Transmission routing
At present, unhealthy eating habits are the main way of infection. In addition, endoscopes that are not thoroughly disinfected in hospitals may also lead to cross-infection of Helicobacter pylori.
The spread of this disease is mainly through the following channels:
● Eat unclean food or drink unclean water;
● Contact with saliva, body fluids, vomit or excrement of infected persons, and do not wash your hands to eat;
● Long-term close contact with infected people;
● Dine with infected persons and use unclean tableware used by infected persons;
Close contact between children and students in kindergartens and schools;
● Direct mouth-to-mouth feeding or close contact.
symptom
Some people infected with Helicobacter pylori may have no obvious symptoms, or they may not get sick. The symptoms of Helicobacter pylori infection vary with the location of the disease. Recently infected people may have acute gastritis. About 30% of people infected with Helicobacter pylori develop chronic gastritis, 10%~20% develop peptic ulcer, and a few develop gastric cancer and MALT lymphoma.
characteristic symptoms
The patient has chronic epigastric pain, fullness, discomfort, acid regurgitation, belching, nausea in the morning and other digestive tract symptoms, suggesting that Helicobacter pylori infection causes inflammatory changes in gastric mucosa, that is, chronic gastritis.
When a few patients develop epigastric discomfort, fullness after eating, pain or emaciation from the above chronic gastritis, it is suggested that long-term chronic inflammation may lead to normal gastric mucosa-+superficial gastritis-+atrophic gastritis->; Intestinal metaplasia-atypical hyperplasia-+gastric cancer is aggravated in this process.
The typical symptoms of some patients are chronic, rhythmic epigastric pain and periodic attacks, suggesting that they may develop into peptic ulcer. Some patients only show mild gastrointestinal discomfort, because Helicobacter pylori infection is related to functional dyspepsia, Barrett's esophagus, gastroesophageal reflux disease, lymphocytic gastritis, hyperplastic polyp and so on.
medicine
Triple scheme
Consists of proton pump inhibitor (PPI) or bismuth combined with two antibiotics, specifically PPI+ clarithromycin+amoxicillin or PPI+ clarithromycin+metronidazole.
In recent years, the resistance rate of Helicobacter pylori to clarithromycin, metronidazole and levofloxacin (fluoroquinolones) in China is on the rise. Helicobacter pylori can produce double, triple or more resistance to these antibiotics, so triple therapy has basically been abandoned.
Quadruple therapy
At present, bismuth quadruple is recommended as the main empirical eradication scheme of Helicobacter pylori, including bismuth +PPI+ two antibiotics. The classical bismuth quadruple scheme consists of PPI+ bismuth+tetracycline+metronidazole. At present, there is a new preparation (Pylera) which puts bismuth, tetracycline and metronidazole in the same capsule, and it is expected to be popularized and applied in the world.
There are 7 combinations of traditional Chinese medicine and antibiotics: amoxicillin+clarithromycin; Amoxicillin+levofloxacin; Amoxicillin+furazolidone; Amoxicillin+metronidazole; Amoxicillin+tetracycline; Tetracycline+metronidazole; Tetracycline+furazolidone.
Antibiotics are taken after meals. PPI and bismuth are taken twice a day and half an hour before meals. PPI can be omeprazole, pantoprazole, lansoprazole, esomeprazole, etc. The course of treatment of quadruple regimen is generally 14 days.
remedial treatment
For patients who failed the first eradication treatment, doctors can choose another treatment scheme for remedial treatment. For those who are resistant to multiple antibiotics, drug sensitivity test can be done before treatment and sensitive antibiotics can be selected. When a patient who has repeatedly failed in treatment needs to continue treatment, the doctor will first make an "individualized overall assessment" of the patient, including the disease itself, the patient's drug resistance, compliance, treatment plan, treatment opportunity and treatment benefit.
In addition, patients who are allergic to penicillin should not receive treatment containing amoxicillin.
Traditional Chinese Medicine Treatment According to the National Treatment of Helicobacter pylori-related "Disease-Syndrome" with Integrated Traditional Chinese and Western Medicine, if combined with traditional Chinese medicine treatment, it may improve the eradication rate of mycorrhiza, help relieve symptoms and reduce adverse reactions during treatment.
"Combination of disease and syndrome" and syndrome differentiation and treatment are the basic principles of Chinese medicine in treating diseases related to Helicobacter pylori. Syndrome differentiation and treatment is a kind of individualized treatment, that is, according to the symptoms, signs and tongue pulse characteristics of each patient, combined with four diagnoses to determine the TCM syndrome types, and then give different prescriptions according to different syndrome types.
Traditional Chinese medicine treatment is mainly through overall adjustment, but it also has a certain direct connection to inhibit and kill Helicobacter pylori. Traditional Chinese medicine treatment can improve the clinical symptoms and quality of life of patients with Helicobacter pylori infection. Combined with the existing knowledge and standards, the syndrome differentiation of diseases caused by Helicobacter pylori infection is based on the onset.
The location is different from other situations. For example, the common symptoms of chronic gastritis caused by Helicobacter pylori infection are disharmony between liver and stomach, damp-heat of spleen and stomach, weakness of spleen and stomach, deficiency of stomach yin and stagnation of stomach collaterals.
The above syndromes can appear independently or at the same time. Clinically, we should distinguish compound syndromes on the basis of distinguishing single syndromes. At the same time, with the development and change of the disease, the syndrome also presents a dynamic change process, which needs careful identification in clinic, so as to choose the corresponding treatment principles and prescriptions.
Home care
People infected with Helicobacter pylori should pay attention to hand hygiene, and wash raw and cold food before eating. It is best to eat in groups. There are patients with Helicobacter pylori infection at home, and the tableware is disinfected at high temperature (disinfection cabinet). Patients infected with Helicobacter pylori should follow the doctor's advice, avoid drinking and pay attention to reexamination.
Daily life management
People infected with Helicobacter pylori should develop good hygiene habits, correct bad eating habits, eat more fruits and vegetables, live a regular life, quit smoking and drinking, and keep a good mood.
Daily prevention of Helicobacter pylori is contagious and can be spread through hands, unclean food, unclean tableware and feces. Therefore, we should develop good hygiene habits in our daily diet to prevent infection and contagion. Wash your hands before and after meals, try to eat cooked food heated at high temperature, drink boiled water, and wash and peel fruits and vegetables raw. Pay attention to oral hygiene: Helicobacter pylori can grow and reproduce on dental calculus and dental caries. After being infected with Helicobacter pylori, it may cause oral odor, which is difficult to clean, so it is necessary to pay attention to oral hygiene. Advocate brushing your teeth and gargling after each meal, changing your toothbrush regularly, and disinfecting cups and washing utensils regularly.
Regular physical examination: After family members are diagnosed with Helicobacter pylori infection, the positive rate of other members living with them is very high, so it should be prevented as soon as possible.
Infected people need active treatment: Helicobacter pylori infection often occurs in families, so in order to effectively eradicate Helicobacter pylori and prevent secondary infection, family members infected with Helicobacter pylori should be actively treated to avoid infecting others. Keep a good mood.
Diet prevention
● Split-meal chopsticks: It is recommended to use split-meal chopsticks for group dining. Tableware should be disinfected to avoid contact and infection. Stop parents from chewing food and feeding it to their babies.
● Avoid smoking and drinking, and do not eat spicy, cold and other irritating foods; Diet should be nutritious, eat less and eat more, chew slowly.
● Put an end to eating raw meat: Many people like to eat medium-rare steak, or eat the meat in a hot pot before it is cooked, which greatly increases the chance of exposure to Helicobacter pylori.
At present, the Helicobacter pylori vaccine is still under development, and there is no mature Helicobacter pylori vaccine on the market.