Aysun Gönderen, Kamil GÖNDEREN, Mehmet YILDIZ

Helicobacter pilori eradikasyonu için verilen iki farklı ardışık tedavinin eradikasyon oranlarının karşılaştırılması

Amaç: Helicobacter Pylori (HP) peptik ülser, gastrik kanser ile ilişkisi iyi bilinen gram (-) mikroaerofilik bakteridir. Bundan dolayı infekte hastalarda HP eradikasyon tedavisi önerilmektedir. Bu çalışmada da iki farklı eradikasyon tedavisinin etkinliğinin karşılaştırılması amaçlandı. Materyal ve Metod: Şubat 2009 – Mayıs 2010 tarihleri arasında Dışkapı Yıldırım Beyazıt Eğitim Araştırma Hastanesi Gastroenteroloji ve Dahiliye polikliniklerine reflü, bulantı-kusma ve gastrik ağrı şikayetleri ile başvurup endoskopi yapılan ve endoskopik olarak gastrik ülser, duodenal ülser veya gastrit tanısı konulan, immüno-histokimyal olarak HP pozitif saptanan ve daha önce eradikasyon tedavisi almamış 98 hasta çalışmaya dahil edildi. Hastalar randomize olarak iki gruba ayrıldı ve ilk gruba bir hafta omeprazol ve amoksisilin ikinci hafta omeprazol ve metronidazol verildi. Diğer gruba ilk 7 gün omeprazol ve amoksisilin ikinci hafta omeprazol, metronidazol ve tetrasiklin verildi. Tedavi bitiminden sonra eradikasyon oranını belirlemek için kontrol endoskopileri yapılarak biyopsileri alındı. Bulgular: Çalışmaya alınan hastaların 47’si (%56) kadın ve 46’sı (%54,7) 40 yaş altındaydı. Birinci rejim tedaviyi alan hastalarda tedavi başarısı tüm hasta grubuna bakıldığında %32.4, ikinci rejim tedaviyi alan hastalarda tedavi başarısı %59.6 olarak saptandı ve iki grup tedavi rejimi arasında istatistiksel olarak anlamlı fark vardı. Sonuç: Tetrasiklin içeren tedavi grubunda eradikasyon başarı oranı sayısal olarak daha yüksek ve istatistiksel olarak anlamlı olmakla beraber eradikasyon oranları genel literatüre göre %80 altında ve düşük bulunmuştur. Bu sonuç başta antibiyotik direnci olmak üzere tedavinin başarısını azaltabilecek nedenlerin ortaya konması gerektiğini ve HP eradikasyonunda alternatif tedavilere ihtiyaç olduğunu göstermektedir.

Anahtar Kelimeler:

Helikobakter pilori, peptik ülser, tedavi

Comparison ratios of two different sequential treatments for Helicobacter pylori eradication

Purpose: Helicobacter Pylori (HP) is a gram (-) microaerophilic bacterium that related with peptic ulcer and gastric cancer. The aim of this study was to compare the efficacy of the two different eradication therapies. Material and Methods: 98 patients were included in the study who was admitted to Gastroenterology and Internal Medicine outpatient clinics of Dışkapı Yıldırım Beyazıt Training and Research Hospital with complaints of reflux, nausea, vomiting or gastric pain and had detected HP positive immunohistochemically also had not received any eradication treatment before. The patients were randomly divided into two groups. The first group was treated with omeprazole and amoxicillin in the first week then with omeprazole and metronidazole in the second week. The second group was treated with omeprazole and amoxicillin in the first week and then with omeprazole, metronidazole and tetracycline in the second week. After the treatment, control endoscopy was performed and the biopsies were taken to determine the eradication ratios. Results: The eradication ratio of treatment in the first group was 32.4% and 59.6% in the second group. There was a statistically significant difference between the eradication ratios of the groups (p<0.001). Conclusion: The eradication ratio was higher in the tetracycline-receiving treatment group however, the eradication ratios of both groups were found to be lower than the ratio of 80% that revealed in the literature. Low eradication ratio of the treatments in this study may be associated with antibiotic resistance. According to this study’s results alternative treatments are needed in HP eradication.

Keywords:

Helicobacter Pylori, peptic ulcer, treatment,

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