Method of eradication therapy selection for ulcer patients associated with helicobacter pylori

FIELD: medicine; gastroenterology.

SUBSTANCE: invention concerns selection of eradication therapy for ulcer patients associated with Helicobacter pylori. Invention implies that patients with exacerbation rates more than two times per year are initially prescribed four-component therapy, and patients with two and less exacerbation annually are initially prescribed with three-component therapy.

EFFECT: method provides registration of established dependence between therapeutic effect and annual exacerbation rate, simplification of eradication therapy regardless severity of clinical semiotics.

1 tbl, 4 ex

 

The invention relates to medicine, in particular to a gastroenterologist.

Currently, eradication therapy is considered a basic standard of treatment of peptic ulcer disease (PUD)associated with Helicobacter pylori (HP), which is reflected in the international (II Maastricht Treaty) and the Russian recommendations for treatment of gastroenterological patients. According to these recommendations, the treatment of patients YAB you must begin with the application of first-line drugs (triple therapy), and in cases where the HP eradication was not achieved, it is recommended to assign a second-line drugs (quadruple therapy) (the Maastricht Treaty II, 2002; standards (protocols) for the diagnosis and treatment of patients with diseases of the digestive system, RF Ministry of health, 2002). The lack of modern treatment recommendations YAB associated with HP is the lack of methods differentiated approach to the choice of eradication therapy tailored to the individual characteristics of the organism and clinical disease.

The objective of the invention was to individualize approaches in the choice of schemes eradication therapy in patients with PUD based on the characteristics of the clinical picture of the disease and offer the available criteria for selection of schemes eradication therapy for doctors, outpatient services, which will increase efficiency the efficiency of therapy in these patients and reduce the economic cost of treatment.

The basis for this proposal was the finding that the severity of YAB largely depends on the depth and persistence of violations of metabolic and trophic processes in the body and especially in the gastric mucosa, as well as on the degree of contamination of its HP (Nikitin G.A., 2002; Nikitin GA, Michalik DS., Russianow V.V., 2003; Michalik DS., Nikitin GA, Russianow CENTURIES, 2005).

The essence of the invention lies in the fact that the choice of eradication therapy in patients with PUD associated with HP, carried out taking into account the severity of the disease: in the mild course, and over moderate appoint triple therapy if severe - quadruple therapy.

The method is as follows: patients with mild illness (and one less aggravation in the year) and for moderate (two exacerbations per year) is assigned to triple therapy (omeprazole 20 mg×2 R, clarithromycin 500 mg×2 R, amoxicillin 1000 mg×2 R) in 7 days, with severe (more than two exacerbations per year) - quadruple therapy (omeprazole 20 mg×2 R, de-Nol 120 mg×4 p, tetracycline 500 mg×4 R, metronidazol 250 mg×4 R) in 7 days.

Examples

Example 1. Patient N., 36 years, the economist. Went to the clinic with complaints of dull, aching pain in the epigastrium, resulting in 1.5-2.0 hours is the ass eating, heartburn, weakness. Suffering from peptic ulcer 12 SC cancer for 8 years, during this time there was 2 of aggravation. Deterioration of health came about 5-7 days ago. From the anamnesis and objective examination of the data for the presence of concomitant chronic diseases it is not revealed. Palpation of the abdomen revealed tenderness in the epigastric region. General blood and urine analysis, biochemical analysis of blood within normal limits. At endoscopy in the bulb 12 SC ulcer was identified ulcer size 0,8×0,6×0,2 see the Study mucous membrane of the antrum and body of the stomach in the presence of HP has not revealed a high degree of contamination (++). Given the evidence of history, endoscopic examination and coolant for the presence of HP in patients diagnosed with peptic 12 SC ulcer associated with HP easy for acute stage. Were assigned to the treatment: omeprazole 20 mg×2 R; clarithromycin 500 mg×2 R; amoxicillin 1000 mg×2 R within 7 days. As a result of therapy on day 3 pain disappeared, and I feel much better. When re-faggs 7 days after completion of eradication therapy, the ulcer healed, the patient was discharged on the work. After 4 weeks study coolant on the HP was negative. In the subsequent 6 years of follow-up recurrence of the disease was not observed.

P is the iMER 2. Patient 28 years old, engineer. He complained of a dull, aching epigastric pain that occurs after 1.5-2.0 hours after a meal, sour belching, heartburn. Suffering from peptic ulcer disease within 4 years, exacerbation was observed up to two times per year. When faggs in the bulb 12-p. intestine revealed ulcer 0.6×0,6×0,2 see In the study of the coolant on the HP revealed high levels of contamination (+++). Given the history and data of additional methods of research, was diagnosed with a peptic ulcer 12 SC ulcer associated with HP, average severity, acute stage. Assigned to triple eradication therapy with omeprazole 20 mg×2 R; clarithromycin 500 mg×2 R; amoxicillin 1000 mg×2 R within 7 days. On day 10 after eradication therapy, the ulcer healed, drawn on the work. 4 weeks after treatment in the control study coolant on HP the result was negative. In the subsequent 6 years of follow-up recurrence of the disease was not observed.

Example 3. A 29 year old woman sold. Applied for medical assistance with complaints of dull, aching pain in the epigastrium, resulting in 1.5-2 hours after eating and at night, nausea, weakness, dizziness, black chair. Suffering from peptic ulcer 12 SC cancer for 7 years. Disease flare was observed up to three times per year. A year ago about strange was accompanied by ulcer bleeding, treated stationary, the bleeding was stopped by a conservative. From the anamnesis and additional research methods related diseases it is not revealed. In the study of blood count and biochemical analysis was revealed hypochromic iron deficiency anemia. The reaction of occult blood in the stool strongly positive (+++). When faggs was identified ulcer bulb 12 SC intestine (0,9×0,9×0.2 cm). The study coolant on HP revealed a high degree of contamination (+++). Given the history data and additional methods of examination, was diagnosed with a peptic ulcer 12 SC ulcer, severe, acute stage, complicated by hemorrhage and posthemorrhagic iron deficiency anemia. Appointed four triple therapy (omeprazole 20 mg×2 R, de-Nol 120 mg×2 R, tetracycline 500 mg×4 R, metronidazol 250×4 p) within 7 days and iron supplements. Two weeks after completion of eradication therapy in faggs ulcer healed, research coolant at HP were negative. The patient was discharged on the work continued maintenance dose administration of iron preparations. In the subsequent 6 years of follow-exacerbation of peptic ulcer disease was not observed.

Example 4. Patient 32 years old, locksmith. He complained of a dull aching pain in the epigastrium, occurring in 0.5-1 hour after pickup the food and, sometimes at night, sour belching, heartburn. The pain had stopped taking antacid drugs and antispasmodics. Suffering from peptic ulcer disease within 5 years. Exacerbations frequent: 3-4 times per year. When faggs in the antrum of the stomach revealed an ulcer size of 0.9×0,8×02 see the Study of the gastric mucosa on HP showed a high degree of contamination (+++) in the antrum and body of stomach. Given the history and data of additional methods of research, was diagnosed with peptic ulcer disease localization of ulcers in the stomach associated with HP, severe. Scheduled for 7 days four triple therapy (omeprazole 20 mg×2 times a day, tetracycline 500 mg×4 R; de-Nol 120 mg×4 R; metronidazole 250 mg×4P). On the 14th day after eradication therapy in the control of faggs ulcer healed drawn on the work. 4 weeks after completion of eradication therapy study of the gastric mucosa on HP showed a negative result. In the subsequent 6 years of follow-up (annual monitoring) reinfection and relapse was not.

Clinical trials of the method was performed in 62 patients with peptic ulcer disease associated with HP, with various disease States. With a light period of 16 patients, with an average severity - 28 and with heavy 18. All patients when about is strenia appointed triple or quadruple therapy. The results showed that in the treatment of patients with mild illness with the use of triple regimens for the eradication managed to achieve the 75,0±11.2% of patients, in individuals with moderate flow - 62,5±12.5%, with severe course - none of them (0,0±22,2%). When treating patients with the use of quadruple therapy for eradication was achieved in persons with a slight over - 100±50,0%, over moderate - 77,8±10.1% and with heavy - 55,5±12.1% of patients. The obtained data are presented in the attached table.

From the presented data shows that of the 16 patients with mild illness in 12 (75,0±10,4%) after triple therapy came eradication of HP. 4 patients (26,3±10,4%) remained not a high degree of contamination. Complete eradication of HP they have managed to achieve after repeated course quadruple therapy. Therefore, all patients (100,0±20,0%) with a slight over YAB was achieved eradication of HP. In 16 patients with an average degree of severity of the disease was conducted triple therapy and only 10 (62,5±12.5%) of them had achieved the eradication of HP. The rest of the patients (12) and those who have not been achieved eradication (6), was administered quadruple therapy is eradication was achieved in 14 (77,8±10.1 per cent) of them. Thus, with an average weight of course what I diseases of HP eradication was achieved in 24 of 28 patients, that amounted to 85.7±6.7 percent. Of the 18 patients with severe disease are the four were held triple therapy is eradication was not achieved in any of them (0,0±22,2%), and only in 10 cases (55.5±12,1%) patients, after the appointment of quadruple therapy, came eradication of HP.

The results imply that in the treatment of patients with light over and over moderate with use of triple regimens, eradication was achieved in most of them. To achieve eradication in patients with severe course it was necessary at once to appoint a four-part therapy. The findings suggest that in severe YAB HP eradication is achieved more difficult and less frequent than in patients with mild over (0,1>p>0.05), and quadruple therapy in patients with severe course was more effective than triple (P<0,05).

The application of the proposed method provides the following advantages:

1) allows you to individualize approaches in the choice of schemes eradication therapy in patients with PUD based on the characteristics of the clinical picture of the disease;

2) increases the efficiency of treatment of patients YAB: leads to earlier eradication of HP that prevents the development of complications and shortens the period of temporary disability in patients YAB;

3) significantly reduces the economic is their cost of treating these patients.

Table.
The selection method of eradication therapy in patients with peptic ulcer disease associated with Helicobacter pylon.
Disease severityTriple therapyQuadruple therapyThe total number of
1. Easy n=16n=1612 (75,0±11,2%)*4 (100±50,0%)**16 (100,0±20,0%)
2. Moderate n=28n=1610 (62,5±12,5%)*
n=1814 (77,8±10,1%)**24 (85,7±6,7%)
3. Heavy n=18n=100 (0,0±22,2%)*
n=1810 (55,5±12,1%)**10 (55,5±12,1%)
p1*-**>0,05P1-2>0,05
p2*-**>0,05P2-3>0,05
p3*-**<0,050,1>R1-3>0,05

The selection method of eradication therapy day is in patients with peptic ulcer, associated with Helicobacter pylori, characterized in that the number of patients with exacerbations of the disease more than two per year beginning treatment with quadruple therapy, and patients with exacerbations of two or less per year - with triple therapy.



 

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