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материалы выездного пленума ногр | materials of the interregional scientific and practical conference
ЭРАДИКАЦИЯ HELICOBACTER PYLORI У ПАЦИЕНТОВ ДУОДЕНАЛЬНОЙ ЯЗВОЙ. ПОБОЧНЫЕ ЭФФЕКТЫ СТАНДАРТНОЙ ТРОЙНОЙ ТЕРАПИИ
Рустамов М. Н., Лазебник Л. Б.
УО «Белорусский государственный медицинский университет», Минск, Республика Беларусь Московский государственный медико-стоматологический университет, Москва, Россия
ERADICATION OF HELICOBACTER PYLORI IN PATIENTS WITH DUODENAL ULCER. SIDE EFFECTS OF THE STANDARD TRIPLE THERAPY
Rustamov M. N., Lazebnik L. B.
Belarusian State Medical University, Minsk, Belarus
Moscow State 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.
Rustamov Mirzabek N. Рустамов Мирзабек Н. E-mail:
dr.rustamov@mail.ru
PURPOSE: To investigate the efficacy and drug-related side effects of a regimen that included proton pump inhibitors, clarithromycin and amoxicillin in patients with Helicobacter pylori — positive duodenal ulcer.
MATERIAL AND METHODS. This study included 50 Helicobacter pylori-positive patients with duodenal ulcer. Helicobacter pylori infection was confirmed by a histological examination of samples obtained from the antrum and corpus of stomach during endoscopy. The eradication therapy consisted of 10-days twice daily oral administration of proton pump inhibitors in standard dose, amoxicillin 1000 mg, clarithromycin 500 mg, then 20-days twice daily proton pump inhibitors. Therapeutic success was confirmed by a negative histological examination, performed 4-12 weeks after treatment. FINDINGS. Before the treatment 82 % of patients had pain syndrome and 70 % — dyspeptic complaints. During the treatment in 50 % of patients increased the frequency of dyspeptic complaints and in 42 % of them such complaints appeared for the first time and continued during 1,5 months more after treatment. The eradication rate was 70 %. Healing of duodenal ulcer was noted in 82 % cases. The level of basal pH was significantly (p <0,001) increased in the corpus of stomach from 1,39 ± 0,41 to 1,83 ± 0,31, in antrum 1,97 ± 0,29 to 2,52 ± 0.34 and in the duodenum from 4,09 ± 0,59 to 5,14 ± 0,95. After treatment significantly increased the levels of alanine transaminase from 36,78 ± 0,78 to 42,52 ± 1,22 IU/L, asparagines transaminase from 36,36 ± 0,79 to 40, 76 ± 1,27 IU/L, alkaline phosphatase from 96,90 ± 1,37 to 101,24 ± 2,17 IU/L, and triglycerides from 1,57 ± 0,07 to 1,72 ± 0.10 mmol/l, which must be noted as drug-related side effects of clarithromycin-based triple therapy. Increase of the levels of bilirubin from 19,41 ± 0,24 to 20,88 ± 0,34 mmol/l and cholesterol from 5,17 ± 0,16 to 5,56 ± 0,19 mmol/l were not statistically significant.
Thus the standard triple eradication therapy based on clarithromycin leads to healing of duodenal ulcer in 82 % of patients, initially reduces the acidity in the stomach, but does not reach the minimum eradication rate, causes a number of serious side effects.
CONCLUSIONS. Standard triple eradication therapy based on clarithromycin has low efficacy (70 %), does not reach the success rate, causes or increases the frequency of dyspeptic complaints associated with the use of antibiotics, in 42 % of patients such complaints appeared for the first time and continued during 1,5 months more after treatment, has a hepa-totoxic effect. Triple eradication therapy based on clarithromycin must not be recommended in patients with diseases of the hepatobiliary system and the metabolic syndrome.
Экспериментальная и клиническая гастроэнтерология 2014; 111 (11):107 Eksperimental'naya i Klinicheskaya Gastroenterologiya 2014; 111 (11):107
