Chẩn đoán sớm nhiễm Helicobacter pylori ở bệnh nhân xuất huyết tiêu hóa do loét dạ dày tá tràng
Các tác giả
DOI: https://doi.org/10.59294/HIUJS.33.2025.712Từ khóa:
H.pylori, chẩn đoán sớm, loét dạ dày tá tràng, urease nhanh, test hơi thở C13Tóm tắt
Đặt vấn đề: Chẩn đoán và điều trị sớm Helicobacter pylori (H.pylori) giúp giảm tái xuất huyết tiêu hóa ở bệnh nhân loét dạ dày tá tràng. Mục tiêu: Xác định tỷ lệ nhiễm H.pylori ở bệnh nhân xuất huyết tiêu hóa do loét dạ dày tá tràng và mối liên quan giữa vị trí loét, thời gian truyền thuốc ức chế bơm proton (PPI) với tỷ lệ nhiễm H.pylori. Phương pháp: Nghiên cứu tiến cứu 79 bệnh nhân nhập viện từ 4/2020 đến 9/2020 tại Bệnh viện Thống Nhất, Đồng Nai. H.pylori được chẩn đoán bằng xét nghiệm urease nhanh (trong pha cấp) hoặc test hơi thở C13 (sau pha cấp). Kết quả: Tỷ lệ nhiễm H.pylori trong pha cấp, sau pha cấp và trước xuất viện lần lượt là 31.0%, 30.8% và 43.0%. Tỷ lệ nhiễm ở loét dạ dày, loét tá tràng, loét cả hai vị trí lần lượt là 31.3%, 55.3%, và 33.3%. Bệnh nhân loét tá tràng có tỷ lệ nhiễm cao hơn nhóm còn lại (55.3% so với 31.7%, p<0.05). Thời gian từ khi truyền PPI đến khi test hơi thở C13 càng dài, tỷ lệ nhiễm H.pylori càng giảm (≤3 ngày: 35.7%, 4 ngày: 30.0%, ≥5 ngày: 21.4%), p>0.05. Kết luận: Dù được điều trị PPI liều cao, gần 50% bệnh nhân xuất huyết tiêu hóa do loét dạ dày tá tràng được chẩn đoán sớm nhiễm H.pylori bằng urease nhanh và/hoặc test hơi thở C13 trước xuất viện.
Abstract
Background: Early diagnosis and treatment of Helicobacter pylori (H.pylori) infection are essential for reducing the recurrence of gastrointestinal bleeding in patients with peptic ulcer disease. Objective: To determine the prevalence of H.pylori infection in patients with gastrointestinal bleeding caused by peptic ulcer disease and analyze its correlation with ulcer location and the timing of proton pump inhibitor (PPI) administration. Methods: This was a prospective study conducted on 79 patients admitted between April and September 2020 at Thong Nhat Hospital, Dong Nai. H.pylori infection was diagnosed using the rapid urease test (within the acute phase) or the C13 urea breath test (post-acute phase). Results: The prevalence of H.pylori infection during the acute phase, post-acute phase, and prior to discharge was 31.0%, 30.8%, and 43.0%, respectively. The infection rates in patients with gastric ulcers, duodenal ulcers, and combined gastric and duodenal ulcers were 31.3%, 55.3%, and 33.3%, respectively. Patients with duodenal ulcers exhibited a significantly higher prevalence of infection compared to those with gastric or combined ulcers (55.3% vs. 31.7%, p<0.05). A longer interval from the initiation of PPI therapy to C13 urea breath testing was associated with lower detection rates of H.pylori (≤3 days: 35.7%, 4 days: 30.0%, ≥5 days: 21.4%), though this trend was not statistically significant (p>0.05). Conclusion: Despite high-dose PPI therapy, nearly 50% of patients with gastrointestinal bleeding due to peptic ulcer disease were diagnosed with H.pylori infection before discharge using the rapid urease test and/or the C13 urea breath test.
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