scholarly journals Possibilities for optimization of eradication therapy for Helicobacter pylori infection in modern clinical practice

2017 ◽  
Vol 89 (2) ◽  
pp. 84-90 ◽  
Author(s):  
D N Andreev ◽  
D T Dicheva ◽  
I V Maev
Keyword(s):  
Helicobacter Pylori ◽  
Clinical Practice ◽  
Side Effects ◽  
Adjuvant Therapy ◽  
Eradication Therapy ◽  
Optimization Methods ◽  
Helicobacter Pylori Infection ◽  
Double Dose ◽  
Treatment Protocols ◽  
Inflammatory Processes

A steady decline in the effectiveness of standard eradication therapy (ET) regimens for Helicobacter pylori infection necessitates a search for ways of their optimization, by enhancing the efficiency of treatment protocols and by improving their safety and tolerability. The review systematizes the data available in the literature on main accessible methods for optimizing ET regimens. Among the optimization methods that can considerably enhance the efficiency of ET regimens, one may identify their addition of a bismuth agent (by 10—20%), the use of rebamipide (by 11.9%), adjuvant therapy with probiotics (by 8.1—13%), or double-dose proton pump inhibitors (by 8%). Only adjuvant therapy with probiotics results in a significant decrease in the incidence of side effects from ET. In posteradication period, rebamipide should be used to potentiate gastric mucosal repair and to regress inflammatory processes.

THE EFFICACY OF THE BISMUTH-CONTAINING QUADRUPLE REGIMEN IN HELICOBACTER PYLORI INFETION

2017 ◽  
pp. 29-34
Author(s):  
Thi Khanh Tuong Tran ◽  
Quoc Bao Vu
Keyword(s):  
Helicobacter Pylori ◽  
Side Effects ◽  
Breath Test ◽  
Eradication Therapy ◽  
Urea Breath Test ◽  
Helicobacter Pylori Infection ◽  
Adherence Rate ◽  
Helicobacter Pylori Eradication ◽  
Colloidal Bismuth Subcitrate ◽  
Helicobacter Pylori Eradication Therapy

Background and Objectives: Bismuth-containing quadruple regimen is recommended as an first-line therapy in areas with high clarithromycin and metronidazole resistance as well as an option for patients who have previously failed to respond to Helicobacter pylori eradication therapy. There have been very few researches on the effectiveness of this regimen on Helicobacter pylori infection treatment in our country. The our study aimed to show the efficacy of Bismuth-based therapy for the treatment of Helicobacter pylori infection. Patients and Methods: The study was carried out on 196 patients with Helicobacter pylori infection. All of patients received a quadruple therapy consisted of Rapeprazole 20 mg bid, Colloidal bismuth subcitrate 120mg qid, Tetracycline 500mg qid and Metronidazole 500mg tid for 14 days. The diagnosis of Helicobacter Pylori infection was performed by Clotest or C13 urea-breath test. Four to eight weeks after completion of therapy, Helicobacter pylori status was rechecked by Clotest or C13 urea-breath test. Results: A total of 196 patients with Helicobacter pylori infection were recruited. The eradication rates of the Bismuth-containing quadruple regimen overall, fornaïve,previously failed to respond to Helicobacter pylori eradication therapy on intention to treat (ITT) and per-protocol (PP) analysis were 97.4-97.3%; 98.3-98.1% and 96.3-96.2%. Side effects occurred in 80.5% of subjects. The common side effects were fatigue, anorexia and nausea. The compliancerate was 98.4%. Conclusions: Bismuth-containing quadruple regimen achieved very highe radication rates. Side effects were common but not serious. The medication adherence rate was high. Key words: Bismuth-containing quadruple regimen, eradication, Helicobacter pylori infection

scholarly journals European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years

2019 ◽  
Vol 91 (2) ◽  
pp. 16-24 ◽  
Author(s):  
D S Bordin ◽  
Yu V Embutnieks ◽  
L G Vologzhanina ◽  
T A Ilchishina ◽  
I N Voynovan ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Clinical Practice ◽  
Serological Test ◽  
Eradication Therapy ◽  
Diagnostic Methods ◽  
Helicobacter Pylori Infection ◽  
Rapid Urease Test ◽  
Urease Test ◽  
H Pylori ◽  
European Registry

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

scholarly journals Study on Association between Chronic Idiopathic Urticaria and Helicobacter Pylori Infection in Armed Forces Personnel

2016 ◽  
Vol 12 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Md Sayeed Hasan ◽  
Md Shirajul Islam Khan ◽  
Jannatun Nayeem
Keyword(s):  
Helicobacter Pylori ◽  
Eradication Therapy ◽  
Armed Forces ◽  
Case Control ◽  
Chronic Idiopathic Urticaria ◽  
Helicobacter Pylori Infection ◽  
Enteric Infection ◽  
Clinical Disorder ◽  
Serum Igg ◽  
H Pylori

Introduction: Chronic Idiopathic Urticaria (CIU) has an estimated prevalence of 35-65% and impacts 15 to 25% of the population at some point in their lives. Studies have shown the possible involvement of Helicobacter pylori (H. pylori) infection in chronic idiopathic urticaria (CIU), but the relationship remains controversial. Objective: To quantitatively assess the association between H. pylori infection and chronic idiopathic urticaria. Materials and Methods: This was a case-control type of analytical study and 100 patients were enrolled fifty patients of CIU fulfilling inclusion criteria with no identifiable cause were taken as case and patients without urticaria were taken as control, attending in the department of Dermatology & Venereology, CMH Dhaka for treatment from May 2015 to Aug 2016. Helicobacter pylori infection was confirmed by serum IgG for H. pylori test. Results: The result showed that H. pylori infection significantly affected a high percentage of patients 30 (60%) with chronic idiopathic urticaria. Male respondents were more positive 16(53.3%) than female 14(46.7%), in the middle aged 31-50 year about 18(60%) and triple drug therapy was successful in 16(53.33%) patients in whom H. pylori was detected. Conclusion: Urticaria is a common clinical disorder with complex triggering factors. Chronic urticaria has provided evidence that enteric infection with H. pylori may induce the disease. In this case control study, it was evident that chronic idiopathic urticaria was associated with positive serum IgG for H. Pylori. A trial of H. pylori eradication therapy may be offered to patients with CIU and evidence of H. pylori infection. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 122-126

scholarly journals The efficacy and safety of quadruple therapy without bismuth (concomitant therapy) in the treatment of patients with Helicobacter pylori - associated gastric and duodenal peptic ulcer disease

2019 ◽  
Vol 91 (8) ◽  
pp. 28-33 ◽  
Author(s):  
A M Veliev ◽  
I V Maev ◽  
D N Andreev ◽  
D T Dicheva ◽  
A V Zaborovskii ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Helicobacter Pylori ◽  
Side Effects ◽  
Triple Therapy ◽  
Eradication Therapy ◽  
Test System ◽  
Efficacy And Safety ◽  
Concomitant Therapy ◽  
Quadruple Therapy ◽  
H Pylori

Aim. Evaluation of the efficacy and safety of quadrupletherapy without bismuth (concomitant therapy) in patients with Helicobacter pylori - associated gastric ulcer and duodenal ulcer in the framework of a comparative research in the population of patients in Russia. Materials and methods. A prospective randomized trial was conducted, which included 210 patients with H. pylori - associated gastric/duodenal ulcer without complications. During the process of randomization, the patients were divided into three equal groups (n=70) depending on the prescribed 10-day scheme of eradication therapy (ET): the first group received the classic triple scheme (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day and Clarithromycin 500 mg 2 times a day); the second group received quadruple therapy with bismuth drugs (Omeprazole 20 mg 2 times a day, Tetracycline 500 mg 4 times a day, Metronidazole 500 mg 3 times a day, Bismuth subcitrate potassium 120 mg 4 times a day); the third group received quadruple therapy without bismuth - concomitant therapy (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day, Clarithromycin 500 mg 2 times a day and Metronidazole 500 mg 2 times a day). Diagnostics of H. pylori infection during screening and control of eradication was carried out via the fast urease biopsy sample test and urea breath test system. Control of the effectiveness of ET of the microorganism was carried out not earlier than 4 weeks after the end of the treatment. During the course of therapy, the frequency of development of side effects was assessed using a special questionnaire. Results and discussion. The effectiveness of triple therapy was 72.8% (ITT; 95% CI of 62.17-83.54) and 78,4% (PP; 95% CI 68.19-88.72); quadruple therapy with the preparation of bismuth - 80.0% (ITT; 95% CI 70.39-89.6) and 84,8% (PP; 95% CI, 75.96-93.73); quadruple therapy without bismuth - concomitant therapy - 84.2% (ITT; 95% CI 75.54-93.02) and 92.1% (PP; 95% CI 85.43-98.94). Quadruple therapy without bismuth was reliably more effective than the classical triple therapy in the PP selection (p=0.044883). Statistical analysis showed a tendency to poorer effectiveness of ET in patients who had previously used antibiotic therapy (OR 0.4317; 95% CI 0.1776-1.049), and in individuals with a rapid metabolism genotype - CYP2C19*1/*1 (OR 0.12; 95% CI 0.005848-2.4624). The frequency of development of side effects during the use of triple therapy was 18.5% (95% CI of 9.23-27.91), when using quadruple therapy with bismuth - 20.0% (95% CI 10.39-29.6), and with the use of quadruple therapy without bismuth - concomitant therapy - 24.2% (95% CI 13.98-34.58). Conclusion. This prospective randomized study demonstrated the high efficiency of quadruple therapy without bismuth (concomitant therapy) in the framework of eradication of H. pylori infection in Russia.

scholarly journals Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review

2020 ◽  
Vol 13 ◽  
pp. 175628482096873
Author(s):  
Javier P. Gisbert
Keyword(s):  
Helicobacter Pylori ◽  
Clinical Practice ◽  
Helicobacter Pylori Infection ◽  
Alternative Methods ◽  
First Line ◽  
Time Saving ◽  
Line Therapy ◽  
H Pylori ◽  
Guided Therapy

Although susceptibility-guided therapy is frequently recommended for Helicobacter pylori infection, the evidence available to date supporting this strategy is limited. The aim of the present article is to review the advantages and limitations of the susceptibility-guided and the empirical strategies to treat this infection. We performed a bibliographic search to identify studies investigating H. pylori susceptibility-guided therapy. Culture is not the only way to assess antibiotic resistance, as different polymerase chain reaction-based approaches have been developed as alternative methods. For detecting H. pylori antimicrobial resistance, a molecular approach based on a stool sample might enable more convenient, time-saving methods. Unfortunately, the antimicrobial susceptibility cannot be obtained in all cases. Furthermore, antibiotic susceptibility testing in clinical practice yields useful information only for a few antibiotics: clarithromycin, metronidazole, and quinolones. In addition, susceptibility towards clarithromycin and metronidazole in vitro does not necessarily lead to eradication in vivo. In the case of H. pylori therapy failure, we should not re-administer any of the antibiotics against which H. pylori has probably become resistant. Our updated meta-analysis showed that susceptibility-guided treatment is not better than empirical treatment of H. pylori infection in first-line therapy if the most updated quadruple regimens are empirically prescribed, and similar efficacy results were also demonstrated with the two strategies for second-line therapy. Cumulative H. pylori eradication rate with several successive rescue therapies empirically prescribed reaches almost 100%. Finally, the studies that have evaluated the cost-effectiveness of the susceptibility-guided treatment have achieved contradictory results. In summary, we can conclude that the evidence is too limited to support the generalized use of susceptibility-guided therapy for H. pylori treatment in routine clinical practice, either as first-line or as rescue treatment. Nevertheless, it would be recommended that susceptibility tests are performed routinely, even before prescribing first-line treatment, in specialized centers with an interest in H. pylori management.

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