การหายของแผลที่กระเพาะอาหารและผลการกำจัดเชื้อ Helicobacter Pylori ด้วยสูตรยารักษามาตรฐาน PPI-based Triple Therapy ที่โรงพยาบาลนครปฐม

บทคัดย่อ

Objective: To evaluate various factors influencing the healing rate of gastric ulcers and the efficacy of standard PPI-based triple therapy in eradication of Helicobacter pylori infection in the present.
Materials and Methods: Prospective study of patients with gastric ulcers diagnosed by gastroscopy with any indication at Nakhonpathom Hospital since November 2011-December 2012. Clinical, laboratory features, ulcer characteristics from endoscopic findings, etiology of ulcers and Helicobacter pylori status were compared between those with ulcer which healed within 8 weeks after omeprazole treatment and those which did not. Standard PPI-based triple therapy, consisting of omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1,000 mg twice daily administered for 10 days in patients who had Helicobacter pylori infection and the eradication rate was determined.
Results: Overall patients in this study were 80 (male 50, female 30), 58 patients (72.5%) had gastric ulcer which healed within 8 weeks and 22 patients (27.5%) had ulcer which did not. Compared to patient’s group with ulcer which healed within 8 weeks, the other group which did not had more patients with large ulcers ≥ 1.5 cm. (n = 13, 48.1% vs n = 14, 24.1%), more patients which still smoking (n = 5, 22.7 % vs n = 4, 6.9%), more patients which still use NSAIDs during treatment (n = 5, 22.7% vs n = 1, 1.7%). Multiple logistic regression analysis identified only large ulcers ≥ 1.5 cm. and continuing NSAIDs use as individually affecting ulcer healing. This study found just 31 from 43 patients (72.1%) with Helicobacter pylori infection, successfully eradicated by standard PPI-based triple therapy.
Conclusions: Important factors influencing the healing rate of gastric ulcers were large ulcers ≥ 1.5 cm. and continuing NSAIDs use. Efficacy of standard PPI-based triple therapy for Helicobacter pylori eradication in patients with gastric ulcer at Nakhonpathom Hospital was 72.1% which lower than acceptable eradication rate (> 80%) recommended by The Gastroenterological Association of Thailand.