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экспериментальная и клиническая гастроэнтерология | выпуск 111 | № 11 2014
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РАЗРАБОТКА РЕЖИМОВ ЭРАДИКАЦИИ HELICOBACTER PYLORI У ПАЦИЕНТОВ ДУОДЕНАЛЬНОЙ ЯЗВОЙ
Рустамов М. Н., Лазебник Л. Б.
УО «Белорусский государственный медицинский университет», Минск, Республика Беларусь Московский государственный медико-стоматологический университет, Москва, Россия
ELABORATION OF THE HELICOBACTER PYLORI ERADICATION REGIMENS WITH DUODENAL ULCER
Rustamov M. N., Lazebnik L. B.
Belarusian State Medical University, Minsk, Belarus MoscowState University of Medicine and Dentistry, Moscow, Russia
Рустамов Мирзабек Надирович, кандидат медицинских наук, доцент 3-й кафедры внутренних болезней Учреждения образования «Белорусский государственный медицинский университет», Минск, Беларусь; вице-президент Научного общества гастроэнтерологов России по международному сотрудничеству, член редакционной коллегии журнала «Экспериментальная и клиническая гастроэнтерология», Москва, Россия.
Лазебник Леонид Борисович, доктор медицинских наук, профессор, заведующий кафедрой терапии, гериатрии и профилактики Московского государственного медико-стоматологического университета имени А. И. Евдокимова, президент Научного общества гастроэнтерологов России, главный редактор журнала «Экспериментальная и клиническая гастроэнтерология», Москва, Россия.
PURPOSE: To investigate the effects of proton pump inhibitors (PPIs), probiotics and different mineral water in patients with Helicobacter pylori-positive duodenal ulcer and to elaborate the optimal Helicobacter pylori eradication regimens in such patients. MATERIAL AND METHODS. In this study 250 Helicobacter pylori -positive patients with duodenal ulcer were randomized into 5 groups, 50 patients in each. Helicobacter pylori infection was confirmed by a histological examination of samples obtained from the antrum and corpus of stomach during endoscopy. Intragastric and intraduodenal pH-metry, blood analyses also were performed. The following eradication regimens were recommended: Group I: 10-days twice daily oral administration of PPIs in standard dose, amoxicillin (AMO) 1000 mg, clarithromycin (CLA) 500 mg, then 20-days twice daily PPIs; Group II: the same treatment plus once daily oral administration of probiotics, containing 3,025 billion alive lyophilized Lactobacillus bulgaricus DDS-14, Lactobacillus rhamnosus, Lactobacillus acidophilus DDS-1 and Bifidobacterium bifidum (probiotics) during one month; Group III: PPIs and probiotics once daily and alkaline hydrocarbonate-chloride sodium mineral water Essentuki-4 200 ml trice daily during one month; Group IV: PPIs and probiotics once daily and chloride sodium mineral water Minsk-4 200 ml trice daily during one month; Group V: probiotics and PPIs once daily during one month. Therapeutic success was confirmed by a negative histological examination, performed in 4-12 weeks after therapy. FINDINGS. 82 % of patients had pain syndrome and 70 % — dyspeptic complaints. In 50 % of patients of group I increased the frequency of dyspeptic complaints and in 42 % of them such complaints appeared for the first time. In Group II dyspeptic complaints disappeared in 74 %, and decreased in 20 %. Disappearance of dyspeptic complaints was 78 %, 76 %, 74 % in III, IV and V groups respectively. Decrease of dyspeptic complaints was 20 %, 22 %, 24 % in III, IV and V groups respectively. The eradication rate of Helicobacter pylori were 70 %, 82 %, 80 %, 78 % and 68 % in I, II, III, IV and V groups, respectively. Healing of duodenal ulcer was noted in 82 %, 84 %, 86 %, 84 % and 78 % of cases, in I, II, III, IV and V groups, respectively. Intragastric and intraduodenal pH was significantly increased in all groups, especially in III. After treatment in group I significantly increased alanine transaminase, asparagines transaminase, alkaline phosphatase, and triglycerides, which must be noted as drug-related side effects of clarithromycin-based triple therapy. In group II such changes did not happen. In III IV and V groups significantly decreased alanine transaminase, asparagines transaminase, blood bilirubin, alkaline phosphatase, cholesterol and triglycerides.
Thus, several aspects of Helicobacter pylori eradication have been analyzed, regimen containing PPI, mineral water and probiotics was superior to triple therapy based on clarithromycin. The combination of PPI, probiotics and alkaline hydrocarbonate-chloride sodium mineral water is more preferable regimen among above mentioned ones. CONCLUSIONS. Standard clarithromycin-based triple Helicobacter pylori eradication therapy causes or increases the frequency of dyspeptic complaints related with antibiotics has low efficacy and hepatotoxic effect. Adding probiotics to standard triple therapy improves compliance and efficacy of Helicobacter pylori eradication, however, the treatment becomes more expensive. The combined use of PPIs, probiotics and alkaline hydrocarbonate-chloride sodium mineral water is a highly-effective and low-cost alternative therapy in patients with Helicobacter pylori-associated duodenal ulcer. This regimen may especially be helpful in patients with a history of gastrointestinal adverse effects with antibiotics, comorbid patients with diseases of the hepatobiliary system and the metabolic syndrome. Экспериментальная и клиническая гастроэнтерология 2014; 111 (11):106 Eksperimental'naya i Klinicheskaya Gastroenterologiya 2014; 111 (11):106
IN PATIENTS
Rustamov Mirzabek N. Рустамов Мирзабек Н. E-mail:
