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Professor Hu Fulian: Interpretation of "New Path of Helicobacter Pylori Treatment"

Professor Hu Fulian: Interpretation of "New Path of Helicobacter Pylori Treatment"

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-12-02
  • Views:0

(Summary description)

Professor Hu Fulian: Interpretation of "New Path of Helicobacter Pylori Treatment"

(Summary description)

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-12-02
  • Views:0
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  At present, the current infection rate of Helicobacter pylori (Hp) in my country is as high as 40%. However, the overall eradication rate is not optimistic. Hp's resistance to antibiotics, especially the occurrence of dual drug resistance, is the main reason for the decline in eradication rate. The overall eradication rate of traditional eradication programs is decreasing year by year. The treatment of "refractory Hp infection" is an important problem faced in recent years. Exploring an eradication program that meets Chinese characteristics and creating a "new path for Hp treatment" is the only way to cure. Today we are fortunate to invite Professor Hu Fulian from Peking University First Hospital to share with us the relevant content of the "New Path of Hp Treatment".

  What is the background of the concept of "Hp Treatment New Path"?

  Professor Hu Fulian: In 2011, the 6th "National Helicobacter Pylori and Digestive Disease Diagnosis and Treatment Clinical Forum" discussed the concept of "Hp treatment new path". Immediately I published a review and formally proposed the "New Path of Hp Treatment". Through the five versions of the consensus launched in the past 17 years, that is, from the Hainan consensus in 1999 and the fifth consensus in 2016, the H. pylori treatment plan recommended by the fifth consensus has changed from triple to quadruple, and the treatment course increased from 7d, 10d to 14d.

  Whether it is domestic or foreign, the consensus recommended course of treatment in the future will hardly exceed 14 days. At present, regardless of the Masstricht V consensus, the Toronto consensus and the latest domestic consensus, the recommended course of treatment is up to 14 days. This shows that the increase in the course of treatment is limited, and the increase in dose is also limited, and not all patients can be successfully treated according to the consensus, and a small number of patients still fail repeatedly despite the consensus treatment. Therefore, HP treatment has entered a bottleneck period. Therefore, the "new path of Hp treatment" came into being. This is also the only way for the further development of Hp treatment.

  What is included in the new path of Hp treatment?

  Professor Hu Fulian: There are currently two ways to kill or treat Hp: the first is to use antibiotics to kill directly; the second is to affect the colonization and adhesion of Hp in the stomach. The "new treatment path" we mentioned is mainly the second path. And many drugs mentioned in the "New Path" also have the effect of killing Hp.

  So what exactly does the "New Path of Hp Treatment" include? The first is Chinese medicine, the second is mucosal protectants, and the third is probiotics.

  Regarding traditional Chinese medicine and traditional Chinese medicine, we have released the "National Consensus on the Integrated Treatment of Helicobacter Pylori-related Diseases and Syndrome with Traditional Chinese and Western Medicine" this year. This is the first in our country to treat Helicobacter pylori-related diseases and syndromes with integrated Chinese and Western medicine from the perspective of integrated medicine consensus. In terms of treatment, we particularly emphasize the need to treat in accordance with consensus as well as individualized treatment. Therefore, we have many aspects of treatment. In addition to choosing standard treatments that include antibiotics, there are also non-antibiotic therapies such as Chinese medicine, mucosal protectants, and probiotics other than antibiotics.

  The position and role of mucosal protective agents in the "New Path of Hp Treatment"

  Professor Hu Fulian: The scope of mucosal protective agents is relatively wide, and there are many categories. Mucosal protective agents have many functions, such as increasing mucosal blood flow, increasing mucus secretion, increasing hexamine content, and increasing prostaglandins to protect the gastric mucosa. There are also some mucosal protective agents that have other prominent effects, such as both Hydromagnesium carbonate neutralizing gastric acid, polyprezinc, which also has the effect of killing Hp, etc. Therefore, we need to do more and more in-depth research on the role of mucosal protective agents. From the perspective of integrated medicine, mucosal protective agents are a better choice for the treatment of Hp-related diseases and syndromes.

  Second, let’s look at peptic ulcers. Should we treat the disease from the perspective of integrated medicine? Peptic ulcers must not only inhibit gastric acid, but also kill Helicobacter pylori, and protect the gastric mucosa. This is a treatment for digestion. Three principles of sexual ulcer, one is indispensable. A healthy gastric mucosa will not get sick. Based on the damage of Hp to the gastric mucosa, it can cause ulcers. For the damage of Hp to the gastric mucosa, mucosal protective agents also play a very important role. In addition, long-term drinking and long-term use of non-steroidal anti-inflammatory drugs can also be prevented with mucosal protective agents. It can be said that the application range of mucosal protective agents is very wide.

  In recent years, research on mucosal protective agents has gradually increased. We have conducted a multi-center clinical study on the treatment of peptic ulcer with a mucosal protective agent of domestic zinc acetocaproate. Studies have found that adding zinc preparations can increase the healing rate of ulcers. Specifically, there is one group that uses proton pump inhibitor (PPI) alone, and the other group uses zinc preparation on the basis of PPI. The results of the study found that the ulcer healing rate of the PPI group was lower, and the quality of ulcer healing was not as good as that of the zinc preparation group. In recent years, there have been a series of studies on a new mucosal protective agent-polyprezinc. Foreign countries, such as Japan, published a related article in Elementary Pharmacology as early as 1999. The results showed that triple therapy plus polyprezinc can increase the Hp eradication rate by nearly 17% compared to triple therapy alone. This shows that zinc preparations have a certain effect in increasing the eradication rate of Hp. In 2017, a domestic study was also done. The study published by Professor Qian Jiaming and included 332 patients in 11 centers. The results were published on PLOS ONE, indicating that the triple regimen containing clarithromycin and amoxicillin plus polypu Compared with the single triple plan, the eradication rate of Swiss zinc is increased by nearly 18%.

  What is the future development direction of the "New Path of Hp Treatment"?

  Professor Hu Fulian: Regarding the treatment of Hp, I want to clarify two concepts: first, not only treating Hp, we must treat Hp-related diseases and syndromes; second, there is a "non-antibiotic therapy" for the treatment of Hp. Now let’s look at the treatment plan. It is impossible to completely leave antibiotics, but opening up a "new path for Hp treatment" can increase the Hp eradication rate and shorten the course of standard antibiotic treatment. The current standard course of treatment is 14 days, but treatment failures will still occur. Therefore, the direction of our efforts is how to use certain strategies of the new route to shorten the course of antibiotic treatment and reduce the amount of antibiotics. At present, the real "non-antibiotic therapy" has a long way to go. Some patients, such as multiple antibiotic allergies, the elderly, and children (no treatment under 13 years old are stipulated), expand research on "non-antibiotic therapy" applicable to these special populations. This is the goal of our efforts and the further treatment of Helicobacter pylori The only way to develop and explore.

  How to use the new path of Hp treatment in clinical practice?

  Professor Hu Fulian: Quadruple therapy with bismuth is currently recommended by consensus at home and abroad and has been recognized by everyone. Bismuth-based agents have certain side effects, which are not particularly suitable for the elderly and children. For such patients, you can try other mucosal protective agents, such as polyprezinc. The metal element zinc contained in it is also an essential trace element for the human body.

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