Necip TİYNAK, FİKRET AKSOY, GÖKHAN DEMİRAL, Alp ÖZÇELİK, Burhan ŞABAN

Perfore peptik ülser olgularında Helikobakter pilori insidtansı ve lansoprozol, klaritromisin, amoksisilin ile yapılan üçlü eradikasyon tedavi sonuçları

Helikobakter pilori peptik ülser hastalığının en sık sebebidir. Bu çalışmada perfore peptik ülser olgularında H. pilori insidansını ve ameliyat sonrası uygulanan üçlü eradikasyon tedavisi sonuçlarını inceledik. Gereç ve yöntem: Peptik ülser perforasyonu tanısıyla acil olarak opere edilen 80 hasta prospektif olarak incelendi. Ameliyatta perforasyon odağından alınan biyopsi materyali hızlı üreaz testi ile değerlendirildi. Sonuçlar negatif, hafif ve şidetli H. pilori enfeksiyonu şeklinde gruplandırıldı. Hastalara, ağızdan beslenmeye başladıkları günden itibaren H. pilori eradikasyonu amacıyla klaritromisin 2x500 mg 10 gün, amoksisilin 2x1000 mg 10 gün, lansoprozol 2x30 mg 28 gün süreyle verildi. Hastalar ameliyattan 45 gün sonra üst gastrointestinal sistem endoskopisi için kontrole çağrıldı ve sonuçlar histopatolojik olarak değerlendirildi. Bulgular: Çalışmaya 80 hasta alındı ancak 71 hasta ile çalışma tamamlandı. Perforasyon odağından alınan tam kat biyopsi materyallerinin hızlı üreaz testi ile yapılan değerlendirmesinde 7 (%8,75) hastada negatif, 10 (%12,5) hastada hafif, 63 (%78,75) hastada ise şiddetli H. pilori enfeksiyonu saptandı. Üçlü eradikasyon tedavisi uygulanan 71 hastanın kontrol endoskopilerinde alınan biyopsi materyalleri histolojik olarak değerlendirildiğinde 53 (%74,6) hastada negatif, 17 (%23,9) hastada hafif, 1 (%1,3) hastada şiddetli H. pilori enfeksiyonu saptandı. Sonuç: H. pilori, peptik ülser perforasyonu gelişiminde çok önemli bir rol oynamaktadır. Peptik ülser perforasyon ameliyatı sonrası üçlü eradikasyon tedavisi verilmeli ve 45 gün sonra üst gastrointestinal sistem endoskopisi ile eradikasyonun başarısı ve ülserin son durumu değerlendirilmelidir.

Anahtar Kelimeler:

İlaç tedavisi, kombinasyon, Peptik ülser, Görülme sıklığı, Helicobacter pylori, Klaritromisin, Amoksisilin, Peptik ülser perforasyonu, İleriye dönük çalışma

Incidence of Helicobacter pylori infection and the results of triple eradication therapy combining lansoprazole, clarithromycin, amoxicillin for perforated peptic ulcer

Helicobacter pylori (H. pylori) is the most common etiological factor in peptic ulcer. In this article, we review the incidence of H. pylori and the results of triple eradication therapy for perforated peptic ulcer. Materials and methods: 80 patients operated for peptic ulcer perforation were examined prospectively. Biopsies were taken from perforation site in order to perform rapid urease test. The results were grouped as negative, mild and severe H. pylori infection. The patients were treated with an eradication regimen consisting of a triple therapy of clarithromycin 2x500 mg 10 days, amoxicillin 2x1000 mg 10 days and lansoprazole 2x30 mg 28 days. Gastroscopy was performed 45 days postoperatively and histopathological investigations made. Results: The study was completed with 71 of the 80 patients. Full thickness mucosal biopsies were obtained from perforation site in all patients. The rapid urease test for H. pylori was severely positive in 63 (78.75%) and mildly positive in 10 (12.5%) patients. Seven (8.75%) of these patients had negative test results. After triple eradication therapy, biopsy materials of 71 patients were investigated histologically. In 53 (74.6%) patients, there was no H. pylori infection. Seventeen (23.9%) patients had mild and 1 (1.3%) patient had severe H. pylori infection. Conclusion: H. pylori plays an important role in the pathogenesis of peptic ulcer perforation. An appropriate triple H. pylori eradication therapy should be performed for peptic ulcer perforation and efficacy of treatment should be confirmed with gastroscopy 45 days postoperatively.

Keywords:

Drug Therapy, Combination, Peptic Ulcer, Incidence, Helicobacter pylori, Clarithromycin, Amoxicillin, Peptic Ulcer Perforation, Prospective Studies,

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