A. Gastric disease associated with Helicobacter pylori
1, chronic gastritis
The incidence of chronic gastritis is high. The detection rate of patients with epigastric discomfort can reach more than 80%, and studies have confirmed that H. pylori is the main cause of chronic gastritis. In 1985, H. pylori was isolated for the first time, and a lot of basic and clinical research on H. pylori was conducted, and it was found that the infection rate of H. pylori in patients with chronic active gastritis was 95%, and H. pylori-positive gastritis was mostly active gastritis, and after killing H. pylori it became inactive gastritis. Chronic active superficial gastritis can gradually develop into chronic atrophic gastritis, which can be aggravated by atrophic gastritis and become precancerous by intestinal epithelial metaplasia and heterotypic hyperplasia. Atrophic gastritis is considered to be a precancerous disease of the stomach, so patients with atrophic gastritis need to be reviewed by gastroscopy once every 1-2 years for timely detection of early cancerous changes.
2.Peptic ulcer
Peptic ulcer is relatively common, and its gastroscopic detection rate is 16.5%-28.9%. In the past, it was believed that “no acid is no ulcer” and acid suppression can heal ulcers. Although it is not difficult to heal ulcers with acid suppression, the recurrence rate is as high as 60%-90% within one year. The discovery of H. pylori and related studies have shown that peptic ulcers are closely related to H. pylori infection. In China, the detection rate of H. pylori in gastric ulcers is about 70% and in duodenal ulcers is about 90%, while the recurrence rate of ulcers drops significantly to less than 10% after long-term follow-up observation after H. pylori eradication. Therefore, some people put forward the saying that “no Hp is no ulcer”.
3.Gastric cancer
According to epidemiological data, H. pylori has a very close relationship with the occurrence of gastric cancer, and H. pylori is considered a high-risk causative factor of gastric cancer. Experimental studies have shown that H. pylori can cause excessive cell proliferation, making DNA vulnerable to damage; H. pylori can also cause activation of proto-oncogenes, inactivation of oncogenes, overexpression of oncogenes and gene mutations, etc. Therefore, it is believed that H. pylori is an initiating factor for gastric cancer.
II. Diagnosis of H. pylori infection
In principle, the diagnostic criteria for H. pylori infection should be reliable and simple for implementation and promotion. there are many diagnostic methods for H. pylori infection, which should be selected according to different diagnostic purposes and unit conditions. Reagents and methods with high sensitivity and specificity should be selected for testing after examination.
Third, the eradication criteria of H. pylori
Negative urease dependent test. For clinical purposes, 1 test is sufficient; for scientific purposes, 2 tests should be negative (for biopsy, for clinical purposes, take the mucosa of the gastric sinus; for scientific purposes, take the mucosa of the gastric sinus and body.
IV. Treatment plan for Hp infection
First-line regimen.
PPI/RBC (standard dose) + amoxicillin (1.0g) + clarithromycin 0.5gBid×7 days.
PPI/RBC (standard dose) + metronidazole (0.4g) + clarithromycin 0.5gBid x 7 days.
PPI/RBC (standard dose) + amoxicillin (1.0g) + furazolidone 0.1g/metronidazole (0.4g) Bid×7 days.
Bismuth standard dose + furazolidone (0.1g)/metronidazole (0.4g) + clarithromycin 0.25gBid×7 days.
Standard dose of bismuth + metronidazole (0.4g) + amoxicillin 1.00gBid×14 days.
V. How to avoid the generation of drug-resistant strains
1.Strictly grasp the indications of H.pylori eradication.
2.Select a regimen with high eradication rate.
3, when treatment fails, those who are in a position to do drug sensitivity testing before treating again, avoid using H. pylori resistant antibiotics.
4, advocate the rational use of various oral antibiotics.
Sixth, prevention of H. pylori infection
Prevention of H. pylori infection and prevention of gastrointestinal infections, as well as to keep the disease from the mouth. Just do wash your hands before and after meals, try to eat cooked food heated at high temperatures, drink boiled water, and wash raw fruits and vegetables. Combined application of antibiotics is the only effective measure to treat H. pylori-related diseases. As patients become more and more aware of the relationship between H. pylori infection and gastrointestinal diseases, many people take the initiative to go to the hospital and ask for tests, and some patients even take antibacterial agents such as amoxicillin and gentamicin on their own, a practice that is clearly not scientific. Because this not only can not kill H. pylori, but also easily cause the emergence of drug-resistant strains, resulting in future eradication difficulties. Therefore, the presence of H. pylori infection, the need for treatment, and how to treat it should be diagnosed by a professional gastroenterologist.