Rustamov M.N., Lazebnik L.B. Alternative treatment of patients with Helicobacter pylori-associated duodenal ulcer // Гастроэнтерология Санкт-Петербурга. - 2018. №2. С. 114.
Alternative treatment of patients with Helicobacter pylori-associated duodenal ulcer
Rustamov M.N.1, Lazebnik L.B.2
1 Belarusian State Medical University, Minsk, Belarus, 2 Moscow State Medical University of Dentistry, RussiaPurpose: to elaborate the optimal Helicobacter pylori (HP) eradication regimens in duodenal ulcer (DU) patients using nonpharmacologic remedies.
Materials and methods. In this study 250 HP-positive DU patients were randomized into 5 groups, 50 patients in each. Histological detection of HP, intragastric and intraduodenal pH-metry by tool Gastroscan-5M, blood analyses were performed. The next eradication regimens were recommended: Group I - 10-days twice daily oral administration of PPIs, amoxicillin 1000 mg, clarithromycin 500 mg, then 20-days twice daily PPIs; Group II - the same treatment plus oral administration of probiotics (P), containing Lactobacillus bulgaricus DDS-14, Lactobacillus rhamnosus, Lactobacillus acidophilus DDS-1 and Bifidobacterium bifidum during 1 month; Group III - PPIs and P and alkaline hydrocarbonate-chloride sodium mineral water (MW) 200 ml trice daily during 1 month; Group IV - PPIs and P once daily and chloride sodium MW trice daily during 1 month; Group V - P and PPIs twice daily during 1 month.
Findings. 82% of patients had pain syndrome and 70% - dyspeptic complaints (DC). In 50% of patients of Group I increased the frequency of DC and in 42% of them such complaints appeared for the first time. In Group II DC disappeared in 74%, and decreased in 20%. Disappearance of DC was 78%, 76%, 74% in III, IV and V groups respectively. Decrease of DC was 20%, 22%, 24% in III, IV and V groups respectively. The eradication rate were 70%, 82%, 80%, 78% and 68% in I, II, III, IV and V groups, respectively. Healing of DU were in 82%, 84%, 86%, 84% and 78% of cases, in I, II, III, IV and V groups, respectively. Intragastric and intraduodenal pH increased in all groups, especially in III. In group I increased alanine transaminase, asparagjnes transaminase, alkaline phosphatase, and triglycerides, which must be noted as drug-related side effects of clarithromycin-based triple therapy. In group II such changes did not happen. In III, IV and V groups decreased alanine transaminase, asparagines transaminase, blood bilirubin, alkaline phosphatase, cholesterol and triglycerides.
Conclusions. Standard clarithromycin-based triple HP eradication therapy causes or increases the frequency of DC related with antibiotics, has low efficacy and hepatotoxic effect. Adding P to standard triple therapy improves compliance and efficacy of HP eradication. The combined use of PPIs, P and MW is a highly-effective and low-cost alternative therapy in patients with HP-associated duodenal ulcer.
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