continued colonization Helicobacter pylori in gastroduodenal CO
is the cause of amplification factors of aggression and the weakening of protective factors.
Sometimes amplification factors of aggression may be associated with the use of nonsteroidal
dasgs (aspirin, etc.), caffeine, as well as strong
alcoholic beverages.
Methods detection of Helicobacter pylori in the clinic
If there are indications for diagnostic endoscopy (gastric ulcer, ulcerative
bleeding, hemorrhagic gastritis, gastric neoplasm, etc.), the most
preferred method to detect Hp are aiming
biopsy CO from pyloric vestibule (one plot) and body (two
areas - front and rear wall) of the stomach, holding
histological examination and urease activity (urease accelerated tests).
fixation and staining for histological examination usually take
few days, and evaluation results urease test - a few hours. On special
testimony may be held seeding bacterial cultures, polymerase
chain reaction (PCR), urease breath test. However, these
studies are labor intensive, expensive and yet are rarely used.
PCR method in the media (eg, saliva) can identify Hp
without isolation of pure culture of the audience in the material fragments of its genome.
If the diagnosis, such as DU, was established earlier, during
esophagogastroduodenoscopy, the method of choice for detecting infection CO
gastric Hp may be serological or urease breath test. These methods
noninvasive and fairly accurate. Urease breath test with urea
can also be used to detect infection after a course of eradication therapy
. The investigation shall be held not earlier than 4 weeks after the end of
antigelikobakterna therapy. Bacteriological examination though
is a valuable method of detecting Hp in duodenal CO, but
practice rarely performed due to the fact that this process is quite time consuming
, requires special enriched medium and
prolonged incubation (3-5 days) in a particularly controlled microaerophilic (mikroaerobnyh)
conditions. This method is mainly used for the detection of Hp
sensitivity to antibiotics in the treatment of resistant forms of diseases such as
asle, patients with recurrent ulcer after a course of eradication therapy.
to detect Hp most commonly used material (biopsy) obtained during
endoscopy. Plot taken at biopsy, placed on
glass or film, which contains urea and a pH indicator. If the tissue is
Hp, is the hydrolysis of urea to ammonia and bicarbonate, resulting in
which increases the pH and changes the color of light (usually from yellow to red).
sensitivity and specificity of this test is 95% or more.
How to treat infection caused by Helicobacter pylori, in identifying one or
that pathology in the stomach and / or duodenal intestine
modern approach to the elimination (eradication) infection in gastroduodenal CO
based on the use of multi-component circuits of three or even four
medicines. It was established that for successful eradication of Hp required at
period of treatment to raise intragastric pH to 5,0-7,0 with
included in the dasg combination of antisecretory agents. Preference is given to
proton pump inhibitors (omeprazole, rabeprazole, lansoprazole,
pantoprazole), but not eliminated as antagonists of N 2 -histamine receptor
(ranitidine, famotidine). Such a combined treatment, no doubt,
is time consuming, costly and not without side effects. However, while
that other approaches that achieve the eradication of Hp, does not exist.
an unsuccessful eradication is often used deliberately
ineffective dasg combinations, which are not taken into account
biological characteristics of the Hp and the environment, making microorganism
inaccessible to therapy. Implementation of effective eradication schemes throughout
territory of Russia is determined by Order № 125 of the Russian Federation Ministry of Health of 17.04.1998 "On Approval
standards (protocols) diagnosis and treatment of patients with diseases of the digestive
.
modern concept of management of patients infected with bacteria
Helicobacter pylori
Research, confirming the role of Hp in the occurrence of disease
Rights, and the creation of antisecretory and antimicrobial dasgs can
adopt new guidelines for diagnosis and treatment of infection gelikobakternoy
(Maastricht consensus, Febasary 2000). Let us dwell on only two aspects
this problem: how to treat patients and who should conduct therapy,
to destroy (eradication) Hp infection, persisting in
gastroduodenal SB.
Absolute indications for the course (s) eradication therapy
are:
Regardless of the success of eradication therapy assessment and treatment of these patients
performed in a volume which provides relevant
state standards.
eradication therapy is not mandatory, but it can also be
useful if a patient with symptoms of dyspepsia are no destasctive changes in the gastroduodenal
CO (erosions and ulcerations), or they arise in the admission
NSAIDs, including acetylsalicylic acid. In such situations
along with courses of eradication therapy is very important
prolonged receiving antisecretory dasgs, including blockers of H 2 -histamine receptor
(ranitidine, famotidine, etc.) , proton pump inhibitors (omeprazole,
lansoprazole, etc.) and misoprostol (saytotek, etc.). In this situation
cytoprotectors type sucralfate ineffective and should not be used.
1-I scheme of eradication therapy include: proton pump inhibitor or ranitidine bismuth citrate
(pilorid) in standard dose ingestible
two times a day, and one of the following dasgs:
Clinico-morphological manifestations of Helicobacter pylori
Clarithromycin (klatsid, fromalid ) 500 mg twice daily + amoxicillin (flemoksin,
hikontsil) 1000 mg twice daily or metronidazole *
(or tinidazole) to 0.5 g twice a day. Course of treatment is not less than 7 days
.
clarithromycin and amoxicillin are acid-antibiotic
their bactericidal action on bacteria spreads Hp, are undergoing
division (reproduction) at pH from 6,0 to 7,0. This level of pH in the stomach
can only be created by using proton pump inhibitor (from the first day
Pariet and the third day of other dasgs in this group), received in
twice the (effective) daily dose and metronidazole ( or tinidazole),
tetracycline and bismuth has a bactericidal effect on bacteria Hp,
lost the ability to reproduce. However, it should be borne in mind that bismuth is also
warns adhesion of Hp to gastric epithelium. In the absence of side effects from
combined seven-day therapy may prolonging it until
14 days, as is the case, for example, in the U.S. and certain other countries. With
to simplify treatment regimens in recent yearsmoreandmoreinsistently
experts recommend to reduce the multiplicity of the dasgs, timing it to receive
food. In case of failure of eradication therapy, ie, if after 4-6 weeks after completion of multidasg therapy
any of the tests for Hp (urease breath and
etc.) is positive, or if after 5-6 months after
treatment there aggravation of the disease with recurrent ulcers or severe erosion in the CO
stomach or duodenum in SB against the backdrop of chronic active gastritis
(gastroduodenitis) - in all these situations are encouraged to
second course of eradication therapy including any of the previously
proton pump inhibitors in the standard single dose twice daily +
colloidal bismuth subcitrate 120 mg four times a day (three times for 30 minutes before meals and
fourth time after 2 hours after eating before bedtime) or twice daily
to 240 mg over 30 minutes before meals + metronidazole (Trichopol, etc.) or tinidazole for
500 mg three times daily with meals + tetracycline 500 mg four times a day with meals.
course of treatment is not less than 7 days. If such a combination is detected
intolerance of bismuth, in the future it should be excluded from the scheme
eradication therapy.
Hp bacteria may be resistant to major antibiotics in
eradication of this infection. Hp resistance not only to set
bismuth preparations (de-nol, ventrisol, pilorid). In this connection, these
dasgs are now included in all backup classic eradication scheme.
If the microorganism becomes resistant to one or another antigelikobakterna
means it persists over a long period, thereby decreasing
choice therapeutics for a re-
courses. Choice of adequate dasg combinations, ensuring a successful
eradication of Hp, is problematic both in Russia and abroad. Solve
this problem can, using only standardized recommended
RF Ministry of Health scheme of eradication therapy.
1. Standards (protocols) diagnosis and treatment of patients with diseases of the digestive
. Order № 125 of the RF Ministry of 08/17/1998.
2. Grigoriev PY, Yakovenko EP Modern conceptions of pyloric
gelikobakterioze / practitioner, 1998. № 13. S. 14-17.
3. Beekeepers VD Chukov SZ value Genomic heterogeneity of strains
Helicobacter pylori in the development of pathology associated gastroduodenal
/ / Ross. Journ. gastroenterol., gepatol., koloproktol. 2000. № 3. S. 7-12.
article was published in the journal
Attending Physician