Aralik 2017
Helicobacter pylori eradikasyonunda ardisik 5+5 (10) günlük ve ardisik 7+7 (14) günlük tedavilerin karsilastirilmasi
Comparison of 10 and 14 days sequential therapy for the eradication of Helicobacter pylori
- Ana Sayfa
- Sayılar
- Aralik 2017
- Helicobacter pylori eradikasyonunda ardisik 5+5 (10) günlük ve ardisik 7+7 (14) günlük tedavilerin karsilastirilmasi ...
Özet
Giris ve Amaç: 1. basamak Helicobacter pylori tedavisinde klasik 3’lütedavi (amoksisilin+klaritromisin+proton pompa inhibitörü) ile eradikasyon oranlari %50’lerin altina düsmüstür. Bu randomize, prospektifçalismada gastroskopisinde peptik ülser (gastrik ülser ve/veya duodenal ülser) saptanan, histopatolojik olarak Helicobacter pylori pozitifolan hastalarda 5+5 (10) günlük ve 7+7 (14) günlük ardisik tedavisonuçlarinin karsilastirilmasi amaçlanmistir. Gereç ve Yöntem: Mart2014-Agustos 2015 tarihleri arasinda gastroskopide peptik ülser saptanan, histopatoloji, üre-nefes testi veya gaitada Helicobacter pylori antijeni sonuçlarindan en az ikisinde pozitiflik tespit edilen ve daha önceeradikasyon tedavisi almamis 66 hasta ardisik olarak 2 gruba randomizeedilerek çalismaya alindi. Grup 1 hastalara (n: 33) 5 gün (amoksisilin 1gr+esomeprazol 40 mg 2x1) ardindan 5 gün (klaritromisin 500 mg+-metronidazol 500 mg+esomeprazol 40 mg 2x1) verildi. Grup 2 hastalara (n: 33) 7 gün (amoksisilin 1 gr+esomeprazol 40 mg 2x1) ardindan 7gün (klaritromisin 500 mg+metronidazol 500 mg+esomeprazol 40 mg2x1) verildi. Her iki grupta esomeprazol 40 mg (1x1) 12 haftaya tamamlandi. 15 gün ilaçsiz dönem sonrasi üre-nefes testi ve gaitada Helicobacter pylori antijen testi ile eradikasyon kontrolü yapildi. Bulgular: Grup1 hastalarinin 10’u (%30.3) kadin, yas ortalamasi 38±13.1 yas, grup 2hastalarinin 12’si kadin (%34.4), yas ortalamasi 39±15.6 yas idi. Tedavi sonrasi üre-nefes testi ve gaitada Helicobacter pylori antijen testi ileyapilan degerlendirmede grup 1’de eradikasyon orani %70, grup 2’de%72.7, toplamda %71.2 saptandi. Iki grup arasinda istatistiksel anlamlifarklilik yoktu.Sonuç: Ardisik 5+5 (10) günlük ve 7+7 (14) günlük tedavi sonucunda benzer sekilde yüzde yetmis civarinda eradikasyon saglanmistir. Çok ideal olmamakla birlikte bu eradikasyon orani 5+5 (10) günlük ardisik tedavinin 1. basamak için alternatif olabilecegini göstermistir.
Abstract
Background and Aims: The eradication rate of Helicobacter pylori using standard triple therapy (amoxicillin+clarithromycin+proton pump inhibitor) as the first-line therapy has fallen below 50%. This prospective,randomized study was conducted to compare the 5+5 (10)-day and7+7 (14)-day sequential treatment results in patients with peptic ulcer(gastric ulcer and/or duodenal ulcer) who were identified as histologically positive for Helicobacter pylori infection by gastroscopy.Materialsand Methods: This study included 66 patients who had peptic ulcerdiagnosed through gastroscopy, had at least two histopatholgicallypositive results, underwent urea breath test, had positive stool testfor Helicobacter pylori antigen, and did not receive eradication therapy before. These patients were randomly divided into two groups andenrolled into the study between March 2014 and August 2015. Group1 patients (n=33) were administered amoxicillin 1 g+esomeprazole 40mg 2x1 for the first 5 days, followed by clarithromycin 500 mg+metronidazole 500 mg+esomeprazole 40 mg 2x1 for the next 5 days. Group2 patients (n=33) were administered amoxicillin 1 g+esomeprazole 40mg 2x1 for the first 7 days, followed by clarithromycin 500 mg+metronidazole 500 mg+esomeprazole 40 mg 2x1 for the next 7 days. Esomeprazole 40 mg (1x1) treatment was completed during 12 weeks in bothgroups. After a drug-free period of 15 days, the eradication rate wasanalyzed by urea breath test and Helicobacter pylori antigen stool test.Results: Ten patients in Group 1 (30.3%) were females, with a meanage of 38.0±13.1 years. Twelve patients in Group 2 (34.4%) were females, with a mean age of 39.0±15.6 years. After treatment, the ureabreath test and Helicobacter pylori antigen stool test revealed an eradication rate of 70% in Group 1 and 72.7% in Group 2, with an overalleradication rate of 71.2% in all patients. No significant difference wasobserved between the two groups.Conclusion: At the end of the consecutive 5+5-day and 7+7-day treatment, an eradication rate of about70% was achieved in all patients. Although not ideal, this eradicationrate implies that the 5+5 (10)-day consecutive treatment could be usedan alternative first-line therapy.
