Persistent or Recurrent Peptic Ulcer in Patients with Negative Urea Breath Test after H. Pylori Eradication and Proton Pump Inhibitor Therapy

持續或復發的消化性潰瘍存在於經過幽門螺旋桿菌滅菌及氫離子阻斷劑治療後尿素呼氣測試陰性的病患

陳立偉(Li-Wei Chen) ； 林昆儒(Kun-Ju Lin) ； 張良慈(Liang-Che Chang) ； 林志榮(Jr-Rung Lin) ； 簡榮南(Rong-Nan Chien)

《臺灣消化醫學雜誌》 30卷2期 (2013/06) Pp. 190-198

https://doi.org/10.6557/GJT.201306_30(2).0002

摘要

背景／目的：對於有消化性潰瘍及胃幽門螺旋桿菌感染的病患，尿素呼氣測試普遍應用在評估胃幽門螺旋桿菌感染的情形及滅菌的成效。胃鏡追蹤並不是一種例行檢查。本研究的目的想要知道如果病患經過胃幽門螺旋桿菌滅菌及消化性潰瘍治療後，碳14尿素呼氣測試結果為陰性（代表滅菌成功）的病患中，仍然存在活動性潰瘍的比例有多大。病患及方法：從2009年6月到2010年12月，總共有165位合併胃或十二指腸潰瘍及幽門螺旋桿菌感染的病患，到基隆長庚醫院診治被收入本實驗。所有病患都接受一個星期的標準三合一胃幽門螺旋桿菌滅菌及八週的氫離子阻斷劑治療。在治療前及治療後都接受胃鏡切片檢查、快速尿素酶測試及碳14尿素呼氣測試。結果：治療前的碳14尿素呼氣測試數值高低無法預測胃幽門螺旋桿菌滅菌成功與否。治療後在尿素呼氣測試結果為陽性的病患中有23.5%的病患有活動性的潰瘍；在尿素呼氣測試結果為陰性的病患中有9.8%的病患有活動性的潰瘍（p = 0.20）。在多變項分析中，年紀大於65歲是預測在尿素呼氣測試結果為陰 性的情況下仍然有活動性潰瘍的最重要因子（odds ratio = 7.3, 95% CI = 2.09-25.44, p = 0.002）。結論：治療前的碳14尿素呼氣測試數值高低，無法預測胃幽門螺旋桿菌滅菌成功與否。經過一週標準三合一滅菌及八週的氫離子阻斷劑治療，雖然病患的尿素呼氣測試已呈陰性，但仍然有9.8%的病患有活動性潰瘍。年紀大於65歲是預測仍然有活動性潰瘍的重要因子。

關鍵字

內視鏡檢 ； 幽門螺旋桿菌 ； 消化性潰瘍 ； 尿素呼氣測試

並列摘要

Background and Aims: For patients with Helicobacter pylori (H. pylori) infection-related peptic ulcer, urea breath test (UBT) is usually performed to evaluate the success of H. pylori eradication therapy. Follow-up esophagogastroduodenoscopy is not a routine practice after treatment. This study aims to elucidate the possibility of active peptic ulcers in the patients with negative result of UBT following H. pylori eradication and proton pump inhibitor (PPI) therapy. Materials and Methods: A total of 165 patients with peptic ulcer (gastric and duodenal ulcers) and H. pylori infection were consecutively enrolled between June 2009 and November 2010. Endoscopic biopsy, rapid urease test (RUT) and 14C-UBT were performed in all patients before and after 1 week of standard triple H. pylori eradication therapy and an 8-week course of PPI treatment. Results: Pre-treatment 14C-UBT values could not predict the success of H. pylori eradication therapy. After treatment, active duodenal ulcers were found in 23.5% of patients with a positive follow-up UBT result, while active duodenal ulcers were present in 9.8% patients with a negative follow-up UBT result (p = 0.20). In the multivariate analysis, old age (＞65 years) was the most important factor for persistence of active peptic ulcers in patients with negative follow-up UBT results (odds ratio [OR]=7.3, 95% confidence interval =2.09-25.44, p = 0.002). Conclusions: Pretreatment 14C-UBT values could not predict the success of H. pylori eradication therapy. After H. pylori eradication and 8-week PPI treatment, active peptic ulcers could still be discerned by endoscopy in 9.8% patients whose follow-up UBT results were negative. Old age (＞65 years) might be the single most important factor for persistence of active peptic ulcers in these patients.

並列關鍵字

endoscopy ； Helicobacter pylori ； peptic ulcer ； urea breath test