幽门螺杆菌感染 - 诊断与治疗 - 妙佑医疗国际

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幽门螺杆菌感染

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诊断

医生可以使用几种检查和程序来确定您是否有幽门螺杆菌感染。检查对于检测幽门螺杆菌很重要，但在治疗后也要进行检查，以确保该细菌已被彻底清除。粪便检测。糞便抗原检测是最常见的幽门螺杆菌糞便检测项目，用于检测粪便中与幽门螺杆菌感染相关的外来蛋白质（抗原）。抗生素和质子泵抑制剂（PPI）及次水杨酸铋等抑酸药物会影响这些检查的准确性。如果您之前确诊感染幽门螺杆菌并接受了治疗，医生通常会在您完成抗生素治疗后至少等待四周再安排您进行糞便检测。如果您在服用 PPI，医生会要求您在检查前一周或两周停用 PPI 药物。这项检查适用于成人和 3 岁以上的儿童。一种名为粪便聚合酶链反应（PCR）的实验室检测可以检测粪便中的幽门螺杆菌感染，以及可能对用于治疗幽门螺杆菌的抗生素产生耐药性的突变。这项检查更昂贵，并非所有医疗中心都有提供。这项检查适用于成人和儿童。呼吸检查。呼吸检查要求吞咽含标记碳分子的药片、液体或布丁。如果您发生幽门螺杆菌感染，溶剂在胃中分解后会释放碳。您的身体吸收碳并在呼气时排出。您往袋子中呼气，然后医生利用特殊装置检测碳分子。与在糞便检测中一样，PPI、次水杨酸铋和抗生素也会影响这项检查的准确性。如果您在服用 PPI，医生会要求您在检查前一周或两周停用 PPI 药物。如果您之前确诊感染幽门螺杆菌并接受了治疗，医生通常会在您完成抗生素治疗后至少等待四周再进行呼吸检查。这项检查适用于成人和儿童。内镜检查。这项检查称为上消化道内镜检查，需要给您用镇静剂。检查期间，医生会沿咽喉和食管向您的胃和十二指肠中插入带有小型摄像头的长软管（内镜）。医生借助这个工具检查上消化道是否有任何异常并提取组织样本（活检）。这些样本用于分析幽门螺杆菌感染。这项检查是为了调查其他疾病引起的症状，例如幽门螺杆菌所致的胃溃疡或胃炎等疾病。根据第一次内镜检查发现的情况，或者如果在进行幽门螺杆菌治疗后症状持续存在，可在治疗后再次进行这项检查。在第二次检查中，可以通过活检来确保幽门螺杆菌已被彻底清除。如果您之前确诊感染幽门螺杆菌并接受了治疗，医生通常会在您完成抗生素治疗后至少等待四周再进行呼吸检查。如果您在服用 PPI，医生会要求您在检查前一周或两周停用 PPI 药物。这项检查比呼吸或粪便检查更具入侵性，因此一般不建议单独用于诊断幽门螺杆菌感染。但它可以用于进行详细检查，以便医生决定使用哪种抗生素来治疗幽门螺杆菌，尤其是在某些抗生素无效或已排除其他消化道疾病的情况下。

Stool tests

Stool antigen test. This is the most common stool test to detect H. pylori. The test looks for proteins (antigens) associated with H. pylori infection in the stool. Stool PCR test. A lab test called a stool polymerase chain reaction (PCR) test can detect H. pylori infection in stool. The test can also identify mutations that may be resistant to antibiotics used to treat H. pylori. However, this test is more expensive than a stool antigen test and may not be available at all medical centers.

Breath test

During a breath test - called a urea breath test - you swallow a pill, liquid or pudding that contains tagged carbon molecules. If you have H. pylori infection, carbon is released when the solution comes in contact with H. pylori in your stomach. Because your body absorbs the carbon, it is released when you breathe out. To measure the release of carbon, you blow into a bag. A special device detects the carbon molecules. This test can be used for adults and for children over 6 years old who are able to cooperate with the test.

Scope test

A health care provider may conduct a scope test, known as an upper endoscopy exam. Your provider may perform this test to investigate symptoms that may be caused by conditions such as a peptic ulcer or gastritis that may be due to H. pylori. For this exam, you'll be given medication to help you relax. During the exam, your health care provider threads a long, flexible tube with a tiny camera (endoscope) attached down your throat and esophagus and into your stomach and the first part of the intestine (duodenum). This instrument allows your provider to view any problems in your upper digestive tract. Your provider may also take tissue samples (biopsy). These samples are examined for H. pylori infection. Because this test is more invasive than a breath or stool test, it's typically done to diagnose other digestive problems along with H. pylori infection. Health care providers may use this test for additional testing and to look for other digestive conditions. They may also use this test to determine exactly which antibiotic may be best to treat H. pylori infection, especially if the first antibiotics tried didn't get rid of the infection. This test may be repeated after treatment, depending on what is found at the first endoscopy or if symptoms continue after H. pylori infection treatment.

Testing considerations

Antibiotics can interfere with the accuracy of testing. In general, retesting is done only after antibiotics have been stopped for four weeks, if possible. Acid-suppressing drugs known as proton pump inhibitors (PPIs) and bismuth subsalicylate (Pepto-Bismol) can also interfere with the accuracy of these tests. It's possible acid-suppressing drugs known as histamine (H-2) blockers may also interfere with the accuracy of these tests. Depending on what medications you're taking, you'll need to stop taking them, if possible, for up to two weeks before the test. Your health care provider will give you specific instructions about your medications. The same tests used for diagnosis can be used to tell if H. pylori infection is gone. If you were previously diagnosed with H. pylori infection, you'll generally wait at least four weeks after you complete your antibiotic treatment to repeat these tests.

治疗

治疗幽门螺杆菌感染时通常会同时使用至少两种不同的抗生素，这有助于防止细菌对某种特定抗生素产生耐药性。为促进胃黏膜愈合，医生还可能会开具或推荐抑酸药。能抑制胃酸分泌的药物包括：质子泵抑制剂 (PPI)。这些药物能阻止胃酸分泌。质子泵抑制剂 (PPI) 包括奥美拉唑 (Prilosec)、埃索美拉唑 (Nexium)、兰索拉唑 (Prevacid) 和泮托拉唑 (Protonix)。组胺（H-2）阻滞剂。这些药物可阻断一种叫做组胺的物质，这种物质会引发胃酸分泌。西咪替丁 (Tagamet HB) 就属于这类药物。次水杨酸铋。这种药物更常以其品牌名 Pepto-Bismol 为人所知，可覆盖溃疡区以防止其与胃酸接触。医生可能会建议您在完成治疗至少四周后进行幽门螺杆菌检测。如果检测显示治疗不成功，您可能需要使用其他抗生素药物组合，再进行一轮治疗。申请 Mayo Clinic 预约

准备您的预约

如果您出现幽门螺杆菌感染并发症的体征或症状，请咨询您的初级保健医生。您的医生可能会检查并治疗您的幽门螺杆菌感染，或将您转诊给治疗消化系统疾病的专家（消化科医生）。由于就诊时间可能很短，而且往往要讨论很多事情，因此最好做好充分准备。以下信息可以帮助您做好就诊准备，并了解医生可能会做些什么。

您能做些什么

约诊时，一定要询问是否需要提前做准备，例如限制饮食。在约诊前，您可能需要列出以下问题的答案：您的症状何时开始？有什么会改善或加剧症状吗？您的父母或兄弟姐妹有过类似问题吗？您经常服用哪些用药或补充剂？您的就诊时间有限。准备好问题清单使您能充分利用就诊时间。如果是幽门螺杆菌感染，要问医生的基本问题包括：幽门螺杆菌感染如何引起我目前的并发症？幽门螺杆菌会造成其他并发症吗？我需要做哪些检查？这些检查需要任何特殊准备吗？有哪些治疗方法？我如何得知治疗见效？您约诊期间可随时提问其他问题。

医生可能做些什么

医生可能会询问一些问题。准备好回答这些问题，可以让您有更多的时间讨论您想解决的其他问题。医生可能会问：您的症状是持续存在还是偶尔出现？您的症状有多严重？您是否在使用非处方镇痛药，例如阿司匹林、布洛芬（Advil、Motrin IB 等）和萘普生钠 (Aleve)？来自妙佑医疗国际员工申请 Mayo Clinic 预约症状与病因医生与科室 May 18, 2021 打印显示参考文献 Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/all-content. Accessed Jan. 9, 2017. Papadakis MA, et al., eds. Gastrointestinal disorders. In: Current Medical Diagnosis & Treatment 2017. 56th ed. New York, N.Y.: The McGraw-Hill Companies; 2017. http://www.accessmedicine.com. Accessed Jan. 9, 2017. Helicobacter pylori infection. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-ulcer-disease/helicobacter-pylori-infection. Accessed May 6, 2021. Helicobacter pylori and cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/h-pylori-fact-sheet. Accessed Jan. 9, 2017. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. American College of Gastroenterology. http://gi.org/guideline/management-of-helicobacter-pylori-infection/. Accessed Jan. 9, 2017. Crowe SE. Bacteriology and epidemiology of Helicobacter pylori infection. http://www.uptodate.com/home. Accessed Jan. 9, 2017. Crowe SE. Indications and diagnostic tests for Helicobacter pylori infection. http://www.uptodate.com/home. Accessed May 6, 2021. AskMayoExpert. Helicobacter pylori (adult). Mayo Clinic; 2020.