Nisan 2012
Helikobakter pilori eradikasyonunda klasik 3?lü tedavi Dogu Anadolu bölgesinde halen etkilidir
Classic triple therapy of Helicobacter pylori eradication still an effective treatment in Eastern Anatolia
- Ana Sayfa
- Sayılar
- Nisan 2012
- Helikobakter pilori eradikasyonunda klasik 3?lü tedavi Dogu Anadolu bölgesinde halen etkilidir...
Istanbul Egitim ve Arastirma Hastanesi, 2Gastroenteroloji Klinigi, Istanbul
Erzurum Bölge Egitim ve Arastirma Hastanesi, 3Iç Hastaliklari Klinigi, Erzurum
Özet
Amaç: Helikobakter pilori eradikasyonunda, proton pompa inhibitörübazli üçlü tedavi birinci basamak tedavisi olarak önerilmektedir. Bu klasik tedavinin, özellikle klaritromisin direnci gelistiginden etkisiz olduguna dair yayinlar çikmistir. Bu çalismada klasik üçlü tedavinin birinci basamakta etkinligi arastirilmistir. Materyal ve Metod: Subat 2010 Temmuz 2011 tarihleri arasinda endoskopik biyopsisinde Helikobakter pilori saptanan, daha önce 1. basamak tedavi almayan, çalismaya katilmayi kabul edip, ilaçlarin en az %90?ini kullanan hastalar prospektif olarak takip edildi. Tedavi protokolü olarak klaritromisin, amoksisilin ve proton pompa inhibitöründen olusan hazir 3?lü tedavi paketi 2x1 14 gün, devaminda 1x1 2 ay lansoprazol verilmistir. Tedaviyi tamamlayan hastalarda eradikasyon kontrolü için gaitada Helikobakter pilori antijeni bakilmis, negatif gelen hastalarda eradikasyon basarili kabul edilmistir. Erozyon ve ülser rapor edilen hastalar peptik ülser, digerleri non-ülser dispepsi olarak kabul edilmistir. Bulgular: Gastroskopik biyopsi sonucu Helikobakter pilori pozitif saptanan ve çalismayi tamamlayan 104 hastanin 51?i (%49) erkek, yas ortalamasi 39.98±12.82 (dagilim 13-73) idi. Hastalardan 60?i (%57) peptik ülser, 44?ü (%43) non-ülser dispepsi idi. Hastalardan 101?inde (%97) kontrol Helikobakter pilori antijeni negatif saptanmistir. Eradike olmayan 3 hastadan ikisi peptik ülser (1 eroziv gastrit, 1 duodenal ülser), biri de non-ülser dispepsi (eritemli gastrit) idi. Sonuç: Dogu Anadolu bölgesinde Helikobakter pilori eradikasyonunda, klasik 3?lü tedaviyle %97 eradikasyon saglanmis olup, birinci basamakta halen ilk önerilecek tedavidir.
Abstract
Background and Aims: For Helicobacter pylori eradication, proton pump inhibitor -based triple therapy is recommended as the first-line therapy. This classic treatment has been reported to be ineffective, in particular with development of clarithromycin resistance. The aim of this study was to evaluate the efficiency of the classic triple therapy as the first line of eradication. Materials and Methods: This prospective study included patients seen between February 2010 and July 2011, with endoscopic biopsy-detected Helicobacter pylori who were previously untreated with a first-line therapy and who accepted to participate in the study, with at least 90% drug usage. The treatment protocol included clarithromycin, amoxicillin and proton pump inhibitorfor 14 days as 2x1, and 1x1 continuation of lansoprazole for two months. Successful eradication of Helicobacter pylori was considered as eradication of Helicobacter pylori antigen in the stool for control patients who completed the treatment. Patients with erosion and ulcer were considered as peptic ulcer patients and others as having non-ulcer dyspepsia. Results: 104 patients with biopsyproven and gastroscopic-identified Helicobacter pylori completed the study. 51 (49%) patients were male, with a mean age of 39.98±12.82 years (range: 13-73). 60 (57%) patients had peptic ulcer and 44 (43%) had non-ulcer dyspepsia. Helicobacter pylori antigen negativity was determined in 101 patients (97%). Helicobacter pylori was not eradicated in 3 patients: 2 peptic ulcer disease patients (1 erosive gastritis, 1 duodenal ulcer) and 1 non-ulcer dyspepsia patient (erythematous gastritis). Conclusions: For Helicobacter pylori eradication in the eastern region, the classic triple therapy resulted in 97% eradication, and thus this therapy remains the first to be proposed in primary care.
