• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권2호
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• pp.153-162
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• 2004

목적: H. pylori 대변항원(Helicobacter pylori stool antigen; HpSA) 검사는 H. pylori 감염 여부를 진단하는 데 이용되는 비침습적 검사이지만, 소아에서 제균요법 후 H. pylori 대변항원검사의 유용성에 대한 연구가 거의 이루어지지 못한 상태이다. 본 연구에서는 소아에서 H. pylori의 제균 여부를 확인하는 데 있어 enzyme immunoassay에 의한 HpSA 검사의 진단 정확도를 평가하고자 하였다. 연구방법: 2001년 1월부터 2003년 10월까지 서울대학교병원 소아과에서 146명의 소아(평균 연령 $9.3{\pm}4.3$세)를 대상으로 총 164회의 H. pylori 대변항원검사(Primier platinum HpSA)를 시행하였다. H. pylori 감염여부를 확인하기 위해 모든 환아에서 H. pylori 대변항원검사와 상부위장관내시경에 의한 위점막 생검을 병행하였다. H. pylori 감염이 확인되어 사제요법(omeprazole, amoxicillin, metronidazole, bismuth subcitrate)을 1주 동안 시행 받은 환아들에서는 치료 종결 후 최소 4주가 경과하였을 때 위내시경과 H. pylori 대변항원검사를 반복 실시하였다. H. pylori 대변항원검사는 OD값이 0.16 이상일 때 양성, 0.14~0.16 사이는 감염 미확정, 0.14 미만은 음성으로 판정하였다. 결과: 1) 제균 전 시행한 131회의 위내시경 조직검사 결과 28명이 H. pylori 양성이었고 나머지 103명은 H. pylori 음성이었다. 동시에 시행한 H. pylori 대변항원검사 결과에서 30명이 H. pylori 양성이었고, 101명이 음성으로 판정되었다. 따라서 제균요법 시행 전 H. pylori 대변항원검사의 민감도, 특이도, 양성 예측치, 음성 예측치는 각각 96.4%, 97.1%, 90% 그리고 99%이었다. 2) 제균요법 4주 후 33명의 환아에서 시행한 위내시경에 의한 조직검사에서 H. pylori는 24명에서 음성이었으나 9명은 여전히 양성이었다. 동시에 시행한 H. pylori 대변항원검사는 10명에서 양성, 23명에서 음성이었다. 따라서 제균요법 후 H. pylori 대변항원검사의 민감도, 특이도, 양성 예측치, 음성 예측치는 각각 88.9%, 91.7%, 80% 그리고 95.7%이었다. 결론: 소아에서 H. pylori 대변항원검사는 제균 후에도 높은 진단 정확도를 보였다. 따라서 H. pylori 대변항원검사는 소아에서 제균요법 후 균 박멸여부를 확인하는 데에도 매우 유용한 비침습적인 검사방법이라고 하겠다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권1호
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• pp.17-22
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• 2015

Purpose: This study aims to investigate Saccharomyces boulardii CNCM I-745 during Helicobacter pylori eradication in children. Methods: One hundred ninety-four H. pylori positive children were randomized in two groups. Therapy (omeprazole+ clarithromycin+amoxicillin or omeprazole+clarithromycin+metronidazole in case of penicillin allergy) was given to both groups during two weeks. In the treatment group (n: 102) S. boulardii was added to the triple therapy, while the control group (n: 92) only received triple therapy. The incidence, onset, duration and severity of diarrhea and compliance to the eradication treatment were compared. A $^{13}C$ urea breath test was done 4 weeks after the end of eradication therapy in two groups of 21 patients aged 12 years and older to test the H. pylori eradication rate. Results: In the treatment group, diarrhea occurred in 12 cases (11.76%), starting after $6.25{\pm}1.24days$, lasting $3.17{\pm}1.08days$, and compliance to eradication treatment was 100%. In the control group, diarrhea occurred in 26 cases (28.26%), starting after $4.05{\pm}1.11days$, lasting $4.02{\pm}0.87days$, and in six cases eradication treatment was stopped prematurely (p<0.05). The $^{13}C$ urea breath test showed successful H. pylori eradication in 71.4% of the patients in the treatment and in 61.9 % in the control group (not significant). Conclusion: S. boulardii has a beneficial effect on the prevention and treatment of diarrhea during H. pylori eradication in children. Although S. boulardii did only slightly increase H. pylori eradication rate, compliance to eradication treatment was improved.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.152-160
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• 2016

Purpose: Endoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication. Materials and Methods: We included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and $^{13}C$-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint. Results: Inconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE. Conclusions: We demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.1797-1802
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• 2013

Background: The aim of this study was to assess clinical factors associated with Helicobacter pylori positivity and to evaluate the incidence of gastric carcinoma in first-degree family members of infected patients. A total of 580 patients (mean age:$38{\pm}17$) with gastrointestinal complaints underwent C-14 urea breath test (UBT). Patients were grouped as: Group-1, untreated patients (n:384); and Group-2, patients who previously treated with eradication triple therapy (n:196). C-14 UBT was performed 1-2 months after the completion of eradication therapy. Associations of H pylori positivity with age, gender, ABO and Rhesus groups, smoking, dietary habits, and history of gastric cancer in first-degree family members were evaluated. The frequency of H pylori positivity was significantly higher in group-1 (58%) compared to group-2 (20%), p=0.001. There were no correlations between H pylori positivity and age, gender, ABO groups, Rhesus subgroups, smoking and dietary habits in both patient groups. The frequency of gastric cancer in family members was significantly higher in patients with H pylori infection among group-1, compared to infected patients among group-2 (56% vs. 28.6% respectively, p=0.03). We observed a significant association between H pylori positivity and the presence of gastric cancer in first-degree relatives of group-1 patients. Our results provide some confirmation of the presence of a link between gastric cancer development and H pylori. C-14 UBT is a sensitive, reliable and a widely recommended test for the detection of H pylori infection and recurrence. We suggest that detection and eradication of H pylori may contribute to a reduced risk of gastric cancer in the family members of infected patients.

• 한국임상약학회지
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• 제21권1호
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• pp.39-42
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• 2011

Idiopathic thrombocytopenic purpura is a potentially life-threatening condition characterised by thrombocytopenia and mediated by an autoimmune mechanism. Several recent studies have suggested that an association exists between H. pylori eradication and improvement in platelet count in a significant proportion of patients with idiopathic thrombocytopenic purpura. This study confirmed the efficacy of H. pylori eradication in increasing the platelet count in steroid refractory idiopathic thrombocytopenic purpura patients. Eradication therapy is simple and inexpensive, with limited toxicity and the advantage of avoiding long-term immunosuppressive treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제9권2호
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• pp.129-138
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• 2006

Lots of cases relating Helicobacter pylori infection to iron-deficiency anemia have been described in the literature and H. pylori infection has emerged as a cause of refractory iron-deficiency anemia which is unresponsive to oral iron therapy. H. pylori-associated iron-deficiency anemia can be treated by H. pylori eradication. It is not thought to be attributable to gastrointestinal blood loss, such as duodenal ulcer. The mechanism by which H. pylori infection contributes to iron-deficiency anemia remains unclear. However, four possible explanations can be posited for this relationship; occult blood loss secondary to chronic gastritis, reduced iron absorption due to hypo- or achlorhydria, increased iron consumption by H. pylori, and iron sequestration in gastric mucosa. H. pylori-associated iron-deficiency anemia seems to develop in populations at increased risk for iron depletion. When pubescent girls, including athletes, are found to have iron-deficiency anemia refractory to iron administration, they should be evaluated for H. pylori infection.

• 대한한방내과학회지
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• 제33권1호
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• pp.39-53
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• 2012

Objectives : Many studies have shown that helicobacter pylori (H. pylori) infection is associated with gastroduodenal diseases. The purpose of this report was to evaluate recently published research on the influence of oriental herbal medicine on H. pylori infections. Methods : Recently published literature were systematically compared with their findings of how oriental herbal medical treatment affects H. pylori-associated disease. Results : The eradication rate of H. pylori in oriental herbal medicine groups was 66.93% while it was 66.02% in western medicine groups. In oriental herbal plus western medicine groups, interestingly, the rate increased to 84.78%. On the other hand, the total treatment efficacy rate of H. pylori in oriental herbal medicine groups was 91.27%. The treatment efficacy rate in oriental herbal plus western medicine groups rose to a record 93.22%, which was 15.34% higher than the rate in western medicine groups. In addition, the rate of adverse effects was 2.71%, 4.85%, 15.80% in oriental herbal medicine, western medicine, and oriental herbal plus western medicine groups, respectively. Diarrhea was most frequently observed in oriental herbal medicine groups, while nausea was most frequently observed in the other groups. Conclusions : The results of this study showed that herbal medicinal treatment can increase the rate of H. pylori eradication and improve H. pylori-related gastrointestinal symptoms. These findings suggest that herbal medicine can solve the problems including side effects due to antibiotic resistance of standard triple therapy.

• Journal of Digestive Cancer Reports
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• 제8권2호
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• pp.91-96
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• 2020

헬리코박터 파일로리 박멸이 위선종의 내시경 절제술 후 이시성 재발 발생에 미치는 영향은 잘 정의되어 있지 않다. 본 연구의 목적은 위선종의 내시경 절제술 후 헬리코박터 박멸이 이시성 재발 예방에 미치는 효능을 평가하는 것이다. Ovid-MEDLINE, EMBASE, Cochrane Library, KoreaMed 및 KMBASE 데이터베이스를 사용하여 체계적인 문헌 검토 및 메타분석이 수행되었다. 헬리코박터 박멸에 따른 이시성 위병변에 대한 통합 위험비(Pooled risk ratio)를 계산하고 이질성도 측정하였다. 5개의 적격한 연구가 최종적으로 체계적인 검토에서 확인되어 메타분석에 포함되었다. 헬리코박터 박멸은 전체적으로 이시성 재발을 55% 낮출 수 있었다(RR=0.55; 95 % CI 0.34-0.92). 체계적인 문헌 검토 및 메타분석 결과를 바탕으로 헬리코박터 박멸은 위선종의 내시경 절제술 후 이시성 재발 예방에 효과적임을 알 수 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9909-9913
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• 2014

Background: Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcer disease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However, standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy for H. pylori eradication. Materials and Methods: In this prospective single center study, H. pylori infected gastritis patients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo. Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycin MR once daily and 1,048mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt without probiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication was defined as a negative $^{13}C$-urea breath test at least 2 weeks after completion of treatment. Results: One hundred subjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%, 49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14 regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantly lower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%; p=0.04). Conclusions: The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent cure rate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19 genotype. Adding a probiotic also reduced treatment-related adverse events.

• 한국식품과학회지
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• 제36권5호
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• pp.779-783
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• 2004

P. pentosaceus CBT SL4균이 생산하는 항균물질 농축건조물은 H. pylori균에 대하여 평판 및 액상배양 조건에서 생육억제 활성이 확인되었고, 사막모래쥐를 사용한 감염실험에서는 감염방어 및 제균작용이, 보균자 인체실험에서는 제균작용이 확인되었다. 최근 3제 요법이나 신규 약물 등에 의하여 자각증세가 있는 위염증 환자에서의 제균율은 크게 향상되었으나, 국내의 경우에는 전체국민의 감염율이 매우 높은 것과 식습관 등의 요인에 의하여 단체 및 사회생활을 통한 신규감염이나 재감염을 방어할 효과적 수단은 없는 상태에 있다. 따라서, 일상적인 섭취가 가능하고, 병원균의 내성개발 우려나 인체에 대한 부작용이 없으며, H. pylori균에 대한 감염방어 및 제균작용을 동시에 지닌 유산균 및 그 항균활성물질을 이용한 식품소재는 국민전체의 H. pylori 감염율을 낮추고, 신규감염과 재감염의 악순환을 방지하기 위한 유용한 방어수단이 될 수 있을 것으로 판단된다. 한편, 유산균 배양액에 의한 H. pylori균에 대한 생육억제 현상은 모든 유산균에서 보편적인 현상은 아닌 것으로서 특정한 균주의 배양액에서만 관찰되고 있어 단순히 젖산 등 유기산에 의한 효과로 보기에는 어려움이 있으며 Gram 음성의 병원균들은 외막의 보호작용에 의하여 분자량이 큰 박테리오신 성분에 의해서는 생육이 억제되지 않는 것으로 판단되고 있다. 저자들은 당 균주가 생성하는 H. pylori 생육 억제 물질을 산성의 저분자 물질로 추정하고, 물질 및 작용기작 규명을 위하여 활성물질의 분리 및 구조분석 작업을 진행 중에 있으며, 이러한 연구가 완료되면 분리정제 물질을 활용한 추가적인 산업화 용도 개발이 가능할 것으로 기대하고 있다.