Ayhan Hilmi ÇEKİN, Nur Turgut TÜKEL, Yeşim ÇEKİN, Cem SEZER, Ezel TAŞDEMİR

Effect of bismuth addition to the triple therapy of Helicobacter pylori eradication

Amaç: Helicobacter pylori (Hp) eradikasyonunda ilk basamak tedavi olan amoksisilin, klaritromisin ve proton pompa inhibitörü tedavisinin başarı oranları düşmektedir. Klasik üçlü tedaviye bizmut subsitrat eklenmesinin Hp eradikasyon başarısına etkisinin araştırılması amaçlandı. Gereç ve yöntem: Helicobacter pylori enfeksiyonu teşhisi, histoloji ve gaita antijen (HpSA) testlerinin her ikisinin bir-likte pozitifliğiyle konulan ve eradikasyon tedavisi alan 148 hasta retrospektif olarak incelenmiştir. Hastalar aldıkları tedavi şemalarına göre 3 gruba ayrılmıştır. İlk grupta 14 gün klasik üçlü tedavi (klaritromisin 2x500 mg, amoksisilin 2x1 gr ve proton pompa inhibitörü 2x1) (n:40), ikinci grupta 14 gün klasik üçlü tedavi ve beraberinde 120 mg bizmut subsitrat 4x1 tablet (n:73), üçüncü grupta ise klasik tedavi öncesi bizmut subsitrat 4x1 ve proton pompa inhibitörü 2x1 en az ondört gün alıp sonrasında 14 gün klasik tedavi alan hastalar (n:35) yer almıştır. Tedavi sonrası Hp eradikas-yon kontrolünde C-14 üre - nefes ve HpSA testleri kullanıldı. Bulgular: Hasta grupları arasında cinsiyet ve yaş açısından istatistiksel fark yoktu (p>0,05). Klasik tedavi grubunda 12 hastada, klasik tedavi ve bizmut subsitrat alan 20 hastada, bizmut subsitrat ile proton pompa inhibitörü tedavisi alıp sonra klasik tedavi alan 10 hastada tedavi sonrası Hp pozitif olarak tespit edildi. Eradikasyon oranları sırası ile klasik tedavi grubunda %70, klasik üçlü tedavi ve bizmut subsitratı beraber alanlarda %72,6, bizmut ve proton pompa inhibitörü tedavisi alıp sonrasında klasik tedavi alanlarda %71,4 olarak bulunmuştur. Her üç grup arasında Hp eradi-kasyon başarısı açısından istatistiksel olarak anlamlı fark yoktur (p > 0,05). Sonuç: Helicobacter pylori eradikasyonunda birinci basamak tedavi olan klasik üçlü tedaviye bizmut eklenmesi tedavi başarı oranlarını etkilememiştir.

Anahtar Kelimeler:

Helicobacter pylori, bizmutsubsitrat, klaritromisin, amoksisilin, proton pompa inhibitörü.

Effect of bismuth addition to the triple therapy of Helicobacter pylori eradication

Objective: Success rates of amoxicillin, clarithromycin, and proton-pump inhibitor therapy in the Helicobacter pylori (Hp) eradication have been decreasing. The aim of this study was to investigate the impact of bismuth subcitrate ad-dition to triple therapy. Materials and methods: 148 patients diagnosed Hp infection with both histology and Hp stool antigen (HpSA) tests were examined retrospectively. The patients were divided into 3 groups according to the eradication therapy. The first group received triple therapy with claritromycine 2x 500 mg, amoxicilline 2x1 g and PPI 2x1 for 14 days (n=40). The second group had bismuth subcitrate 4x120 mg with triple therapy for 14 days (n=73). The third group received 14 days pretreatment with bismuth subcitrate 4x1 together with PPI 2x1 then had triple therapy for 14 days (n=35). (14)C urea breath and HpSA tests were used to detect posttreatment H.pylori status. Results: There were no statistical difference between the groups in terms of gender and age (p > 0.05). In group one 12 patients, in group two 20 patients and in group three 10 patients were identified as Hp positive after treatment. Eradication rates were 70% for group one, 72.6% for group two and 71.4% for group three respectively. There was no statistical difference between the groups in terms of eradication rates of treatment (p > 0.05). Conclusions: The addition of bismuth to conventional triple therapy did not affect treatment success rates.

Keywords:

Helicobacter pylori, bismuth subcitrate, clarithromycin, amoxicillin, proton-pump inhibitor.,

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