Improvement of Helicobacter pylori eradication efficacy at stomach and duodenum peptic ulcers

Aim of investigation. To estimate efficacy of the modified sequential therapy regimen of Helicobacter pylori (H. pylori) eradication (with addition of bismuth tripotassium dicitrate) at treatment of peptic ulcer of the stomach (PUS) and duodenum (PUD) of severe and complicated course in the Russian population. Material and methods. Original study included overall 105 patients with PUS and PUD with severe and complicated course of disease. The main group received modified sequential therapy regimen, the comparison group - standard triple mode. All patients underwent quantitative serological test for H. pylori-specific IgG antibodies, stool test for H. pylori antigen, fibrogastroscopy with stomach mucosa (SM) biopsy and rapid urease test, microscopic examination of SM biopsy specimens, polymerase chain reaction for H. pylori DNA in SM biopsy specimens. Results. Efficacy of H. pylori eradication at modified sequential therapy was 95,8%, at standard, also combined with bismuthate tripotassium dicitrate, - 86,4%. After successful H. pylori eradication decrease of inflammatory activity of the stomach mucosa at less prominent decrease of mononuclear infiltration was noted, however the tendency for reduction of these features was more significant in patients at modified sequential regimen. Conclusions. Growth of H. pylori antibiotic resistance requires accumulation of the Russian data on efficacy of sequential therapy to increase eradication rate and prevent growth of macrolide resistance. Sequential therapy was proposed as a way to overcome resistance to clarithromycin. Sequential eradication therapy with inclusion of bismuth tripotassium dicitrate has shown advantage over standard triple therapy at severe and complicated forms of gastroduodenal peptic ulcers. Results of original study allow to recommend sequential eradication therapy in Russia. Key words: peptic ulcer, Helicobacter pylori, eradication, modified sequential therapy, bismuth tripotassium dicitrate.

язвенная болезнь, Helicobacter pylori, эрадикация, модифицированная последовательная терапия, висмута трикалия дицитрат

1. Лапина Т.Л. Значение кларитромицина в эрадикационной терапии инфекции Helicobacter pylori // Consilium medicum.- 2010. - Т. 12, № 8. - С. 3-6.

2. Маев И.В., Самсонов А.А., Голубев Н.Н. Лечение инфекции Helicobacter pylori // Фарматека.- 2012.№ 2. - С. 11-17.

3. Gene E., Calvert X., Azagra R. et al. Triple vs quadruple therapy for treating Helicobacter pylori infection: An updated meta-analysis // Aliment Pharmacol Ther - 2003. - Vol. 18. - P. 543-544.

4. Laine L., Hunt R., El-Zimaity H. et al. Bismuthbased quadruple therapy using a single capsule of bismuth biskalcitrate, metronidazole, and tetracycline given with omeprazole versus omeprazole, amoxicillin, and clarithromycin for eradication of Helicobacter pylori in duodenal ulcer patients: a prospective, randomized, multicenter, North Americantrial // Am J Gastroenterol.- 2003. - Vol. 98. - P. 562-567.

5. De Francesco V., Della Valle N., Stoppino V. et al. Effectiveness and pharmaceutical cost of sequential treatment for Helicobacter pylori in patients with nonulcer dyspepsia / / Aliment Pharmacol Ther - 2004. - Vol. 19. - P. 993-998.

6. De Francesco V., Zullo A., Hassan C. et al. The prolongation of triple therapy for Helicobacter pylori does not allow reaching therapeutic outcome of sequential scheme: a prospective, randomized study // Dig Liver Dis.- 2004. - Vol. 36. - P. 322-326.

7. Delgado J., Bujanda L., Gisbert P. et al. Effectiveness of 10-day sequential treatment for Helicobacter pylori eradication in clinical practice // Gastroenterology.- 2007. - Vol. 132. - A 112.

8. Focareta R., Forte G., Forte F. et al. Could the 10-days sequential therapy be considered a first choice treatment for the eradication of Helicobacter pylori infection / / Dig Liver Dis.- 2003. - Vol. 36. - P. 322.

9. Francavilla R., Lionetti E., Castellaneta S.P. et al. Improved efficacy of 10-day sequential treatment for Helicobacter pylori eradication in children: a randomized trial // Gastroenterology.- 2005. - Vol. 129. - P. 1414- 1419.

10. Hassan C., De Francesco V., Zullo A. et al. Sequential treatment for Helicobacter pylori eradication in duodenal ulcer patients: improving the cost of pharmacotherapy // Aliment Pharmacol Ther. - 2003. - Vol. 18. - P. 641-646.

11. Zullo A., Vaira D., Vakil N. et al. High eradication rates of Helicobacter pylori with a new sequential treatment // Aliment Pharmacol Ther.- 2003. - Vol. 17. - P. 719-726.

12. Ивашкин В.Т., Маев И.В., Лапина Т.Л., Шептулин А.А. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению инфекции Helicobacter pylori у взрослых // Рос. журн. гастроэнтерол., гепатол., колопроктол.- 2012. - Т. 22, № 1. - С. 87-89.

13. Аруин Л.И., Капуллер Л.Л., Исаков В.А. Морфологическая диагностика болезней желудка и кишечника. - М: Триада-Х, 1998. 1998.

14. Маев И.В., Кучерявый Д.Н., Андреев Д.Н. Причины неэффективности антигеликобактерной терапии // Рос. журн. гастроэнтерол., гепатол., колопроктол.- 2013. - Т. 23, № 6. - С. 62-72.

15. Старостин Б.Д. Эрадикация Helicobacter pylori у пациентов с хроническим хеликобактерным гастритом // Гастроэнтерология Санкт-Петербурга. - 2011. - № 2-3. - С. М86.

16. Tepes B., O’Connor A., Gisbert J. P., O’Morain C. Treatment of Helicobacter pylori infection 2012 // Helicobacter.- 2012. - Vol. 17. - P. 36-42.

17. O’Connor A., Molina-infante J., Gisbert J.P., O’Morain C. Treatment of Helicobacter pylori infection 2013 // Helicobacter.- 2013. - Vol. 18. - P. 58-65.

18. Liou J.-M. et al. Sequential therapy for 10 days versus triple therapy for 14 days in first line treatment of Helicobacter pylori infection - a multicenter, open label, randomized trial / / United Eur Gastroenterol J. - 2013. - N1 (1S). - A4-A5.

19. Fiorini G. Efficacy of sequential therapy in never been treated Helicobacter pylori patients with multi-resistant strains // United Eur Gastroenterol J.- 2013. - N1 (1S). - A423.

20. Kalapothakos P. et al. Initial empirical treatment for Helicobacter pylori eradication in routine. Non bismuth sequential or concomitant regimen? A preliminary prospective comparative study in Sparta Greece // United Eur Gastroenterol J.- 2013. - N1 (1S). - A272.

21. O’Connor A., Vaira D., Gisbert J.P., O’Morain C. Treatment of Helicobacter pylori infection 2014 // Helicobacter. - 2014. - Vol. 19. - P. 38-45.