Ahmet UYANIKOĞLU, Muharrem COŞKUN, Doğan Nasır BİNİCİ

Helikobakter pilori eradikasyonunda klasik 3’lü tedavi Doğu Anadolu bölgesinde halen etkilidir

Amaç: Helikobakter pilori eradikasyonunda, proton pompa inhibitörübazlı üçlü tedavi birinci basamak tedavisi olarak önerilmektedir. Bu klasik tedavinin, özellikle klaritromisin direnci geliştiğinden etkisiz olduğuna dair yayınlar çıkmıştır. Bu çalışmada klasik üçlü tedavinin birinci basamakta etkinliği araştırılmıştır. Materyal ve Metod: fiubat 2010 - Temmuz 2011 tarihleri arasında endoskopik biyopsisinde Helikobakter pilori saptanan, daha önce 1. basamak tedavi almayan, çalışmaya katı lmayı kabul edip, ilaçların en az %90’ını kullanan hastalar prospektif olarak takip edildi. Tedavi protokolü olarak klaritromisin, amoksisilin ve proton pompa inhibitöründen oluşan hazır 3’lü tedavi paketi 2x1 14 gün, devamında 1x1 2 ay lansoprazol verilmiştir. Tedaviyi tamamlayan hastalarda eradikasyon kontrolü için gaitada Helikobakter pilori antijeni bakılmış, negatif gelen hastalarda eradikasyon başarılı kabul edilmiştir. Erozyon ve ülser rapor edilen hastalar peptik ülser, diğerleri non-ülser dispepsi olarak kabul edilmiştir. Bulgular: Gastroskopik biyopsi sonucu Helikobakter pilori pozitif saptanan ve çalışmayı tamamlayan 104 hastanın 51’i (%49) erkek, yaş ortalaması 39.98±12.82 (dağılım 13-73) idi. Hastalardan 60’ı (%57) peptik ülser, 44’ü (%43) non-ülser dispepsi idi. Hastalardan 101’inde (%97) kontrol Helikobakter pilori antijeni negatif saptanmıştır. Eradike olmayan 3 hastadan ikisi peptik ülser (1 eroziv gastrit, 1 duodenal ülser), biri de non-ülser dispepsi (eritemli gastrit) idi. Sonuç: Doğu Anadolu bölgesinde Helikobakter pilori eradikasyonunda, klasik 3’lü tedaviyle %97 eradikasyon sağlanmış olup, birinci basamakta halen ilk önerilecek tedavidir.

Anahtar Kelimeler:

Hastalıkla mücadele, Helicobacter, Helicobacter pylori, İleriye dönük çalışma

Classic triple therapy of Helicobacter pylori eradication still an effective treatment in Eastern Anatolia

Background and Aims: For Helicobacter pylori eradication, proton pump inhibitor -based triple therapy is recommended as the first-line therapy. This classic treatment has been reported to be ineffective, in particular with development of clarithromycin resistance. The aim of this study was to evaluate the efficiency of the classic triple therapy as the first line of eradication. Materials and Methods: This prospective study included patients seen between February 2010 and July 2011, with endoscopic biopsy- detected Helicobacter pylori who were previously untreated with a first-line therapy and who accepted to participate in the study, with at least 90% drug usage. The treatment protocol included clarithromycin, amoxicillin and proton pump inhibitorfor 14 days as 2x1, and 1x1 continuation of lansoprazole for two months. Successful eradication of Helicobacter pylori was considered as eradication of Helicobacter pylori antigen in the stool for control patients who completed the treatment. Patients with erosion and ulcer were considered as peptic ulcer patients and others as having non-ulcer dyspepsia. Results: 104 patients with biopsyproven and gastroscopic-identified Helicobacter pylori completed the study. 51 (49%) patients were male, with a mean age of 39.98±12.82 years (range: 13-73). 60 (57%) patients had peptic ulcer and 44 (43%) had non-ulcer dyspepsia. Helicobacter pylori antigen negativity was determined in 101 patients (97%). Helicobacter pylori was not eradicated in 3 patients: 2 peptic ulcer disease patients (1 erosive gastritis, 1 duodenal ulcer) and 1 non-ulcer dyspepsia patient (erythematous gastritis). Conclusions: For Helicobacter pylori eradication in the eastern region, the classic triple therapy resulted in 97% eradication, and thus this therapy remains the first to be proposed in primary care.

Keywords:

Disease Eradication, Helicobacter, Helicobacter pylori, Prospective Studies,

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