Helicobacter pylori Eradikasyonunda Kullanılan Kombine Tedavilerin Etkinliklerinin Karşılaştırılması

Year 2023, Volume: 13 Issue: 1, 119 - 122, 20.01.2023

Recep Çağlar

https://doi.org/10.33631/sabd.1210607

Cited By: 1

Abstract

Amaç: Helicobacter pylori; ülser, gastrik atrofi, intestinal metaplazi ve gastrik adenokanserlere neden olabilmektedir. Bu çalışmada H. pylori eradikasyonunda kullanılan kombine tedaviler ve bu tedavilere bizmut subsitrat (BS) eklenerek H. pylori eradikasyon oranlarının karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Ocak 2019- Ocak 2022 tarihleri arasında Mersin Şehir Eğitim Araştırma Hastanesi Gastroenterolojik Cerrahi Kliniğinde endoskopik biyopside H. pylori tespit edilen ve eradikasyonda 14 günlük; 1- Klasik üçlü tedavi, 2- Klasik üçlü tedavi + BS, 3- proton pompa inhibitörleri (PPI) + amoksisilin-klavulanik asit + metranidazol ve 4- PPI + amoksisilin-klavulanik asit + metranidazol + BS kombine tedavileri kullanan 190 hasta retrospektif olarak dört gruba ayrılarak çalışmaya dahil edildi.
Bulgular: Çalışmaya alınan 190 hastanın 85’i (%44,70) erkek, 105’i (%55,30) kadın ve yaş ortalaması 41,90 idi. H. pylori eradikasyonu için klasik üçlü tedavi kullanan 42 (%22,10) hastanın 27’si (%64,28), klasik üçlü tedavi + BS kullanan 44 (%23,20) hastanın 33’ü (%75), PPI + amoksisilin-klavulanik asit + metranidazol kullanan 43 (%22,60) hastanın 35’i (%81,39) ve PPI + amoksisilin-klavulanik asit + metranidazol + BS tedavi kullanan 61 (%32,10) hastanın 54’ünde (%88,52) H. pylori eradikasyonunun başarılı olduğu görülmüştür (p=0,027). Her dört grupta da H. pylori eradikasyon başarısı istatistiksel olarak anlamlı bulunmuştur (p<0,05).
Sonuç: H. pylori eradikasyonunda kombine tedavilere BS eklenmesi tedavi başarı oranlarını arttırmıştır. H. pylori eradikasyonunun başarılı şekilde yapılabilmesi, seçilen tedavi rejimi, hastanın uyumu ve antibiyotik direncine bağlıdır.

Keywords

Helicobacter pylori;, eradikasyon, bizmut subsitrat, proton pompa inhibitörleri

Supporting Institution

yoktur

Comparison of the Efficiency of Combined Treatments Used in the Eradication of Helicobacter Pylori

Abstract

Aim: Helicobacter pylori, can cause ulcer, gastric atrophy, intestinal metaplasia, and gastric adenocarcinoma. In this study, it was aimed to compare the H. pylori eradication rates obtained with the combined treatments used in H. pylori eradication and the addition of bismuth subcitrate (BS) to these treatments.
Material and Methods: 190 patients who were found to have H. pylori in endoscopic biopsy in the gastroenterological surgery clinic of Mersin City Training and Research Hospital between January 2019 and January 2022 and used 14-day 1- classical triple therapy, 2- classical triple therapy + BS, 3- proton pump inhibitors (PPI) + amoxicillin-clavulanic acid + metranidazol, and 4- combination of PPI + amoxicillin-clavulanic acid + metranidazol + BS for 14 days for HP eradication, were retrospectively divided into 4 groups and included in the study.
Results: Of 190 patients enrolled in the study, 85 (44.70%) were male and 105 (55.30%) were female; the mean age of the study population was 41.9 years. H. pylori eradication was successful in 33 (75%) of 44 (23.20%) patients who used the classical triple therapy; 33 (75%) of 44 (23.20%) patients who used the classical triple therapy + BS; 35 (81.39%) of 42 (22.60%) patients who used PPI + amoxicillin-clavulanic acid + metranidazol; and 54 (88.52%) of 61 (32.10%) patients who used PPI + amoxicillin-clavulonic acid + metranidazol + BS (p=0.027). H. pylori eradication success was statistically significant in each of the four groups (p<0.05).
Conclusion: Adding BS to combination therapies increased the success rates in H. pylori eradication. Successful H. pylori eradication depends on the treatment regimen chosen, patient compliance, and antibiotic resistance.

Keywords

Helicobacter pylori, eradication, bismuth subcitrat, proton pump inhibitors

References

• Mitchell H, Katelaris P. Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection. Med J Aust. 2016; 204: 376-80.
• Kavitt RT, Cifu AS. Management of Helicobacter pylori infection. JAMA. 2017; 317: 1572-3.
• Ferwana, M, Abdulmajeed I, Alhajiahmed A, Madani W, Firwana B, Hasan R, et al. Accuracy of urea breath test in Helicobacter pylori infection: meta-analysis. World journal of gastroenterology: WJG. 2015; 21(4): 1305.
• Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017; 112(2): 212-38.
• Hirschl AM, Makristathis A. Methods to detect Helicobacter pylori from: Culture to molecular biology. Helicobacter. 2007; 12 Suppl 2: 6-11.
• Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. European Helicobacter study group. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut. 2012; 61(5): 646-64.
• Malfertheiner P, Megraud F, O'morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut. 2017; 66(1): 6-30.
• Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther. 2007; 26: 343-57.
• Altintas E, Sezgin O, Ulu O, Aydin O, Camdeviren H. Maastricht II treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori. World J Gastroenterol. 2004; 10: 1656-8.
• Güliter S, Keleş H, Özkurt ZN, Cengiz DU, Kolukisa E. Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of helicobacter pylori? Turk J Gastroenterol. 2005; 16(1): 29-33.
• Çekin AH, Tükel NT, Çekin Y, Sezer C, Taşdemir E. Klasik üçlü tedaviye bizmut eklenmesinin Helicobacter pylori eradikasyonuna etkisi. Dicle Tıp Derg. 2012; 39(1): 54-7.
• Uyanıkoğlu A, Coşkun M, Binici DN. Helikobakter pilori eradikasyonunda klasik 3’lü tedavi Doğu Anadolu bölgesinde halen etkilidir. Akademik Gastroenteroloji Derg. 2012; 11 (1): 24-8.
• Uyanıkoğlu A, Ağan Z, Yenice N. Eradikasyon öncesi test gerekli mi? 2011-2016 şanlıurfa yöresi Helikobakter pilori sıklığı. 33. Ulusal Gastroenteroloji Haftası, 2016; 180.
• Demir AK, Kefeli A, Dilaveroğlu H. Helicobacter pylori eradikasyonunda klasik 3'lü tedavinin etkinliği. Genel Tip Derg. 2020; 30(1): 32-5.
• Schindler R, Heemann U, Haug U, Stoelck B, Karatas A, Pohle C, et al. Bismuth coating of non-tunneled haemodialysis catheters reduces bacterial colonization: a randomized controlled trial. Nephrology Dialysis Transplantation. 2010; 25(8): 2651-6.
• Luther J, Higgins PD, Schoenfeld PS, Moayyedi P, Vakil N, Chey WD. Empiric quadruple vs. triple therapy for primary treatment of Helicobacter pylori infection: Systematic review and meta-analysis of efficacy and tolerability. Official journal of the American College of Gastroenterology. 2010; 105(1): 65-73.
• Sun Q, Liang X, Zheng Q, Liu W, Xiao S, Gu W, et al. High efficacy of 14-day triple therapy-based, bismuth-containing quadruple therapy for initial Helicobacter pylori eradication. Helicobacter. 2010; 15(3): 233-8.
• Lee BH, Kim N, Hwang TJ, Lee SH, Park YS, Hwang JH,et al. Bismuth-containing quadruple therapy as second-line treatment for Helicobacter pylori infection: effect of treatment duration and antibiotic resistance on the eradication rate in Korea. Helicobacter. 2010; 15(1): 38-45.
• Qua CS, Manikam J, Goh KL. Efficacy of 1-week proton pump inhibitor triple therapy as first-line Helicobacter pylori eradication regime in Asian patients: is it still effective 10 years on? J Dig Dis. 2010; 11(4): 244–8.
• Sasaki M, Ogasawara N, Utsumi K, Kawamura N, Kamiya T, Kataoka H, et al. Changes in 12-year first-line eradication rate of Helicobacter pylori based on triple therapy with proton pump inhibitor, amoxicillin and clarithromycin. Journal of clinical biochemistry and nutrition. 2010; 47(1): 53-8.
• Graham DY, Dore MP, Lu H. Understanding treatment guidelines with bismuth and non-bismuth quadruple radication therapies. Expert review of anti-infective therapy. 2018; 16(9): 679-87.
• Ko SW, Kim YJ, Chung WC, Lee SJ. Bismuth supplements as the first-line regimen for Helicobacter pylori eradication therapy: Systemic review and meta-analysis. Helicobacter. 2019; 24(2): e12565.