Helicobacter pylori Eradikasyonunda Kullanılan Kombine Tedavilerin Etkinliklerinin Karşılaştırılması

Amaç: Helicobacter pylori; ülser, gastrik atrofi, intestinal metaplazi ve gastrik adenokanserlere neden olabilmektedir. Bu çalışmada H. pylori eradikasyonunda kullanılan kombine tedaviler ve bu tedavilere bizmut subsitrat (BS) eklenerek H. pylori eradikasyon oranlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Ocak 2019- Ocak 2022 tarihleri arasında Mersin Şehir Eğitim Araştırma Hastanesi Gastroenterolojik Cerrahi Kliniğinde endoskopik biyopside H. pylori tespit edilen ve eradikasyonda 14 günlük; 1- Klasik üçlü tedavi, 2- Klasik üçlü tedavi + BS, 3- proton pompa inhibitörleri (PPI) + amoksisilin-klavulanik asit + metranidazol ve 4- PPI + amoksisilin-klavulanik asit + metranidazol + BS kombine tedavileri kullanan 190 hasta retrospektif olarak dört gruba ayrılarak çalışmaya dahil edildi. Bulgular: Çalışmaya alınan 190 hastanın 85’i (%44,70) erkek, 105’i (%55,30) kadın ve yaş ortalaması 41,90 idi. H. pylori eradikasyonu için klasik üçlü tedavi kullanan 42 (%22,10) hastanın 27’si (%64,28), klasik üçlü tedavi + BS kullanan 44 (%23,20) hastanın 33’ü (%75), PPI + amoksisilin-klavulanik asit + metranidazol kullanan 43 (%22,60) hastanın 35’i (%81,39) ve PPI + amoksisilin-klavulanik asit + metranidazol + BS tedavi kullanan 61 (%32,10) hastanın 54’ünde (%88,52) H. pylori eradikasyonunun başarılı olduğu görülmüştür (p=0,027). Her dört grupta da H. pylori eradikasyon başarısı istatistiksel olarak anlamlı bulunmuştur (p<0,05). Sonuç: H. pylori eradikasyonunda kombine tedavilere BS eklenmesi tedavi başarı oranlarını arttırmıştır. H. pylori eradikasyonunun başarılı şekilde yapılabilmesi, seçilen tedavi rejimi, hastanın uyumu ve antibiyotik direncine bağlıdır.

Anahtar Kelimeler:

Helicobacter pylori;, eradikasyon, bizmut subsitrat, proton pompa inhibitörleri

Comparison of the Efficiency of Combined Treatments Used in the Eradication of Helicobacter Pylori

Aim: Helicobacter pylori, can cause ulcer, gastric atrophy, intestinal metaplasia, and gastric adenocarcinoma. In this study, it was aimed to compare the H. pylori eradication rates obtained with the combined treatments used in H. pylori eradication and the addition of bismuth subcitrate (BS) to these treatments. Material and Methods: 190 patients who were found to have H. pylori in endoscopic biopsy in the gastroenterological surgery clinic of Mersin City Training and Research Hospital between January 2019 and January 2022 and used 14-day 1- classical triple therapy, 2- classical triple therapy + BS, 3- proton pump inhibitors (PPI) + amoxicillin-clavulanic acid + metranidazol, and 4- combination of PPI + amoxicillin-clavulanic acid + metranidazol + BS for 14 days for HP eradication, were retrospectively divided into 4 groups and included in the study. Results: Of 190 patients enrolled in the study, 85 (44.70%) were male and 105 (55.30%) were female; the mean age of the study population was 41.9 years. H. pylori eradication was successful in 33 (75%) of 44 (23.20%) patients who used the classical triple therapy; 33 (75%) of 44 (23.20%) patients who used the classical triple therapy + BS; 35 (81.39%) of 42 (22.60%) patients who used PPI + amoxicillin-clavulanic acid + metranidazol; and 54 (88.52%) of 61 (32.10%) patients who used PPI + amoxicillin-clavulonic acid + metranidazol + BS (p=0.027). H. pylori eradication success was statistically significant in each of the four groups (p<0.05). Conclusion: Adding BS to combination therapies increased the success rates in H. pylori eradication. Successful H. pylori eradication depends on the treatment regimen chosen, patient compliance, and antibiotic resistance.

Keywords:

Helicobacter pylori, eradication, bismuth subcitrat, proton pump inhibitors,

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