根除幽门螺杆菌与胃食管反流病疗效间的关系研究

摘要

Objective To investigate the relationship between helicobacter pylori(HP)eradication and curative effect of gastroe-sophageal reflux disease(GERD) .Methods Two hundred and fifty four patients with GERD were prospectively recruited for endo-scope and acid reflux evaluation .According to the results of gastroscope ,the eligible patients were divided into non-erosive reflux disease (NERD) and erosive esophagitis (EE) group ,and each divided into HP positive and HP negative group ,the HP positive group were randomly divided into the anti HP treatment group and not .These patients were assigned to rabeprazole triple therapy (the anti HP treatment group) or rabeprazole(20 mg ,twice per day) single(other groups) for 10 d ,then rabeprazole (20mg ,twice per day) was given to all patients until two months .Then all patients underwent acid reflux evaluation ,EE group underwent endos-copy ,and all patients underwent a 13 C urea breath test 4 weeks after cessation of rabeprazole to determine HP status .Results One hundred and seventy nine GERD patients were included in the study(NERD group 119 cases ,including anti HP treatment group 47 cases ,not anti HP treatment group 32 cases ,HP negative group 40 cases ;EE group 60 cases ,including anti HP treatment group 24 cases ,not anti HP treatment group 15 cases ,HP negative group 21 cases) .HP was eradicated in 76 .6% of the NERD anti HP treatment group and in 75 .0% of the EE anti HP treatment group .Overall ,there is no difference between the anti HP treatment group and other groups on these aspects ,including symptom、esophagitis and acid reflux improvement .Conclusion There are no significant correlation between HP eradication and GERD .%目的：探讨根除幽门螺杆菌（HP）与胃食管反流病（GERD）疗效间的关系。方法选取GERD患者254例，分为非糜烂性反流病（NERD）组和糜烂性食管炎（EE）组，再进一步分为 HP阳性组、HP阴性组，HP阳性组随机分为不抗 HP治疗组和抗 HP治疗组，抗HP治疗组行HP根除三联疗法，不抗HP治疗组和HP阴性组仅服用雷贝拉唑（20 mg每天2次）；10 d后所有患者仅服用雷贝拉唑（20 mg 每天2次）直至试验疗程2个月。试验结束时EE组行胃镜检查，所有患者均行食管酸反流测定和13 C呼气试验检测H P。结果179例患者完成了临床研究（N ERD组119例，其中抗 H P治疗组47例，不抗 H P治疗组32例，H P阴性组40例；EE组60例，其中抗HP治疗组24例，不抗HP治疗组15例，HP阴性组21例）。NERD组中抗HP治疗组36例患者HP转阴（76．6％），EE组中抗HP治疗组18例HP转阴（75．0％）。NERD组或EE组中HP根除成功患者组分别与 HP根除失败组、不抗HP治疗组、HP阴性组在治疗前后症状、食管炎症和食管酸反流方面比较差异无统计学意义（P＞0．05）。结论根除HP治疗与GERD疗效间没有明显相关性。