Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/51956
標題: 幽門螺旋桿菌三合一根除療法搭配益生菌服用後對根除效果及療程副作用之影響
The effect of probiotic supplementation on the reduce side effects and efficacy of Helicobacter pylori eradication treatment
作者: Yu, Yi-Min
游義敏
關鍵字: Helicobacter pylori;幽門螺旋桿菌;13C-UBT;Clarithromycin;Omeprazole;Amoxicilline;Probiotic;13C-UBT;Clarithromycin;Omeprazole;Amoxicilline;Probiotic
出版社: 食品暨應用生物科技學系所
引用: 行政院衛生署中央健康保局。2010。全民健康保險藥品給付規定。 行政院衛生署中央健康保局。2007。全民健康保險專業檔案分析報告-消化性潰瘍與胃幽門螺旋桿菌感染專案分析。 1-41。 陳慶源,林富美。2004。益生菌之保健功效。食品工業。36 (3): 1-3。 蘇麗如、許博翔、莊喬雄、葉鳳英、周辰熹 。 2005。臺灣醫學。會臺灣醫學 9(3) : 395-402。 蔡承諺、林英欽、周碩渠。2011。幽門螺旋桿菌之感染與治療。家庭醫學與基層醫療26(3): 92-98。 蔡英傑。1998。乳酸菌與益生菌。生物產業 9: 26-32。 林肇堂。1995。幽門螺旋桿菌與胃腸疾病。內科學誌 6:15-20。 王怡仁、杜明勳。2003。益生菌。基層醫學18(3):72-75。 黃崇真。2004。腸道微生物與益生菌。食品工業 36: 4-15。 黃淑芬。2003。比較含Esomeprazole 與含Omeprazole三合療法根除幽門螺旋桿菌之臨床研究。國立成功大學臨床藥學研究所碩士論文。 Arents, N.L., Van Zwet, A.A., Thijs, J.C., de Jong, A., Pool, M.O., Kleibeuker, J.H. 2001. The accuracy of the Helicobacter pylori stool antigen test in diagnosing H. pylori in treated and untreated patients. Eur J Gastroenterol Hepatol. 13: 383-386. Asaka, M., Takeda, H., Sugiyama, T. and Kato, M. 1997. What role does. Helicobacter pylori play in gastric cancer. Gastroenterology 113: S56-S60. Bazzoli, F. 2001. Key points from the revised Maastricht Consensus Report: the impact on general practice. Eur J Gastroenterol Hepatol. 13(suppl 2): 3-7. Bruce, M.G., Maaroos, H.I. 2008. Epidemiology of Helicobacter pylori infection. Helicobacter. 13(supp1):1-6. Chang, W.L., Shbu, B.S., Cheng, H.C., Yang, Y.J., Yamg H.B., Wu, J.J. 2009. Resistance to metronidacole, clarithromycin and levofloxacin of Helicobacter pylori before and after clarithromycin-base therapy in Taiwan. J Gastroenterol Hepatol. 24: 1230-1235. Chen, T., Isomäki, P., Rimpiläinen, M., Toivanen, P. 1999. Human cytokine responses induced by gram-positive cell walls of normal intestinal microbiota. Clin Exp Immunol. 118(2):261-7. Chen, T.S., Lou, J.C., Chan, F.Y. 2010. Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro-duodenal ulcer diseases in Taiwan. J Gastroenterol Hepatol. 25: 919-922. Denter and Bisping. 1994. Formation of B-vitamins by bacteria during the soaking process of soybeans for temper fermentation. Int. J. Food Microbiol. 22(1): 23-31. Drahoslava, L.P., Ire`ne, C.T., and Andre´ L.B. 2007. Helicobacter pylori and Probiotics. J. Nutr. 137: 812S–818S. Fendrick, A.M. 2000. The role of economic evaluation in the diagnosis and treatment of Helicobacter pylori infection. Gastroenterol Clin North Am. 29:837-851. Forman, D., Newell, D.G., Fullerton, F. 1991. Association between infection with Helicobacter pylori and risk of gastric cancer. Evidence from a prospective investigation. BMJ. 302: 1302-1305. Fuller, R. 1989. Probiotic in man and animals. J. Appl. Bacteriol. 66: 365-378. Fuller, R. 1992. Probiotics: The Scientific Basis. Chapman and Hall, London.Gadelle, D., P. Raibaud, and E. Sacquet. 1985. β-glucuronidase activities of intestinal bacterial determined both in vitro and in vivo rate. Appl. Microbiol. 49: 682-685. Gill, H. S. 1998. Stimulation of the immune system by lactic cultures. Int. Dairy J. 8:535-544. Gisber, J.P., Pajares, J.M. 2004. Stool antigen test for the diagnosis of Helicobacter pylori Infection. a systematic review. Helocobacter. 9: 347-368. Gisber, J.P., de la, Morena F., Abraira V. 2006. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol. 101: 1921-1930. Goodwin, C.S., Armstrong, J.A. 1990. Microbiological aspects of Helicobacter pylori (Campylobacter pylori). European Journal of Clinical Microbiological & Infectious Diseases 9: 1-13. Graham, D.Y., 1992. Lew G.M., Klein P.D. 1992. Effect Of Helicobacter pylori infection on the long-tern recurrence of gastric or duodenal ulcer: a randomized, controlled study. Ann Intern Med.116: 705-708. Graham, D.Y. 2008. Helicobacter. Wiley Blackwell Publishing Ltd. 13(supp1):1-57. Hackelsberger, A., Mlfertheiner, P. 1996. A risk-benefit assessment of drugs used in the eradicartion of Helicobacter pylori infection. Drug safety.15: 30-52. Havenaar, R., B. T. Brink, and J. H. J. Huis In’t Veld. 1992. Selection of strains for probiotics use. In: R, Fuller. (Ed.). Probiotics:The Scientific Basis. pp. 209-222. Howden, C.W., Hunt, R.H. 1998. Guidelines for the management of Helicobacter pylori Infection. Ad Hoc Committee on practice parameters of the American College of Gastroentrology. Am J Gastroenterol. 93: 2330-2338. Huang, A.H., Sheu, B.S., Yang, H.B., Huang, C.C., Wu ,J.J., Lin, X.Z., 2000. Impact of Helicobacter pylori antimicrobial resistance on the outcome of 1-week lansoprazole-based triple therapy. J Formos Med Assoc. 99(9):704-709. Irene, L.W., Mary, E.S., Michael, D.C., Esber, C., Gerard, C., Nada, R., Philip, M.S., Harro, M. T., Mario, V., Jan, V. L., and Danielle, A.W.W. 2007. Probiotic and Prebiotic Influence Beyond the Intestinal Tract. Nutrition Reviews. 65(11): 469. Jiang, T., A. Mustapha, D.A. Savaiano. 1996. Improvement of lactose digestion in humans by injection of unfermented milk containing Bifidobacterium longum. J.Dairy Sci. 79: 750-757. Josenhans, C., Suerbaum, S. Helicobacter motility and chemotaxis. In: Achtman, M., Suerbaum, S. 2001. Helicobacter pylori molecular and celluar biology. Wymondham. United Kingdam: Horizon scientific press. 171-184. Johnson, T.R., Case, C.L.1995. Laboratory experiments in Microbiology 4th edition. The Benjamin / Cummings Publoshing Co.Inc.Khedkar N, Gordon DL, Wagner R, Dillehay GL , Martinez CJ, Bayer W and Brooks MH. 1993. The effect of fine-needle aspiration biopsy on the thyroid scan. Clin Nucl Med. 18(6):495-7. Julie, P., David, F. 2004. Helicobacter pylori Infection and Gastric Cancer—For Want of More Outcomes. JAMA. 291(2): 244-245. Kathene, C.J.H., David, J.M., Yaron, A., Esther, G.M., Nicola, L.J. 2004. Probiotics Reduce Bacterial Colonization and Gastric Inflammation in H. pylori-Infected Mice. Digestive Diseases and Sciences. 49(7/8 ): 1095–1102. Kim, M.N., Kim, N., Lee, S.H., Park, Y.S., Hwang, J.H., Kim, J.W., Jeong, S.H., Lee, D.H., Kim, J.S., Jung, H.C., and Song, I.S. 2008. The Effects of Probiotics on PPI-Triple Therapy for Helicobacter pylori Eradication. Helicobacter. 13:261-268. Ko, JS, Yang, HR, Chang, JY, Seo, JK. 2007. Lactobacillus plantarum inhibits epithelial barrier dysfunction and interleukin-8 secretion induced by tumor necrosis factor-alpha. World J Gastroenterol. 13(13):1962-5. Lam, S.K., Talley, N.J. 1998. Report of 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol. 13: 1-12. Leung, W.K., Graham ,D.Y. 2001. Ulcer and Gastritis. Endoscopy. 33:8-15. Lin, J.T., Wang, J.T., Wang, T.H. 1993. Helicobacter pylori infection in a randomly selected popuiation healthy volunteers, and patients with gastric ulcer and gastric adenocarcinoma. A seroprevalence study in Taiwan. Scand J Gstroenterol.28: 1067-1072. Liu, H., Ruskon, F.A., Lavergen, S.A., et al. 2001. Resistance of t(11;18)Postive gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication therapy. Lancet. 357: 39-40. Lo, C.C., Hsu, P.I., Lo, G.H., Lai, K.H., Cheng, J.S., Tseng, H.H., Lin, C.K., Chen, H.H., Wang, Y.Y., Ku, M.K., Lin, C.P., Peng, N.J., Chien, E.J. 2001. Comparison of clinical, serological and histological findings between non-ulcer dyspepsia patients with and without Helicobacter pylori infection. J Gastroenterol Hepatol. 16: 276-281. Marshall, B.J., J.A. Armstrong, D.B. Mcgechie, Glancy. arj1985. Attempt to fulfil Koch’s postulates for pyloric Campylobacter. Medical journal of Australian. 142: 436-439. Matthias, V.K., Isabell H., Andrea H., Radvan U. 2008. Randomized, Double-Blind, Placebo-Controlled Trial of Probiotics for Primary Prevention: No Clinical Effects of Lactobacillus GG Supplementation. Pediatrics. 121(4): 1-7. Malfertheiner, P., Chen, F.K., McColl, KE. 2009. Peptic ulcer disease. Lancet. 374: 1449-1461. Malfertheiner, P., Megraud, F., C. O’Morain, Bazzoli, F., El-Omar, E., Graham, D., Hunt, R., Rokkas, T., Vakil, N., Kuipers, E.J. and The European Helicobacter Study Group (EHSG). 2007. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. 56: 772–781. Mcintosh, G. H. 1996. Probiotics and colon cancer prevention. Asia Pac. J. Clin. Nutr.5:48-52. McColl, KE. 2010. Clinical Practice. Helicobacter pylori infection. N Engl J Med. 362: 1597-1604. Neubauer, A., Thiede, C., Morgner, A. 1997. Cure of Helicobacter pylori infection and duration of remission of low-grad gastric mucosa-associated lymphoid tissue lymphoma. J Intl Cancer Inst. 89: 1350-1355. Nicola, B., Giulia, L., Eugenio, C., Andrea, M., Massimo, B., Francesco, C., Maria, G,M., Angelo, R., Fabrizio, C., Stefano, S., Mauro, R., and Santino, M. 2007. Helicobacter pylori Eradication- A Randomized Prospective Study of Triple Therapy Versus Triple Therapy Plus Lactoferrin and Probiotics. Am J Gastroenterol. 102:951–956. Nomura, A., Stemmermann, G.N., Chyou, P.H., Kato, I., Perez-Perez, G.I., Blaser, M.J. 1991. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med; 325: 1132-1136. Morris, A., Nicholson, G. 1987. Ingestion of Campylobacter pyloridis causes gastritis and raised fasting gastric pH. American journal of Gstroenterology. 82: 192-199. Myllyluoma, E., Veijola, L., Ahlroos, T., Tynkkyene, S., Kankuri, E., Vapaatalo, H., Rautelin, H., and Korpela, R. 2005. Probiotic supplementation improves tolerance to Helicobacter pylori eradication therapy – a placebo-controlled, double-blind randomized pilot study. Aliment Pharmacol Ther. 21: 1263–1272. O’sullivan, M. G., G. Thornton, G. C. Osullivan, and J. K. Collins. 1992. Probiotic bacteria: myth or reality. Trends food technol. 3: 309-314. Padol, S., Yuan, Y., Thabane, M., Padol, I.T., Hunt, RH. 2006. The effect of CYP2C19 polymorphisms on H. pylori eradication rate in dual and triple first-line PPI therapies: a meta-analysis. Am J Gastroenterol; 101: 1467-75. Parsonnet, J., Shmuely, H., Haggetry, T. 1999. Fecal and oral shedding of Helicobacter pylori from healthy infected adults. JAMA. 282: 2240-2245. Parsonnet, J., Hansen, S., Rodrigutz, L., Amold, B.G., Roger, A.W., Egil, J., Norman O., Joseph, H.V and Gary, D.F. 1994. Helicobacter pylori infection and gastric lymphoma. N Engl J Med.330: 1237-1271. Parsonnet, J., Friedman, G.D., Vandersteen, D.P., Chang, Y., Joseph, H.V. Norman O. and Richard, KS. 1991. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 325: 1127-1131. Perdigon, G., E. Vintint, S. Alvarez, M. Medina, and M. Medici. 1999. Study of the possible mechanism involved in the mucosalimmune system activation by lactic acid bacteria. J. Dairy Sci. 82: 1108-1114. Rambaud, J.C., Y. Bouhnik, P. Marteau, P. Pochart. 1993. Manipulation of the human gut microflora. Proc. Nutr. Sci. 52: 357-366. Salminen, S., A. Ouwehand, Y. Benno, and Y. K. Lee. 1999. Probiotics: how should they be defined.Trends Food Sci. Technol. 10: 107-110. Sanders, M.E, Walker, D.C, Walker, K.M, Aoyama, K, Klaenhammer, TR.1996. Performance of commercial cultures in fluid milk applications. J Dairy Sci.79(6):943-55. Scheinbach, S. 1998. Probiotics: Functionality and commercial status. Biotechnol. Adv.16: 581-608. Sheu, B.S., Wu, J.J., Lo, C.Y., Wu, H.W., Chen, J.H., Lin, Y.S. and Lin, M.D. 2002. Impact of supplement with Lactobacillus and Bifidobacterium containing yogurt on triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 16: 1669-1675. Sheu, B.S., Huang, J.J., Yang, H.B., Huang, A.H., Wu, J.J. 2003. The selection of triple therapy for Helicobacter pylori eradication in chronic renal insufficiency. Aliment Pharmacol Ther. 17(10): 1283-1290. Sheu, B.S., Kao, A.W., Cheng, H.C. Hunag, S.F., Chen, T.W., Lu, C.C., Wu, J.J. 2005. Esomeprazole 40 mg twice daily in triple therapy and the efficacy of Helicobacter pylori eradication related to CYP2C19 metabolism. Aliment Pharmacol Ther. 21: 283-288. Skouloubris, S., Labigne, A., De Reuse, H. 2001. The AmiE aliphatic amidase and AmiF formamidase of Helocobacter pylori: natural evolution of two enzyme paraloguse. Molecular Microbiology. 40: 596-609. Suerbaum, S. Michetti, P. 2002. Helicobacter pylori infection. N Engl J Med. 347(15): 1175-1186. Telford, J.L., Covacci, R., Rappuoli, and Ghiara, P. 1997. Immunology of Helicobacter pylori infection. Curr Opin Immun. 9: 498-503. Tong, J.L., Ran, Z.H., SHEN, J., Zhang, C.X., Xiao, S.D. 2007. Meta-analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther 25, 155–168. Uemura, N., Mukau, T., Okamoto, S., Yamaguchi, S., Mashiba, H., Taniyama, K., Sasaki, N., Haruma, K., Sumii, K. and Kjiyama, G. 1997. Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev .6: 639-642. Uemura, N., Okamoto, S., Yamamoto, S., Matsumura, N., Yamaguchi, S., Yamakido, M., Taniyama, K., Sasaki, N., Ronald, J. Schlemper. 2001. Helicobacter pylori infection and the development of gastric cancer. N Engj J Med. 345: 784-789. Vesa, T. H., P. R. Marteau, F. B. Breat, M. C. Boutron-Rualt, and J. C. Rambaud. 1997.Raising milk energy content retards gastric emptying of lactose in lactose-intolerant humans with little effect on lactose digestion. J. Nutr. 127: 2316-2320. Vrese, M. and Schrezenmeir, J. 2002. Probiotics and non-intestinal infectious conditions. British Journal of Nutrition. 88 Suppl. 1: 59–S66. Walsh, J.H., Peterson, W.L., 1995. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med. 333: 984-991. Zang, Q.B., Nakashabendi, I.M., Mokhashi, M.S. Daeodu, J.B., Gemmell, C.G., Russell, R.I. Gut 1996. Association of cytotoxin production and neutrophil activation by strains of Helicobacter pylori isolated from patients with peptic ulceration and chronic gastritis. 38: 841-845.
摘要: 
有關胃炎、胃潰瘍、十二指腸潰瘍、甚至胃癌等疾病,已有許多研究證實是由幽門螺旋桿菌(Helicobacter pylori)所造成,在臨床上對幽門螺旋桿菌的根除治療多以數種抗生素搭配制酸劑的組合來使用,但是,隨著不同地區抗生素使用的頻繁性差異,所造成的抗藥性比率就不同;其中不乏因療程中抗生素副作用所引起的不適感,使患者自行停藥或減少服用劑量因此降低治療效果。
本研究於合格的腸胃專科診所,採用中央健保局認可的內視鏡檢查及給藥方法,以碳13尿素呼氣檢測(13C-UBT)篩檢罹患消化性潰瘍伴有幽門螺旋桿菌感染陽性之患者,並以國內最常使用之三合一藥物療法(Clarithromycin+ Amoxicilline+ Omeprazole)給藥14天;試驗組(MP),為根除幽門螺旋桿菌藥物治療之14天療程中,搭配一個月的益生菌膠囊使用(Lactobacillus salivarius ssp. salicinius AP-32 and Lactobacillus johnsonii MH-68 , total number5×109 CFU/Cap.),對照組(M)僅使用14天的幽門螺旋桿菌根除治療藥物;一個半月的總試驗期間進行兩次問卷調查,記錄總療程中所發生的副作用程度,最後再以13C-UBT確認療程結束後之根除情形是否提高。
結果在根除率方面:比對各組治療前與治療後之13C-UBT數值皆有明顯的治療成效(MP組16:3, P<0.0001 ; M組13:5, P <0.0001);然而在有沒有使用益生菌在治療成效上比較,雖有提升但並未達到顯著差異(P=0.7825);以根除治療成功人數來看兩組間的治療成功人數並無顯著差異(16:13; P=0.4470)。
在改善藥物療程副作用方面:將試驗組(MP)患者及對照組(M)患者作比對,就每位患者於療程期間,所發生問卷調查表中之12項副作用程度做積分比較;試驗組(MP)患者,在第一次問卷積分與第二次問卷積分比較上有顯著差異(53:14; P=0.0096),顯示益生菌在三合一藥物療程之後,整體副作用有明顯的改善。而對照組(M)中患者,在第一次問卷積分與第二次問卷積分比較上並無顯著差異(67:70; P=0.6576),顯示在三合一藥物療程之後若未持續使用益生菌,整體副作用的改善較不明顯。
其中,腹痛之副作用部份,試驗組(MP) 在兩次問卷積分等級比較上有顯著差異(7 : 1; P=0.0163),從積分及人數(P=0.0011)顯示益生菌在三合一藥物療程持續服用至制酸劑療程結束,腹痛副作用都有明顯的改善;且據兩受試組第一次問卷內容顯示,在三合一藥物療程14天期間,腹痛副作用之問卷積分也有顯著差異(P=0.0259)。而腹瀉之副作用部份,兩受試組在第一次問卷內容積分比較已顯示,在三合一藥物療程14天期間,腹瀉副作用之問卷積分皆有顯著差異( P=0.0082)。味覺異常及脹氣的部分,味覺異常的症狀雖然在服用抗生素期間,有無使用益生菌輔助,對於味覺異常的改善雖有下降趨勢但無顯著性,而在抗生素療程結束服用制酸劑期間,使用益生菌對於味覺異常的改善則有明顯之差異性,試驗組(MP)有大幅度改善的效果(P=0.0101),在人次的症狀改善比較上,兩組之間也有顯著性差異(P=0.0128);脹氣的部分也是有相同的結果,對脹氣的症狀有改善但無顯著差異,比對制酸服用期間,試驗組(MP)也是有大幅度改善的效果(P=0.0312),在人次的症狀改善比較上,兩組之間也有顯著性差異(P<0.0001)。
綜此,此益生菌膠囊雖然在幽門螺旋桿菌的根除治療上,並未有顯著差異性,但若兩組各自去除極端數據一人後(MP組共17人,M組共18人),試驗組(MP)的治癒率可由對照組(M)的89.4 %上升至95.8 %,且在整體副作用的緩解上確實有幫助,尤其在腹痛及腹瀉部份更見其效果。
URI: http://hdl.handle.net/11455/51956
其他識別: U0005-1708201110161800
Appears in Collections:食品暨應用生物科技學系

Show full item record
 
TAIR Related Article

Google ScholarTM

Check


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.