二维量身定制疗法:在Helicobacter pylori感染多次根除失败后,一种新的救援疗法
Shigemi Nakajima1,2,3, Hisayuki Inoue4, Hiroshi Satake5
1Consortium for Community Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
Gastro hep advances
|August 12, 2024
概括
诺普拉赞并没有得到广泛的应用,因此建议使用基于CYP2C19基因型和抗生素敏感性测试 (AST) 的抗生素和使用质子抑制剂 (PPI) 的二维量身定制疗法 (2dTMT) 进行H. pylori根除.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 药物基因组学 药物基因组学
背景情况:
- 基于质子抑制剂 (PPI) 的疗法是*Helicobacter pylori*根除的标准.
- 诺普拉赞的根除率较高,但在全球范围内无法获得.
- 多次根除失败需要替代治疗策略.
研究的目的:
- 评估一种新的2维量身定制疗法 (2dTMT) 对*H. pylori*根除多次治疗失败的患者的疗效,而不使用vonoprazan.
- 评估CYP2C19基因型和抗生素敏感性测试 (AST) 在指导根除治疗中的有用性.
主要方法:
- 招募至少两次失败的基于PPI的三重疗法患者.
- 对CYP2C19基因型和AST的表现.
- 根据CYP2C19基因型 (维度1) 量身定制PPI剂量,并根据AST结果 (维度2) 选择两种抗生素.
- 给14天的2dTMT或1维量身定制治疗 (1dTMT) 给缺乏AST数据的患者.
主要成果:
- 14天的2dTMT实现了86.4%的根除率 (治疗意图) 和90.5% (每个协议).
- 1dTMT实现了75.0%的根除率 (治疗意图) 和90.0% (每个协议).
- 在51名候选人中,24名候选人获得了足够的信息来进行2dTMT选择.
结论:
- 14天的2dTMT是一种可行的救援疗法,用于在多次治疗失败的患者中消除*H. pylori*,即使没有vonoprazan.
- 当AST信息有限时,1dTMT可以作为替代方案.
- 基于遗传和易感性测试的个性化治疗改善了根除结果.
更多相关视频
相关概念视频
01:16Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
338
Helicobacter pylori, a resilient gram-negative bacterium, can thrive in the stomach's harsh, acidic environment. Infection with H. pylori leads to a cascade of events within the stomach lining. One of the critical disruptions caused by this bacterium is the interference with somatostatin production, a hormone responsible for regulating acid secretion. This interference tips the balance, escalating acid secretion and diminishing bicarbonate levels. This imbalance compromises the defensive...
338
01:26Peptic Ulcer Disease IV: Management
79
Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
79
01:23Gastritis III: Clinical Manifestations and Management
194
The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
194
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
102
Peptic ulcer disease (PUD) presents with diverse symptoms depending on the location and severity of the ulcer. Clinical manifestations of peptic ulcer include dull pain and a burning sensation in the mid-epigastric region.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
102
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
264
Surgical management and nursing care are crucial in treating Peptic Ulcer Disease (PUD). Here is an organized and enhanced overview of the surgical interventions and the associated nursing care for PUD:
Surgical Interventions for Peptic Ulcer Disease
Surgical Interventions for Peptic Ulcer Disease
264
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
64
Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
64