The retrospective study of Helicobacter pylori infection and antibiotic resistant

• Main Authors: Tso-Tsai Liu, 劉作財
• Other Authors: Nien-tsung Lin
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/98442498652277249563

碩士 === 慈濟大學 === 微免暨分子醫學研究所 === 94 === BACKGROUND： It has been 20 years since Helicobacter pylori (Hp) was discovered. It’s a worldwide bacterium, which can be found no matter in developing or industrialized countries except that the rate of infection may be different. However, the source of infection still remains unknown. Both oral-fecal and oral-oral types of transmission are considered. Obviously, researchers found Hp causes inflammation, erosions, ulcers, and even cancer and MALToma in the stomach or duodenum of an infected individual. The Health Bureau of the United Nations has included Hp as a definite risk of gastric cancer. Diagnosis of Hp includes Campylobacter Like Organism (CLO) test, culture, C13 Urea breath test, serum Hp IgG test, immunohistochemitry stain and stool culture antigen. Conventional treatment is either triple therapy using 2 kinds of antibiotics plus high-dose proton pump inhibitor or quadric therapy by 3 kinds of antibiotics plus high-dose proton pump inhibitor for 7 to 14 days. One month after the therapeutic course, a CLO test or most commonly C-13 urea breath test will be performed to confirm whether Hp is eradicated or not. RFLP is used to make sure whether the existence of Hp after treatment is due to recurrence or recrudence. Recently, more and more treatment failure, which is suspected to be related to drug resistance Reports about Hp infection and resistance rates are very few in eastern Taiwan. This thesis aims at understanding Hp infection and resistance rates in eastern Taiwan by clinically retrospective method. MATERIALS AND METHODS： This study recruited symptomatic outpatients and physical checkup subjects who received upper gastrointestinal endoscopy between 1 January 2004 and 30 June 2005 in III Buddhist Tzu Chi Hospital. One or two biopsy specimens were obtained in the antrum for CLOtest. Hp was inoculated into a blood agar plate upon confirmation of the existence of Hp at 37℃，under anaerobic and moist environment for 3 days. After 3 days. After 3 days, E test was performed to check drug resistance of Hp. The infection and resistance rates were calculated by SPSS software version 10. RESULTS AND CONCLUSION: Our study showed the infection rate of Hp in eastern Taiwan is 50.53%, with a female-to-male ration of 1: 1, and age ranging from 1-100 years old. Patients are predominate in the age group of 30-80 years and peaked in the group with age between 51-6 years old. The geographic distribution of Hp infection in Hualien counties is as follows: 83.3% in Fongbin Township, 66.7% in Shioulin Township, and 66.7% in Wanrung Township. In Taitung counties, it is most prevalent in Haiduan Township (71.43%), and followed by the Chenggong Township (70.37%) and the Taimali Township (66.67%). Chronic infection is not associated with surgery of esophagus, stomach, or duodenum. Reflux esophagitis and chronic gastritis seemed not to be related to a higher rate of Hp infection. Most of Hp infection happened in patients with chronic gastritis (especially in the antrum), duodenitis in the second portion, and erosions in the duodenal bulb. Duodeal ulces mostly occurred in the bulbal part. The use of Nimesulid seems to decrease the rate of Hp. The culture rate of Hp is 68.8%. The resistance rates of Hp are Metronidazole 47.9%, Amoxicillin 31.93%, Clarithromycin 14.3%, and Tetracycline 0%. Age and sex is not related to resistance rate. The resistance rates in terms of geographic distribution were as follows-- (1) Metronidazole: Fenglin Township (100%)，Shioulin Township (100%)，Yuli Township (75%)；(2) Clarithromycin: Fuli Township (100%)，Rueisuei Township IV (50%)，Fenglin Township (33.3%)；(3) Amoxicillin: Guangfu Township (100%)，Fuli Township (100%)，Jian Township 30.77%. In Taitung, the resistance rates were as follows—(1) Metronidazole: Changbin Township (100%)、Chenggong Township (100%)、Taitung City (80%)；(2) Clarithromycin: Yanping Township (100%)，Taimali Township (100%)，Taitung City (20%)；(3) Amoxicillin: Yanping Township (100%)，Chenggong Township (100%)，Taitung City (20%). High resistance rate of Clarithromycin was found in patients with cirrhosis (P=0.009). Chronic infection is not associated with surgery of esophagus, stomach, or duodenum. Patients with antral gastritis had higher Clarithromycin resistance (P=0.009). Patients with corpus gastritis had higher Amoxicillin resistance (P=0.041). Patients with Duodenal bulbitis, (P=0.06)、duodenal erosions (P=0.037), duodenal bulb erosions (P=0.037) had higher Amoxicillin resistance. Patients in use of Napoxen (P=0.009) had higher Clarithromycin resistance.