FONKSİYONEL DİSPEPSİLİ HASTALARDA HELICOBAKTER PYLORI ERADİKASYONUNUN EPİGASTRİK AĞRI SKORU İLE DEĞERLENDİRİLMESİ

Öz

Amaç: Dispepsi, erişkinlerin en sık görülen kronik hastalıklarından biridir. Dispepsi tedavisinin maliyeti gelişmiş ülkelerde sağlık harcamalarının büyük bir kısmını temsil etmektedir. Fonksiyonel dispepsi, multifaktöryel, etiyolojinde Helicobacter pylori’nin suçlandığı bir hastalıktır. Bu çalışmada, “Fonksiyonel dispepsi” alt grubu olan epigastrik ağrı sendromlu hastalarda Helicobacter pylori’nin eradikasyonunun epigastrik ağrı şiddeti üzerine etkilerini semptomatik skorlama yaparak değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Fonsiyonel dispepsi teşhisi konulan ve endoskopik biyopsilerinde Helicobacter pylori pozitifliği tespit edilmiş 530 hasta çalışmaya dahil edildi. Hastalara dörtlü eradikasyon tedavisi verildikten sonra hastaların semptom skorları 2. ve 6. ayda tekrar sorgulandı.

Bulgular: Çalışmaya 384 kadın (%73) ve 146 erkek (%27) hasta dahil edildi. Yaş ortalaması 39.8±10.6 /yıl idi. Tedavi başlangıcından 2 ay sonra hastaların skorlarına bakıldığında 463 (%88) hastada ağrı skorunda gerileme saptanırken, 67 (%12) hastanın ağrı skorunda değişiklik olmadı. Tedavi sonrası ağrı skorlarında anlamlı düzeyde azalma saptandı (p=0.001). İkinci ve 6. aydaki ağrı skorları karşılaştırıldığında; 6. ayda ki ağrı skoru, başlangıç ve 2. aydaki ağrı skoruna göre daha düşük bulundu.

Sonuç: Hem iki hem de altıncı aydaki, semptom skorlarındaki saptadığımız azalma eradikasyon oranları ile ilişkili olabilir. Böylelikle gereksiz test yapılmasının önüne geçilerek sağlık giderleri azaltılabilir. Bu bilgileri teyit edecek daha büyük sayıda hasta grubu içeren ve randomize kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• helikobakter pilori,fonksiyonel dispepsi

Evaluation of Helicobacter pylori Eradication on Functional Dyspepsia Using Epigastric Pain Score

Öz

Objective: Dyspepsia is one of the most common chronic illnesses of adults in the Western World. Not surprisingly, the cost of dyspepsia treatment represents a large proportion of the healthcare expenses in developed countries. Functional dyspepsia is a multifactorial disease and Helicobacter pylori infection are thougt to be related to Functional dyspepsia. We aimed to evaluate the effects of H. pylori eradication on epigastric pain severity by symptomatic scoring.

Material and Methods: We enrolled 530 patients which were diagnosed with functional dyspepsia and H. pylori positivity in endoscopic biopsies. Symptom scores were questioned at 2th month and 6th month after the treatment. All patients received standard quadruple therapy for 14 days.

Results: This study was carried out on 384 female and 146 male patients. The mean age of the patients was 39.8±10.6 years. The scores of 463 (88%) patients showed regression after 2 months of treatment and 67(12%) patients had no differences in pain score. We observed statistically significant decrease in pain scores after treatment (p=0.001). When second and sixth month’s pain scores were compared, the pain score at the sixth month was lower than the baseline and second month’s evaluation.

Conclusion: We found a decrease in both 2th and 6th month symptom scores which may be related to eradication rates. This finding can prevent unnecessary investigations and reduce medical expenditures for H. pylori eradication. But more randomized studies with large number of patients are needed to confirm this information.

Anahtar Kelimeler

• Helicobacter pylori,functional dyspepsia,eradication

Kaynakça

1. 1. Agreus L. Natural history of dyspepsia. Gut. 2002;50:2-9.
2. 2. Delaney BC, Wilson S, Roalfe A, Roberts L, Redman V, Wearn A et al. Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care. BMJ. 2001;322(7291):898-901.
3. 3. Kitapçıoğlu G, Mandıracıoğlu A, Bor CC, Bor S. Overlap of symptoms of dyspepsia and gastroesophageal reflux in the community. Turk J Gastroenterol. 2007;18(1):14-9.
4. 4. Rome Foundation. Guidelines: Rome III Diagnostic Criteria for functional gastrointestinal disorders. J Gastrointest Liver Dis. 2006;15(3):307-12.
5. 5. Miwa H, Kusano M, Arisawa T, Oshima T, Kato M, Joh T et al. Evidence-based clinical practice guidelines for functional dyspepsia. J Gastroenterol. 2015;50(2):125-139.
6. 6. Mazzoleni LE, Sander GB, Francesconi CF, Mazzoleni F, Uchoa DM, De Bona LR et al. Helicobacter pylori eradication in functional dyspepsia: HEROES trial. Arch Intern Med. 2011;171(21):1929-36.
7. 7. Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F et al. European Helicobacter Study Group. Management of Helicobacter pylori infection: the Maastricht IV Florence Consensus Report. Gut. 2012;61(5):646-64.
8. 8. Suzuki H, Nishizawa T, Hibi T. Can Helicobacter pylori associated dyspepsia be categorized as functional dyspepsia? J Gastroenterol Hepatol. 2011;26(Suppl.3):42-5.

9. 9. Hong SJ, Sung IK, Kim JG, Lee SW, Choi SC, Yang CH et al. Failure of a randomized, double blind, placebo-controlled study to evaluate the efficacy of H. pylori eradicationin H. pylori infected patients with functional dyspepsia. Gut Liver. 2011;5(4):468-71.
10. 10. Oustamanolakis P, Tack J. Dyspepsia: organic versus functional. J Clin Gastroenterol. 2012;46(3):175-90.
11. 11. Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. Corrigendum: ACG and CAG Clinical Guideline: Management of dyspepsia. Am J Gastroenterol. 2017;112(9):1484. Doi:10.1038/ajg.2017.238.
12. 12. Ozaydin N, Turkyilmaz SA, Cali S. Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test. BMC Public Health. 2013;13(1):1215. Doi:10.1186/1471-2458-13-1215.
13. 13. Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther. 2007;26(3):343-57.
14. 14. Miwa H. Why dyspepsia can occur without organic disease: pathogenesis and management of functional dyspepsia. J Gastroenterol. 2012;47(8):862-71.
15. 15. Armstrong D. Helicobacter pylori infection and dyspepsia. Scand J Gastroenterol Suppl.1996;31(215):38-47.
16. 16. Blum AL, Talley NJ, O'Moráin C, van Zanten SV, Labenz J, Stolte M 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(26):1875-81.
17. 17. Ağbaba E, Nazlıgül Y, Yeniova AÖ, Yıldız M, Bulur O ve ark. Dicle Tip Dergisi. 2010;37(3):211-216.
18. 18. İşler M, Bahçeci M, Aygündüz M, Katırcı S, Özelsancak R, Koçer M et al. The effectiveness of Helicobacter pylori eradication on symptoms in non- ulcer dyspepsia. T Klin Gastroenterohepatol. 2001;12(1):13-8.
19. 19. Gisbert JP, Cruzado AI, Garcia-Gravalos R, Pajares JM. Lack of benefit of treating Helicobacter pylori infection in patients with functional dyspepsia. Randomized one year follow-up study. Hepatogastroenterology. 2004;51(55):303-8.
20. 20. Talley NJ, Vakil N, Ballard ED, Fennerty MB. Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med. 1999;341(15):1106-11.
21. 21. Veldhuyzen van Zanten SJ, Sherman PM. Indications for treatment of Helicobacter pylori infection: a systematic overview. CMAJ. 1994;150(2):189-98.
22. 22. Ford AC, Marwaha A, Sood R, Moayyedi P. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut. 2015;64(7):1049-57. Doi:10.1136/gutjnl-2014-307843.
23. 23. Verbrugge LM.Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985;26(3):156-82.
24. 24. Esmaillzadeh A, Keshteli AH, Tabesh M, Feizi A, Adibi P. Smoking status and prevalence of upper gastrointestinal disorders. Digestion. 2014;89(4):282-90. Doi:10.1159/000358169.
25. 25. Kim SE, Kim N, Park SM, Kim WH, Baik GH, Jo Y et al. Female gender is a poor predictive factor of functional dyspepsia resolution after Helicobacter pylori eradication: a prospective, multi-center Korean trial. Korean J Gastroenterol. 2018;72(6):286-294. Doi:10.4166/kjg.2018.72.6.286.