An Evidence-Based Medicine Practice: What Should be the Appropriate Approach in the Treatment of Helicobacter Pylori Gastritis?

Year 2022, Volume: 3 Issue: 1, 6 - 14, 30.04.2022

Mehmet Can Kutlar Gülser Doğan Lara Gülkaya Aynur Sema Derinyol Kübra Nur Yeğin Fatma Tekin Melis Nur Özdemir Deniz Sarıkcıoğlu Ceren Kişmir Almina Akgün Şükrü Oğuz Özdamar

https://doi.org/10.51261/yiu.2022.00042

Abstract

Introduction: Evidence-Based Medicine Program, which is a part of Phase III education program of Yüksek İhtisas University Faculty of Medicine, was held between 12.10.2021 and 16.11.2021 in six divided sessions, as a total of 13 hours. Material and Method: Our study group students, together with the facilitator lecturer, divided the work among ourselves for the problems of the case chosen and obtained literature information to find out the solution by using the evidence pyramid. Results: By working on the information obtained in the practice of evidence-based medicine, the students developed solutions for the problems of a patient diagnosed with Helicobacter pylori gastritis, who was given traditional triple therapy clarithromycin, amoxicillin, lansoprazole and had problems during the treatment. Conclusion: It was thought that the patient was not treated appropriately. Quadruple bismuth or dual amoxicillin therapy has been suggested. Proton pump inhibitor should be given bid and the patient should comply with the 14-day treatment period. In addition to drug treatment, probiotic supplement Lactobacillus derivatives may also be recommended to the patient.

Keywords

Evidence-based medicine , Helicobacter pylori , gastritis , treatment , dietary supplement

Bir Kanıta Dayalı Tıp Uygulaması: Helicobacter Pylori Gastriti Tedavisinde Uygun Yaklaşım Nasıl Olmalı?

Abstract

Giriş: Yüksek İhtisas Üniversitesi Tıp Fakültesi Dönem III programında yer alan Kanıta Dayalı Tıp Programı 12.10.2021-16.11.2021 tarihleri arasında toplam 13 saatlik altı oturumda yapılmıştır. Materyal ve Metod: Çalışma grubumuz öğrencileri, kolaylaştırıcı öğretim üyesi ile birlikte seçtikleri olgunun sorunlarına yönelik aralarında iş bölümü yapmış ve çözümde kullanacakları kanıtları elde etmede kanıt piramidini kullanarak literatür bilgisi elde etmişlerdir. Bulgular: Öğrenciler, kanıta dayalı tıp uygulamasında elde edilen bilgiler üzerinde çalışarak geleneksel üçlü tedavi klaritromisin, amoksisilin, lansoprazol verilen ve tedavisinde sorunlar yaşayan Helicobacter pylori gastriti tanısı almış hastanın sorunlarına yönelik çözüm önerileri geliştirmişlerdir. Sonuç: Hastaya uygun tedavi verilmediği düşünülmüştür. Dörtlü bizmut veya ikili Amoksisilin tedavisinin uygulanması önerilmiştir. Proton pompa inhibitörü 2x1 olarak verilmeli, hastanın 14 gün olan tedavi süresine uyumu sağlanmalıdır. Tedaviye ek olarak, hastaya probiyotik takviyesi Lactobacillus türevleri de önerilebilir.

Keywords

Kanıta dayalı tıp , Helicobacter pylori , gastrit , tedavi , diyet takviyesi

References

• Sackett, DL, Straus, SE, Richardson, WS, et al. Evidence-based medicine. How to practice and teach EBM, 2nd edition, Churchill Livingstone, Edinburgh, 2000.
• Badenoch D, Heneghan C. Evidence-based medicine toolkit. BMJ Books. Navarra, 2002.
• Erden A. Kanıta Dayalı Radyoloji. Tanısal ve Girişimsel Radyoloji 2004; 10:89-91.
• Akan H. Kanıta Dayalı Tıp. http://tfd.org.tr/sites/default/files/Klasor/Dosyalar/ ebultenler/ktcg/53_3_hamdi_akan_yazi.pdf
• Babaoğlu MÖ, Yaşar Ü, Dost T, Kayaalp SO. Kanıta Dayalı Tıp: Kavramlar, Örnekler Ve Görüşler. Turkiye Klinikleri J Med Sci. 2009;29 5 :1298-305. http://docplayer.biz.tr/32190134-Kanita-dayali-tip-kavramlar-ornekler-ve- gorusler.html
• Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc 2006;2006:359- 63.
• Luijendijk HJ. How to create PICO questions about diagnostic tests. BMJ Evid Based Med 2021;26:155–7.
• Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther 1995;9 Suppl 2 33-39.
• Stolte M. et al. 1996 Clinical presentation, diagnosis and treatment of Helicobacter pylori- related gastric lymphoma. In: Hunt R.H., Tytgat G.N.J. eds Helicobacter pylori. Springer, Dordrecht. https://doi.org/10.1007/978-94- 009-1792-7_22
• Everhart JE, Kruszon-Moran D, Perez-Perez GI, Tralka TS, McQuillan G. Seroprevalence and ethnic differences in Helicobacter pylori infection among adults in the United States. J Infect Dis 2000;181:1359-63.
• Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175-86.
• Makola Di Peura DA, Crowe SE. Helicobacter pylori infection and related gastrointestinal diseases. J Clin Gastroenterol 2007;41:548-58.
• Altındiş M., Özdemir M. Helicobacter pylori ve tanısı. Kocatepe Tıp Derg 2003; 4: 1-12.
• Nagiyev T, Yula E, Abayli B, Koksal F. Prevalence and genotypes of Helicobacter pylori in gastric biopsy specimens from patients with gastroduodenal pathologies in the Cukurova Region of Turkey. J Clin Microbiol 2009; 47: 4150-4153.
• Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, Bazzoli F, Gasbarrini A, Atherton J, Graham DY, Hunt R, Moayyedi P, Rokkas T, Rugge M, Selgrad M, Suerbaum S, Sugano K, El-Omar EM; European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017;66:6-30.
• Polat Mümin, Helicobacter pylori tanımlanmasında farklı yöntemlerin uygulanması, Isparta Süleyman Demirel Üniversitesi, Fen Bilimleri Enstitüsü, Doktora Tezi , 2013.
• Lamont JT. Treatment regimens for Helicobacter pylori in adults [Internet]. UpToDate. 2021 [cited 2021Nov25]. Available from: https://www.uptodate. com/contents/treatment-regimens- for-helicobacter-pylori-in-adults
• Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions. Gastroenterology 2018;155:1372-1382.e17.
• Zou Y, Qian X, Liu X, Song Y, Song C, Wu S, et al. The effect of antibiotic resistance on Helicobacter pylori eradication efficacy: A systematic review and meta-analysis. Helicobacter 2020;25:e12714.
• 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.
• Gökçekuyu BM, Yılmaz Ö, Soytürk M, Ellidokuz H, Akpınar H, Şimşek İ. Unacceptable Antibiotic Resistance Rates for Helicobacter pylori in Turkey: Something Must Change. Turk J Gastroenterol 2021;32:269-275.
• Caliskan R, Tokman HB, Erzin Y, Saribas S, Yuksel P, Bolek BK, et al. Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey. Rev Soc Bras Med Trop 2015;48:278-84.
• Akar M, Aydın F, Kayman T, Abay S, Karakaya E. Detection of Helicobacter pylori by invasive tests in adult dyspeptic patients and antibacterial resistance to six antibiotics, including rifampicin in Turkey. Is clarithromycin resistance rate decreasing? Turk J Med Sci 2021;51:1445-1464.
• Sung JJ, Leung VK, Chung SC, Ling TK, Suen R, Cheng AF, Li AK. Triple therapy with sucralfate, tetracycline, and metronidazole for Helicobacter pylori-associated duodenal ulcers. Am J Gastroenterol 1995;90:1424-7.
• Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017;112:212- 239. doi: 10.1038/ajg.2016.563. Epub 2017 Jan 10. Erratum in: Am J Gastroenterol 2018;113:1102.
• Yang J, Zhang Y, Fan L, Zhu YJ, Wang TY, Wang XW, et al. Eradication Efficacy of Modified Dual Therapy Compared with Bismuth-Containing Quadruple Therapy as a First- Line Treatment of Helicobacter pylori. Am J Gastroenterol 2019;114:437-445. doi: 10.14309/ajg.0000000000000132. Erratum in: Am J Gastroenterol 2019;114:835.
• Song Z, Zhou L, Xue Y, Suo B, Tian X, Niu Z. A comparative study of 14- day dual therapy esomeprazole and amoxicillin four times daily and triple plus bismuth therapy for first-line Helicobacter pylori infection eradication: A randomized trial. Helicobacter 2020;25:e12762. Epub 2020 Oct 11.
• Celebi A, Kocaman O, Savli H, Aygün C, Konduk BT, Sentürk O, Hülagu S. The prevalence of CYP2C19 mutations in Turkish patients with dyspepsia. Turk J Gastroenterol 2009;20:161-4.
• Waldum HL, Kleveland PM, Sİrdal ØF. Helicobacter pylori and gastric acid: an intimate and reciprocal relationship. Therap Adv Gastroenterol 2016;9:836-844.
• Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut 2016;65:1439-46.
• Maruyama M, Tanaka N, Kubota D, Miyajima M, Kimura T, Tokutake K, et al. Vonoprazan- Based Regimen Is More Useful than PPI-Based One as a First- Line Helicobacter pylori Eradication: A Randomized Controlled Trial. Can J Gastroenterol Hepatol 2017;2017:4385161.
• Sue S, Shibata W, Sasaki T, Kaneko H, Irie K, Kondo M, Maeda S. Randomized trial of vonoprazan-based versus proton-pump inhibitor-based third-line triple therapy with sitafloxacin for Helicobacter pylori. J Gastroenterol Hepatol 2019;34:686-692.
• Ierardi E, Goni E, Losurdo G, Di Mario F. Helicobacter pylori and nonmalignant diseases. Helicobacter 2014;19 Suppl 1:27-31. doi: 10.1111/hel.12157.
• Hołubiuk Ł, Imiela J. Diet and Helicobacter pylori infection. Prz Gastroenterol 2016;11:150-154. doi: 10.5114/pg.2016.61487.
• Fontes LES, Martimbianco ALC, Zanin C, Riera R. N-acetylcysteine as an adjuvant therapy for Helicobacter pylori eradication. Cochrane Database Syst Rev 2019;2:CD012357.
• Lü M, Yu S, Deng J, Yan Q, Yang C, Xia G, et al. Efficacy of Probiotic Supplementation Therapy for Helicobacter pylori Eradication: A Meta- Analysis of Randomized Controlled Trials. PLoS One 2016;11:e0163743.
• Wang X, Hirmo S, Willén R, Wadström T. Inhibition of Helicobacter pylori infection by bovine milk glycoconjugates in a BAlb/cA mouse model. J Med Microbiol 2001;50:430-435.
• Hablass FH, Lashen SA, Alsayed EA. Efficacy of lactoferrin with standard triple therapy or sequential therapy for Helicobacter pylori eradication: A randomized controlled trial. Turk J Gastroenterol 2021; 32: 742-74 9.
• Yanaka A, Fahey JW, Fukumoto A, Nakayama M, Inoue S, Zhang S, et al. Dietary sulforaphane-rich broccoli sprouts reduce colonization and attenuate gastritis in Helicobacter pylori-infected mice and humans. Cancer Prev Res Phila 2009;2:353-60.
• Chatterjee A, Yasmin T, Bagchi D, Stohs SJ. Inhibition of Helicobacter pylori in vitro by various berry extracts, with enhanced susceptibility to clarithromycin. Mol Cell Biochem 2004;265:19-26.
• Zhang L, Ma J, Pan K, Go VL, Chen J, You WC. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Helicobacter 2005;10:139-45.
• Boyanova L, Ilieva J, Gergova G, Vladimirov B, Nikolov R, Mitov I. Honey and green/black tea consumption may reduce the risk of Helicobacter pylori infection. Diagn Microbiol Infect Dis 2015;82:85-6.
• Thompson L, Cockayne A, Spiller RC. Inhibitory effect of polyunsaturated fatty acids on the growth of Helicobacter pylori: a possible explanation of the effect of diet on peptic ulceration. Gut 1994;35:1557-61.
• Castro M, Romero C, de Castro A, Vargas J, Medina E, Millán R, et al. Assessment of Helicobacter pylori eradication by virgin olive oil. Helicobacter 2012;17:305-11.
• Ito Y, Suzuki K, Ichino N. The risk of Helicobacter pylori infection and atrophic gastritis from food and drink intake: a cross-sectional study in Hokkaido, Japan. Asian Pac J Cancer Prev 2000; 1:147–56.
• Si XB, Zhang XM, Wang S, Lan Y, Zhang S, Huo LY. Allicin as add-on therapy for Helicobacter pylori infection: A systematic review and meta-analysis. World J Gastroenterol 2019;25:6025-6040.
• Ahmed KS, Khan AA, Ahmed I, Tiwari SK, Habeeb A, Ahi JD, Abid Z, Ahmed N, Habibullah CM. Impact of household hygiene and water source on the prevalence and transmission of Helicobacter pylori: a South Indian perspective. Singapore Med J 2007;48:543-9.
• Miftahussurur M, Nusi IA, Graham DY, Yamaoka Y. Helicobacter, Hygiene, Atopy, and Asthma. Front Microbiol 2017;8:1034.