{"title":"生活在大都市地区的 80 岁及以上患者接受幽门螺杆菌根除疗法的特点：一项多中心回顾性研究","authors":"Eri Iwata, Mitsushige Sugimoto, Daisuke Asaoka, Mariko Hojo, Masayoshi Ito, Naoko Kitazawa, Naoto Kurihara, Tatsuhiro Masaoka, Shigeaki Mizuno, Hideki Mori, Akihito Nagahara, Ryota Niikura, Toshifumi Ohkusa, Masaya Sano, Yuji Shimada, Hidekazu Suzuki, Yoshiaki Takeuchi, Akifumi Tanaka, Kengo Tokunaga, Kumiko Ueda, Nobuhiro Sakaki, Shin'ichi Takahashi, Takashi Kawai","doi":"10.1111/hel.13125","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The situation of <i>Helicobacter pylori</i> eradication therapy has been changing over time, owing to increases in antimicrobial-resistant strains, lifestyle improvements, and changes in indications for eradication. In Japan, eradication therapy is now available to all <i>H. pylori</i>-positive patients under the medical insurance system, and the potassium-competitive acid blocker vonoprazan has been used for eradication from 2015. Recently, with the aging of society, opportunities to provide eradication to elderly patients are increasing, but the current status and effectiveness of eradication in elderly patients remains unclear. Therefore, we aimed to investigate the trends of <i>H. pylori</i> eradication in a metropolitan area to determine the factors associated with successful <i>H. pylori</i> eradication in elderly patients older than 80 years.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Trends in the eradication rates of patients who received first- or second-line eradication at 20 hospitals in the Tokyo metropolitan area from 2013 to 2023 were investigated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The eradication rates in the per-protocol analysis were 82.3% (95% confidence interval [CI]: 81.2%–83.2%) for the first-line treatment (<i>n</i> = 6481), and 87.9% (86.9%–88.9%) for the second-line treatment (<i>n</i> = 4899). Multivariate analysis showed that independent factors for successful eradication in the first-line treatment were an age of older than 80 years (OR: 0.606; 95% CI: 0.448–0.822), peptic ulcers (vs. atrophic gastritis: 3.817; 3.286–4.433), and vonoprazan (vs. proton pump inhibiters (PPIs), 3.817; 3.286–4.433), and an age of older than 80 years (0.503; 0.362–0.699) and vonoprazan (1.386; 1.153–1.667) in the second-line treatment.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>After 2015, the eradication rate of both first- and second-line therapies were maintained at a higher level than before 2015, owing to the use of vonoprazan. As the <i>H. pylori</i> eradication rate in patients older than 80 years was low, an effective strategy for these patients needs to be developed in the future.</p>\n </section>\n </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"29 4","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13125","citationCount":"0","resultStr":"{\"title\":\"Characteristics of Helicobacter pylori Eradication Therapy in Patients 80 Years or Older Living in a Metropolitan Area: A Multicenter Retrospective Study\",\"authors\":\"Eri Iwata, Mitsushige Sugimoto, Daisuke Asaoka, Mariko Hojo, Masayoshi Ito, Naoko Kitazawa, Naoto Kurihara, Tatsuhiro Masaoka, Shigeaki Mizuno, Hideki Mori, Akihito Nagahara, Ryota Niikura, Toshifumi Ohkusa, Masaya Sano, Yuji Shimada, Hidekazu Suzuki, Yoshiaki Takeuchi, Akifumi Tanaka, Kengo Tokunaga, Kumiko Ueda, Nobuhiro Sakaki, Shin'ichi Takahashi, Takashi Kawai\",\"doi\":\"10.1111/hel.13125\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The situation of <i>Helicobacter pylori</i> eradication therapy has been changing over time, owing to increases in antimicrobial-resistant strains, lifestyle improvements, and changes in indications for eradication. In Japan, eradication therapy is now available to all <i>H. pylori</i>-positive patients under the medical insurance system, and the potassium-competitive acid blocker vonoprazan has been used for eradication from 2015. Recently, with the aging of society, opportunities to provide eradication to elderly patients are increasing, but the current status and effectiveness of eradication in elderly patients remains unclear. Therefore, we aimed to investigate the trends of <i>H. pylori</i> eradication in a metropolitan area to determine the factors associated with successful <i>H. pylori</i> eradication in elderly patients older than 80 years.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Trends in the eradication rates of patients who received first- or second-line eradication at 20 hospitals in the Tokyo metropolitan area from 2013 to 2023 were investigated.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The eradication rates in the per-protocol analysis were 82.3% (95% confidence interval [CI]: 81.2%–83.2%) for the first-line treatment (<i>n</i> = 6481), and 87.9% (86.9%–88.9%) for the second-line treatment (<i>n</i> = 4899). Multivariate analysis showed that independent factors for successful eradication in the first-line treatment were an age of older than 80 years (OR: 0.606; 95% CI: 0.448–0.822), peptic ulcers (vs. atrophic gastritis: 3.817; 3.286–4.433), and vonoprazan (vs. proton pump inhibiters (PPIs), 3.817; 3.286–4.433), and an age of older than 80 years (0.503; 0.362–0.699) and vonoprazan (1.386; 1.153–1.667) in the second-line treatment.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>After 2015, the eradication rate of both first- and second-line therapies were maintained at a higher level than before 2015, owing to the use of vonoprazan. As the <i>H. pylori</i> eradication rate in patients older than 80 years was low, an effective strategy for these patients needs to be developed in the future.</p>\\n </section>\\n </div>\",\"PeriodicalId\":13223,\"journal\":{\"name\":\"Helicobacter\",\"volume\":\"29 4\",\"pages\":\"\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-08-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13125\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Helicobacter\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/hel.13125\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Helicobacter","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hel.13125","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Characteristics of Helicobacter pylori Eradication Therapy in Patients 80 Years or Older Living in a Metropolitan Area: A Multicenter Retrospective Study
Background
The situation of Helicobacter pylori eradication therapy has been changing over time, owing to increases in antimicrobial-resistant strains, lifestyle improvements, and changes in indications for eradication. In Japan, eradication therapy is now available to all H. pylori-positive patients under the medical insurance system, and the potassium-competitive acid blocker vonoprazan has been used for eradication from 2015. Recently, with the aging of society, opportunities to provide eradication to elderly patients are increasing, but the current status and effectiveness of eradication in elderly patients remains unclear. Therefore, we aimed to investigate the trends of H. pylori eradication in a metropolitan area to determine the factors associated with successful H. pylori eradication in elderly patients older than 80 years.
Methods
Trends in the eradication rates of patients who received first- or second-line eradication at 20 hospitals in the Tokyo metropolitan area from 2013 to 2023 were investigated.
Results
The eradication rates in the per-protocol analysis were 82.3% (95% confidence interval [CI]: 81.2%–83.2%) for the first-line treatment (n = 6481), and 87.9% (86.9%–88.9%) for the second-line treatment (n = 4899). Multivariate analysis showed that independent factors for successful eradication in the first-line treatment were an age of older than 80 years (OR: 0.606; 95% CI: 0.448–0.822), peptic ulcers (vs. atrophic gastritis: 3.817; 3.286–4.433), and vonoprazan (vs. proton pump inhibiters (PPIs), 3.817; 3.286–4.433), and an age of older than 80 years (0.503; 0.362–0.699) and vonoprazan (1.386; 1.153–1.667) in the second-line treatment.
Conclusion
After 2015, the eradication rate of both first- and second-line therapies were maintained at a higher level than before 2015, owing to the use of vonoprazan. As the H. pylori eradication rate in patients older than 80 years was low, an effective strategy for these patients needs to be developed in the future.
期刊介绍：
Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.
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