ʻO Helicobacter pylori (Hp), kekahi o nā maʻi lele maʻamau i nā kānaka. He kumu pilikia ia no nā maʻi he nui, e like me ka maʻi ʻōpū, ka ʻōpū mau loa, ka adenocarcinoma ʻōpū, a me ka lymphoma pili i ka mucosa-associated lymphoid tissue (MALT). Ua hōʻike ʻia nā haʻawina e hiki ke hoʻemi ʻia ka hoʻopau ʻana i ka Hp i ka maʻi maʻi ʻōpū, hoʻonui i ka hoʻōla ʻana o ka maʻi ʻeha, a i kēia manawa pono e hui pū ʻia me nā lāʻau hiki ke hoʻopau pololei iā Hp. Nui nā ʻano koho hoʻopau lāʻau lapaʻau i loaʻa: ʻo ka lāʻau lapaʻau mua no ka maʻi e pili ana i ka triple therapy maʻamau, expectorant quadruple therapy, sequential therapy, a me concomitant therapy. I ka makahiki 2007, ua hoʻohui ka American College of Gastroenterology i ka triple therapy me ka clarithromycin ma ke ʻano he lāʻau lapaʻau mua no ka hoʻopau ʻana i ka poʻe i loaʻa ʻole i ka clarithromycin a ʻaʻohe maʻi maʻi penicillin. Eia nō naʻe, i nā makahiki i hala iho nei, ua ≤80% ka nui o ka hoʻopau ʻana o ka maʻamau triple therapy ma ka hapa nui o nā ʻāina. Ma Kanada, ua piʻi ka nui o ka pale ʻana o clarithromycin mai 1% i ka makahiki 1990 a i 11% i ka makahiki 2003. Ma waena o nā poʻe i mālama ʻia, ua hōʻike ʻia ka nui o ka pale ʻana i ka lāʻau ma mua o 60%. ʻO ka pale ʻana o Clarithromycin ke kumu nui o ka pau ʻole o ka hoʻopau ʻana. Hōʻike ʻo Maastricht IV consensus i nā wahi me ke kūpaʻa kiʻekiʻe i ka clarithromycin (kūʻai kūʻē ma luna o 15% a 20%), e hoʻololi ana i ka triple therapy maʻamau me ka quadruple a i ʻole ka sequential therapy me ka expectorant a / a ʻaʻohe sputum, aʻo ka carat Quadruple therapy hiki ke hoʻohana mua ʻia -line therapy ma nā wahi me ka haʻahaʻa haʻahaʻa i ka mycin. Ma kahi o nā ʻano o luna, ua manaʻo ʻia nā kiʻekiʻe o ka PPI me amoxicillin a i ʻole nā ​​​​antibiotic ʻē aʻe e like me rifampicin, furazolidone, levofloxacin ma ke ʻano he lāʻau lapaʻau mua.

ʻO ka hoʻomaikaʻi ʻana i ka triple therapy maʻamau

1.1 Hoʻoponopono pāhāhā

I ka hāʻule ʻana o ka helu hoʻopau ʻana o ka triple therapy maʻamau, ma ke ʻano he lāʻau lapaʻau, ʻoi aku ka nui o ka hoʻopau ʻana o ka quadruple therapy. Shaikh et al. mālama ʻia nā maʻi 175 me ka maʻi Hp, me ka hoʻohana ʻana i kēlā me kēia protocol (PP) kānana a me ka manaʻo. ʻO nā hopena o ka nānā ʻana o ka manaʻo e mālama (ITT) i loiloi i ka helu hoʻopau ʻana o ka triple therapy maʻamau: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); ʻoi aku ka nui o ka hoʻopau ʻana i ka quadruple therapy: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). ʻOiai ua hoʻemi ʻia ka helu kūleʻa o ka hoʻopau ʻana i ka Hp ma hope o kēlā me kēia lapaʻau hāʻule ʻole, ua hōʻike ʻia ka lapaʻau quadruple o ka tincture i kahi kiʻekiʻe o ka hoʻopau ʻana (95%) ma ke ʻano he lāʻau ma hope o ka hāʻule ʻole o ka lāʻau triple maʻamau. ʻO kekahi noiʻi ʻē aʻe i loaʻa i kahi hopena like: ma hope o ka pau ʻole o ka triple therapy maʻamau a me ka levofloxacin triple therapy, ʻo ka nui o ka hoʻopau ʻana o ka barium quadruple therapy he 67% a me 65%, kēlā me kēia, no ka poʻe i maʻi i ka penicillin a i loaʻa paha i nā mea maʻi nui. cyclic lactone antibiotics, expectorant quadruple therapy ʻoi aku ka makemake. ʻOiaʻiʻo, ʻoi aku ka nui o ka hoʻohana ʻana i ka tincture quadruple therapy, e like me ka nausea, diarrhea, ʻeha o ka ʻōpū, melena, dizziness, headache, metallic taste, etc., akā no ka mea, hoʻohana nui ʻia ka expectorant ma Kina, maʻalahi ka loaʻa ʻana, a hiki ke hoʻohana ʻia kahi helu hoʻopau kiʻekiʻe ma ke ʻano he lapaʻau hoʻoponopono. Pono e hoʻolaha i loko o ke keʻena hauʻoli.

1.2 SQT

Ua mālama ʻia ʻo SQT me PPI + amoxicillin no 5 mau lā, a laila mālama ʻia me PPI + clarithromycin + metronidazole no 5 mau lā. Manaʻo ʻia ʻo SQT ma ke ʻano he lāʻau lapaʻau hoʻopau mua no ka Hp. ʻO kahi meta-analysis o ʻeono mau hoʻāʻo hoʻokele randomized (RCTs) ma Korea e pili ana i ka SQT ʻo 79.4% (ITT) a me 86.4% (PP), a me ka hoʻopau ʻana o HQ ​​o SQT ʻOi aku ka kiʻekiʻe ma mua o ka maʻamau triple therapy, 95% CI: 1.403 ~ 2.209), ʻo ia paha ka 5d mua (a i ʻole 7d) e hoʻohana i ka amoxicillin e hoʻopau i ke kahawai efflux clarithromycin ma ka paia o ke kelepona, e ʻoi aku ka maikaʻi o ka hopena o ka clarithromycin. Hoʻohana pinepine ʻia ʻo SQT ma ke ʻano he lāʻau lapaʻau no ka hiki ʻole o ka maʻi triple maʻamau ma waho. Eia nō naʻe, ua hōʻike ʻia nā haʻawina e ʻoi aku ka kiʻekiʻe o ka triple therapy eradication rate (82.8%) i ka manawa lōʻihi (14d) ma mua o ka hoʻomaʻamaʻa sequential maʻamau (76.5%). Ua ʻike pū kekahi noiʻi ʻaʻohe ʻokoʻa nui i ka nui o ka hoʻopau ʻana i ka Hp ma waena o SQT a me ka triple therapy maʻamau, e pili ana paha i kahi kiʻekiʻe o ka pale ʻana i ka clarithromycin. He ʻoi aku ka lōʻihi o ka lāʻau lapaʻau ʻo SQT, hiki ke hōʻemi i ka hoʻokō ʻana o ka mea maʻi a ʻaʻole kūpono i nā wahi me ke kūpaʻa kiʻekiʻe i ka clarithromycin, no laila hiki ke noʻonoʻo ʻia ʻo SQT i ka wā contraindications no ka hoʻohana ʻana i ka tincture.

1.3 Hoʻoponopono hoa

Hoʻohui pū ʻia ka lāʻau lapaʻau me ka amoxicillin, metronidazole a me clarithromycin. Ua hōʻike ʻia kahi meta-analysis ua ʻoi aku ka kiʻekiʻe o ka hoʻopau ʻana ma mua o ka triple therapy maʻamau. Ua ʻike hou ʻia kekahi meta-analysis ua ʻoi aku ka kiʻekiʻe o ka hoʻopau ʻana (90%) ma mua o ka triple therapy maʻamau (78%). Hōʻike ka Maastricht IV Consensus e hiki ke hoʻohana ʻia ka SQT a i ʻole concomitant therapy i ka loaʻa ʻole o nā expectorants, a ua like ka hoʻopau ʻana o nā lāʻau lapaʻau ʻelua. Eia nō naʻe, ma nā wahi i kū ai ka clarithromycin i ka metronidazole, ʻoi aku ka maikaʻi me ka lāʻau concomitant. Eia nō naʻe, no ka mea, ʻekolu ʻano lāʻau antibiotic ka lāʻau lapaʻau, e hōʻemi ʻia ke koho ʻana i nā lāʻau antibiotic ma hope o ka hāʻule ʻana o ka mālama ʻana, no laila ʻaʻole ʻōlelo ʻia ʻo ia ka papa hana lapaʻau mua koe wale nō nā wahi i kū ai ka clarithromycin a me metronidazole. Hoʻohana nui ʻia ma nā wahi me ka haʻahaʻa haʻahaʻa i ka clarithromycin a me metronidazole.

1.4 kiʻekiʻe ka lāʻau lapaʻau

Ua ʻike nā haʻawina ʻo ka hoʻonui ʻana i ka nui a me / a i ʻole ka pinepine o ka lawelawe ʻana o PPI a me amoxicillin ʻoi aku ka nui ma mua o 90%. ʻO ka hopena bactericidal o ka amoxicillin ma Hp i manaʻo ʻia e pili ana i ka manawa, a no laila, ʻoi aku ka maikaʻi o ka hoʻonui ʻana i ka pinepine o ka lawelawe. ʻO ka lua, ke mālama ʻia ka pH i loko o ka ʻōpū ma waena o 3 a me 6, hiki ke pale ʻia ka hana hou ʻana. Ke ʻoi aku ka pH o ka ʻōpū ma mua o 6, ʻaʻole e hana hou ʻo Hp a paʻa i ka amoxicillin. Ua alakaʻi ʻo Ren et al i nā hoʻokolohua i hoʻopaʻa ʻia i nā maʻi 117 me nā maʻi Hp-positive. Hāʻawi ʻia ka hui kiʻekiʻe i ka amoxicillin 1g, tid a me rabeprazole 20mg, bid, a ua hāʻawi ʻia ka pūʻulu hoʻokele amoxicillin 1g, tid a me rabeprazole. 10mg, hāʻawi, ma hope o 2 mau pule o ka mālama ʻana, ʻo ka Hp eradicated rate o ka hui kiʻekiʻe he 89.8% (ITT), 93.0% (PP), ʻoi aku ka kiʻekiʻe ma mua o ka pūʻulu mana: 75.9% (ITT), 80.0% (PP), P <0.05. Ua hōʻike ʻia kahi haʻawina mai ʻAmelika e hoʻohana ana i ka esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 mau lā, ITT = 72.2% ma hope o 14 mau lā o ka mālama ʻana, PP = 74.2%. ʻO Franceschi et al. hoʻoponopono hou ʻia ʻekolu lapaʻau: 1 maʻamau triple therapy: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 kiʻekiʻe-dose therapy: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, ka papa o ka lapaʻau ʻana he 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, bid treatment for 5d, lansoprazole 30mg bid, carat Ua mālama ʻia ka 500mg bid a me ka tinidazole 500mg bid no 5 mau lā. ʻO ka nui o ka hoʻopau ʻana o nā ʻano lapaʻau ʻekolu: 55%, 75%, a me 73%. ʻO ka ʻokoʻa ma waena o ka lāʻau lapaʻau kiʻekiʻe a me ka triple therapy maʻamau he mea nui i ka helu, a ua hoʻohālikelike ʻia ka ʻokoʻa me SQT. ʻAʻole nui ka helu helu. ʻOiaʻiʻo, ua hōʻike nā haʻawina ʻaʻole i hoʻomaikaʻi maikaʻi ka omeprazole a me ka amoxicillin therapy i ka nui o ka hoʻopau ʻana, ma muli paha o ka genotype CYP2C19. Hoʻopili ʻia ka hapa nui o nā PPI e ka enzyme CYP2C19, no laila hiki i ka ikaika o ka CYP2C19 gene metabolite ke hoʻopili i ka metabolism o PPI. Hoʻopili nui ʻia ka Esomeprazole e ka cytochrome P450 3 A4 enzyme, hiki ke hōʻemi i ka mana o ka CYP2C19 gene i kekahi ʻano. Eia kekahi, ma kahi o PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, ua ʻōlelo ʻia hoʻi ma ke ʻano he lāʻau lapaʻau kiʻekiʻe.

Hoʻomākaukau microbial hui

ʻO ka hoʻohui ʻana i nā microbial ecological agents (MEA) i ka lāʻau maʻamau e hiki ke hōʻemi i nā hopena ʻino, akā naʻe ke hoʻopaʻapaʻa nei inā hiki ke hoʻonui ʻia ka helu hoʻopau Hp. Ua ʻike ʻia kahi meta-analysis ʻo ka triple therapy o B. sphaeroides i hui pū ʻia me triple therapy wale nō i hoʻonui i ka nui o ka Hp eradication rate (4 randomized controlled trials, n=915, RR=l.13, 95% CI: 1.05) ~1.21), hoʻemi hoʻi. nā hopena ʻino e like me ka maʻi maʻi. Zhao Baomin et al. Ua hōʻike pū kekahi i ka hui pū ʻana o nā probiotics hiki ke hoʻomaikaʻi nui i ka helu hoʻopau ʻana, ʻoiai ma hope o ka pōkole ʻana o ke ʻano o ka mālama ʻana, aia nō ka nui o ka hoʻopau ʻana. Ua hoʻokaʻawale ʻia kahi noiʻi o nā maʻi he 85 me nā maʻi Hp-positive i 4 mau pūʻulu o Lactobacillus 20 mg bid, clarithromycin 500 mg bid, a me tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus hui pū me ka bifidobacteria, placebo no 1 pule, e hoʻopiha i kahi nīnau no ka noiʻi hōʻailona i kēlā me kēia pule no 4 mau pule, 5 a 7 mau pule ma hope e nānā i ka maʻi, ua ʻike ʻia ka haʻawina: probiotics pūʻulu a me ka hōʻoluʻolu ʻAʻohe mea nui. ʻokoʻa i ka helu hoʻopau ma waena o nā hui, akā ʻoi aku ka maikaʻi o nā pūʻulu probiotic āpau i ka pale ʻana i nā hopena ʻino ma mua o ka pūʻulu hoʻomalu, a ʻaʻohe ʻokoʻa koʻikoʻi i ka hopena o nā hopena ʻino ma waena o nā pūʻulu probiotic. ʻAʻole maopopo ke ʻano hana e hoʻopau ai nā probiotics i ka Hp, a hiki ke kāohi a hoʻopau paha me nā wahi hoʻokūkū hoʻokūkū a me nā mea like ʻole e like me nā waikawa organik a me nā bacteriopeptides. Eia nō naʻe, ua ʻike kekahi mau haʻawina ʻaʻole i hoʻomaikaʻi ka hui ʻana o nā probiotics i ka hoʻopau ʻana, hiki ke pili i ka hopena keu o nā probiotics wale nō inā ʻaʻole pono nā lāʻau antibiotic. Aia kekahi wahi noiʻi nui i loko o ka hui probiotics, a pono e noiʻi hou i nā ʻano, nā papa lapaʻau, nā hōʻailona a me ka manawa o ka hoʻomākaukau ʻana i ka probiotic.

Nā mea e pili ana i ka hoʻopau ʻana i ka Hp

ʻO kekahi mau mea e pili ana i ka hoʻopau ʻana i ka Hp e pili ana i ka pale ʻana i ka lāʻau antibiotic, ka ʻāina ʻāina, ka makahiki maʻi, ke kūlana puhi, ka mālama ʻana, ka manawa lapaʻau, ka nui o ka bacteria, ka maʻi atrophic maʻi maʻi, ka hoʻopaʻa ʻana o ka ʻōpū, ka pane ʻana o kēlā me kēia i ka PPI, a me CYP2C19 gene polymorphism. ʻO ke alo. Ua hōʻike ʻia nā haʻawina ma ka loiloi univariate, ka makahiki, ka wahi noho, ka lāʻau lapaʻau, ka maʻi ʻōpū, ka comorbidity, ka moʻolelo hoʻopau, ka PPI, ke ʻano o ka mālama ʻana, a me ka mālama ʻana i ka mālama ʻana e pili ana i nā helu hoʻopau. Eia kekahi, pili kekahi mau ma'i ma'i ma'i, e like me ka ma'i ma'i ma'i, ke ki'eki'e, ka ma'i ma'i ma'i, ka ma'i akepa'a, a me ka ma'i ma'i ma'i ma'i e pili ana i ka ho'opau 'ia o ka Hp. Eia naʻe, ʻaʻole like nā hopena o ka noiʻi ʻana i kēia manawa, a pono nā haʻawina nui aʻe.