研究目的
幽門螺旋桿菌感染可能會造成慢性胃炎、萎縮性胃炎、消化性潰瘍，甚至是胃癌。除菌治療可以使胃炎的黏膜癒合，預防消化性潰瘍復發，降低胃癌的發生率。健保對於消化性潰瘍合併幽門螺旋桿菌感染的病人，有給付除菌治療，但是對於胃炎合併幽門螺旋桿菌感染的病人，並沒有給付除菌治療。且目前並沒有這類病人接受除菌治療的醫療耗用分析報告。本研究的目的在探討幽門螺旋桿菌性胃炎病人，接受殺菌治療與否，是否會影響醫療資源耗用。
研究方法
本研究為回溯性研究，以南部某地區醫院接受上消化道內視鏡檢查的個案為主要的研究對象，以胃鏡報告為胃炎且快速尿素脢試驗陽性的病人為樣本，針對這些個案的病歷資料進行分析，紀錄病人接受殺菌治療與否，確診前一年與後一年的門診次數，胃藥花費，接受胃鏡檢查次數。最後進行統計分析。
結果
幽門螺旋桿菌性胃炎的病人接受除菌治療後，在門診次數及胃藥花費皆明顯的降低，接受胃鏡檢查次數則沒有差異。但若將除菌費用納入統計，治療前後的胃藥花費則沒有顯著差異。至於沒有接受除菌治療的病人，比較其治療前及治療後的門診次數、胃藥花費及接受胃鏡次數都沒有顯著差異。
結論
幽門螺旋桿菌性胃炎病人接受除菌治療後可大幅減少就診次數，隨之而來的是減少醫療資源耗用，包括病人掛號費及部分負擔費用，及全民健康保險署在醫師診察費及藥事服務費上的節省，達到雙贏的局面。假如全民健康保險署將幽門螺旋桿菌性胃炎的除菌治療納入保險給付，並不會造成藥物費用支出的上升。

Objective
Helicobacter pylori (HP) may cause chronic gastritis, atrophic gastritis, peptic ulcer disease (PUD), even gastric cancer. Eradication therapy can not only heal the injured mucosa, but also prevent PUD relapse and reduce the risk of gastric cancer. National Health Insurance paid for eradication therapy of PUD with HP infection, but not the gastritis patients. So far we don’t have available report regarding health resource utility of such patients who receive eradication therapy. The purpose of this study is to figure out the influence of health resource utility of the HP gastritis patients who receive eradication therapy or not.
Method
This is a retrospective study. We enrolled the patients who receive upper gastrointestinal endoscopy (PES) which showed gastritis and rapid urease testing positive in a district hospital. We collected these patient’s medical data, whether receiving eradication therapy, or the frequency of outpatient access and PES, payments for digestant one year before and after the diagnosis made, then go to the statistic analysis.
Result
After the HP gastritis patients receiving eradication therapy, the frequency of outpatient access and payment of digestant all decreased, while the frequency of PES is the same. If we enroll the fee for eradication therapy, the payment before and after treatment is of no difference. By the way, the patients who did not receive eradication therapy, all items of health resource utility is off no difference before and after follow up.
Conclusion
HP gastritis patients who receiving eradication therapy will reduce the frequency of outpatient access, following decreasing of health resource utility, including fee for registration and co-payments of the patients, and fee for physician visit and drug prescription of National Health Insurance. If the National Health Insurance Administration pay for eradication therapy of HP gastritis patients, it wouldn’t increase the expenditure of the drugs at all.

論文審定書……………………………………………………………..………………..i
中文摘要……………………………………………………….……………………......ii
英文摘要……………………………………..………………………………...……….iii
目錄………………………………………………………………………………..........iv
圖次與表次……………………………………………………………………….......…v
第一章 緒論…………………………..…………………………………………….......1
第一節 研究背景與動機………………………………………………………….1
第二節 研究目的………………………………………………………………….1
第三節 預期貢獻………………………………………………………………….2
第二章 文獻探討……………………………………………………………………….3
第一節 幽門螺旋桿菌的特徵與流行病學……………………………………….3
第二節 幽門螺旋桿菌感染與胃炎…………………………………………..…...5
第三節 幽門螺旋桿菌感染的診斷與除菌治療………………………………….6
第四節 除菌治療對幽門螺旋桿菌性胃炎的影響……………………………...10
第三章 研究方法……………………………………………………………………...13
第一節 研究架構………………………………………………………………...13
第二節 研究假設………………………………………………………………...13
第三節 研究樣本與資料來源…………………………………………………...14
第四節 研究資料蒐集程序與變項操作型定義………………………………...15
第五節 統計分析方法……………………………………………………….......17
第四章 研究結果…………………………………………………………………...…18
第一節 研究個案基本資料…………………………………………………...…18
第二節 推論性統計分析……………………………………………………...…19
第五章 討論與建議………………………………………………………………...…21
第一節 研究討論……………………………………………………………...…21
第二節 研究限制……………………………………………………………...…22
第三節 結論與建議…………………………………………………………...…23
參考文獻…………………………………………………………………….……...….25
附錄…………………………………………………………………………………….30

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