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материалы выездного пленума ногр | materials of the interregional scientific and practical conference
нефармакологические факторы в лечении пациентов helicobacter pylori-ассоциированной дуоденальной язвой
Рустамов М. Н., Лазебник Л. Б.
УО «Белорусский государственный медицинский университет», Минск, Республика Беларусь Московский государственный медико-стоматологический университет, Москва, Россия
NONPHARMACOLOGIC FACTORS IN THE TREATMENT OF PATIENTS WITH HELICOBACTER PYLORI-ASSOCIATED DUODENAL ULCER
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 effect of probiotics and mineral water in the treatment of patients with Helicobacter pylori-positive duodenal ulcer.
MATERIAL AND METHODS. In this study 200 Helicobacter pylori-positive patients with duodenal ulcer were randomized into 4 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 1000 mg, clarithromycin 500 mg, then 20-days twice daily PPIs 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 II: PPIs and probiotics once daily and alkaline hydrocarbonate-chloride sodium mineral water Essentuki-4 200 ml trice daily during one month; Group III: PPIs and probiotics once daily and chloride sodium mineral water Minsk-4 200 ml trice daily during one month; Group IV: 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. In Group I dyspeptic complaints disappeared in 74 %, and decreased in 20 %. Disappearance of dyspeptic complaints was 78 %, 76 % and 74 % in II, III and IV groups respectively. Decrease of dyspeptic complaints was 20 %, 22 % and 24 % in II, III and IV groups respectively. The eradication rates were 82 %, 80 %, 78 % and 68 % in I, II, III and IV groups, respectively. Healing of duodenal ulcer was noted in 84 %, 86 %, 84 % and 78 % of cases, in I, II, III and IV groups, respectively. Intragastric and intraduodenal pH was significantly increased in all groups, especially in II. After treatment in II, III and IV groups significantly decreased alanine transaminase, asparagines transaminase, blood biliru-bin, alkaline phosphatase, cholesterol and triglycerides.
Thus several aspects of Helicobacter pylori eradication have been analyzed. The combined use of PPIs, probiotics and alkaline hydrocarbonate-chloride sodium mineral water is more preferable regimen among above mentioned ones.
CONCLUSIONS. Adding probiotics to standard triple therapy improves compliance and efficacy of Helicobacter pylori eradication. Probiotics may be beneficial in reducing adverse effects and increasing tolerability of Helicobacter pylori eradication regimens. 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): 105 Eksperimental'naya i Klinicheskaya Gastroenterologiya 2014; 111 (11):105
