Helicobacter pilori eradikasyonu için verilen iki farklı ardışık tedavinin eradikasyon oranlarının karşılaştırılması

Year 2019, Volume: 52 Issue: 2, 138 - 144, 31.07.2019

Aysun Gönderen , Kamil Gönderen , Mehmet Yıldız

Abstract

Amaç: Helicobacter Pylori (HP) peptik
ülser, gastrik kanser ile ilişkisi iyi bilinen gram (-) mikroaerofilik
bakteridir. Bundan dolayı infekte hastalarda HP eradikasyon tedavisi
önerilmektedir. Bu çalışmada da iki farklı eradikasyon tedavisinin etkinliğinin
karşılaştırılması amaçlandı. Materyal ve
Metod: Şubat 2009 – Mayıs 2010 tarihleri arasında Dışkapı Yıldırım Beyazıt
Eğitim Araştırma Hastanesi Gastroenteroloji ve Dahiliye polikliniklerine reflü,
bulantı-kusma ve gastrik ağrı şikayetleri ile başvurup endoskopi yapılan ve
endoskopik olarak gastrik ülser, duodenal ülser veya gastrit tanısı konulan,
immüno-histokimyal olarak HP pozitif saptanan ve daha önce eradikasyon tedavisi
almamış 98 hasta çalışmaya dahil edildi. Hastalar randomize olarak iki gruba
ayrıldı ve ilk gruba bir hafta omeprazol ve amoksisilin ikinci hafta omeprazol
ve metronidazol verildi. Diğer gruba ilk 7 gün omeprazol ve amoksisilin ikinci
hafta omeprazol, metronidazol ve tetrasiklin verildi. Tedavi bitiminden sonra
eradikasyon oranını belirlemek için kontrol endoskopileri yapılarak biyopsileri
alındı. Bulgular: Çalışmaya alınan
hastaların 47’si (%56) kadın ve 46’sı (%54,7) 40 yaş altındaydı. Birinci rejim
tedaviyi alan hastalarda tedavi başarısı tüm hasta grubuna bakıldığında %32.4,
ikinci rejim tedaviyi alan hastalarda tedavi başarısı %59.6 olarak saptandı ve
iki grup tedavi rejimi arasında istatistiksel olarak anlamlı fark vardı. Sonuç: Tetrasiklin içeren tedavi
grubunda eradikasyon başarı oranı sayısal olarak daha yüksek ve istatistiksel
olarak anlamlı olmakla beraber eradikasyon oranları genel literatüre göre %80
altında ve düşük bulunmuştur. Bu sonuç başta antibiyotik direnci olmak üzere
tedavinin başarısını azaltabilecek nedenlerin ortaya konması gerektiğini ve HP
eradikasyonunda alternatif tedavilere ihtiyaç olduğunu göstermektedir.

Keywords

Helikobakter pilori, peptik ülser, tedavi

Comparison ratios of two different sequential treatments for Helicobacter pylori eradication

Abstract

Purpose: Helicobacter Pylori
(HP) is a gram (-) microaerophilic bacterium that related with peptic ulcer and
gastric cancer. The aim of this study was to compare the efficacy of the two
different eradication therapies. Material
and Methods: 98 patients were included in the study who was admitted to
Gastroenterology and Internal Medicine outpatient clinics of Dışkapı Yıldırım
Beyazıt Training and Research Hospital with complaints of reflux, nausea,
vomiting or gastric pain and had detected HP positive immunohistochemically also
had not received any eradication treatment before. The patients were randomly
divided into two groups.  The first group
was treated with omeprazole and amoxicillin in the first week then with
omeprazole and metronidazole in the second week. The second group was treated
with omeprazole and amoxicillin in the first week and then with omeprazole,
metronidazole and tetracycline in the second week. After the treatment, control
endoscopy was performed and the biopsies were taken to determine the
eradication ratios. Results: The
eradication ratio of treatment in the first group was 32.4% and 59.6% in the
second group. There was a statistically significant difference between the eradication
ratios of the groups (p<0.001). Conclusion:
The eradication ratio was higher in the tetracycline-receiving treatment group
however, the eradication ratios of both groups were found to be lower than the
ratio of 80% that revealed in the literature. Low  eradication ratio of the treatments in this
study may be associated with antibiotic resistance. According to this study’s
results alternative treatments are needed in HP eradication.

Keywords

Helicobacter Pylori, peptic ulcer, treatment

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