Helicobacter pylori eradikasyon tedavisinde lansoprozol, klaritromisin ve amoksisilin ile ranitidin bizmut sitrat, lansoprozol, klaritromisin ve amoksisilin rejimlerinin etkinliğinin karşılaştırılması

Giriş ve amaç: Helicobacter pylori (H. pylori) eradikasyon oranı bölgelere ve tedavi rejimlerine göre farklılıklar göstermektedir. Bu çalışmadaki amacımız farklı tedavi rejimlerinin etkinliğini karşılaştırmaktır. Gereç ve yöntem: Çalışmaya hızlı üreaz testi ve/veya histopatoloji ile H. pylori pozitif olduğu gösterilen dispeptik hastalar alındı. Hastalar iki gruba ayrıldı. Grup A’ya lansoprozol 2x30 mg, klaritromisin 2x500 mg, amoksisilin 2x1000 mg, grup B’ye lansoprozol 2x30 mg, klaritromisin 2x500 mg, amoksisilin 2x1000 mg, ranitidin bismuth sitrat 2x400 mg 14 gün süreyle verildi. Tedavi bitiminden 4 hafta sonra kontrol endoskopi yapılarak histopatolojik olarak H. pylori durumu araştırıldı. Bulgular: Çalışmaya nonülser dispepsisi olan 49 erkek, 86 kadın, toplam 135 hasta alındı. Çalışmaya alınan hastaların endoskopik olarak 56 (%41,5)’sında antral gastrit, 79 (%58,5)’unda pangastrit saptandı. Pangastriti olanları n 51(%64)’inde; antral gastriti olanların 32 (%57)’sinde eradikasyon sağlandı. Eradikasyon oranları grup A ve B’de sırası ile %56, %68 p=0,099 bulundu. Grup A ve B’de yaş ortalaması ve erkek/kadın oranı sırasıyla (41,2±11vs 42,1±12) (25/50 vs 24/36) idi. Grup A’da %58,6 antral gastrit, %41,3 pangastrit, grup B’de %20 antral gastrit, %80 pangastrit vardı. Sonuç: Bismuth içeren tedavi grubunda eradikasyon başarı oranı sayısal olarak daha yüksek olmakla beraber istatistiki fark saptanmamı ş olup eradikasyon oranları genel literatüre göre düşük bulunmuştur.

The comparison of lansoprazole, clarithromycin and amoxicillin with ranitidine bismuth citrate, lansoprazole, clarithromycin and amoxicillin for Helicobacter pylori eradication therapy

Background/aim: The eradication rate of Helicobacter pylori (H. pylori) shows variation in different geographic regions and treatment regimens. We aimed to study the eradication rates of different regimens in our region. Materials and methods: One hundred and thirty-five H. pylori positive patients (49 males, 86 females; mean age: 41,7±12 years) with non-ulcer dyspepsia were included in the study. The patients were divided into two groups according to the treatment regimens. Lansoprozole 30 mg, clarithromycin 500 mg, amoxicilin 1 g were given twice daily for 2 weeks (group A). Patients in group B recevied ranitidine bismuth subcitrate 400 mg, lansoprozole 30 mg, clarithromycin 500 mg, amoxicilin 1 g twice daily for 2 weeks. Two biopsies each before and after treatment were obtained from antrum and corpus, and histopathologically evaluated. Eradication was assumed to be successful if no H. pylori was detected from four biopsy specimens taken after treatment. Results: The overall eradication rate was 61,5%. The rates of eradication were 56%, 68% p=0,099 in groups A and B, respectively. Fifty-six patients (41,5%) were had antral gastritis and 79 (58,5%) patients had pangastritis. Mean ages and male/ female ratio (41,2±11 vs 42,1±12, p=NS) (25/50 vs 24/36, p=NS) in groups A and B, respectively. No correlation between sex and H. pylori eradication was found. Conclusion: The rate of eradication in group B was higher than group A, but not statistically significant. However, our rates of eradication were significantly lower compared to those reported in literature.

Kaynakça

1. Shiotani A, Nurgalivea ZZ, Yamaoka Y, et al. Helicobacter pylori. Med Clin North Am 2000; 84: 1125-36.

2. Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl J Med 1991; 324: 1043-8.

3. Blaser MJ. Helicobacter pylori: Its role in disease. Clin Infect Dis 1992; 15: 386-3.

4. NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in peptic ulcer disease. J Am Med Assoc 1994; 272: 65-9.

5. Lind T, Veldhuyzen van Zanten SJO, Unge P, et al. Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antibiotics: the MACH1 study. Helicobacter 1996; 1: 138- 44.

6. Veldhuyzen Van Zanten SJO, Bradette M, Farley A, et al. The DUMACH study: eradication of Helicobacter pylori and ulcer healing in patients with acute duodenal ulcer using omeprazole based triple therapy. Aliment Pharmacol Ther 1999; 13: 289-95.

7. The European Helicobacter pylori Study Group. Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut 1997; 41: 8-13.

8. Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection the Maastricht 2- 2000 Consensus Report. Aliment Pharmacol Ther 2002; 16: 167-80

9. Özden A. Helicobacter pylori tedavisinde kullanılan ilaçlar. İşte Helicobacter pylori. 114-120.

10. Bölükbaş E, Bölükbaş C, Kılıç H, ve ark. Helicobacter pylori tedavisinde eradikasyon oranlar› ve tedavi süresinin bu oranlara etkisi. Turk J Gastroenterol 2001; 12: suppl 1: P-B/29.

11. Helicobacter pylori eradikasyonunda ranitidin-bizmuth sitrat ve lansoprozol tedavi etkinliklerinin karşılaştrılması. Turk J Gastroenterol 2001; 12: suppl 1: P-B/35.

12. Fenoglio-Preiser C, Noffsinger GN, Lantz PE. The nonneoplastic stomach. In: Gastrointestinal Pathology. An atlas and text. Chapter 6, 2nd ed. Lippincott-Raven. Philadelphia. 1999; 153-236.

13. Malfertheiner P, Megraud F, O'Morain C, et al. European Helicobacter Pylori Study Group (EHPSG). Current concepts in the management of Helicobacter pylori infection--the Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther. 2002 Feb; 16(2): 167-80.

14. Working party of the european Helicobacter study group. Guidlines for clinical trials in Helicobacter pylori infection. Gut 1997: 41(suppl 2): S1-9.

15. Glupczynski Y. Antimicrobial rezistance in Helicobacter pylori: a global overview. Acta Gastroenterol Belg 1998; 61: 357-366.

16. Huang JQ, Hunt RH,. Treatment after failure: the problem of nonresponders. Gut 1999; 45 (Supl1): 140-144.

17. Kim JJ, Reddy R, Lee M, et al. Analysis of metranidazole, claritromycin and tetracycline resistance of helicobacter pylori isolated from Korea. J Antim Chem 2001; 47: 459-461.

18. Bayonova L, Mentis A, Gubina M, et al. The status of antimicrobial resistance of Helicobacter pylori in eastern Europe. Clin Microbiol İnfect 2002; 8: 388-96.

19. Özden A, Bozday› G, Bağlan P, ve ark. Helikobakter pylori’nin klaritromisine karşı direncinin sıklığı. Turk J Gastroenterol 2004: 15: (suppl 1): 40.

20. Aydın A, Önder GF, Çolak Y, ve ark. Proton pompa inhibitörlü üçlü tedavilerin başarısız olduğu olgularda ranitidin bismuth subsitrate klaritromisin ve metranidazol kombinasyonunun helicobakter pylori eradikasyonundaki etkinliği. Turk J Gastroenterol 2004: 15: (suppl 1): 57.

21. Graham DY, Lew GM, Malaty HM, et al. Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology. 1992Feb; 102(2): 493-6.

22. Gisbert JP, Pajares JM. Esomeprazole-based therapy in Helicobacter pylori eradication: a meta-analysis. Dig Liver Dis. 2004 Apr; 36(4): 253-9.

23. Yang HB, Sheu BS, Su IJ, et al. Clinical application of gastric histology to monitor treatment of dual therapy in H. pylori eradication. Dig Dis Sci. 1997 Sep; 42(9): 1835-40.

24. Sheu BS, Yang HB, Su IJ, et al. Bacterial density of Helicobacter pylori predicts the success of triple therapy in bleeding duodenal ulcer. Gastrointest Endosc. 1996 Dec; 44(6): 683-8.

25. Gumurdulu Y, Serin E, Ozer B, et al. Low eradication rate of Helicobacter pylori with triple 7-14 days and quadriple therapy in Turkey. World J Gastroenterol. 2004; 10(5): 668-671.

26. Georgopoulos SD, Ladas SD, Karatapanis S, et al. Factors that may affect treatment outcome of triple Helicobacter pylori eradication therapy with omeprazole, amoxicillin, and clarithromycin. Dig Dis Sci. 2000 Jan; 45(1): 63-7.

27. Avşar E, Kaymakoğlu S, Erzin Y, ve ark. Dispeptik hastalarda Helicobacter pylori eradikasyonunda 14 günlük ranitidin bizmut sitrat bazlı tedavi ile lansoprozol bazlı üçlü tedaviyi karşılaştıran çok merkezli randomize prospektif bir çal›şma. Turk J Gastroenterol 2004: 15: (suppl 1): 57.

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