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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">gastro-j</journal-id><journal-title-group><journal-title xml:lang="ru">Российский журнал гастроэнтерологии, гепатологии, колопроктологии</journal-title><trans-title-group xml:lang="en"><trans-title>Russian Journal of Gastroenterology, Hepatology, Coloproctology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1382-4376</issn><issn pub-type="epub">2658-6673</issn><publisher><publisher-name>«Gastro» LLC</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.22416/1382-4376-2018-28-1-55-70</article-id><article-id custom-type="elpub" pub-id-type="custom">gastro-j-218</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CLINICAL GUIDELINES</subject></subj-group></article-categories><title-group><article-title>Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению инфекции Helicobacter pylori у взрослых</article-title><trans-title-group xml:lang="en"><trans-title>Diagnostics and treatment of Helicobacter pylori infection in adults: Clinical guidelines of the Russian gastroenterological association</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ивашкин</surname><given-names>В. Т.</given-names></name><name name-style="western" xml:lang="en"><surname>Ivashkin</surname><given-names>V. T.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Маев</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Mayev</surname><given-names>I. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лапина</surname><given-names>Т. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Lapina</surname><given-names>T. L.</given-names></name></name-alternatives><email xlink:type="simple">tatlapina@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шептулин</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Sheptulin</surname><given-names>A. A.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Трухманов</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Trukhmanov</surname><given-names>A. S.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Баранская</surname><given-names>Е. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Baranskaya</surname><given-names>Ye. K.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Абдулхаков</surname><given-names>Р. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Abdulkhakov</surname><given-names>R. A.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Алексеева</surname><given-names>О. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Alekseyeva</surname><given-names>O. P.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Алексеенко</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Alekseyenko</surname><given-names>S. A.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дехнич</surname><given-names>Н. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Dekhnich</surname><given-names>N. N.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-6"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Козлов</surname><given-names>Р. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Kozlov</surname><given-names>R. S.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-6"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кляритская</surname><given-names>И. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Klyaritskaya</surname><given-names>I. L.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-7"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Корочанская</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Korochanskaya</surname><given-names>N. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-8"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Курилович</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kurilovich</surname><given-names>S. A.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-9"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Осипенко</surname><given-names>М. Ф.</given-names></name><name name-style="western" xml:lang="en"><surname>Osipenko</surname><given-names>M. F.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-10"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Симаненков</surname><given-names>В. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Simanenkov</surname><given-names>V. I.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-11"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ткачев</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Tkachev</surname><given-names>A. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-12"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Хлынов</surname><given-names>И. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Khlynov</surname><given-names>I. B.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-13"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Цуканов</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Tsukanov</surname><given-names>V. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-14"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский университет)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state government-financed educational institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБОУ ВО «Казанский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state educational government-financed institution of higher education «Kazan State Medical University»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>ГБУЗ «Нижегородская областная клиническая больница им. Н.А. Семашко»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State government-financed healthcare institution «Semashko Nizhny Novgorod regional clinical hospital»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>ФГБОУ ВО «Дальневосточный государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state educational government-financed institution of higher education «Far East state medical university»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-6"><aff xml:lang="ru"><institution>ФГБОУ ВО «Смоленский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state educational government-financed institution of higher education «Smolensk state medical university»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-7"><aff xml:lang="ru"><institution>ФГАОУ ВО «Крымский федеральный университет им. В.И. Вернадского»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state government-financed educational institution of higher education «Vernadsky Crimean Federal University»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-8"><aff xml:lang="ru"><institution>ФГБОУ ВО «Кубанский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state educational government-financed institution of higher education «Kuban state medical university»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-9"><aff xml:lang="ru"><institution>ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук»; ФГБОУ ВО «Новосибирский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal state government-financed scientific institution «Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-10"><aff xml:lang="ru"><institution>ФГБОУ ВО «Новосибирский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State educational government-financed institution of higher professional education «Novosibirsk state medical university»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-11"><aff xml:lang="ru"><institution>ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State educational government-financed institution of higher professional education «Mechnikov North-Western State Medical University»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-12"><aff xml:lang="ru"><institution>ФГБОУ ВО «Ростовский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State educational government-financed educational institution of higher education «Rostov state medical university»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-13"><aff xml:lang="ru"><institution>ФГБОУ ВО «Уральский государственный медицинский университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State educational government-financed institution of higher professional education «Ural state medical university»</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-14"><aff xml:lang="ru"><institution>ФИЦ КНЦ СО РАН</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal research center Krasnoyarsk scientific center of the Siberian Branch of the Russian Academy of Sciences</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2018</year></pub-date><pub-date pub-type="epub"><day>12</day><month>08</month><year>2018</year></pub-date><volume>28</volume><issue>1</issue><fpage>55</fpage><lpage>70</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Ивашкин В.Т., Маев И.В., Лапина Т.Л., Шептулин А.А., Трухманов А.С., Баранская Е.К., Абдулхаков Р.А., Алексеева О.П., Алексеенко С.А., Дехнич Н.Н., Козлов Р.С., Кляритская И.Л., Корочанская Н.В., Курилович С.А., Осипенко М.Ф., Симаненков В.И., Ткачев А.В., Хлынов И.Б., Цуканов В.В., 2018</copyright-statement><copyright-year>2018</copyright-year><copyright-holder xml:lang="ru">Ивашкин В.Т., Маев И.В., Лапина Т.Л., Шептулин А.А., Трухманов А.С., Баранская Е.К., Абдулхаков Р.А., Алексеева О.П., Алексеенко С.А., Дехнич Н.Н., Козлов Р.С., Кляритская И.Л., Корочанская Н.В., Курилович С.А., Осипенко М.Ф., Симаненков В.И., Ткачев А.В., Хлынов И.Б., Цуканов В.В.</copyright-holder><copyright-holder xml:lang="en">Ivashkin V.T., Mayev I.V., Lapina T.L., Sheptulin A.A., Trukhmanov A.S., Baranskaya Y.K., Abdulkhakov R.A., Alekseyeva O.P., Alekseyenko S.A., Dekhnich N.N., Kozlov R.S., Klyaritskaya I.L., Korochanskaya N.V., Kurilovich S.A., Osipenko M.F., Simanenkov V.I., Tkachev A.V., Khlynov I.B., Tsukanov V.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.gastro-j.ru/jour/article/view/218">https://www.gastro-j.ru/jour/article/view/218</self-uri><abstract><p>Цель публикации. Ознакомить практикующих врачей с показаниями к проведению антигеликобактерной терапии, методами и порядком проведения диагностики и эрадикационной терапии инфекции Helicobacter pylori (H. pylori). Основные положения. Хронический гастрит, вызванный инфекцией Н. pylori, в том числе у «бессимптомных» лиц, можно рассматривать как показание к проведению эрадикационной терапии инфекции Н. pylori в качестве этиотропного лечения и оппортунистического скрининга для профилактики рака желудка. Показаниями к обязательному проведению антигеликобактерной терапии служат язвенная болезнь желудка и двенадцатиперстной кишки, MALT-лимфома желудка, ранний рак желудка с эндоскопической резекцией. В качестве методов первичной диагностики инфекции H. pylori используют дыхательный тест с мочевиной, меченной С, определение антигена H. pylori в кале лабораторным способом, быстрый уреазный тест и серологический метод. После проведения антигеликобактерной терапии серологический метод не применяют. Согласно результатам большинства региональных исследований, показатели устойчивости штаммов H. pylori к кларитромицину в России не выше 15%. Получены данные об отсутствии высокой устойчивости H. pylori к метронидазолу и о низком уровне двойной устойчивости к кларитромицину и метронидазолу. Терапией первой линии для эрадикации инфекции H. pylori служит стандартная тройная терапия, включающая ингибитор протонной помпы (ИПП), кларитромицин и амоксициллин. Стандартную тройную терапию следует проводить, применяя различные меры, повышающие ее эффективность. В качестве альтернативного варианта эрадикационной терапии первой линии может быть использована классическая четырехкомпонентная терапия на основе висмута трикалия дицитрата или квадротерапия без препаратов висмута, которая включает ИПП, амоксициллин, кларитромицин и метронидазол. Квадротерапию с висмута трикалия дицитратом применяют также как основную схему терапии второй линии при неэффективности стандартной тройной терапии. Другая схема терапии второй линии включает ИПП, левофлоксацин и амоксициллин. Тройная терапия с левофлоксацином может быть назначена только гастроэнтерологом по строгим показаниям. Терапию третьей линии подбирают индивидуально в зависимости от выбора предшествующих схем лечения. Среди методов оптимизации, позволяющих повысить эффективность эрадикационной терапии инфекции H. pylori, следует отметить увеличение продолжительности лечения до 14 дней, выбор более современного ИПП или увеличение дозы ИПП, добавление висмута трикалия дицитрата или пробиотика. Заключение. В каждом случае обнаружения H. pylori целесообразно решить вопрос о проведении эрадикационной терапии, что особенно актуально в связи с признанием эрадикации инфекции H. pylori эффективной мерой профилактики рака желудка. Методы оптимизации эрадикационной терапии инфекции H. pylori могут быть применены для повышения эффективности не только стандартной тройной терапии, но и других режимов антигеликобактерного лечения, а комбинирование этих методов позволяет добиться наилучшего результата у конкретного пациента.</p></abstract><trans-abstract xml:lang="en"><p>Aim of publication. To present indications for antihelicobacter therapy, methods and sequence of diagnostics and eradication treatment of Helicobacter pylori (H. pylori) infection to general practitioners. Key points. Chronic gastritis caused by H. pylori infection, including that in «asymptomatic» patients can be considered to be an indication for H. pylori eradication therapy both as etiological treatment and opportunistic screening diagnostics for gastric cancer prevention. Indications for obligatory antihelicobacter therapy include stomach and a duodenum peptic ulcer (PU), stomach MALT-lymphoma, early gastric cancer with endoscopic resection. Breath test with 13С-labeled urea, laboratory test for assessment of anti-H. pylori antibodies in feces, rapid urease test and serological method can be recommended for primary diagnostics of infection. Serological test is not applicable after antihelicobacter therapy. According to the bulk of regional studies clarithromycin resistance level of H. pylori strains in Russia does not exceed 15%. Obtained data indicate the absence of high metronidazole-resistance of H. pylori as well as double resistance to clarithromycin and metronidazole. Standard triple therapy including proton pump inhibitor (PPI), clarithromycin and amoxicillin is recommended as first-line treatment for H. pylori eradication. Standard triple therapy should be carried out, applying various means that increase its efficacy. Alternatively to standard triple therapy, first-line eradication treatment may include four-component bismuth tripotassium dicitratebased therapy or non-bismuth quadrotherapy which includes PPI, amoxicillin, clarithromycin and metronidazole. Quadrotherapy with bismuth tripotassium dicitrate can also be applied as a basic mode of the second line treatment at inefficiency of standard triple therapy. Alternative mode of second line eradication treatment includes PPI, levofloxacin and amoxicillin. Levofloxacinbased triple therapy prescription in the presence of strict indications should be limited to gastroenterologists. The third-line eradication treatment is adjusted individually according to the history of previous treatment modes. Eradication efficacy may be increased by prolongation of treatment up to 14 days, applicaiton of modern PPIs or increase of PPI doze, addition of bismuth tripotassium dicitrate or probiotic. Conclusion. In each case of H. pylori detection it is reasonable to consider eradication therapy that is especially actual as H. pylori infection eradication is recognized as effective method of stomach cancer prevention. H. pylori eradication optimization methods can be applied both to standard and alternative modes while combination of these approaches allows to achieve the best result in a given patient.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>Helicobacter pylori</kwd><kwd>хронический гастрит</kwd><kwd>эрадикационная терапия инфекции H. pylori</kwd><kwd>Helicobacter pylori</kwd><kwd>хронический гастрит</kwd><kwd>эрадикационная терапия инфекции H. pylori</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Ивашкин В.Т., Маев И.В., Лапина Т.Л., Шептулин А.А. и комитет экспертов. 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