Aydın Şeref KÖKSAL, Erkan PARLAK, Dilek OĞUZ, Bahattin ÇİÇEK, Burhan ŞAHİN

Helikobacter pilori eradikasyonunun non-ülser dispepsili hastalarda semptomlar üzerine kısa dönemdeki etkisi

Giriş ve amaç: Bu çalışmada Helikobâkter pilori eradikasyonunun non-ülser dispepsili hastalarda semptomlar üzerine kısa dönemdeki etkisini araştırmayı amaçladık. Gereç ve yöntem: Çalışmaya Helikobâkter pilori pozitif non-ülser dispepsili 63 hasta (47 kadın, 16 erkek, ortalama yaş: 42+11 yıl) alındı. Non-ülser dispepsi tanısı kan tetkikleri, üst gastrointestinal sistem endoskopisi, abdomen ultrasonografi ve Roma II kriterleri ile diğer nedenlerin ekarte edilmesi ile konuldu. Hastalar eradikasyon tedavisine başlamadan önce 10 semptomun şiddetinin 0-3 puan üzerinden skorlandığı bir semptom skor skalası formu doldurdular. Eradikasyon için 10 günlük omeprazol (2x20mg), amoksisilin (2xl000mg) ve klarit-romisin (2x500mg) üçlü tedavisi verildi. Eradikasyon tedavisinin başarısı ilaçların bitiminden en az 30 gün sonra biyopsi veya 13C üre solunum testi ile değerlendirildi. Helikobâkter pilori negatifleşen ve pozitif kalan grupların tedavi öncesi ve sonrası semptom skorları karşılaştırıldı. Bulgular: Çalışmaya alınan 63 hastanın 49'unda Helikobâkter pilori eradike edilirken (%77,8) 14'ünde pozitif kaldı. Tedavinin başarılı oldu¬ğu hastalarda tedavi sonrası ortalama toplam semptom skoru (5,3±4,6) tedavi öncesine göre (7,8±4,9) anlamlı ölçüde azaldı. Tedavinin başarısız olduğu hastalarda da tedavi sonrası ortalama toplam semptom skorunda (5,5±3,7) tedavi öncesine göre (9,5±5,1) anlamlı azalma görüldü. Helikobâkter pilorinin eradike edildiği gruptaki ortalama toplam semptom skorundaki azalma (2,4±3,5) ile pozitif kaldığı gruptaki azalma (4±3,5) arasında anlamlı fark bulunmadı. Gruplar kendi aralarında karşılaştırıldığında tedavi öncesi ve sonrası dönemdeki ortalama toplam semptom skorları arasında anlamlı fark olmadığı görüldü. Sonuç: Non-ülser dispepsili hastalarda eradikasyon tedavisi ile semptom skorunda kısa dönemde anlamlı ölçülerde azalma görülmesinin tedavinin kendisine ve/veya plasebo etkisine bağlı olduğu, Helikobâkter pilori'nin eradike edilmesinin ek katkı sağlamadığı düşünülmüştür.

Anahtar Kelimeler:

Helicobacter pylori, Dispepsi

The short term effect of Helicobacter pylori eradication on symptoms in patients with non-ulcer dyspepsia

Background/aim: In this study we aimed to investigate the short-term effect of Helicobacter pylori eradication on symptoms in patients with non-ulcer dyspepsia. Materials and methods: The study group included 63 H. pylori-positive patients (47 female, 16 male, mean age: 42±11 ye¬ars) with non-ulcer dyspepsia. The diagnosis of non-ulcer dyspepsia was based on exclusion of other etiologies by blood tests, upper gastrointestinal endoscopy, abdominal ultrasonography, and Rome II criteria. Before starting eradication treatment, patients completed a form for symptom scoring in which the severity of 10 symptoms was scored from 0 to 3. Patients received omeprazole (2X20mg), amoxicillin (2xl000mg) and cla-rithromycin (2x500mg) triple eradication therapy for 10 days. The success of eradication was assessed with either endoscopic biopsy or 13C-urea breath test at least 30 days after the treatment. The symptom scores of patients in whom Helicobacter pylori was eradicated or remained po¬sitive were compared before and after the treatment. Results: Among the 63 patients enrolled into the study, Helicobacter pylori was eradicated in 49 patients (77.8%) and remained positive in 14. In patients with successful eradication treatment, the mean total symptom score decreased significantly after the treatment (5.3+4.6) compared to pre-treatment le¬vels (7.8+4.9). In patients who failed treatment, we also observed a sig¬nificant decrease in the mean total symptom score after the treatment (5.5±3.7) compared to pre-treatment levels (9.5+5.1). There was no significant difference between the decreases in the mean total symptom score of patients in whom Helicobacter pylori was eradicated (2.4±3.5) and those in whom it remained positive (4±3.5). When groups were compared, we observed that there was no significant difference between the mean total symptom scores of groups before and after the treatment. Conclusion: We think that the significant decrease in the symptom scores of patients with non-ulcer dyspepsia after the eradication treatment is due to the treatment and/or placebo effect and that eradication of Helicobacter pylori contributes no further.

Keywords:

Helicobacter pylori, Dyspepsia,

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