ObjectiveTo investigate the clinical curative effect of traditional Chinese medicineKuiyu decoction combined with quadruple therapy for peptic ulcer (PU).MethodsThis study was a randomized controlled trial. 82 patients with PU and conformed to the indusive criteria were randomly divided into a control group and a treatment group by the random number table method, with 41 cases in each group. The control group was treated with quadruple therapy, while the treatment group was treated with traditional Chinese medicineKuiyu decoction based on the treatment of the control group. Integral change of main symptoms before and after treatment and the level changes of serum motilin (MTL), somatostatin (SS) of the two groups before and after treatment were compared and clinical total effective rate was evaluated.ResultsThe total effective rate was 95.1% (39/41) in the treatment group and 80.5% (33/41) in the control group. There was statistical difference between the two groups(χ2=4.100,P=0.043). Stomach pain (0.58 ± 0.21vs.0.73 ± 0.28,t=2.744), gasteremphraxis (0.35 ± 0.12vs.0.43 ± 0.14,t=2.778), sour regurgitation integral (0.28 ± 0.09vs.0.34 ± 0.11,t=2.703) and serum MTL level (358.5 ± 81.3 pg/mlvs.422.8 ± 86.9 pg/ml,t=3.460) in the treatment group were lower than those in the control group (P<0.01);the serum SS level (87.5 ± 18.7 pg/mlvs.73.8 ± 17.9 pg/ml,t=3.389) in the treatment group was higher than that in the control group(P<0.01).ConclusionsTraditional Chinese medicineKuiyu decoction combined with quadruple therapy for the patients with PU can promote SS secretion through decreasing MTL, so it can improve the clinical effect.

Objective:To explore the efficacy of precise and empirical bismuth-containing quadruple therapy guided by clarithromycin sensitivity testing in the first eradication of Helicobacter pylori ( H. pylori) in Ningxia. Methods:From August 12, 2022 to March 22, 2023, 600 patients diagnosed as H. pylori-positive by 14C-urea breath test ( 14C-UBT) for the first time in People′s Hospital of Ningxia Hui Autonomous Region, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region, Zhongwei People′s Hospital, Yanchi County People′s Hospital, and Pingluo People′s Hospital were selected, and divided into empirical treatment group (hereinafter referred to as the empirical group), genetic testing group (hereinafter referred to as the genetic group), and drug sensitivity testing group (hereinafter referred to as the drug sensitivity group) by using random number table with 200 patients in each group. The empirical group did not undergo drug sensitivity testing and genetic testing, while the genetic and drug sensitivity groups were confirmed to be sensitive to clarithromycin through genetic testing and drug sensitivity testing, and the patients with drug-resistant were excluded, respectively. All the patients of the 3 groups received the same clarithromycin bismuth-containing quadruple therapy. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed to compare the eradication rates of H. pylori among 3 groups. Cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER) were used for cost-effectiveness and sensitivity analysis based on the ITT. Chi-square test was used for statistical analysis. Results:There were 200, 126, and 168 patients included in the empirical group, genetic group, and drug sensitivity group in ITT analysis, and 190, 123, and 164 patients were enrolled in the 3 groups in PP analysis, respectively. The results of ITT analysis showed that the eradication rates of H. pylori in the empirical group, genetic group, and drug sensitivity group were 80.5% (161/200), 94.4% (119/126), and 95.2% (160/168), respectively. The results of PP analysis indicated that the eradication rates of H. pylori in the 3 groups were 84.7% (161/190), 96.7% (119/123), and 97.6% (160/164), respectively, and the differences were statistically significant ( χ2=25.39 and 24.93, both P<0.001). The H. pylori eradication rates of genetic group and drug sensitivity group were both higher than that of empirical group in ITT and PP analysis( χ2=12.40, 17.80, 11.42, and 17.13; all P<0.001). The cost-effectiveness analysis showed that the direct treatment cost of the empirical group, genetic group, and drug sensitivity group was 400.8, 729.2, and 779.2 yuan, respectively, and the CER was 4.98, 7.72, and 8.18 yuan/%, respectively. Compared to the empirical group, the ICER of the genetic group and drug sensitivity group was 23.6 and 25.7 yuan/%, respectively. The sensitivity analysis demonstrated that, when the cost of genetic testing reduced or increased by 20%, the ICER of the genetic group compared to the empirical group was 21.8 or 25.5 yuan/%, respectively. When the cost of drug sensitivity testing reduced or increased by 20%, the ICER of the drug sensitivity group compared to the empirical group was 23.3 or 28.2 yuan/%. When the cost of gastroscopy reduced or increased by 20%, the ICER of the genetic group compared to the empirical group was 20.8 or 26.5 yuan/%, and the ICER of the drug sensitivity group compared to the empirical group was 23.0 or 28.4 yuan/%, respectively. Conclusion:In Ningxia, if the clarithromycin bismuth-containing quadruple regimen is applied as the first H. pylori eradication regimen, in order to achieve the clinical eradication efficacy of H. pylori, and the patients can accept an additional payment of 23.6 or 25.7 yuan for each 1% increasing in the H. pylori eradication rate, then the precision treatment after clarithromycin resistance test is recommended.