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Comparison of Classical Triple Therapy and Classical Triple + Bismuth Therapy for Eradication of Helicobacter Pylori

Year 2019, , 484 - 487, 25.12.2019
https://doi.org/10.35440/hutfd.585601

Abstract

Background: Comparison of the Helicobacter Pylori (HP) eradication rate between classicaltriple
therapy and bismuth added into the classical therapy on the HP positive
patients with peptic ulcer is aimed.

Materials and Methods: Sixty patients whom gastric and/or duodenal
ulcer (peptic ulcer) was detected by endoscopy as well as who presented positive
results in any of histopathology, urea breath test or HP antigen in the stool
between January 2012 and January 2013 were included into the study
prospectively. Classical triple therapy was applied to the patients in Group 1
(n=30) whereas classical triple therapy +bismuth were applied to the patients
in group 2 (n=30) Therapeutic efficiency of both groups were compared
statistically after 3 months.

Results: HP
antigen detection in the stool revealed eradication rates of 83.3 % and 73.3 %
in Group 1 and Group 2, respectively. There was not any difference for
therapeutic efficiency between both groups by the evaluation through HP antigen
detection in the stool (p=0.532). Urea breath test determined eradication rates
of 56.7 % and 53.3 % in Group 1 and Group 2, respectively. No difference was
detected for therapeutic efficiency between both groups by the evaluation
through urea breath test (p=0.795). Eradication rates by HP antigen test were
more than rates by urea breath test for all patients treated; this difference
was statistically significant (p=0.011).

Conclusion: No difference was detected between classical triple therapy and
classical triple therapy + bismuth therapy in terms of eradication. Therefore,
the therapy should be planned by considering clarithromycin resistance.
Furthermore, a significant difference was detected between Hp antigen in the
stool and urea breath test for evaluation of therapeutic efficiency after the
therapy and rate of eradication by HP antigen detection in the stool seems
higher.









Key words: Helicobacter pylori, Classical triple therapy, Bismuth

References

  • Referans1 Rothenbacher D, Brenner H. Burden of Helicobacter pylori and Helicobacter pylori-related diseases in developed countries: recent developments and future implications. MicrobInfect 2003; 5:693-703.Referans2 Lehours P, Yılmaz O. Epidemiology of Helicobacter pylori infection. Helicobacter 2007; 12 (Suppl1):S1-53.Referans3 Doğan E, Kefeli A, Nazlıgül Y, et al. Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. Dicle Tıp Dergisi 2011;38:7-11.Referans4 Ermis F, Akyuz F, Uyanikoglu A, et al. Second- line levofloxacin- based triple therapy's efficiency for Helicobacter pylori eradication in patients with peptic ulcer. South Med J 2011;104: 579-83.Referans5 Uyanıkoğlu A, Coşkun M, Binici DN. Helikobakter pilori eradikasyonunda klasik 3’lü tedavi Doğu Anadolu bölgesinde halen etkilidir. Akademik Gastroenteroloji Dergisi, 2012; 11 (1): 24-28. Referans6 Uyanıkoğlu A, Ağan Z, Yenice N. Eradikasyon Öncesi Test Gerekli Mi ? 2011-2016 Şanlıurfa Yöresi Helikobakter Pilori Sıklığı. 33. Ulusal Gastroenteroloji Haftası,2016;180Referans7 Hirschl AM, Makristathis A. Methods to Detect Helicobacter Pylori From Culture to Molecular Biology. Helicobacter 2007; 12( 2):6-11.Referans8 Uyanık MH, Aktaş O. Helicobacter Pylori'nin Mikrobiyolojik Tanısı. EAJM 2007; 39(3): 205-9Referans9 Vale DJ. Peptic ulcer disease and related disorders. In: Braunwald E, Hauser SL, Faucci AS, editors. Harrison’s 15 th edition Principles of Internal Medicine. New York: McGraw-Hill; 2001. 19. Referans10 Doğan E, Kefeli A, Nazlıgül Y, et al. Anti-CagA positivity in duodenal ulcer and functional dyspepsia patients infected with Helicobacter pylori and its effect on the outcome of eradication treatment. Dicle Medical Journal. 2011; 38:7- 11.Referans11 Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut [Internet]. 2012 May [cited 2014 Dec 4];61(5):646-64Referans12 Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J SurgPathol 1996;20:1161–81.Referans13 Hegedus O, Rydén J, Rehnberg AS, Nilsson S, Hellström PM. Validated accuracy of a novelurea breath test forrapid Helicobacter pylori detection and in-office analysis. Eur J Gastroenterol Hepatol. 2002;14:513–520.Referans14 Uyanıkoğlu A, Davutoğlu C, Toğan M, Ranitidin Bizmut Sitrat ve Klaritromisinli İkili Kombinasyonla alternatif Helikobakter Pylori Tedavisi. İst Tıp Fak Derg 2008;71: 61-4.Referans15 Demirtaş L, Sayar İ, Akbaş EM, ve ark. Distribution of the incidence and location of the Helicobacter pylori according to age and gender in patients who undergone endoscopy. Dicle Med J 2014;41:507-511.Referans16 Uyanıkoğlu A, Coşkun M, Binici DN, ve ark. Frequency of Helicobacter pylori in patients underwent endoscopy. Dicle Med J 2014;41:507-511.Referans17 Uyanıkoğlu A, Aydoğan T, Nar H et all. Şanlıurfa Yöresinde Gastroskopi Yapılan Hastalarda Helicobacter Pylori Sıklığı. 30. Ulusal Gastroenteroloji Haftası, The Turkish Journal of Gastroenterology 2013, 24(suppl.1): 115. 11-15 Eylül 2013, Antalya, Türkiye, P-136.Referans18 Alkim H, Iscan M, Oz F. Effectiveness of ranitidine bismuth citrate and proton pump inhibitör based triple therapies of Helicobacter pylori in Turkey. Libyan J Med 2011;6. doi: 10.3402/ljm.v6i0.8412. Epub 2011 Sep 8.Referans19 Rathbone M, Rathbone B. Helicobacter pylori and gastric cancer. Recent Results Cancer Res. 2011;185:83-97.Referans20 KuipersEJ.WhenIsEndoscopicFollow-up Appropriate After Helicobacter pylori Eradication Therapy?. GastroenreolClin North Am. 2015; 44(3):597-608.Referans21 Ferwana M, Abdulmajeed I et all. Accuracy of ureabreath test in Helicobacter pylori infection: Meta-analysis. World Journal of Gastroenterology 2015, 21(4): 1305-1314.Referans22 Garza-González E, Perez-Perez GI, Maldonado-Garza HJ, Bosques-Padilla FJ. A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication. World J Gastroenterol 2014; 20: 1438-1449 [PMID: 24587620 DOI: 10.3748/wjg.v20. i6.1438].Referans23 Hwang JJ, Lee DH. etall. Fourteen - vs seven- day bismuth based quadruple therapy for second-line Helicobacter pylori eradication. World Journal of Gastroenterology 2015; 21(26): 8132-8139.Referans24 Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P. Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. Digestion 2013; 88: 33-45 [PMID: 23880479 DOI: 10.1159/000350719].Referans25 Ermis F, Akyuz F, Uyanikoglu A, et al. Second-line levofloxacin-based triple therapy's efficiency for Helicobacter pylori eradication in patients with peptic ulcer. South Med J 2011;104:579-83.Referans26 Selgrad M, Malfertheiner P. Treatment of Helicobacter pylori. CurrOpinGastroenterol 2011;27:565-70.Referans27 Toros AB, Ince AT, Kesici B, et al. A new modified concomitant therapy for Helicobacter pylori eradication in Turkey. Helicobacter 2011;16:225-8.Referans28 Zeng M, MAoXu-Hu, LiJing-Xin et al. Efficacy, safety and immunogenicity of an oral recombinant Helicobacterpylori vaccine in children in china: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015; 386(10002): 1424-5Referans29 Doğan E, Kefeli A, Nazlıgül Y et al. Anti-CagApositivity in duodenal ulcer and functional dyspepsia patients infected with Helicobacter pylori and its effect on the outcome of eradication treatment. Dicle Med.J 2011; 38 (1): 7-11

Helikobakter Pilori Eradikasyonunda Klasik ÜçlüTedavi İle Klasik Üçlü+Bizmut Tedavisinin Karşılaştırılması

Year 2019, , 484 - 487, 25.12.2019
https://doi.org/10.35440/hutfd.585601

Abstract

Amaç: Kliniğimize başvuran peptik ülserli, Helikobakter Pilori (HP) pozitif
hastalarda klasik üçlü tedavi verilen hastalarla klasik üçlü tedaviye bizmut
eklenen hastalar arasındaki HP eradikasyon oranının karşılaştırılması
amaçlanmaktadır.

Materyal ve
Metod:
Ocak 2012- Ocak 2013
tarihleri arası prospektif olarak, endoskopilerinde gastrik ve/veya duodenal
ülser (peptik ülser) saptanan, histopatoloji, üre nefes testi ya da dışkıda HP antijeni
sonuçlarından herhangi birinde pozitiflik saptanan 60 hasta ardışık olarak
çalışmaya alındı. Grup 1 hastalara (n=30) klasik üçlü tedavi, grup 2 hastalara
(n=30) klasik üçlü tedavi+bizmut tedavileri uygulandı. 3 ay sonra her iki
grubun tedavi etkinliği istatistiksel olarak karşılaştırıldı.

Bulgular: Dışkıda HP antijeni saptanması testi ile grup 1’ de %83,3, grup 2’ de %73,3
eradikasyon olduğu belirlendi. Dışkıda HP antijeni saptanması ile yapılan
değerlendirmede her iki grup arasında tedavi etkinliği açısından herhangi bir
fark saptanmadı (p=0,532). Üre nefes testi ile grup 1’ de %56,7, grup 2’ de %53,3
eradikasyon olduğu belirlendi. Üre nefes testi ile yapılan değerlendirmede her
iki grup arasında tedavi etkinliği açısından herhangi bir fark saptanmadı
(p=0,795). Tüm tedavi alanlarda dışkıda HP antijeni testi ile eradike olma
oranı üre nefes testine göre daha fazla görüldü, istatiksel olarak anlamlı idi
(p=0,011).







Sonuç: Klasik üçlü tedavi ile klasik üçlü tedavi+ bizmut tedavisi arasında
eradikasyon açısından herhangi bir farklılık saptanmamıştır. Bu yüzden
klaritromisin direnci göz önünde bulundurularak seçilecek tedavi ona göre
belirlenmelidir. Ayrıca tedavi sonrası etkinliği değerlendirmede dışkıda HP
antijeni testi ile üre nefes testi arasında anlamlı fark bulunup dışkıda HP
antijeni ile eradikasyon oranı daha yüksek görünmektedir.

References

  • Referans1 Rothenbacher D, Brenner H. Burden of Helicobacter pylori and Helicobacter pylori-related diseases in developed countries: recent developments and future implications. MicrobInfect 2003; 5:693-703.Referans2 Lehours P, Yılmaz O. Epidemiology of Helicobacter pylori infection. Helicobacter 2007; 12 (Suppl1):S1-53.Referans3 Doğan E, Kefeli A, Nazlıgül Y, et al. Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. Dicle Tıp Dergisi 2011;38:7-11.Referans4 Ermis F, Akyuz F, Uyanikoglu A, et al. Second- line levofloxacin- based triple therapy's efficiency for Helicobacter pylori eradication in patients with peptic ulcer. South Med J 2011;104: 579-83.Referans5 Uyanıkoğlu A, Coşkun M, Binici DN. Helikobakter pilori eradikasyonunda klasik 3’lü tedavi Doğu Anadolu bölgesinde halen etkilidir. Akademik Gastroenteroloji Dergisi, 2012; 11 (1): 24-28. Referans6 Uyanıkoğlu A, Ağan Z, Yenice N. Eradikasyon Öncesi Test Gerekli Mi ? 2011-2016 Şanlıurfa Yöresi Helikobakter Pilori Sıklığı. 33. Ulusal Gastroenteroloji Haftası,2016;180Referans7 Hirschl AM, Makristathis A. Methods to Detect Helicobacter Pylori From Culture to Molecular Biology. Helicobacter 2007; 12( 2):6-11.Referans8 Uyanık MH, Aktaş O. Helicobacter Pylori'nin Mikrobiyolojik Tanısı. EAJM 2007; 39(3): 205-9Referans9 Vale DJ. Peptic ulcer disease and related disorders. In: Braunwald E, Hauser SL, Faucci AS, editors. Harrison’s 15 th edition Principles of Internal Medicine. New York: McGraw-Hill; 2001. 19. Referans10 Doğan E, Kefeli A, Nazlıgül Y, et al. Anti-CagA positivity in duodenal ulcer and functional dyspepsia patients infected with Helicobacter pylori and its effect on the outcome of eradication treatment. Dicle Medical Journal. 2011; 38:7- 11.Referans11 Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut [Internet]. 2012 May [cited 2014 Dec 4];61(5):646-64Referans12 Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J SurgPathol 1996;20:1161–81.Referans13 Hegedus O, Rydén J, Rehnberg AS, Nilsson S, Hellström PM. Validated accuracy of a novelurea breath test forrapid Helicobacter pylori detection and in-office analysis. Eur J Gastroenterol Hepatol. 2002;14:513–520.Referans14 Uyanıkoğlu A, Davutoğlu C, Toğan M, Ranitidin Bizmut Sitrat ve Klaritromisinli İkili Kombinasyonla alternatif Helikobakter Pylori Tedavisi. İst Tıp Fak Derg 2008;71: 61-4.Referans15 Demirtaş L, Sayar İ, Akbaş EM, ve ark. Distribution of the incidence and location of the Helicobacter pylori according to age and gender in patients who undergone endoscopy. Dicle Med J 2014;41:507-511.Referans16 Uyanıkoğlu A, Coşkun M, Binici DN, ve ark. Frequency of Helicobacter pylori in patients underwent endoscopy. Dicle Med J 2014;41:507-511.Referans17 Uyanıkoğlu A, Aydoğan T, Nar H et all. Şanlıurfa Yöresinde Gastroskopi Yapılan Hastalarda Helicobacter Pylori Sıklığı. 30. Ulusal Gastroenteroloji Haftası, The Turkish Journal of Gastroenterology 2013, 24(suppl.1): 115. 11-15 Eylül 2013, Antalya, Türkiye, P-136.Referans18 Alkim H, Iscan M, Oz F. Effectiveness of ranitidine bismuth citrate and proton pump inhibitör based triple therapies of Helicobacter pylori in Turkey. Libyan J Med 2011;6. doi: 10.3402/ljm.v6i0.8412. Epub 2011 Sep 8.Referans19 Rathbone M, Rathbone B. Helicobacter pylori and gastric cancer. Recent Results Cancer Res. 2011;185:83-97.Referans20 KuipersEJ.WhenIsEndoscopicFollow-up Appropriate After Helicobacter pylori Eradication Therapy?. GastroenreolClin North Am. 2015; 44(3):597-608.Referans21 Ferwana M, Abdulmajeed I et all. Accuracy of ureabreath test in Helicobacter pylori infection: Meta-analysis. World Journal of Gastroenterology 2015, 21(4): 1305-1314.Referans22 Garza-González E, Perez-Perez GI, Maldonado-Garza HJ, Bosques-Padilla FJ. A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication. World J Gastroenterol 2014; 20: 1438-1449 [PMID: 24587620 DOI: 10.3748/wjg.v20. i6.1438].Referans23 Hwang JJ, Lee DH. etall. Fourteen - vs seven- day bismuth based quadruple therapy for second-line Helicobacter pylori eradication. World Journal of Gastroenterology 2015; 21(26): 8132-8139.Referans24 Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P. Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. Digestion 2013; 88: 33-45 [PMID: 23880479 DOI: 10.1159/000350719].Referans25 Ermis F, Akyuz F, Uyanikoglu A, et al. Second-line levofloxacin-based triple therapy's efficiency for Helicobacter pylori eradication in patients with peptic ulcer. South Med J 2011;104:579-83.Referans26 Selgrad M, Malfertheiner P. Treatment of Helicobacter pylori. CurrOpinGastroenterol 2011;27:565-70.Referans27 Toros AB, Ince AT, Kesici B, et al. A new modified concomitant therapy for Helicobacter pylori eradication in Turkey. Helicobacter 2011;16:225-8.Referans28 Zeng M, MAoXu-Hu, LiJing-Xin et al. Efficacy, safety and immunogenicity of an oral recombinant Helicobacterpylori vaccine in children in china: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015; 386(10002): 1424-5Referans29 Doğan E, Kefeli A, Nazlıgül Y et al. Anti-CagApositivity in duodenal ulcer and functional dyspepsia patients infected with Helicobacter pylori and its effect on the outcome of eradication treatment. Dicle Med.J 2011; 38 (1): 7-11
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Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Umut Sert 0000-0002-8419-4871

Çiğdem Cindoğlu 0000-0002-1805-6438

Ahmet Uyanıkoğlu 0000-0003-4881-5244

Publication Date December 25, 2019
Submission Date July 2, 2019
Acceptance Date October 25, 2019
Published in Issue Year 2019

Cite

Vancouver Sert U, Cindoğlu Ç, Uyanıkoğlu A. Helikobakter Pilori Eradikasyonunda Klasik ÜçlüTedavi İle Klasik Üçlü+Bizmut Tedavisinin Karşılaştırılması. Harran Üniversitesi Tıp Fakültesi Dergisi. 2019;16(3):484-7.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty