醇提大黃對消化性潰瘍合併幽門螺旋桿菌感染之作用探討 ;The efffect of alcohol extracted Dahuang (hubarb) on peptic Ucer Disease with Helicobacter pylori infection
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(2) 130. 1 *. De-Nol. (n=32). DU/GU. *. 42.2 (23-68). 40.5 (21-75). NS. 24/8. 21/5. 26/14. NS. 28/4. 20/6. 32/8. NS. 17 (53.1). 12 (46.2). 22 (55.0). NS. 500. 1. 3. 2. 8. metronidazole 250. 1 4. 6. NS=. De-Nol. De-Nol 120. tetracycline 500. 1. De-Nol. [30]. 1 1. 8 2. GU=. ) [28]. 1 4 1 4. DU=. [26,27] [29]. p. (n=40). 42.7 (69-72). De-Nol 120 De-Nol 120. (n=26). 4. 1 1. 2. 4. Hp. 1. 6. 5. Hp. Hp Hp. (CLOtest. [12,13]. R. Delta West. Beatley. ). (A1. 86. 1. A2. ). 87. (Rheum palmatum L.). 6 500. 1.5. (rapid urease test). (A1. Hp. S2. (1). A2. ). (S1. ) (healing stage). (2). (eradication). (3). (4) (5). Hp. (6) Student's t-test,. (7). Fisher's exact test. chi-square test p (. ). 2. (500 8. ). (De-Nol. 1. 0.05. 3. ). tri-potassium di-citrato bismuthate (DeNol. R. 120. / (. ). 1. 4. ). metronidazole (250. 1. 8. 32. 26. 40. (. 1). De-Nol, ). tetracycline (500. 4.4.
(3) 131. 2 De-Nol (n = 32). (n = 26). (n = 40). p. 1. 18 (56.2%). 9 (34.6%). 30 (75.0%). < 0.05. 4. 30 (93.7%). 20 (66.9%). 39 (97.51%). < 0.01. Hp. 3. De-Nol. p. (n = 32). (n = 26). (n = 40). 13 (40.6%). 14 (53.8%). 33 (82.5%). < 0.05. 2 (6.2%). 4 (15.4%). 32 (80.0%). < 0.05. Hp. 4 De-Nol (n = 32). (n = 26). p. (n = 40). 5. 1. 2. 2. 3. 3. 0. 3. 4. 0. 1. 1. 0. 0. 1. 7 (21.9%). 8 (30.8%). 11 (27.5%). NS. 1 75.0%. 56.2%. 34.6% 93.7%. [18,23,24,35]. De-Nol (. 40.6%. 2). De-Nol. 82.5%. 53.8% [22-25]. De-Nol (p < 0.05). De-Nol. [34]. Hp 6.2%. [18]. De-Nol. 4. De-Nol. 15.4%. 80.0%. De-Nol (p < 0.01. 3). (. 4 1. 5. ) [21]. 2-3 [29]. 38. [30]. Hp [17]. Hp DNA.
(4) 132. [20,26-28,36-. Hirschowitz B. Management of duodenal ulcer. In: Winawer SJ, ed. Management of Gastroin-. (. 38]. 1.. testinal Disease. New York: Gower Med Pub,. ). 1992:2.1-2.3. 2. Friedmen LS, Peterson WL. Peptic ulcer and. cimetidine Hp. related disorders, In: Fauci AS, Braunwald E,. [28] 90. Isselbacher KJ, et al., eds. Harrison's Principles. [28]. of Internal Medicine. New York: Mcgraw-Hill, 1998:1595-616. 3. Marshall B. Unidentified curred bacilli on gastric. (40.6% vs. Hp 53.8%. 6.2% vs 15.4%). epithelium in active chronic gastritis. Lancet 1983;i:1273-5. 4. Warren JK. Unidentified curred bacilli on gastric. Hp. 82.5%. epithelium in active chronic gastritis. Lancet 1983;i:1273.. 80.0%. 5. Marshall B, Warren JR. Unidentified curred bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;i:1311-4.. (1). 6. Hoodwin CS, Armstrong JA, Chilvers T, et al. Transfer. of. Campylobacter. pylori. and. Campylobacter mustelae to Helicobacter gen. nov. as Helicobacter pylori comb. nov. and Helicobacter mustelae comb. nov., respectively. Int J Syst Bacteriol 1989;39:397-405. 7. Marshall BJ, Mcgecsie DB, Rogers PA, et al.. (2). Pyloric Campylobacter infection and gastro-. (compliance). duodenal disease. Med J Aust 1985;142:439-44. 8. Niemala S, Kartturen T, Lehtole J. Campylo-. (3). bacter-like organism in patients with gastric ulcer. Scand J gastroenterol 1987;22:487-90. 9. O'Connor HJ, Dixon MF, Wyatt JI, et al.. (4). Campylobacter pylori and peptic ulcer disease. Lancet 1987;ii:633-4. 10. Marshall BJ, Goodwin CS, Worren JR, et al. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter. 1 52.6%. pylori. Lancet 1988;ii:1437-42. 11. Goodwin CS, Marshall BJ, Blincow ED, et al. Prevention of nitroimidazole resistance in. 5 1. 2. (15.6%). Campylobacter pylori by coadministration of colloidal bismuth subcitrate: clinical and in vitro. 3. studies. J Clin Pathol 1988;41:207-10.. [18,29,30]. 12. Smith AC, Price AB, Borriello P, et al. A comparison of ranitidine and tripotassium dicitratobismuth (TDB) in relapse rates of. (. duodenal ulcer. The role of Campylobacter. ). pylori (CP). Gastroenterology 1988:94:A431.. Hp. 13. Goodwin CS, Armstrong JA, Marshall BJ. Campylobacter pyloridis, gastrtis and peptic ulceration. J Clin Pathol 1986;39:353-65.. Hp Hp. 14. Graham DY, Lew GM, Klein PD, et al. Effect of treatment of Helicobacter pylori infection on the long term recurrence of gastric or duodenal ulcer. A randomized, controlled study. Ann Intern Med 1992:116:705-8. 15.Lam SK, Talley NJ. H e l i c o b a c t e r. pylori.
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(6) 134. The Effect of Alcohol Extracted Dahuang (Rhubarb) on Peptic Ulcer Disease With Helicobacter pylori Infection Hwang-Huei Wang, Hsueh-Chou Lai, Yeong-Shuin Chang1 Division of Gastroenterology, Department of Internal Medicine and 1Division of Traditional Chinese Medicine Pharmacy, Department of Pharmacy, China Medical College Hospital, Taichung, Taiwan, R.O.C.. Helicobacter pylori (Hp) has been reported as an important factor of recurrence in peptic ulcer disease. Clinically, the ulcer recurrence rate will be much reduced when the Hp has been eradicated. In the literature, Dahuang has been reported to have the efficacy to cure peptic ulcer and also has anti-Hp effect. The aim of this study was to evaluate the efficacy of alcohol extracted Dahuang in the treatment of peptic ulcer disease, eradication rate of Hp and the side effects of the drugs. Ninety-eight consecutive cases were randomized to three groups according to the date of endoscopic examination in China Medical College Hospital from January 1997 to Jun 1998. Group I (n=32), Dahuang (500 mg) 2 tablets tid for 8 weeks. Group II (n=26), De-Nol (120 mg) 1 tablet qid for 8 weeks. Group III (n=40), De-Nol 120 mg qid, metronidazole 250 mg qid and tetracycline 500 mg qid for 2 weeks then De-Nol 120 mg qid for another 6 weeks. Follow-up endoscopic examination was performed 1 month later. The results of this study showed that triple therapy provided the best effect of symptom relief. After treatment for 1 week, 56.2% of patients in Group I, 34.6% in Group II and 75.0% in Group III had complete symptom relief (p < 0.01). The ulcer healing rates are 40.6% in Group I, 53.8% in Group II and 82.5% in Group III (p < 0.05). Hp eradication rates are 6.2% (Group I), 15.4% (Group II ) and 80.0% (Group III), respectively (p < 0.01). No significant difference in ulcer healing rate and Hp eradication rate between Group I and Group II was observed. Side effects of these drugs were mild and there was no significant difference in side effects among these three groups. We concluded that the efficacy of alcohol extracted Dahuang alone to treat peptic ulcer is poor and no obvious effect to inhibit the growth of Hp in patients with peptic ulcer disease. Triple therapy is still the best choice for Hp-associated peptic ulcer disease. ( Mid Taiwan J Med 1999;4:129-34 ). Key words Dahuang (rhubarb), Helicobacter pylori, peptic ulcer disease. Received. October 21, 1998.. Accepted. March 24, 1999.. Address reprint requests to. Revised. January 20, 1999.. Hwang-Huei Wang, Division of. Gastroenterology, Department of Internal Medicine, China Medical College Hospital, No 2, Yuh-Der Road, Taichung, Taiwan, R.O.C..
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