple therapies for 6 or 2 weeks(Group I and Ill) are better than omeprazole and amoxicillin therapy(Group II), and in the aspect of symptom reduction, the triple therapy for 2 weeks after ranitidine or omeprazole for 4 weeks(Group Ill) is better than the triple therapy for 6 weeks (Grup I ). (Korean J Gastroenterol 1994; 26: 47 55)
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