What is gastric triple therapy?

Gastrointestinal diseases are usually caused by Helicobacter pylori, a bacterium that lives on the surface of the stomach and produces toxins that cause inflammation of the gastric mucosa. People who have had gastrointestinal diseases usually know that the stomach pain is really excruciating, but there is nothing they can do about it. The gastric triple therapy is currently the most advanced method for treating gastrointestinal diseases in China. So what is the gastric triple therapy?

1. Gastrointestinal triple therapy is more beneficial for children with gastritis

In the case of gastrointestinal diseases caused by Helicobacter pylori (Hp) in adults, a large number of clinical trials have confirmed that triple therapy (OAC) consisting of omeprazole, amoxicillin and clarithromycin can effectively eradicate Hp and completely eliminate clinical symptoms. However, there is a lack of controlled clinical trials of triple therapy in the pediatric literature.

French researchers recently published the results of a randomized, double-blind clinical trial in JPediatr (2001, 139:664). The study found that one week of triple therapy could eradicate H. pylori in three-quarters of children with gastritis.

The study included 73 children with an average age of 10.8 years (range, 3.3-15.4 years) and symptoms of dyspepsia. These children had no symptoms of gastroduodenal ulcers but had histological evidence of gastritis, a positive urea breath test, or serological or histological evidence of H. pylori infection or a positive H. pylori culture. The study group used triple therapy, and the control group used dual therapy without omeprazole. The dose of omeprazole was 10-20 mg per day, and the course of treatment was 7 days. The researchers repeated the (13)C-labeled urea breath test 4 weeks after the children completed treatment. They found that the H. pylori eradication rate was 74.2% in children receiving triple therapy, compared with 9.4% in the group receiving either antibiotic alone. Hp in a small number of children is resistant to clarithromycin, but this does not increase the risk of treatment failure.

Interestingly, however, there were no differences in dyspeptic symptoms and pain measured with a visual analog scale between the two groups before and after treatment. The researchers believe that their follow-up period was too short (4 to 6 weeks) to evaluate dyspepsia symptoms in children with gastritis, as at least 12 months of follow-up is required in adults.

However, some people believe that the urea breath test is unreliable in children, especially those under 2 years old, as false positive results may be caused by the presence of urease-producing microorganisms in the mouth.

How should we evaluate the results of this study? Is triple therapy also being used in China to treat childhood gastritis?

Relevant experts believe that after anti-Hp treatment, the clinical symptoms of most children disappear or improve quickly as Hp is eradicated, indicating that active Hp infection is the cause of abdominal pain in some children. However, some children do not experience relief after Hp eradication. This may be because pediatric gastritis is a chronic inflammatory process and the causes of pediatric abdominal pain are more complicated. In addition to Hp infection, it is also affected by mental and dietary factors. Therefore, in some cases, eradication of Hp may not completely eliminate clinical symptoms.

The best treatment regimen for Hp infection in children now is short-course, low-dose treatment, which achieves a high eradication rate. It is currently believed that the efficacy of single drug eradication of Hp is poor. In order to improve the cure rate, combination therapy is often used, and the effect of triple therapy is better than dual therapy. Omeprazole can inhibit the activity of H+-K+-ATPase in gastric mucosal parietal cells, reduce the degradation of antibiotics, inhibit the growth of Hp, and enhance the efficacy of antibiotics when used in combination with antibiotics. The omeprazole triple therapy used by French researchers to treat childhood gastritis has been extensively studied in China and applied clinically, proving that the therapy is effective in eliminating Hp, has few side effects, and can achieve an eradication rate of 85% to 95%.

2. Prescriptions for gastric disease

Colloidal bismuth (such as colloidal bismuth pectin) or a proton pump inhibitor (such as rabeprazole) plus clarithromycin plus amoxicillin or metronidazole (furazolidone)

Generally speaking, triple therapy is used for one to two weeks. In addition, gastric mucosal protectants, drugs that promote gastric emptying, anticholine drugs, etc. can be used appropriately according to the condition of the disease.

Drugs that inhibit gastric acid include: proton pump inhibitors such as omeprazole, omeprazole and lansoprazole. Histamine H2 receptor antagonists, such as cimetidine, ranitidine, famotidine, etc. This type of drug can mainly inhibit gastric acid secretion and promote the healing of ulcers. Therefore, it is best to take the medicine half an hour before meals. Taking histamine H2 receptor antagonists before bed can inhibit the peak of gastric acid secretion at night. This type of gastric acid-suppressing drug is generally used for about three months.

Antibacterial drugs include: clarithromycin, amoxicillin, and metronidazole. This type of drug has anti-Helicobacter pylori effects. Because taking it on an empty stomach may cause stomach discomfort, it is best to take it half an hour after a meal and the medication duration is one to two weeks.

Antacids include: single and compound drugs, such as Weishuping, aluminum hydroxide, Ledewei, etc. The main function of this type of drug is to neutralize gastric acidity, so it is best to take it half an hour before meals or 1-2 hours after meals. These drugs are usually taken as needed.

Gastric mucosal protective agents include: such as colloidal bismuth (bismuth citrate), sucralfate, carbenoxolone, etc. This type of medicine mainly protects the gastric mucosa from the stimulation of gastric acid pepsin, thereby promoting the healing of ulcers. Therefore, it is best to take it half an hour before meals and half an hour before bedtime. It can also be taken as needed, but it cannot be taken continuously for more than two months due to the metal content.

3. The most commonly used triple therapy is as follows:

Drug combinations

(1) Losec 20 mg (1 tablet) + amoxicillin 750 mg (3 tablets, each containing 250 mg) + metronidazole 400 mg (2 tablets, each containing 200 mg).

(2) Losec 20 mg + erythromycin 500 mg (4 tablets, each containing 125 mg) + metronidazole 400 mg.

(3) Losec 20 mg + amoxicillin 750 mg + erythromycin 500 mg.

usage

Any of the above group of drugs can be taken, and each drug should be taken twice a day (once in the morning and once in the afternoon) according to the above dosage. One course of treatment is 7-14 days. After one course of treatment, continue to take Losec alone for another 2 weeks, with the same dosage and method of administration as before.

When using triple therapy, attention should be paid to the toxic and side effects of drugs (especially anti-HP drugs). For example, metronidazole can cause nausea and prickle tongue; amoxicillin and erythromycin can cause diarrhea, nausea, glossitis, allergic urticaria, rash and drug fever, etc. Therefore, the drugs should be used under the guidance and supervision of a doctor.

4. Toxic side effects

Metronidazole can cause nausea and prickle tongue; amoxicillin and erythromycin can cause diarrhea, nausea, glossitis, allergic urticaria, rash and drug fever.