Individualized precise eradication of Helicobacter pylori

doi:10.3760/cma.j.issn.1007-1245.2022.01.008

Abstract

Abstract: Helicobacter pylori (Hp) infection is associated with digestive tract diseases and the incidence of multiple systems throughout the body, with a high infection rate and strong pathogenicity, and is threatening people's health. In recent years, due to the abuse of antibiotics, antibiotic resistance has been increasing year by year, which leads to the decline of Hp eradication rate, and it has become a difficult clinical problem. In recent years, in order to improve the Hp eradication rate, domestic and foreign scholars have made active exploration, proposed the concept of "individualized" precise eradication therapy, and selected individualized drug radical cure plan according to the patients' specific circumstances. This article reviews the individualized differences in patients treated with Hp eradication combination, so as to provide valuable suggestions for clinicians to select the best treatment for Hp eradication.

Key words: Helicobacter pylori, Eradication therapy, Individualization, Antacid, Antibiotics, Bismuth

摘要： 幽门螺杆菌（Helicobacter pylori，Hp）感染与消化道疾病及全身多个系统的发病相关，其感染率高、致病力强，威胁着人们的身体健康。近年来由于抗生素的滥用，抗生素耐药呈逐年上升趋势，从而导致Hp根除率下降，成为临床棘手的问题。近年来，为了努力提高Hp根除率，国内外学者做了积极探索，提出了“个体化”精准根除治疗的概念，根据患者自身具体情况，选择个体化药物根治方案。本文将对Hp根治联合用药的患者个体化差异作一综述，旨在为临床医师根治Hp选择最佳治疗方案提供具有参考价值的建议。

关键词: 幽门螺杆菌, 根除治疗, 个体化, 抑酸剂, 抗生素, 铋剂

Jiang Xin, Gao Xuefeng, She Qiang, Ding Yanbing. Individualized precise eradication of Helicobacter pylori [J]. International Medicine and Health Guidance News, 2022, 28(1): 32-37.

姜鑫, 高雪峰, 佘强, 丁岩冰. 幽门螺杆菌个体化精准根治的研究进展[J]. 国际医药卫生导报, 2022, 28(1): 32-37.

References

[1] Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis[J]. Lancet, 2002,359(9300):14-22. DOI: 10.1016/S0140-6736(02)07273-2.

[2] Sipponen P. Natural history of gastritis and its relationship to peptic ulcer disease[J]. Digestion, 1992,51 Suppl 1:70-75. DOI: 10.1159/000200919.

[3] Franceschi F, Covino M, Roubaud Baudron C. Review: helicobacter pylori and extragastric diseases[J]. Helicobacter, 2019 ,24 Suppl 1:e12636. DOI: 10.1111/hel.12636.

[4] Hughes WS. An hypothesis: the dramatic decline in heart attacks in the United States is temporally related to the decline in duodenal ulcer disease and Helicobacter pylori infection[J]. Helicobacter, 2014,19(3):239-241. DOI: 10.1111/hel.12123.

[5] Shindler-Itskovitch T, Chodick G, Shalev V, et al. Helicobacter pylori infection and prevalence of stroke[J]. Helicobacter, 2019,24(1):e12553. DOI: 10.1111/hel.12553.

[6] Fani L, Wolters FJ, Ikram MK,et al. Helicobacter pylori and the risk of dementia: a population-based study[J]. Alzheimers Dement, 2018,14(10):1377-1382. DOI: 10.1016/j.jalz.2018.05.005.

[7] Chen LW, Kuo SF, Chen CH, et al. A community-based study on the association between helicobacter pylori infection and obesity[J]. Sci Rep, 2018,8(1):10746. DOI: 10.1038/s41598-018-28792-1.

[8] Vanegas YAM, Vishnu P. Management of helicobacter pylori in patients with immune thrombocytopenia[J]. Hamostaseologie, 2019,39(3):279-283. DOI: 10.1055/s-0039-1683974.

[9] 张万岱,胡伏莲,萧树东,等. 中国自然人群幽门螺杆菌感染的流行病学调查[J]. 现代消化及介入诊疗,2010,15(5):265-270. DOI:10.3969/j.issn.1672-2159.2010.05.001.

[10] Kuo CH, Kuo FC, Hu HM, et al. The optimal first-line therapy of helicobacter pylori infection in year 2012[J]. Gastroenterol Res Pract, 2012,2012:168361. DOI: 10.1155/2012/168361.

[11] Malfertheiner P, Megraud F, O'Morain CA, et al. Management of helicobacter pylori infection-the Maastricht V/Florence consensus report[J]. Gut, 2017,66(1):6-30. DOI: 10.1136/gutjnl-2016-312288.

[12] 中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组,刘文忠,谢勇,等.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):346-360. DOI: 10.3969 /j.issn.1008-7125.2017.06.006.

[13] Labenz J. Current role of acid suppressants in helicobacter pylori eradication therapy[J]. Best Pract Res Clin Gastroenterol, 2001,15(3):413-431. DOI: 10.1053/bega.2001.0188.

[14] Gao CP, Zhang D, Zhang T, et al. PPI-amoxicillin dual therapy for Helicobacter pylori infection: an update based on a systematic review and meta-analysis[J]. Helicobacter, 2020,25(4):e12692. DOI: 10.1111/hel.12692.

[15] 方洒,李恕军.幽门螺杆菌根除药物研究进展[J].人民军医,2017,60(5):444-447.

[16] Kuo CH, Lu CY, Shih HY, et al. CYP2C19 polymorphism influences Helicobacter pylori eradication[J]. World J Gastroenterol, 2014,20(43):16029-16036. DOI: 10.3748/wjg.v20.i43.16029.

[17] Chen L, Qin S, Xie J, et al. Genetic polymorphism analysis of CYP2C19 in Chinese Han populations from different geographic areas of mainland China[J]. Pharmacogenomics, 2008,9(6):691-702. DOI: 10.2217/14622416.9.6.691.

[18] Tang HL, Li Y, Hu YF, et al. Effects of CYP2C19 loss-of-function variants on the eradication of H. pylori infection in patients treated with proton pump inhibitor-based triple therapy regimens: a meta-analysis of randomized clinical trials[J]. PLoS One, 2013,8(4):e62162. DOI: 10.1371/journal.pone.0062162.

[19] 杨然,马晓慧,郭嘉华,等.药物代谢酶的特性[J].中国新药杂志,2016,25(7):751-759.

[20] 张石革.质子泵抑制剂临床应用的药学监护[J].中国执业药师,2015,12(7):31-37.DOI:10.3969/j.issn.1672-5433. 2015.07.008.

[21] Sapone A, Vaira D, Trespidi S, et al. The clinical role of cytochrome p450 genotypes in helicobacter pylori management[J]. Am J Gastroenterol, 2003,98(5):1010-1015. DOI: 10.1111/j.1572-0241.2003.07427.x.

[22] Zhao F, Wang J, Yang Y, et al. Effect of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple therapy for Helicobacter pylori eradication: a meta-analysis[J]. Helicobacter, 2008,13(6):532-541. DOI: 10.1111/j.1523-5378.2008.00643.x.

[23] 姜英杰, 李瑜元, 聂玉强, 等. 雷贝拉唑根除幽门螺杆菌疗效及其与CYP2C19基因多态性的关系[J].广州医学院学报,2004,32(3):22-25.DOI:10.3969/j.issn.1008-1836.2004. 03.007.

[24] McNicholl AG, Linares PM, Nyssen OP, et al. Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection[J]. Aliment Pharmacol Ther, 2012,36(5):414-425. DOI: 10.1111/j.1365-2036.2012.05211.x.

[25] Yang JC, Wang HL, Chern HD, et al. Role of omeprazole dosage and cytochrome P450 2C19 genotype in patients receiving omeprazole-amoxicillin dual therapy for Helicobacter pylori eradication[J]. Pharmacotherapy, 2011,31(3):227-238. DOI: 10.1592/phco.31.3.227.

[26] Anagnostopoulos GK, Tsiakos S, Margantinis G, et al. Esomeprazole versus omeprazole for the eradication of Helicobacter pylori infection: results of a randomized controlled study[J]. J Clin Gastroenterol, 2004,38(6):503-536. DOI: 10.1097/01.mcg.0000129061.54277.c6.

[27] Ishizawa Y, Yasui-Furukori N, Takahata T, et al. The effect of aging on the relationship between the cytochrome P450 2C19 genotype and omeprazole pharmacokinetics[J]. Clin Pharmacokinet, 2005,44(11):1179-89. DOI: 10.2165/00003088-200544110-00005.

[28] Vardi M, Cryer BL, Cohen M, et al. The effects of proton pump inhibition on patient-reported severity of dyspepsia when receiving dual anti-platelet therapy with clopidogrel and low-dose aspirin: analysis from the Clopidogrel and the optimization of gastrointestinal events trial[J]. Aliment Pharmacol Ther, 2015,42(3):365-374. DOI: 10.1111/apt.13260.

[29] Tanabe H, Yoshino K, Ando K, et al. Vonoprazan-based triple therapy is non-inferior to susceptibility-guided proton pump inhibitor-based triple therapy for Helicobacter pylori eradication[J]. Ann Clin Microbiol Antimicrob, 2018,17(1):29. DOI: 10.1186/s12941-018-0281-x.

[30] Li M, Oshima T, Horikawa T, et al. Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori[J]. Helicobacter, 2018,23(4):e12495. DOI: 10.1111/hel.12495.

[31] 胡伏莲.幽门螺杆菌根除失败的原因分析和处理策略[J].现代消化及介入诊疗,2010,15(2):108-112.DOI:10.3969/j.issn.1672-2159.2010.02.013.

[32] Bai P, Zhou LY, Xiao XM, et al. Susceptibility of Helicobacter pylori to antibiotics in Chinese patients[J]. J Dig Dis, 2015,16(8):464-470. DOI: 10.1111/1751-2980. 12271.

[33] 李云振,胡伟鹏,高宏志,等.幽门螺杆菌抗生素耐药机制研究进展[J].微生物学通报,2014,41(5):983-989.DOI:10.13344/j.microbiol.china.130659.

[34] Mégraud F. H pylori antibiotic resistance: prevalence, importance, and advances in testing[J]. Gut,2004,53(9):1374-1384. DOI: 10.1136/gut.2003.022111.

[35] Binh TT, Suzuki R, Trang TT, et al. Search for novel candidate mutations for metronidazole resistance in Helicobacter pylori using next-generation sequencing[J]. Antimicrob Agents Chemother, 2015,59(4):2343-2348. DOI: 10.1128/AAC.04852-14.

[36] Kim SY, Joo YM, Lee HS, et al. Genetic analysis of Helicobacter pylori clinical isolates suggests resistance to metronidazole can occur without the loss of functional rdxA[J]. J Antibiot (Tokyo), 2009,62(1):43-50. DOI: 10.1038/ja.2008.6.

[37] Tankovic J, Lascols C, Sculo Q, et al. Single and double mutations in gyrA but not in gyrB are associated with low- and high-level fluoroquinolone resistance in Helicobacter pylori[J]. Antimicrob Agents Chemother, 2003,47(12):3942-3944. DOI: 10.1128/AAC.47.12.3942-3944.2003.

[38] Garcia M, Raymond J, Garnier M, et al. Distribution of spontaneous gyrA mutations in 97 fluoroquinolone-resistant Helicobacter pylori isolates collected in France[J]. Antimicrob Agents Chemother, 2012,56(1):550-551. DOI: 10.1128/AAC.05243-11.

[39] Lee JW, Kim N, Nam RH, et al. Favorable outcomes of culture-based Helicobacter pylori eradication therapy in a region with high antimicrobial resistance[J]. Helicobacter, 2019,24(2):e12561. DOI: 10.1111/hel.12561.

[40] 汪平凡,张高松,高虎云,等.药敏实验指导及个体化治疗幽门螺杆菌感染的临床探讨[J].中国医药指南,2014,12(25):242-243. DOI: 10.15912/j.cnki.gocm.2014.25.477.

[41] 周丽雅,闫秀娥.含铋剂四联疗法治疗幽门螺杆菌感染药物选择[J].中国实用内科杂志,2013,33(3):185-187.

[42] Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori Infection[J]. Am J Gastroenterol, 2017,112(2):212-239. DOI: 10.1038/ajg.2016.563.

[43] Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence consensus report[J]. Gut, 2012,61(5):646-664. DOI: 10.1136/gutjnl-2012-302084.

[44] 刘文忠,谢勇,成虹,等.第四次全国幽门螺杆菌感染处理共识报告[J].现代消化及介入诊疗,2012,17(6):358-363.

[45] 付伟,宋志强,周丽雅.青霉素过敏患者的幽门螺杆菌根除治疗[J].临床消化病杂志,2016,28(4):259-262.DOI:10.3870/lcxh.j.issn.1005-541X.2016.04.20.

[46] Liou JM, Fang YJ, Chen CC, et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial[J]. Lancet, 2016,388(10058):2355-2365. DOI: 10.1016/S0140-6736(16)31409-X.

[47] Lee JW, Kim N, Nam RH, et al. Risk factors of rescue bismuth quadruple therapy failure for Helicobacter pylori eradication[J]. J Gastroenterol Hepatol, 2019,34(4):666-672. DOI: 10.1111/jgh.14625.