Helicobacter pilori eradikasyonu için verilen iki farklı ardışık tedavinin eradikasyon oranlarının karşılaştırılması

Yıl 2019, Cilt: 52 Sayı: 2, 138 - 144, 31.07.2019

Aysun Gönderen , Kamil Gönderen , Mehmet Yıldız

Öz

Amaç: Helicobacter Pylori (HP) peptik
ülser, gastrik kanser ile ilişkisi iyi bilinen gram (-) mikroaerofilik
bakteridir. Bundan dolayı infekte hastalarda HP eradikasyon tedavisi
önerilmektedir. Bu çalışmada da iki farklı eradikasyon tedavisinin etkinliğinin
karşılaştırılması amaçlandı. Materyal ve
Metod: Şubat 2009 – Mayıs 2010 tarihleri arasında Dışkapı Yıldırım Beyazıt
Eğitim Araştırma Hastanesi Gastroenteroloji ve Dahiliye polikliniklerine reflü,
bulantı-kusma ve gastrik ağrı şikayetleri ile başvurup endoskopi yapılan ve
endoskopik olarak gastrik ülser, duodenal ülser veya gastrit tanısı konulan,
immüno-histokimyal olarak HP pozitif saptanan ve daha önce eradikasyon tedavisi
almamış 98 hasta çalışmaya dahil edildi. Hastalar randomize olarak iki gruba
ayrıldı ve ilk gruba bir hafta omeprazol ve amoksisilin ikinci hafta omeprazol
ve metronidazol verildi. Diğer gruba ilk 7 gün omeprazol ve amoksisilin ikinci
hafta omeprazol, metronidazol ve tetrasiklin verildi. Tedavi bitiminden sonra
eradikasyon oranını belirlemek için kontrol endoskopileri yapılarak biyopsileri
alındı. Bulgular: Çalışmaya alınan
hastaların 47’si (%56) kadın ve 46’sı (%54,7) 40 yaş altındaydı. Birinci rejim
tedaviyi alan hastalarda tedavi başarısı tüm hasta grubuna bakıldığında %32.4,
ikinci rejim tedaviyi alan hastalarda tedavi başarısı %59.6 olarak saptandı ve
iki grup tedavi rejimi arasında istatistiksel olarak anlamlı fark vardı. Sonuç: Tetrasiklin içeren tedavi
grubunda eradikasyon başarı oranı sayısal olarak daha yüksek ve istatistiksel
olarak anlamlı olmakla beraber eradikasyon oranları genel literatüre göre %80
altında ve düşük bulunmuştur. Bu sonuç başta antibiyotik direnci olmak üzere
tedavinin başarısını azaltabilecek nedenlerin ortaya konması gerektiğini ve HP
eradikasyonunda alternatif tedavilere ihtiyaç olduğunu göstermektedir.

Anahtar Kelimeler

Helikobakter pilori, peptik ülser, tedavi

Comparison ratios of two different sequential treatments for Helicobacter pylori eradication

Öz

Purpose: Helicobacter Pylori
(HP) is a gram (-) microaerophilic bacterium that related with peptic ulcer and
gastric cancer. The aim of this study was to compare the efficacy of the two
different eradication therapies. Material
and Methods: 98 patients were included in the study who was admitted to
Gastroenterology and Internal Medicine outpatient clinics of Dışkapı Yıldırım
Beyazıt Training and Research Hospital with complaints of reflux, nausea,
vomiting or gastric pain and had detected HP positive immunohistochemically also
had not received any eradication treatment before. The patients were randomly
divided into two groups.  The first group
was treated with omeprazole and amoxicillin in the first week then with
omeprazole and metronidazole in the second week. The second group was treated
with omeprazole and amoxicillin in the first week and then with omeprazole,
metronidazole and tetracycline in the second week. After the treatment, control
endoscopy was performed and the biopsies were taken to determine the
eradication ratios. Results: The
eradication ratio of treatment in the first group was 32.4% and 59.6% in the
second group. There was a statistically significant difference between the eradication
ratios of the groups (p<0.001). Conclusion:
The eradication ratio was higher in the tetracycline-receiving treatment group
however, the eradication ratios of both groups were found to be lower than the
ratio of 80% that revealed in the literature. Low  eradication ratio of the treatments in this
study may be associated with antibiotic resistance. According to this study’s
results alternative treatments are needed in HP eradication.

Anahtar Kelimeler

Helicobacter Pylori, peptic ulcer, treatment

Kaynakça

• .Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori infection. Helicobacter. 2014;19.s1:1– 5.
• F ederico A, Gravina AG, Miranda A, Loguercio C, Romano M. Eradication of Helicobacter pylori infection: which regimen first? World J Gastroenterol 2014;20: 665 – 72
• Calvet X,Ramírez Lázaro MJ, Lehours P, Mégraud F. Diagnosis and epidemiology of Helicobacter pylori infection. Helicobacter 2013; 18 Suppl 1: 5-11 [PMID: 24011238 DOI: 10.1111/hel.12071]
• M alfertheiner P, Megrau d F, O’Morai n C, et al. Current concepts in the management o f Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56:772 – 81.
• Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. European Helicobacter Pylori Study Group. Gut 1997; 41: 8-13 [PMID:9274464 DOI: 10.1136/gut.41.1.8]
• Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56:772-781 [PMID: 17170018 DOI: 10.1136/gut.]
• Gisbert JP, Pajares JM. T reatment of Helicobacter pylori infection: the past and the future. Eur J Intern Med 2010; 2:357 – 9.
• Malfertheiner P, Bazz oli F, Del chier JC, et al. Helicobacter pylori eradication w ith a capsule containing bismuth subcitrate potassium,metronidazole, and tetracyclin e given with omepraz ole versus clarithromycin-based triple therapy: a randomised, open-lab el, non-inferio rity, phase 3 trial. Lancet 2011;377: 905– 13.
• De Francesco V, Hassan C, Ridola L, et al. Sequential, concomitant and hybrid first-line therapies for Helicobacter pylori eradication: a prospective randomized study. J Med Microbiol 2014;63:748-52
• Lee SW, Kim HJ, Kim JG. Treatmentof helicobacter pyloriinfection in Korea: asystematic review and meta-analysis. J Korean Med Sci. 2015;30:1001–9
• L iou JM, Chen CC, Chen M J, et al. Sequential versus triple therapy for the first-lin e treatment o f H elicoba cter pylori: a multicentre, open -label,randomised trial. Lancet 2013;381:205 – 13.
• Huang AH, Sheu BS, Y ang HB, et al. Impact of Helicoba cter pylori antimicrobial resistance on the outcom e of 1-week lansoprazo le-based triple therapy. J Formos Med Assoc 2000;99: 704 – 9
• M alfertheiner P, Megrau d F,O’Morai n CA, et al. Management ofHelicobacter pylori infect ion-the M aastricht IV/ Florence Consensus Report. Gut 2012;61: 646– 64.14. Zhao X. Efficacy of amoxicillin combined with different antibiotic in anti Helicobacter pylori treatment. Nanjing Yikedaxue Xiebao (Ziran Kexueban) 2013; 33 : 255-256
• Vaira D, Zullo A, Vakil N, et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication. A randomized trial. Ann Intern Med 2007;146:556–63.
• Kim JS, Kim BW, Ham JH, et al. Sequential therapy for helicobacter pylori infection in Korea: systematic review and meta-analysis. Gut Liver. 2013;7:546 51.
• Chung JW, Ha M, Yun SC, et al. Meta-analysis: sequential therapy is superior to conventional therapy for helicobacter pylori infection in Korea. Korean J Gastroenterol.2013;62:267 – 71
• Camelia Quek, Son T. Pham, Kieu T. Tran, et al. Pham Antimicrobial susceptibility and clarithromycin resistance patterns of clinical isolates in Vietnam Helicobacter pylori. Version 1. F1000Res. 2016; 5: 671.
• Vilaichone RK, Yamaoka Y, Shiota S, et al. Antibiotics resistance rate of Helicobacter pylori in Bhutan. World J Gastroenterol 2013; 19:5508-5512 [PMID: 24023494 DOI: 10.3748/wjg.v19.i33.5508]
• Vilaichone RK, Gumnarai P, Ratanachu-Ek T, Mahachai V.Nationwide survey of Helicobacter pylori antibiotic resistance inThailand. Diagn Microbiol Infect Dis 2013; 77: 346-349 [PMID:24094837 DOI: 10.1016/j.diagmicrobio.2013.08.010]
• Lobo AJ, McNulty CA, Uff JS, Dent J, Eyre-Brook IA, Wilkinson SP. Preservation of gastric antral mucus is associated with failure of eradication of Helicobacter pylori by bismuth, metronidazole and tetracycline. Aliment Pharmacol Ther 1994; 8: 181-185 [PMID: 8038349 DOI: 10.1111/j.1365-
• Graham DY, Lew GM, Ramirez FC, Genta RM, Klein PD, Malaty HM. Short report: a non-metronidazole triple therapy for eradication of Helicobacter pylori infection--tetracycline, amoxicillin, bismuth. Aliment Pharmacol Ther 1993; 7:111-113[PMID: 8439632 DOI: 10.1111/j.1365]
• Hu H, Hsu P, Chuah S, et al.Amoxicillin in Replacement for Bismuth Subcitrate Offers Similar Helicobacter pylori Eradiation Response in Second-Line Rabeprazole-Based Quadruple Therapy. Gastroenterology 2012; 142 (5, Supplement 1): 485 [DOI: 10.1016/S0016-5085(12)61849-6]
• Cetinkaya ZA, Sezikli M, Güzelbulut F, Coşgun S, Düzgün S, Kurdaş OO. Comparison of the efficacy of the two tetracycline-containing sequential therapy regimens for the eradication of Helicobacter pylori: 5 days versus 14 days amoxicillin. Helicobacter 2010; 15 : 143-147
• Lv ZF, Wang FC, Zheng HL, et al. Meta-analysis: iscombination of tetracycline and amoxicillin suitable forHelicobacter pylori infection? World J Gastroenterol. 2015;21:2522 – 33
• Perri F, Festa V, Merla A, Quitadamo M, Clemente R, Andriulli A. Amoxicillin/tetracycline combinations are inadequate as alternative therapies for Helicobacter pyloriinfection. Helicobacter. 2002;7:99–104.
• Caliskan R, Tokman HB, Erzin Y, et al. Antimicrobial resistance of Helicobacter pylori strains to five antibiotics, including levofloxacin, in Northwestern Turkey. Revista da Sociedade Brasileira de Medicina Tropical 2015;48:278-84
• Ju Yup Lee, Nayoung Kim, Kyung Sik Park, et al. Comparison of sequential therapy and amoxicillin/tetracycline containing bismuth quadruple therapy for the first-lineeradication of Helicobacter pylori:a prospective, multi-center, randomized clinical trial BMC Gastroenterol. 2016; 16: 79
• Chung JW, Lee JH, Jung HY, et al.Second-line Helicobacter pylori eradication: a randomized comparison of 1-week or 2-week bismuth-containing quadruple therapy. Helicobacter 2011; 16: 289-294 [PMID: 21762268
• Lee BH, Kim N, Hwang TJ, et al. Bismuth-containing quadruple therapy as second-line treatment for Helicobacter pylori infection: effect of treatment duration and antibiotic resistance on the eradication rate in Korea. Helicobacter 2010; 15:38-45 [PMID: 20302588 DOI: 10.1111/j.1523]
• Byun YH, Jo YJ, Kim SC, et al. Clinical factors that predicts successful eradication ofHelicobacter pylori.Korean J Gastroenterol. 2006;48:172– 9.
• Cho DK, Park SY, Kee WJ,et al. The trend of eradication rate of Helicobacter pyloriinfection and clinical factors that affect the eradication of first-line therapy. Korean J Gastroenterol. 2010;55:368– 75
• Kim SE, Park MI, Park SJ, et al. Trends in Helicobacter pylori eradication rates by first-line triple therapy and related factors in eradication therapy. KoreanJ Intern Med. 20 15;30:801–7
• Suzuki T, Matsuo K, Ito H, et al. Smoking increases the treatment failure for Helicobacter pylorieradication. Am J Med. 2006;119:217–24.
• McNicho ll AG, Marin AC, Molina-Infante J, et al. Randomised clinical trial comparing sequential and concomitant therapies for Helicobacter pylori eradication in routine clinical practice. Gut 2 014;63:244–9.
• Zhi-Fa Lv, Fu-Cai Wang, Hui-Lie Zheng, et al. Meta-analysis: Is combination of tetracycline and amoxicillin suitable for Helicobacter pylori infection? World J Gastroenterol. 2015 Feb 28; 21(8): 2522–2533.