This article tells you that the eradication of Helicobacter pylori failed, what should I do?

*For medical professionals to read and reference this article tells you that the eradication of Helicobacter pylori has failed, what should I do? Since Professor Marshall discovered Helicobacter pylori and won the Nobel Prize in Medicine, this bacterium that has coexisted with human beings for hundreds of thousands of years has gradually become popular from the original obscurity, and now it has become a well-known "net red bacteria".
"
.

It is not only related to chronic gastritis and peptic ulcer, but also closely related to gastric cancer
.

More and more people take it seriously and receive eradication treatment
.

At present, the standard quadruple therapy recommended by my country's guidelines has a decreasing success rate year by year.
According to research, the current success rate is lower than 80%-90%.
That is to say, the classic quadruple therapy will also have nearly 1/5 People will fail to sterilize, and there are even common cases of refractory Helicobacter pylori infection in clinical practice, so how should we deal with it? What is refractory Helicobacter pylori infection? The definition of refractory Helicobacter pylori infection (RHPI) is mainly based on the definition of Professor Hu Fulian in China [1], while there is currently no unified definition abroad
.

① The "standard quadruple therapy" in the "consensus" has failed more than 3 times within two years; ② each course of treatment is 10-14 days; ③ each treatment is completed according to the "consensus" requirements; , in line with treatment indications
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Finding the cause of eradication failure is the basis ▌ Factors affecting the efficacy of Helicobacter pylori eradication programs 1.
Selection of antibiotics
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The drug resistance of Helicobacter pylori is the main reason for the decreasing eradication rate.
Therefore, the selection and course of antibiotics should be based on the local drug resistance of Helicobacter pylori, which varies from place to place
.

2, the choice of acid-suppressing drugs
.

Raising the pH value in the stomach can increase the concentration of anti-Helicobacter pylori IgA in the stomach, the IgA concentration increases, the immune activity in vivo is enhanced, and the eradication rate of Helicobacter pylori increases
.

Multinational guidelines have also pointed out that adequate acid suppression is essential for the eradication of Helicobacter pylori
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In addition, for the population with the CPY2C19 fast metabolism gene, an appropriate acid suppressant should be selected
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Patient compliance is critical
.

Patients often stop taking the medicine on their own due to various side effects (nausea, vomiting, etc.
), or forget to take the medicine because of the fast pace of life
.

In this regard, doctors should strengthen publicity and education for patients, so that patients can pay more attention to the treatment of Helicobacter pylori
.

3.
Smoking reduces the eradication rate
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Smoking will reduce gastric blood flow and mucus secretion, reduce the concentration of antibiotics in the stomach, stimulate gastric acid secretion, and accelerate the metabolism of PPI by cytochrome oxidase P450, resulting in a decrease in gastric pH and an increase in the resistance of Helicobacter pylori, so it should be strictly implemented.
Quit smoking
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Choosing an individualized treatment plan is the key.
We can make breakthroughs in several aspects such as antibiotic selection, the use of acid suppressants, and individualized Hp eradication plans.
According to the patient's medication history and drug resistance, we can design an optimal and individualized treatment plan.
treatment options
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The quadruple regimen (PPI + bismuth + 2 antibiotics) is currently recommended as the main empirical treatment for the eradication of Helicobacter pylori
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(1) Antibiotic selection: When choosing antibiotics, doctors should choose antibiotics with high sensitivity to avoid the transformation of Helicobacter pylori eradication failure to refractory Helicobacter pylori infection.
risk ratio, seek the most appropriate drug
.

Adjust the treatment plan according to the previous medication history: If the patient develops drug resistance, the patient’s medication record can be obtained through the electronic medical record system, patient recall, and asking relatives/friends/other relevant doctors, so as to use antibiotics that the patient has not used to improve treatment.
rate
.

(2) Selection of acid-suppressing agents: PPIs that are less dependent on CYP2C19 metabolic pathways, such as rabeprazole, esomeprazole, vornoprazole, etc.
, can reduce or avoid the influence of CYP2C19 gene polymorphism Hp eradication rate
.

(3) Salvage treatment regimen: When both treatment regimens fail, it is likely that the patient's compliance is not satisfactory, or H.
pylori is resistant to one or more antibiotics, and drug susceptibility testing is recommended
.

(4) Non-antibiotic therapy [2]: Inhibit or eradicate Helicobacter pylori by affecting inflammatory factors, enhancing mucosal barrier, changing gastric microenvironment, and affecting the adhesion and colonization of Helicobacter pylori in the stomach
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Clinical studies have confirmed that adjuvant therapy with traditional Chinese medicine, probiotics, and mucosal protective agents can improve the eradication rate of Helicobacter pylori
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Gao Yu, director of the Gastroenterology Department of Shandong Maternal and Child Health Hospital, once again reminded everyone that during the first eradication of Helicobacter pylori, you should not take medicine blindly.
You must go to the Gastroenterology Department of a professional hospital to formulate a reasonable sterilization plan to improve the success rate of the first eradication
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If it is the second eradication, it should not be carried out immediately and should be carried out at an interval of 3-6 months to restore the susceptibility of bacteria to antibiotics
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The selection of drugs for re-treatment is more difficult and must be carried out under the guidance of a gastroenterologist
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Reference source: [1] Hu Fulian, Principles and strategies for treatment of refractory Helicobacter pylori infection [J].
Chinese Medical Journal, 2017, 97(10): 721-723.
[2] Consensus Expert Group, National Integrated Treatment of Traditional Chinese and Western Medicine Consensus on Helicobacter pylori-related "disease-syndrome"[J].
Chinese Medical Journal, 2018, 98(26): 2066-2072.
Source of this article: Digestive Endoscopy of Shandong Maternal and Child Health Hospital Author of this article: Sun Yangxin Responsible editor: XU Copyright statement If you need to reprint this article, please contact the authorization - End - The medical community strives to be accurate and reliable when the published content is approved, but it does not guarantee the timeliness of the published content, and the accuracy and completeness of the cited materials (if any), etc.
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