Esen AĞBABA, Yaşar NAZLIGÜL, ABDULLAH ÖZGÜR YENİOVA, Mehmet YILDIZ, Oktay BULUR, Ayla TEZER, Heyecan ÖKTEN

Helikobakter pilori eradikasyonun fonksiyonel dispepsi semptomları üzerine kısa dönem etkileri

Amaç: Helikobakter pilori (H.pylori) kronik aktif gastrit ve peptik ülserin major etyolojik faktörüdür. Fonksiyonel dispepsi (FD), semptomları açıklayacak kesin yapısal veya biyokimyasal nedeni olmayan epigastrik bölgeye lokalize tekrarlayan veya sürekli karın ağrısı ve rahatsızlık hissidir. H.pylori eradikasyonunun dispepsi semptomlarına etkisi, henüz tam olarak aydınlatılamamıstır. Bu çalısmada, FD hastalarında H.pylori eradikasyonun dispepsi semptomlarına kısa dönem etkileri arastırılmıstır. Gereç ve Yöntem: Çalısma, FD tanısı almıs ve çalısmaya alınma kriterlerine uyan 167 hastada (99 kadın, 68 erkek) gerçeklestirildi. Her hastaya üst gastrointestinal endoskopi yapıldı ve mide mukozasından biyopsiler alındı. H.pilori enfekte çıkan hastalara 7 gün süreyle lansoprozol 30 mg 2x1, amoksisilin 1 gr 2x1, levofl oksasin 500 mg 1x1 verildi. Tedaviden 6–8 hafta sonra 14C üre-nefes testiyle tedavinin basarısı değerlendirildi. Hastaların tedavi öncesi ve sonrası semptom skorları sorgulandı. Bulgular: Tedavi sonunda 114 (%68) hastada H.pylori negatifl esirken 53 hasta (%32) pozitifl ik devam etti. H.pylori eradikasyonun sağlandığı ve sağlanamadığı hasta grupları, yas ve cinsiyet açısından benzerdi. H.pylori negatifl esen 114 hastanın 111’inin (%97.4) semptom skorları azalma gösterdi, pozitif kalan grupta ise 53 hastanın 38’inde (%71,7) semptom skorları geriledi (p = 0.001). Sonuç: H.pylori eradikasyonu, kısa dönemde FD semptomlarında rahatlama sağlamaktadır. Uzun dönem sonuçları için yeni çalısmalara ihtiyaç vardır

The short-term effects of Helicobacter pylori eradication on symptoms of functional dyspepsia

Objectives: Helicobacter pylori (H.pylori) infection is major etiologic factor of chronic active gastritis and peptic ulcer disease. Functional dyspepsia (FD) is defi ned as “persistent or recurrent abdominal pain or discomfort centered in the upper abdomen in patient who has no defi nite structural or biochemical explanation of their symptoms. It is uncertain whether treatment of H.pylori infection relieves symptoms in patients with FD. We searched short term effects of H.pylori eradication for symptoms in patients with FD. Material and method: We enrolled patients with dyspeptic symptoms which were diagnosed FD and satisfi ed enrollment criteria of trial. Endoscopic biopsy was taken from each patient during upper gastrointestinal endoscopy. H.pylori infected patients were assigned to seven days of treatment with 30 mgr of lansoprozole twice daily, 1000 mg of amoksisilin twice daily, and 500 mg levofl oxacin once daily. Patients were assessed whether treatment was successful or not by 14C urea breathe test after 6-8 week. Also pretreatment and post treatment symptom scores were questioned. Results: There were 99 female and 68 male patients. After treatment 114 patients (68%) was negative for H. pylori, 53 patients (32%) remained positive. Mean of age and proportion of sex was similar in H.pylori (+) and (-) groups. While 111 (97.4%) of H.pylori (-) patients’ symptom scores decreased, 38 (71.7%) of H.pylori (+) patients’ scores decreased. There was signifi cant differences between two groups (p=0.001). Conclusion: Eradication of H.pylori relieves the symptoms of functional dyspepsia. New trials for long term effect of H.pylori eradication on symptoms must be conducted in future.

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1. Warren JR, Marshall BJ. Unidentifi ed curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983;1:1273-5.
2. Marshall BJ, Warren JR. Unidentifi ed curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-5.
3. Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician 2007;76:1005-12.
4. Duggan A. Helicobacter pylori: when is treatment now indicated? Intern Med J 2002;32:465–9.
5.Zullo A, Hassan C, Andriani A, et al. Eradication therapy for Helicobacter pylori in patients with gastric MALT lymphoma: a pooled data analysis. Am J Gastroenterol. 2009;104:1932-7.
6. Blum Al, Talley NJ, O’Morain C, et al. Lack of effect of treating Helicobacter pylori infection in patients with non-ulcer dyspepsia: Omeprazole plus Clarithromycin plus Amoxicillin: Effect one year after treatment (OCAY) study group. N Engl J Med 1998;339:1875-81.
7. Pantofl ickova D, Blum AL. Antagonist: Should we eradicate Helicobacter pylori in non-ulcer dyspepsia? Gut 2001;48:758-9.
8. McColl K E L. Protagosit: Should we eradicate Helicobacter pylori in non-ulcer dyspepsia? Gut 2001;48:759-61.
9. Bergamaschi A, Magrini A, Pietrouiusti A. Recent advances in the treatment of Helicobacter pylori infection. Recent Pat Antiinfect Drug Discov 2007;2:197-205
10. O’Morain C. Role of of Helicobacter pylori in functional dyspepsia. World J Gastroenterol 2006; 12:2677-80.
11.Nazlıgül Y, Uzunköy A. Fonksiyonel (nonülser) dispepsi. Türkiye Klin J Gastroenterohepatol 1999;10:137-41.
12.Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenteroloji 2006 130:1377-90.
13.Tack J, Talley NJ, Camilleri M, et al. Functional gastroduodenal disorders. Gastroenterology 2006;130:1466-79.
14.Talley NJ, Phillips SF. Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med 1988; 108:865-79.
15. Talley NJ, Weaver AL, Zinsmeister AR. Smoking, alcohol, and nonsteroidal anti-infl ammatory drugs in outpatients with functional dyspepsia and among dyspepsia subgroups. Am J Gastroenterol 1994; 89:524-8.
16. Armstrong D. Helicobacter pylori infection and dyspepsia. Scand J Gastroenterol 1996; 31: 38 -47.
17.Rosentock S, Kay L, Rosentock C, Andersen LP, Bonnevie O, Jørgensen T. Relation between Helicobacter pylori infection and gastrointestinal symptoms and syndromes. Gut 1997; 41:169-76.
18.18.Magistà AM, Ierardi E, Castellaneta S, et al. Helicobacter pylori status and symptom assessment two years after eradication in pediatric patients from a high prevalence area. J Pediatr Gastroenterol Nutr 2005; 40:312-8.
treating Helicobacter pylori infection in patients with nonulcer dyspepsia: Omeprazole plus Clarithromycin plus Amoxicillin: Effect one year after treatment (OCAY) study group. N Engl J Med 1998;339:1875-81.
20. Talley NJ, Janssens J, Lauritsen K, Rácz I, Bolling-Sternevald E. Eradication of Helicobacter pylori in functional dyspepsia: Randomised double blind placebo controlled trial with 12 months follow up. The Optimal Regimen Cures Helicobacter Induced Dyspepsia (ORCHID) Study Group. BMJ 1999; 318: 833-7.
21. Gisbert JP, Cruzado AI, Garcia-Gravalos R, Pajares JM. Lack of benefi t of treating Helicobacter pylori infection in patients with functional dyspepsia. Randomized one-year follow-up study. Hepatogastroenterology 2004;51:303-8.
22. Talley NJ, Vakil N, Ballard ED, Fennerty MB. Absence of benefi t of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med 1999; 341:1106-11.
23. Veldhuyzen van Zanten SJ, Sherman PM. Indications for treatment of Helicobacter pylori infection: a systematic overview. CMAJ 1994; 150:189-98.
24.Laheij RJ, Jansen JB, van de Lisdonk K, Severens JL, Verbeek AL. Review article: Symptom improvement through eradication of Helicobacter pylori in patients non-ulcer dyspepsia. Aliment Pharmacol Ther 1996;10: 843-50.
25.McColl K, Murray L, El-Omar E, et al. Symptomatic benefi t from eradicating Helicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 1998;339:1869-74.
26.Moayyedi P, Soo S, Deeks J et al. Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. Dyspepsia Review Group. BMJ 2000; 321:659-64.
27.Bruley Des Varannes S, Fléjou JF, Colin R, Zaïm M, Meunier A, Bidaut-Mazel C. There are some benefi ts for eradicating Helicobacter pylori in patients with non-ulcer dyspepsia. Aliment Pharmacol Ther 2001; 15:1177-85.
28.de Artaza Varasa T, Valle Muñoz J, Pérez-Grueso MJ, et al. [Effect of Helicobacter pylori eradication on patients with functional dyspepsia]. Rev Esp Enferm Dig 2008; 100:532-9.
29.Gürbüz AK, Dağalp K, Karaeren N, Uygurer C, Alper A. [Does Helicobacter pylori eradication infl uence nonulcer dyspepsia?] Turk J Gastroenterol1993; 4:489-94.
30.Çınar K, Soykan İ, Özden A. The effect of Helicobacter pylori eradication with functional dyspepsia: Assessment of different diagnostic tests. Turk J Gastroenterol 2004; 15: 159-63.
31.İsler M, Bahçeci M, Aygündüz M, et al. [The effevtiveness of Helicobacter pylori eradication on symptoms in non- ulcer dyspepsia.] T Klin Gastroenterohepatol 2001; 12:13-8.