Correlation between endoscopic classification and antibiotic resistance of Helicobacter pylori in 5 441 patients with benign gastric diseases / 中华消化杂志

ABSTRACT

Objective:To analyze the relationship between the gastric diseases classification under endoscopy and infection and antibiotic resistance of Helicobacter pylori ( H. pylori) based on the data of gastric diseases classification under endoscopy, H. pylori isolation and antibiotic resistance. Methods:From January 1, 2015 to December 31, 2019, endoscopic diagnosis and the data of drug susceptibility of H. pylori of 5 441 patients with benign gastric diseases along with gastrointestinal symptoms who visited The First People′s Hospital of Putuo District of Zhoushan were retrospectively collected. The H. pylori infection in patients with different genders and different types of gastric diseases and the drug resistance rates of H. pylori among different antibiotic types were analyzed. Chi-square test was used for statistical analysis. Results:The positive rate of H. pylori in 5 441 patients with benign gastric diseases was 51.37% (2 795/5 441). The drug resistance rates of clarithromycin, levofloxacin, metronidazole, amoxicillin, tetracycline and furazolidone were 26.73% (747/2 795), 43.22% (1 208/2 795), 98.68% (2 758/2 795), 0.32% (9/2 795), 0 and 0, respectively. Among the 2 795 cases of H. pylori-positive patients, only 23 cases (0.82%) were sensitive to all six antibiotics; 1 263 cases (45.19%) were resistant to single antibiotic; 1 072 cases (38.35%) were resistant to combination of two antibiotics, and 433 cases (15.49%) were resistant to combination of three antibiotics. The drug resistance rate to three antibiotics, clarithromycin, levofloxacin and metronidazole simultaneously was the highest (15.31%, 428/2 795). And only four patients (0.14%) were simultaneously resistant to four antibiotics clarithromycin, levofloxacin, metronidazole and amoxicillin. H. pylori infection rate in men was higher than that in women (55.23%, 1 615/2 924 vs. 46.88%, 1 180/2 517), and the difference was statistically significant ( χ2=37.76, P<0.01). However there were no statistically significant differences in the drug resistance rates of six antibiotics between different gender among H. pylori-positive patients (all P>0.05). There was statistically significant difference in the positive rate of H. pylori among patients with different types of gastric diseases ( χ2=909.07, P<0.01). The positive rate of H. pylori was the highest in patients with duodenal ulcer (97.53%, 79/81), and the lowest in patients with bile reflux gastritis (19.79%, 37/187). There were statistically significant differences in the drug resistance rates of metronidazole, clarithromycin, levofloxacin and amoxicillin among 9 types of gastric diseases ( χ2=24.75, 38.62, 80.54 and 7.01, all P<0.01). Conclusions:The positive rate of H. pylori and antibiotic resistance rate are different in patients with different types of gastric diseases. It is necessary to pay attention to the selection of drugs for ulcerative diseases in the process of clinical treatment. Individualized treatment is recommended according to the results of antibiotic susceptibility test.