A. Ferit ERDOĞAN, Kutlu ABACI, Ender SERİN, Birol ÖZER, M. Okan İÇER

Birinci tercih Helikobakter pilori eradikasyon tedavileri alarm mı veriyor?

Amaç: Helikobakter pilori pozitif nonülser dispepsili hastalarda birinci tercih dört farklı eradikasyon tedavi protokolünün etkinliğinin değerlendirilmesi Gereç ve Yöntem : Gastroenteroloji polikliniğinde endoskopi ile Helikobakter pilori (+) nonülser dispepsi tanısı konan, daha önce eradikasyon tedavisi almamış hastaların dosya bilgileri retrospektif olarak incelendi. 14 günlük eradikasyon tedavisi verilen ve tedavinin bitiminden 4-6 hafta sonra 14C üre nefes testi kontrolü yapılan 248 hastanın dosya bilgisi kaydedildi. Birinci tercih eradikasyon tedavi protokolleri dört gruba ayrıldı. Bunlar; Grup LAK: Lansoprazol 2x30 mg, amoksisilin 2x1000 mg, klaritromisin 2x500 mg Grup LAKB: Lansoprazol 2x30 mg, amoksisilin 2x1000 mg, klaritromisin 2x500 mg, bizmuth subsitrat 4x300 mg Grup PLA: Proton pompa inhibitörü (standart doz) 2x1, levofloksasin 1x500 mg, amoksisilin 2x1000 mg Grup PBTM: Proton pompa inhibitörü (standart doz) 2x1, bizmuth subsitrat 4x300 mg, tetrasiklin 4x500 mg, metronidazol 3x500 mg Bulgular: Grup LAK'da hasta sayısı: 114 ve eradikasyon oranı: %52.6, Grup LAKB'de hasta sayısı: 62 ve eradikasyon oranı: %59.7, Grup PLA'da hasta sayısı: 43 ve eradikasyon oranı: %60.5, Grup PBTM'de hasta sayısı: 29 ve eradikasyon oranı: %72.4 bulundu. Gruplar arasında eradikasyon başarısı açısından istatistiksel olarak anlamlı fark bulunmadı (p=0,261). Sonuç: Antibiyotiklere karşı Helikobakter pilori direnci ciddi bir problem olarak karşımıza çıkmaktadır. Helikobakter pilori tedavilerinin tekrar gözden geçirilmesi ve bu alanda yeni araştırmalara ihtiyaç vardır.

Anahtar Kelimeler:

Helikobakter pilori, eradikasyon tedavisi, klaritromisin, amoksisilin, levofloksasin, metronidazol, tetrasiklin, bizmuth subsitrat

Are first-line Helicobacter pylori eradication therapies alarming?

Background and Aims: We aimed to assess the efficacy of four different eradication therapies (first-line) in non-ulcer dyspeptic patients in a gastroenterology polyclinic. Materials and Methods: The file information of 248 patients was examined retrospectively. These patients had been diagnosed as non-ulcer dyspepsia via endoscopy. They tested positive for Helicobacter pylori and received eradication therapy for two weeks. Subsequently, they were monitored using the C14 urea breath test after 4-6 weeks. Four first-line eradication therapy regimes were used as follows: Group LAC (n: 114): Lansoprazole 2x30 mg, amoxicillin 2x1000 mg, clarithromycin 2x500 mg; Group LACB (n: 62): Lansoprazole 2x30 mg, amoxicillin 2x1000 mg, clarithromycin 2x500 mg, bismuth subcitrate 4x300 mg; Group PLA (n: 43): proton pump inhibitor (PPI) (standard dose) 2x1, levofloxacin 1x500 mg, amoxicillin 2x1000 mg; Group PBTM (n: 29): PPI (standard dose) 2x1, bismuth subcitrate 4x300 mg, tetracycline 4x500 mg, metronidazole 3?500 mg. Results: The eradication rates were as follows: Group LAC 52.6%, Group LACB 59.7%, Group PLA 60.5%, and Group PBTM 72.4%. The difference in eradication rates between groups was not statistically significant (p=0.261). Conclusions: The resistance of H. pylori to antibiotics is a significant problem. Current H. pylori therapies should be revised and new studies should be conducted.

Keywords:

Helicobacter pylori, eradication therapy, clarithromycin, amoxicillin, levofloxacin, metronidazole, tetracycline, bismuth subcitrate,

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