Helicobacter pylori eradication schemes. Choosing an eradication therapy regimen for Helicobacter pylori in case of need for re-treatment Side effects during Helicobacter eradication

Content

Peptic ulcer disease causes a lot of trouble for patients. To cope with pathology, a set of measures is used. Eradication is a treatment method whose main task is to eliminate the infection and restore the body. It is worth understanding what drugs are used and how the procedures are carried out.

Indications for use

Eradication therapy is aimed at destroying viruses or bacteria in the body. Since a huge problem in medicine is damage to the gastrointestinal tract by Helicobacter Pylori bacteria, a technique has been developed to counteract these microorganisms. In such a situation, indications for eradication may include:

• gastroesophageal reflux (reflux of stomach contents into the esophagus);
• precancerous conditions;
• consequences of surgery to remove a malignant tumor;
• peptic ulcer of the stomach, duodenum;
• MALT lymphoma of the stomach (tumor of lymphoid tissues).

Helicobacter Pylori eradication is prescribed to patients who are planning long-term treatment with non-steroidal anti-inflammatory drugs. Indications for using the technique are often:

• chronic atrophic gastritis;
• gastropathy (inflammatory diseases of the mucous membranes and blood vessels of the stomach from the effects of drugs);
• autoimmune thrombocytopenia (rejection by the immune system of its own platelets);
• Iron-deficiency anemia;
• prevention for people who have relatives with a history of stomach cancer.

Purpose of the procedure

Eradication of Helicobacter pylori is a special method of treatment. It is aimed at creating a favorable atmosphere for the patient to carry out procedures. The technique has several goals:

• reduce the duration of treatment;
• create comfortable conditions for compliance with the regime;
• limit the number of types of drugs used - combination drugs are used;
• eliminate the need to follow a strict diet;
• prevent the development of side effects;
• speed up the healing of ulcers.

Ecadification is popular among doctors and patients due to its cost-effectiveness - inexpensive drugs are used, and effectiveness - the condition improves from the first days of therapy. The procedures pursue the following goals:

• reduce the number of medications taken per day - medications with a prolonged action and increased half-life are prescribed;
• overcome bacterial resistance to antibiotics;
• provide alternative eradication regimens in the presence of allergies, contraindications, or in the absence of treatment results;
• reduce the toxic effects of drugs.

Doctors around the world dealing with infections caused by Helicobacter pylori have reached international agreements. They include the creation of standards and schemes that increase the effectiveness of diagnostic and therapeutic techniques, called Maastricht. The information is regularly updated and currently contains the following requirements for eradication:

• positive treatment results in 80% of patients;
• duration of therapy is no more than 14 days;
• use of drugs with low toxicity.

• interchangeability of medicines;
• reducing the frequency of taking medications;
• slight resistance (resistance) of Helicobacter pylori strains to drugs;
• ease of use of treatment regimens;
• the occurrence of side effects is no more than 15% of patients; their effect should not interfere with the implementation of treatment procedures.

Doctors came to the conclusion that the proposed methods reduce the number of complications that arise. Two lines of eradication are recommended, which require compliance with the following sequence:

• The treatment process begins with first-line regimens.
• If there are no positive results, they move on to the second.
• Treatment monitoring is carried out one month after completing the course of all measures.

Drugs

Several groups of medications are used for eradication. They are included in treatment plans. To counteract the bacterium Helicobacter Pylori, the use of antibiotics is mandatory. Doctors prescribe medications taking into account contraindications and side effects. The following drugs from the groups of antibacterial agents differ in their effectiveness:

• penicillins – Amoxiclav, Amoxicillin;
• macrolides – Azithromycin, Clarithromycin;
• tetracyclines – Tetracycline;
• chlorofluorinols – Levofloxacin;
• ansamycins – Rifaximin.

The second group of drugs used in the eradication of Hilobacter pylori includes anti-infective drugs. They are highly toxic; doctors must take into account contraindications for use. The eradication regimen includes the following medications:

• Metronidazole;
• Nifuratel;
• Tinidazole;
• McMiror.

Bismuth-containing agents show high effectiveness in counteracting the bacterium Helicobacter Pylori. These drugs are resistant to the acidic environment of the stomach, form a protective film on the mucous membrane, and accelerate the scarring of ulcerations. The drugs used in eradication have a minimum of side effects and contraindications. This group includes the following tools:

• Bismuth subsalicylate;
• De-Nol;
• Bismuth subnitrate.

The eradication treatment regimen for peptic ulcers includes proton pump inhibitors (PPIs). These drugs reduce the aggressive effect of the acidic environment on the mucous membranes. Medicines create destructive conditions for the existence of microorganisms. PPIs have an antacid effect - they neutralize hydrochloric acid. The products destroy bacteria that comfortably exist in it. The group includes the following drugs:

• Rabeprazole;
• Omeprazole (Omez);
• Pantoprazole (Nolpaza);
• Esomeprazole;
• Lansoprazole.

Helicobacter pylori eradication schemes

Treatment methods for gastric and duodenal ulcers are constantly being improved. This is due to research conducted by doctors around the world. The first Helicobacter pylori eradication schemes included two methods:

• Monotherapy. This technique involves the use of antibiotics or bismuth-containing agents. Due to its low efficiency, it is rarely used.
• Two-component eradication scheme. It is distinguished by the use of both groups of drugs from the first method, and has an effectiveness of 60%.

Research by medical scientists led to the creation of new eradication schemes, which were proposed at the Maastricht conferences. Modern methods include:

• Three-component therapy, characterized by an effectiveness of 90%. Anti-infective agents are added to the dual treatment regimen.
• Four-component eradication, which contains proton pump inhibitors in addition to the previous option. The method achieves positive results in 95% of cases.

First line

The Helicobacter pylori eradication scheme can be used in several versions. Treatment begins from the first line. Doctors select medications depending on the patient’s condition; the duration of treatment can be increased to two weeks. The standard three-component scheme includes the use of the following means:

If necessary, doctors prescribe a four-component eradication regimen. It involves the use of such medications:

If, as a result of diagnostic tests, atrophy of the mucous membranes is revealed in a patient, an eradication technique is used without the use of proton pump inhibitors. The regimen includes the following medications:

If treatment of stomach ulcers caused by the bacterium Helicobacter pylori is required in elderly patients, a truncated eradication regimen is used. It includes the use of the following medications:

Second line

If the eradication regimens used do not produce results, the following treatment options are prescribed. The second line involves the use of three schemes, all of them four-component. The first regimen includes the following medications:

Before prescribing drugs, doctors conduct tests to identify the pathogen and its sensitivity to antibiotics. The second eradication scheme involves a combination of the following:

In all eradication options, doctors additionally prescribe vitamin complexes. Scheme No. 3 is a four-component therapy, which includes the following medications:

Nutrition during treatment

During eradication, no special diet is required. The exception is bleeding in the stomach or perforation of an ulcer. In other cases, nutritionists recommend including in the diet:

• homemade crackers;
• low-fat soups;
• river fish;
• pasta;
• lean meat;
• milk and water based porridges;
• vegetable oil;
• vegetables - boiled or baked - potatoes, carrots, zucchini, beets;
• berry compotes;
• jelly;

During the eradication period, it is advisable to use warm dishes - hot or cold are irritating to the stomach. The following are prohibited:

• spicy, fatty sauces;
• alcohol;
• fried foods;
• fatty broths;
• smoked meats;
• canned food;
• marinades;
• fatty fish, meat;
• spicy seasonings;
• raw fruits and vegetables (during an exacerbation);
• mushrooms;
• pepper;
• sweets;
• cakes;
• garlic;
• strong coffee, tea.

Folk remedies

Home treatment cannot replace eradication prescribed by a doctor. Folk remedies will be an addition to treatment regimens. It is important to coordinate them with your doctor. To speed up the healing of ulcers, take a decoction of flaxseed, which has an enveloping effect on the gastric mucosa. To prepare it you will need:

1. Take a teaspoon of seeds.
2. Pour a glass of boiling water over them.
3. Leave covered for 2 hours.
4. Shake to separate the seed from the mucus.
5. Strain.
6. Drink during the day in 4 doses.

Traditional healers recommend using raw chicken eggs for peptic ulcers once a day, before breakfast. The course of treatment is two weeks. A decoction of St. John's wort and yarrow has an antimicrobial effect. To prepare it you need:

1. Take 100 grams of each herb.
2. Add a liter of boiling water.
3. Leave for 30 minutes.
4. Strain.
5. Take 100 ml before meals three times a day.
6. The course of therapy is a month.

When treating peptic ulcers caused by Helicobacter pylori bacteria, it is recommended to use propolis. Treatment must be agreed with your doctor. Propolis is a natural antibacterial agent that regulates stomach acidity. Traditional healers recommend this recipe:

1. Freeze 50 g of propolis to make it easier to chop.
2. Take 0.5 liters of milk.
3. Add crushed propolis.
4. Place in a water bath for 30 minutes.
5. Add a spoonful of honey.
6. Drink a glass warm at night.
7. Can be stored in the refrigerator for 48 hours.
8. The duration of treatment is from two weeks.

Normalization of microflora after eradication

The use of antibiotics leads to disruption of the intestinal microflora. To restore the condition after the eradication procedure, drugs of two groups are used. One of them is probiotics, which contain live microorganisms - bifidobacteria, lactobacilli. Doctors prescribe the following drugs:

• Enterol;
• Linux;
• Acipol;
• Biosporin;
• Bifiform;
• Lactobacterin;

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Table of contents

1. What tests can a doctor prescribe for Helicobacter pylori?
2. Basic methods and treatment regimens for helicobacteriosis
   • Modern treatment of Helicobacter-associated diseases. What is the Helicobacter pylori eradication scheme?
   • How to kill Helicobacter pylori reliably and comfortably? What requirements are met by the standard modern treatment regimen for diseases such as Helicobacter pylori-associated gastritis and gastric and/or duodenal ulcers?
   • Is it possible to cure Helicobacter pylori if the first and second lines of eradication therapy are powerless? Bacterial sensitivity to antibiotics
3. Antibiotics are the number one drug for treating Helicobacter pylori
   • What antibiotics are prescribed for Helicobacter pylori infection?
   • Amoxiclav is an antibiotic that kills particularly persistent bacteria Helicobacter pylori
   • Azithromycin is a “spare” drug for Helicobacter pylori
   • How to kill Helicobacter pylori if the first line of eradication therapy has failed? Treatment of infection with tetracycline
   • Treatment with fluoroquinolone antibiotics: levofloxacin
4. Chemotherapy antibacterial drugs against Helicobacter pylori
5. Eradication therapy of Helicobacter pylori using bismuth preparations (De-nol)
6. Proton pump inhibitors (PPIs) as a cure for helicobacteriosis: Omez (omeprazole), Pariet (rabeprazole), etc.
7. What treatment regimen for gastritis with Helicobacter pylori is optimal?
8. What complications can there be during and after treatment for Helicobacter pylori if a multicomponent course of eradication therapy with antibiotics is prescribed?
9. Is it possible to treat Helicobacter without antibiotics?
   • Bactistatin is a dietary supplement used as a remedy for Helicobacter pylori.
   • Homeopathy and Helicobacter pylori. Reviews from patients and doctors
10. Helicobacter pylori bacterium: treatment with propolis and other folk remedies
    • Propolis as an effective folk remedy for Helicobacter pylori
    • Treatment of Helicobacter pylori with antibiotics and folk remedies: reviews
11. Traditional recipes for treating Helicobacter pylori infection - video

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Which doctor should I contact if I have Helicobacter pylori?

What tests can a doctor prescribe for Helicobacter pylori?

As a rule, if helicobacteriosis is suspected, the doctor must prescribe an endoscopic examination - fibrogastroscopy (FGS) or fibrogastroesophagoduodenoscopy (FEGDS) (sign up), during which a specialist can assess the condition of the gastric mucosa, identify the presence of ulcers, bulges, redness, swelling, flattening of folds and cloudy mucus. However, endoscopic examination allows only to assess the condition of the mucosa, and does not give an exact answer to the question of whether Helicobacter pylori is present in the stomach.

Therefore, after an endoscopic examination, the doctor usually prescribes some other tests that make it possible to answer with a high degree of certainty the question of whether Helicobacter is present in the stomach. Depending on the technical capabilities of the institution, two groups of methods can be used to confirm the presence or absence of Helicobacter pylori - invasive or non-invasive. Invasive involves taking a piece of stomach tissue during endoscopy (sign up) for further tests, and for non-invasive tests, only blood, saliva or feces are taken. Accordingly, if an endoscopic examination was carried out and the institution has the technical capabilities, then to identify Helicobacter pylori, one of the following tests is prescribed:

• Bacteriological method. It is the inoculation of microorganisms on a nutrient medium found on a piece of the gastric mucosa taken during endoscopy. The method makes it possible to identify with 100% accuracy the presence or absence of Helicobacter pylori and determine its sensitivity to antibiotics, which makes it possible to prescribe the most effective treatment regimen.
• Phase contrast microscopy. It is the study of a whole unprocessed piece of the gastric mucosa, taken during endoscopy, under a phase-contrast microscope. However, this method allows you to detect Helicobacter pylori only when there are many of them.
• Histological method. It is the study of a prepared and stained piece of mucous membrane, taken during endoscopy, under a microscope. This method is highly accurate and allows you to detect Helicobacter pylori, even if they are present in small quantities. Moreover, the histological method is considered the “gold standard” in the diagnosis of Helicobacter pylori and allows one to determine the degree of contamination of the stomach with this microorganism. Therefore, if technically possible, after endoscopy to identify the microbe, the doctor prescribes this particular study.
• Immunohistochemical study. It is the detection of Helicobacter pylori in a piece of mucous membrane taken during endoscopy using the ELISA method. The method is very accurate, but, unfortunately, it requires highly qualified personnel and technical equipment of the laboratory, and therefore is not carried out in all institutions.
• Urease test (sign up). It involves immersing a piece of mucous membrane taken during endoscopy into a urea solution and then recording changes in the acidity of the solution. If within 24 hours the urea solution turns crimson, this indicates the presence of Helicobacter pylori in the stomach. Moreover, the rate of appearance of the crimson color also makes it possible to determine the degree of contamination of the stomach with bacteria.
• PCR (polymerase chain reaction), carried out directly on a collected piece of the gastric mucosa. This method is very accurate and also allows you to detect the number of Helicobacter pylori.
• Cytology. The essence of the method is that fingerprints are made from a taken piece of mucous membrane, stained according to Romanovsky-Giemsa, and examined under a microscope. Unfortunately, this method has low sensitivity, but is used quite often.

• Urease breath test. This test is usually performed during an initial examination or after treatment, when it is necessary to determine whether Helicobacter pylori is present in a person’s stomach. It consists of taking samples of exhaled air and subsequent analysis of the carbon dioxide and ammonia content in them. First, baseline breath samples are taken, and then the person is given breakfast and labeled C13 or C14 carbon, followed by 4 more breath samples taken every 15 minutes. If in test air samples taken after breakfast, the amount of labeled carbon is increased by 5% or more compared to the background, then the test result is considered positive, which undoubtedly indicates the presence of Helicobacter pylori in the human stomach.
• Test for the presence of antibodies to Helicobacter pylori (sign up) in blood, saliva or gastric juice using ELISA. This method is used only when a person is examined for the first time for the presence of Helicobacter pylori in the stomach, and has not previously been treated for this microorganism. This test is not used to monitor treatment, since antibodies remain in the body for several years, while Helicobacter pylori itself is no longer present.
• Analysis of stool for the presence of Helicobacter pylori using PCR. This analysis is rarely used due to the lack of necessary technical capabilities, but it is quite accurate. It can be used both for the initial detection of Helicobacter pylori infection and for monitoring the effectiveness of therapy.

How to treat Helicobacter pylori. Basic methods and treatment regimens for helicobacteriosis

Modern treatment of Helicobacter-associated diseases. What is the Helicobacter pylori eradication scheme?

New treatment methods have been developed based on the removal of Helicobacter pylori from the body by ingesting combinations of medications (the so-called eradication therapy ).

The standard Helicobacter pylori eradication regimen necessarily includes drugs that have a direct antibacterial effect (antibiotics, chemotherapeutic antibacterial drugs), as well as drugs that reduce the secretion of gastric juice and thus create an unfavorable environment for bacteria.

Should Helicobacter pylori be treated? Indications for the use of eradication therapy for helicobacteriosis

However, the global community of gastroenterologists has developed clear standards regulating cases when eradication therapy for Helicobacter pylori disease using special regimens is absolutely necessary.

Regimens with antibacterial drugs are prescribed for the following pathological conditions:

• peptic ulcer of the stomach and/or duodenum;
• condition after gastric resection for stomach cancer;
• gastritis with atrophy of the gastric mucosa (precancerous condition);
• stomach cancer in close relatives;

• functional dyspepsia;
• gastroesophageal reflux (a pathology characterized by the reflux of stomach contents into the esophagus);
• diseases requiring long-term treatment with non-steroidal anti-inflammatory drugs.

How to kill Helicobacter pylori reliably and comfortably? What requirements are met by the standard modern treatment regimen for diseases such as Helicobacter pylori-associated gastritis and gastric and/or duodenal ulcers?

1. High efficiency (as clinical data show, modern eradication therapy regimens provide at least 80% of cases of complete elimination of helicobacteriosis);
2. Safety for patients (regimens are not allowed into general medical practice if more than 15% of subjects experience any adverse side effects of treatment);
3. Convenience for patients:

• the shortest possible course of treatment (today, regimens involving a two-week course are allowed, but 10 and 7-day courses of eradication therapy are generally accepted);
• reducing the number of medications taken due to the use of medications with a longer half-life of the active substance from the human body.

First and second line of eradication therapy. Three-component regimen for the treatment of Helicobacter pylori with antibiotics and quadruple therapy for Helicobacter (4-component regimen)

The first such global consultation of doctors on the fight against Helicobacter pylori was held in the city of Maastricht at the end of the last century. Since then, several similar conferences have taken place, all of which were called Maastricht, although the last meetings took place in Florence.

World luminaries have come to the conclusion that none of the eradication schemes provides a 100% guarantee of getting rid of helicobacteriosis. Therefore, it has been proposed to formulate several “lines” of regimens, so that a patient treated with one of the first-line regimens can turn to second-line regimens in case of failure.

First line schemes consist of three components: two antibacterial substances and a drug from the group of so-called proton pump inhibitors, which reduce the secretion of gastric juice. In this case, the antisecretory drug, if necessary, can be replaced with a bismuth drug, which has a bactericidal, anti-inflammatory and cauterizing effect.

Second line circuits They are also called Helicobacter quadrotherapy because they consist of four drugs: two antibacterial medications, an antisecretory substance from the group of proton pump inhibitors and a bismuth drug.

Is it possible to cure Helicobacter pylori if the first and second lines of eradication therapy are powerless? Bacterial sensitivity to antibiotics

To destroy the harmful bacterium, doctors conduct a preliminary diagnosis of the strain's sensitivity to antibiotics. To do this, during fibrogastroduodenoscopy, a culture of Helicobacter pylori is taken and sown on nutrient media, determining the ability of various antibacterial substances to suppress the growth of colonies of pathogenic bacteria.

The patient is then prescribed third line eradication therapy , the regimen of which includes individually selected antibacterial drugs.

It should be noted that increasing resistance of Helicobacter pylori to antibiotics is one of the main problems of modern gastroenterology. Every year, more and more new eradication therapy regimens are tested, designed to destroy particularly resistant strains.

Antibiotics are the number one drug for treating Helicobacter pylori

What antibiotics are prescribed for Helicobacter pylori infection to treat: amoxicillin (Flemoxin), clarithromycin, etc.

However, these data have not been confirmed in clinical practice. So, for example, the antibiotic erythromycin, which is highly effective in a laboratory experiment, turned out to be absolutely powerless to expel Helicobacter from the human body.

It turned out that an acidic environment completely deactivates many antibiotics. In addition, some antibacterial agents are not able to penetrate the deep layers of mucus, where most Helicobacter pylori bacteria live.

So the choice of antibiotics that can cope with Helicobacter pylori is not so great. Today the most popular medications are the following:

• amoxicillin (Flemoxin);
• clarithromycin;
• azithromycin;
• tetracycline;
• Levofloxacin.

Amoxicillin (Flemoxin) - tablets for Helicobacter pylori

Amoxicillin (another popular name for this medication is Flemoxin) belongs to the semi-synthetic penicillins, that is, it is a distant relative of the first antibiotic invented by mankind.

This drug has a bactericidal effect (kills bacteria), but acts exclusively on reproducing microorganisms, so it is not prescribed together with bacteriostatic agents that inhibit the active division of microbes.

Like most penicillin antibiotics, amoxicillin has a relatively small number of contraindications. The drug is not prescribed for hypersensitivity to penicillins, as well as for patients with infectious mononucleosis and a tendency to leukemoid reactions.

Amoxicillin is used with caution during pregnancy, renal failure, and also when there are indications of previous antibiotic-associated colitis.

Amoxiclav is an antibiotic that kills particularly persistent bacteria Helicobacter pylori

The fact is that penicillins are the oldest group of antibiotics, which many strains of bacteria have already learned to fight by producing special enzymes - beta-lactamases, which destroy the core of the penicillin molecule.

Clavulanic acid is a beta-lactam and takes the hit of beta-lactamases from penicillin-resistant bacteria. As a result, enzymes that destroy penicillin are bound, and free amoxicillin molecules destroy bacteria.

Contraindications for taking Amoxiclav are the same as for amoxicillin. However, it should be noted that Amoxiclav more often causes serious dysbiosis than regular amoxicillin.

Antibiotic clarithromycin (Klacid) as a remedy against Helicobacter pylori

Clarithromycin (Klacid) belongs to the antibiotics from the erythromycin group, which are also called macrolides. These are broad-spectrum bactericidal antibiotics with low toxicity. Thus, taking second-generation macrolides, which include clarithromycin, causes adverse side effects in only 2% of patients.

The most common side effects are nausea, vomiting, diarrhea, less often - stomatitis (inflammation of the oral mucosa) and gingivitis (inflammation of the gums), and even less often - cholestasis (stagnation of bile).

Clarithromycin is one of the most powerful drugs used against the bacterium Helicobacter pylori. Resistance to this antibiotic is relatively rare.

The second very attractive quality of Klacid is its synergism with antisecretory drugs from the group of proton pump inhibitors, which are also included in eradication therapy regimens. Thus, clarithromycin and antisecretory drugs prescribed together mutually enhance each other’s actions, promoting the rapid expulsion of Helicobacter from the body.

Clarithromycin is contraindicated in case of increased individual sensitivity to macrolides. This drug is used with caution in infancy (up to 6 months), in pregnant women (especially in the first trimester), with renal and liver failure.

The antibiotic azithromycin is a “spare” drug for Helicobacter pylori

However, azithromycin is prescribed as an alternative to clarithromycin in cases where the use of the latter is prevented by side effects, such as diarrhea.

The advantages of azithromycin over Klacid are also increased concentration in gastric and intestinal juice, which promotes targeted antibacterial action, and ease of administration (only once a day).

How to kill Helicobacter pylori if the first line of eradication therapy has failed? Treatment of infection with tetracycline

This is a broad-spectrum bacteriostatic antibiotic, which is the founder of the group of the same name (tetracycline group).

The toxicity of drugs from the tetracycline group is largely due to the fact that their molecules are not selective and affect not only pathogenic bacteria, but also the reproducing cells of the macroorganism.

In particular, tetracycline can inhibit hematopoiesis, causing anemia, leukopenia (decreased number of white blood cells) and thrombocytopenia (decreased number of platelets), disrupt spermatogenesis and cell division of epithelial membranes, contributing to the occurrence of erosions and ulcers in the digestive tract, and dermatitis on the skin.

In addition, tetracycline often has a toxic effect on the liver and disrupts protein synthesis in the body. In children, antibiotics of this group cause impaired growth of bones and teeth, as well as neurological disorders.

Therefore, tetracyclines are not prescribed to small patients under 8 years of age, as well as to pregnant women (the drug crosses the placenta).

Tetracycline is also contraindicated in patients with leukopenia, and pathologies such as renal or liver failure, gastric and/or duodenal ulcers require special caution when prescribing the drug.

Treatment of Helicobacter pylori bacteria with fluoroquinolone antibiotics: levofloxacin

Like all fluoroquinolones, levofloxacin is a broad-spectrum bactericidal antibiotic. Restrictions on the use of fluoroquinolones in Helicobacter pylori eradication regimens are associated with the increased toxicity of drugs in this group.

Levofloxacin is not prescribed to minors (under 18 years of age) as it can negatively affect the growth of bone and cartilage tissue. In addition, the drug is contraindicated in pregnant and lactating women, patients with severe damage to the central nervous system (epilepsy), as well as in cases of individual intolerance to drugs in this group.

Nitroimidazoles, when they are prescribed in short courses (up to 1 month), extremely rarely have a toxic effect on the body. However, when taking them, unpleasant side effects may occur such as allergic reactions (itchy skin rash) and dyspeptic disorders (nausea, vomiting, loss of appetite, metallic taste in the mouth).

It should be borne in mind that metronidazole, like all drugs from the nitroimidazoles group, is not compatible with alcohol (causes severe reactions when taking alcohol) and turns the urine a bright red-brown color.

Metronidazole is not prescribed in the first trimester of pregnancy, as well as in case of individual intolerance to the drug.

Historically, metronidazole was the first antibacterial agent to be successfully used in the fight against Helicobacter pylori. Barry Marshall, who discovered the existence of Helicobacter pylori, conducted a successful experiment on himself with Helicobacter pylori infection, and then cured type B gastritis that developed as a result of the research with a two-component regimen of bismuth and metronidazole.

However, today an increase in the resistance of the bacterium Helicobacter pylori to metronidazole is being recorded all over the world. Thus, clinical studies conducted in France showed resistance of Helicobacteriosis to this drug in 60% of patients.

Treatment of Helicobacter pylori with Macmiror (nifuratel)

When taken for a short time, nitrofurans, including Macmiror, do not have a toxic effect on the body. Side effects rarely include allergic reactions and dyspepsia of the gastralgic type (stomach pain, heartburn, nausea, vomiting). It is characteristic that nitrofurans, unlike other anti-infective substances, do not weaken, but rather strengthen the body’s immune response.

The only contraindication to the use of Macmiror is increased individual sensitivity to the drug, which is rare. Macmiror crosses the placenta, so it is prescribed to pregnant women with great caution.

If there is a need to take Macmiror during lactation, you must temporarily stop breastfeeding (the drug passes into breast milk).

As a rule, Macmiror is prescribed in second-line Helicobacter pylori eradication therapy regimens (that is, after an unsuccessful first attempt to get rid of Helicobacter pylori). Unlike metronidazole, Macmiror is characterized by higher efficiency, since Helicobacter pylori has not yet developed resistance to this drug.

Clinical data show high efficiency and low toxicity of the drug in four-component regimens (proton pump inhibitor + bismuth drug + amoxicillin + Macmiror) in the treatment of helicobacteriosis in children. So many experts recommend prescribing this drug to children and adults in first-line regimens, replacing metronidazole with Macmiror.

Eradication therapy of Helicobacter pylori using bismuth preparations (De-nol)

Bismuth preparations were used in the treatment of gastrointestinal ulcers even before the discovery of Helicobacter pylori. The fact is that when De-nol gets into the acidic environment of the gastric contents, it forms a kind of protective film on the damaged surfaces of the stomach and duodenum, which prevents aggressive factors from the gastric contents.

In addition, De-nol stimulates the formation of protective mucus and bicarbonates, which reduce the acidity of gastric juice, and also promotes the accumulation of special epidermal growth factors in the damaged mucosa. As a result, under the influence of bismuth preparations, erosions quickly epithelialize, and the ulcers undergo scarring.

After the discovery of Helicobacter pylori, it turned out that bismuth preparations, including De-nol, have the ability to inhibit the growth of Helicobacter pylori, having both a direct bactericidal effect and transforming the habitat of bacteria in such a way that Helicobacter pylori is removed from the digestive tract.

It should be noted that De-nol, unlike other bismuth preparations (such as, for example, bismuth subnitrate and bismuth subsalicylate), is able to dissolve in gastric mucus and penetrate into the deep layers - the habitat of most Helicobacter pylori bacteria. In this case, bismuth gets inside microbial bodies and accumulates there, destroying their outer shells.

The drug De-nol, in cases where it is prescribed in short courses, does not have a systemic effect on the body, since most of the drug is not absorbed into the blood, but passes through the intestines.

So the only contraindications to prescribing De-nol are increased individual sensitivity to the drug. In addition, De-nol should not be taken during pregnancy, lactation and in patients with severe kidney damage.

The fact is that a small part of the drug that enters the blood can pass through the placenta and into breast milk. The drug is excreted by the kidneys, so serious violations of the excretory function of the kidneys can lead to the accumulation of bismuth in the body and the development of transient encephalopathy.

How to reliably get rid of the bacterium Helicobacter pylori? Proton pump inhibitors (PPIs) as a cure for helicobacteriosis: Omez (omeprazole), Pariet (rabeprazole), etc.

The mechanism of action of all drugs in this group is the selective blockade of the activity of the parietal cells of the stomach, which produce gastric juice containing such aggressive factors as hydrochloric acid and proteolytic (protein-dissolving) enzymes.

Thanks to the use of drugs such as Omez and Pariet, the secretion of gastric juice is reduced, which, on the one hand, sharply worsens the living conditions for Helicobacter pylori and promotes the eradication of bacteria, and, on the other hand, eliminates the aggressive effect of gastric juice on the damaged surface and leads to rapid epithelization of ulcers and erosions. In addition, reducing the acidity of gastric contents allows one to maintain the activity of acid-sensitive antibiotics.

It should be noted that the active ingredients of drugs from the PPI group are acid-labile, so they are produced in special capsules that dissolve only in the intestines. Of course, for the medicine to work, the capsules must be consumed whole, without chewing.

Absorption of the active ingredients of drugs such as Omez and Pariet occurs in the intestines. Once in the blood, PPIs accumulate in the parietal cells of the stomach in fairly high concentrations. So their therapeutic effect lasts for a long time.

All drugs from the PPI group have a selective effect, so unpleasant side effects are rare and, as a rule, consist of headache, dizziness, and the development of signs of dyspepsia (nausea, intestinal dysfunction).

Medicines from the group of proton pump inhibitors are not prescribed during pregnancy and lactation, as well as in cases of increased individual sensitivity to drugs.

Children (under 12 years of age) are a contraindication to the use of Omez. As for the drug Pariet, the instructions do not recommend using this drug in children. Meanwhile, there is clinical data from leading Russian gastroenterologists indicating good results in the treatment of helicobacteriosis in children under 10 years of age with regimens including Pariet.

What treatment regimen for gastritis with Helicobacter pylori is optimal? This is the first time this bacteria has been found in me (the test for Helicobacter is positive), I have been suffering from gastritis for a long time. I read the forum, there are a lot of positive reviews about treatment with De-nol, but the doctor did not prescribe this drug for me. Instead, he prescribed amoxicillin, clarithromycin and Omez. The price is impressive. Can the bacteria be removed with less medication?

The doctor prescribed you a regimen that is considered optimal today. The effectiveness of combining a proton pump inhibitor (Omez) with the antibiotics amoxicillin and clarithromycin reaches 90-95%.

Modern medicine is categorically against the use of monotherapy (that is, therapy with only one drug) for the treatment of Helicobacter-associated gastritis due to the low effectiveness of such regimens.

For example, clinical studies have shown that monotherapy with the same drug De-nol can achieve complete eradication of Helicobacter in only 30% of patients.

What complications can there be during and after treatment for Helicobacter pylori if a multicomponent course of eradication therapy with antibiotics is prescribed?

• individual sensitivity of the body to certain drugs;
• presence of concomitant diseases;
• the state of the intestinal microflora at the time of initiation of anti-Helicobacter therapy.

Is it possible to treat Helicobacter without antibiotics?

How to cure Helicobacter pylori without antibiotics?

Since eradication therapy represents a serious burden on the body and often causes adverse side effects in the form of dysbiosis, patients with asymptomatic carriage of Helicobacter are advised to choose “lighter” drugs, the action of which is aimed at normalizing the gastrointestinal microflora and strengthening the immune system.

Bactistatin is a dietary supplement used as a remedy for Helicobacter pylori.

In addition, the components of bactistatin activate the immune system, improve digestive processes and normalize intestinal motility.

Contraindications to the prescription of bactistatin are pregnancy, breastfeeding, as well as individual intolerance to the components of the drug.

The course of treatment is 2-3 weeks.

Homeopathy and Helicobacter pylori. Reviews from patients and doctors about treatment with homeopathic medicines

Homeopathy specialists are convinced that the general improvement of the body with the help of homeopathic remedies should lead to the restoration of the microflora of the gastrointestinal tract and the successful elimination of Helicobacter pylori.

Official medicine, as a rule, is without prejudice towards homeopathic medicines in cases where they are prescribed according to indications.

The fact is that with asymptomatic carriage of Helicobacter pylori, the choice of treatment method remains with the patient. As clinical experience shows, in many patients Helicobacter pylori is an accidental finding and does not manifest itself in any way in the body.

Here the opinions of doctors were divided. Some doctors argue that Helicobacter should be removed from the body at any cost, since it poses a risk of developing many diseases (pathology of the stomach and duodenum, atherosclerosis, autoimmune diseases, allergic skin lesions, intestinal dysbiosis). Other experts are confident that in a healthy body Helicobacter pylori can live for years and decades without causing any harm.

Therefore, turning to homeopathy in cases where there are no indications for prescribing eradication regimens is completely justified from the point of view of official medicine.

Symptoms, diagnosis, treatment and prevention of Helicobacter pylori - video

Helicobacter pylori bacterium: treatment with propolis and other folk remedies

Propolis as an effective folk remedy for Helicobacter pylori

After the discovery of Helicobacter pylori, additional research was carried out on the bactericidal properties of bee products against Helicobacter pylori and a technology for preparing an aqueous tincture of propolis was developed.

The Geriatric Center conducted clinical trials of the use of an aqueous solution of propolis for the treatment of helicobacteriosis in elderly people. Patients took 100 ml of an aqueous solution of propolis as eradication therapy for two weeks, while in 57% of patients complete healing from Helicobacter pylori was achieved, and in the remaining patients there was a significant decrease in the prevalence of Helicobacter pylori.

Scientists have concluded that multicomponent antibiotic therapy can be replaced by taking propolis tincture in such cases as:

• elderly age of the patient;
• presence of contraindications to the use of antibiotics;
• proven resistance of the Helicobacter pylori strain to antibiotics;
• low contamination with Helicobacter pylori.

Is it possible to use flax seed as a folk remedy for Helicobacter?

However, flax seed preparations do not have a bactericidal effect, and therefore are not able to destroy Helicobacter pylori. They can be considered as a kind of symptomatic therapy (treatment aimed at reducing the severity of signs of pathology), which in itself is not capable of eliminating the disease.

It should be noted that flax seed has a pronounced choleretic effect, therefore this folk remedy is contraindicated for calculous cholecystitis (inflammation of the gallbladder, accompanied by the formation of gallstones) and many other diseases of the biliary tract.

I have gastritis, Helicobacter pylori was discovered. I took treatment at home (De-nol), but without success, although I read positive reviews about this drug. I decided to try folk remedies. Will garlic help against helicobacteriosis?

You should not experiment on yourself; contact a specialist who will prescribe an effective Helicobacter pylori eradication regimen that suits you.

Treatment of Helicobacter pylori with antibiotics and folk remedies: reviews (materials taken from various forums on the Internet)

It should be noted that many patients ask each other to provide an “effective and harmless” treatment regimen for Helicobacter. Meanwhile, such treatment is prescribed individually, taking into account the following factors:

• the presence and severity of pathology associated with Helicobacter pylori;
• degree of contamination of the gastric mucosa with Helicobacter pylori;
• treatment previously taken for helicobacteriosis;
• general condition of the body (age, presence of concomitant diseases).

We found no evidence of the terrible complications of antibiotic therapy, with which patients for some reason constantly scare each other (“antibiotics are only a last resort”).

As for reviews of the treatment of Helicobacter pylori with folk remedies, there is evidence of successful treatment of Helicobacter with the help of propolis (in some cases we are even talking about the success of “family” treatment).

At the same time, some so-called “grandmother’s” recipes are striking in their illiteracy. For example, for gastritis associated with Helicobacter pylori, it is advised to take blackcurrant juice on an empty stomach, and this is a direct road to a stomach ulcer.

In general, from a study of reviews of the treatment of Helicobacter pylori with antibiotics and folk remedies, the following conclusions can be drawn:
1. The choice of treatment method for Helicobacter pylori should be made in consultation with a gastroenterologist, who will make the correct diagnosis and, if necessary, prescribe a suitable treatment regimen;
2. Under no circumstances should you use “health recipes” from the Internet - they contain many gross errors.

Traditional recipes for treating Helicobacter pylori infection - video

A little more about how to successfully cure helicobacteriosis. Diet for the treatment of Helicobacter pylori

In case of asymptomatic carriage, it is enough to simply follow the correct diet, refusing to overeat and foods harmful to the stomach (smoked food, fried “crust”, spicy and salty foods, etc.).

For peptic ulcers and type B gastritis, a strict diet is prescribed; all dishes that have the properties of increasing the secretion of gastric juice, such as meat, fish and strong vegetable broths, are completely excluded from the diet.

It is necessary to switch to fractional meals 5 or more times a day in small portions. All food is served in semi-liquid form - boiled and steamed. At the same time, limit the consumption of table salt and easily digestible carbohydrates (sugar, jam).

Whole milk (with good tolerance, up to 5 glasses a day), mucous milk soups with oatmeal, semolina or buckwheat help very well to get rid of stomach ulcers and gastritis type B. The lack of vitamins is compensated for by the introduction of bran (a tablespoon per day - taken after steaming with boiling water).

For the speedy healing of defects in the mucous membrane, proteins are needed, so you need to eat soft-boiled eggs, Dutch cheese, non-acidic cottage cheese and kefir. You should not give up eating meat - meat and fish soufflés and cutlets are recommended. The missing calories are supplemented with butter.

In the future, the diet is gradually expanded, including boiled meat and fish, lean ham, non-acidic sour cream and yogurt. The side dishes are also varied - boiled potatoes, porridge and noodles are included.

As ulcers and erosions heal, the diet approaches table No. 15 (the so-called recovery diet). However, even in the late recovery period, you should avoid smoked meats, fried foods, seasonings, and canned foods for quite a long time. It is very important to completely eliminate smoking, alcohol, coffee, and carbonated drinks.

Not everyone knows that most stomach and duodenal ulcers are a consequence of the activity of a bacterium called. It can destroy the gastric mucosa, causing peptic ulcers, which means you can become infected with an ulcer through contact with a sick person.

Treatment of helicobacteriosis is carried out only after examination. It consists of a number of procedures. All drugs are selected individually only after diagnosis and clarification of the diagnosis.

Helicobacter pylori: description, features, causes

Helicobacteriosis is a dangerous disease of the stomach and duodenum

The bacterium Helicobacter pylori is a microorganism resistant to gastric acid, which, with the help of protective mechanisms, can survive for a long time and move in and around.

It is believed that the percentage of people infected with this bacterium is huge, but it was discovered and described as a cause of ulcers and gastritis only in the 70s of the 20th century.Eradication of Helicobacter pylori, that is, the destruction of the bacterium, is not required by all infected people. The bacterium can live in the human body for a long time without causing significant harm.

The eradication procedure is prescribed only if characteristic signs appear.

This bacterium has a number of features that allow it to exist in an acidic environment, causing various complications in an infected person:

• The bacterium has a spiral shape, which allows it to penetrate the gastric mucosa, protecting itself from the action of gastric juice. The mucous membrane of the stomach is designed to protect the walls from acid, therefore, penetrating into it, the bacterium can exist there for a long time.
• Helicobacter Pylori does not require large amounts of oxygen and other substances; moreover, it does not live outside the human body at all.
• The bacterium has flagella. With their help, it can move along the gastric mucosa immediately after entering the body.
• Helicobacter pylori secretes urease, which neutralizes the acid around the bacterium itself.
• The waste products of the bacteria negatively affect the walls of the stomach, causing inflammation. However, in some cases, the body is able to cope with bacteria on its own. If this does not happen, the person begins to feel pain and discomfort, which indicates the beginning of the inflammatory process.
• Under the influence of acid-neutralizing substances, the production of gastric juice is activated, which leads to various ulcerations on the walls of the stomach, but the bacterium does not die under the influence of acid.

The reasons why bacteria enter the body are almost always related to contact with an infected person. It is transmitted through saliva and other fluids.

There is an opinion that in addition to harm, the bacterium also brings benefits, like other bacteria living in. However, the specific benefits of the bacterium have not yet been proven, while its harm to the stomach has long been known.

Signs and diagnosis of Helicobacter pylori

Blood test - effective diagnosis of helicobacteriosis

Sometimes the bacterium is discovered by chance during donation. In this case, antibiotic treatment is not required, but the patient is constantly monitored.

Symptoms that may indicate Helicobacter pylori are no different from the symptoms of gastritis and ulcers:

• Pain in the abdomen. As a rule, pain occurs in the stomach area in the upper abdomen. They can be cutting or dull and non-intense. If pain occurs with a certain frequency (after eating or, conversely, during prolonged fasting), you should consult a doctor and undergo treatment.
• Belching. This seemingly harmless symptom, when constantly occurring, signals increased acidity of gastric juice. Particularly alarming is frequent sour belching after eating.
• Nausea and vomiting. Single nausea may indicate increased workload, deviation from diet, etc. If nausea appears regularly, before or after meals, or vomiting occurs, it is necessary to conduct an examination of the stomach. Vomiting like coffee grounds indicates internal bleeding and requires immediate hospitalization.
• Increased gas formation and flatulence. Most often, rumbling and flatulence indicate a malfunction, but the whole body needs to be examined.
• Problems with stool. The bacterium can affect not only the stomach, but also the functioning of the intestines. If sudden changes in stool are observed, constipation appears for more than 2-3 days, constant diarrhea, blood or mucus in the stool, you should consult a proctologist.

More information about the treatment of helicobacteriosis can be found in the video.

Diagnosis of Helicobacter pylori can be carried out using various methods. The analysis of the material obtained during endoscopy is very informative. During the examination of the stomach, a small piece of material is taken and carefully examined. The sample is tested for sensitivity to certain antibiotics.

You can determine the presence of bacteria in the body using a breath test, as well. It is worth remembering that when a bacteria is detected, serious antibacterial therapy is not always prescribed. Moreover, you should not start taking antibiotics on your own, since the bacteria may develop immunity to them.

Eradication - what is it, the goals of the procedure

Eradication - treatment of helicobacteriosis with special antibacterial drugs

Eradication means a set of procedures aimed at destroying Helicobacter pylori. The patient is prescribed a number of drugs that act on the bacterium and destroy it, creating conditions for the healing of mucosal ulcers.

Unfortunately, even carefully selected eradication does not always give excellent results. Too often, people take antibiotics for no reason, so the bacteria have already become insensitive to most of them.

There are a number of requirements for the procedure itself. Eradication will be successful if it meets all the requirements. Helicobacter pylori eradication schemes are constantly being supplemented, changed and improved.

Main advantages:

• Brief course. Antibacterial drugs are taken in short courses. Eradication usually lasts no more than 2 weeks. During this time, progress should be made.
• Minimum side effects. Drugs must have minimal toxicity so that the benefits significantly outweigh the harm. If side effects occur, the drugs are replaced.
• Ease of use. The drugs must have a prolonged effect in order to reduce the number of doses per day. Also, more and more preference is given to combination drugs, which can significantly reduce the list of medications taken.
• Efficiency. The drugs must actively act on bacteria, overcoming their growing resistance to antibacterial drugs.

Eradication is carried out only if necessary, when there is a pronounced inflammatory process, pain, an ulcer has already formed, or gastritis has worsened. If Helicobacter pylori is detected, but without obvious symptoms, antibacterial therapy is not advisable.

In some cases, the bacterium lives in the human stomach all its life without causing obvious harm; only 15% of all infections lead to ulcers and complications.

Many people strive to eradicate and destroy the bacterium, believing that Helicobacter pylori leads to stomach cancer. However, there is no direct connection between the bacterium and cancer. Infection with the bacterium only slightly increases the risk of cancer due to damage to the mucosa, but the predisposition to it does not depend on the bacterium.

Helicobacter pylori eradication scheme

The treatment regimen must first of all ensure a constant high level of eradication of the bacterium. The regimen is selected individually depending on the sensitivity of the bacterium and the body’s response to the drug.

The regimen includes several drugs that act on bacteria or the walls of the stomach. According to the latest data, the following drugs may be included in the Helicobacter pylori eradication regimen:

1. Metronidazole. This is an antibacterial drug that simultaneously has an antiulcer effect. It is prescribed in a group with Amoxicillin, as it suppresses bacterial resistance to Metronidazole. The drug is not used for, as well as for the treatment of people with serious diseases and. For eradication, the drug is taken three times a day for a week. Possible side effects include diarrhea, nausea, vomiting, constipation, attacks of pancreatitis, headaches, and allergic reactions.
2. Amoxicillin. It is an antibiotic from the penicillin group, which is widely used to treat many antibacterial infections. The sensitivity of the bacteria to this drug may be reduced, but when combined with other drugs, the effect can be achieved. Available in the form of a suspension or capsules. Side effects include nausea, allergic reactions, diarrhea, insomnia, headaches and dizziness.
3. Tetracycline. A widely known antibiotic used to treat many bacterial infections. It is also prescribed in combination with other drugs. Tetracycline should not be taken simultaneously with dairy products, as they interfere with its absorption. The course of treatment can last up to a week. As a rule, the antibiotic is well tolerated, but there may be side effects such as headache, pigmentation and allergic reactions, pancreatitis.
4. Clarithromycin. An antibiotic from the macrolide group with a minimum of side effects. For eradication, it is prescribed in combination with other drugs. The drug in the form of a suspension can also be prescribed to children over 6 months. During pregnancy, the drug is prescribed only in extreme cases.
5. In addition to all of the above, the regimen may include antacids and proton pump inhibitors.

Eradication of Helicobacter pylori can include up to three lines. The second is used if the first does not help, and the third - if the second does not help.

The first line is a three- or four-component therapy. There are several options for such schemes, let’s consider one of them:

• Proton pump inhibitor. One of these drugs is selected that reduces the production of acid in the stomach and promotes the healing of injuries and ulcers. Omeprazole and Lanzoptol are most often prescribed. These drugs are taken in combination with antibiotics twice a day at the prescribed dosage.
• Amoxicillin. The antibiotic is taken in a dosage of 500 mg up to 4 times a day. Daily dose – 2000 mg.
• Clarithromycin. It is taken in a daily dosage of 1000 mg, that is, 500 mg twice a day.

This treatment regimen lasts about two weeks. The field of its completion is carried out, clarifying the effectiveness of the scheme. If it was not effective enough, proceed to the second line of therapy.

The second line usually includes four-component circuits. Here is one possible option:

• One of the proton pump inhibitors twice daily. The drug is selected by the doctor taking into account its effectiveness.
• Bismuth preparation (bismuth tripotassium dicitrate) up to 4 times a day at a dosage of 120 mg. This drug has a complex effect on its own. It helps destroy Helibacter pylori, increases the production of mucus that protects the stomach, and also envelops the surface of the mucosa, creating favorable conditions for the healing of ulcers.
• Two antibiotics that enhance each other's effect, for example, Metronidazole and Tetracycline. As a rule, drugs that were not involved in the first line of therapy are selected. Antibiotics are taken in a dosage of 500 mg up to 4 times a day.

A third line of therapy is necessary if the second does not produce results. In this case, the selection of antibiotics is approached especially carefully. First, tests are carried out to determine the sensitivity of the bacteria to certain drugs, and then the most effective of them is prescribed. As a rule, regimens using bismuth preparations are very effective. New regimens are constantly being developed to significantly reduce the duration of treatment.

Consequences, routes of infection and prevention of Helicobacter pylori

Unfortunately, even successful eradication therapy cannot guarantee that relapse will not occur within several years.

It is quite difficult to predict infections. In some cases they are completely absent. Most often, the bacterium leads to gastritis, which is called gastritis B, and this is about 80% of all cases of chronic gastritis.

However, for active reproduction of bacteria, certain conditions are necessary, and these are created by poor diet, alcohol and smoking.Gradually, inflammatory processes spread to the entire surface of the mucosa, become deeper and lead to the formation of ulcers.

As a result, the bacterium can lead to the following diseases:

• Gastroduodenitis. It occurs when inflammation from the stomach spreads to the duodenum. There is abdominal pain, bitterness in the mouth, belching, nausea and vomiting.
• Erosion of the stomach and duodenum. Over time, inflammation can lead to the formation of erosions and damage on the surface of the mucous membrane. Erosion is accompanied by pain that occurs an hour after eating, nausea, sour belching, and possible vomiting.
• Stomach ulcer. In the formation of ulcers, not only bacteria play an important role, but also predisposition. Men suffer from ulcers 4 times more often than women. Main symptoms: clearly localized pain that occurs with prolonged absence of food, nausea, heartburn, constipation.

We can talk about such a consequence as stomach cancer only taking into account the fact that the bacterium itself does not cause cancer. It creates conditions that doctors call precancerous conditions. Damaged mucosa is definitely more prone to tumor formation.

As you know, the bacterium is transmitted through saliva and other fluids.

In order not to become infected and not to infect others, it is necessary to undergo regular preventive examinations with a doctor, as well as observe the rules of personal hygiene: wash your hands every time before eating, have your own cups, spoons and towels, especially at work, do not bite off a whole piece, but cut it off or break off, do not smoke or abuse alcohol, do not kiss friends, girlfriends and just acquaintances.

After the discovery of Helicobacter pylori in 1983 and the establishment of their role in the etiology and/or pathogenesis of a number of gastroduodenal diseases (HP-associated forms of chronic gastritis and peptic ulcer; cancer of the distal stomach), the problem of eradication (destruction, eradication) of HP infection with the use of antibacterial agents.

The initially used antibacterial monotherapy and double Helicobacter pylori eradication regimens turned out to be ineffective (eradication did not exceed 30-50%) and actually stimulated the accumulation of resistant Helicobacter pylori strains in the population, and therefore they soon had to be abandoned.

Currently, the “standard” anti-HP therapy is triple eradication regimens, recommended by a group of European gastroenterologists led by P. Malfertheiner and known as the “Maastricht Consensus”.

Consensus participants adhere to a strategy for total eradication of Helicobacter pylori (“good” Helicobacter pylori is dead Helicobacter pylori). However, the validity of such a strategy is disputed by many researchers on this problem, since the majority of HP-infected people (more than 70%) never develop symptoms of gastroduodenal diseases. It has been proven that with a morphologically normal gastric mucosa, its colonization by Helicobacter pylori is detected in 80% of cases, and antibodies to them are detected in 60% of healthy donors.

First-line anti-HP treatment regimens include two antibiotics, most often clarithromycin and amoxicillin, and a proton pump inhibitor, usually omeprazole and its analogues (rabeprazole or esomeprazole, lansoprazole or pantoprazole).

The Maastricht Consensus 2 established a lower threshold for recognizing eradication therapy as successful (80%), which must be confirmed by at least two methods 4 or more weeks after the end of the course of treatment, and also determined the optimal course duration of 7 days. Drugs included in triple Helicobacter pylori eradication regimens, are used in the following doses: omeprazole - 20 mg 2 times a day; lansoprazole -30 mg 2 times a day; pantoprazole - 40 mg 2 times a day; rabeprazole - 10 mg 2 times a day, esomeprazole - 20 mg 2 times a day; clarithromycin - 500 mg 2 times a day; amoxicillin - 1000 mg 2 times a day.

Amoxicillin can be replaced with metronidazole or tinidazole - 500 mg 2 times a day. It was noted that triple regimens with metronidazole or tinidazole are not inferior in effectiveness to regimens with amoxicillin.

The triple regimen “proton pump inhibitor + amoxicillin + metronidazole (tinidazole)” was excluded from the recommendations of the “Maastricht Consensus-2” as ineffective (eradication of Helicobacter pylori at the level of 58-60%); the doses of clarithromycin were increased from 250 to 500 mg 2 times a day and amoxicillin - from 500 to 1000 mg 2 times a day, which increases the eradication effect from 78.2 to 86.6% and minimizes subsequent resistance of Helicobacter pylori to clarithromycin and amoxicillin. At the same time, it was noted that a further increase in the doses of these antibiotics is undesirable, since, without increasing the eradication effect, it leads to a significant increase and aggravation of side effects. Increasing the duration of treatment from 7 to 10 and 14 days also, in most cases, does not entail a significant increase in the effect of eradication (Helicobacter pylori) therapy, which is 86, 90 and 92%, respectively (p>0.05), but contributes to an increase in side effects phenomena from 20 to 34-38% or more. At the same time, reducing the treatment period from 14 to 7 days with a comparable effect of Helicobacter pylori eradication creates favorable conditions for patients to comply with the “treatment protocol” (compliance), reduces the frequency of side effects and the cost of the course of treatment. It is 7-day triple eradication therapy regimens that are the most cost-effective and are recognized today as a strategic way to treat HP-associated diseases.

As is known, the recommendations of the “Maastricht Consensus-1” proposed a 3-week course of “follow-up treatment” of patients with antisecretory drugs (H2-histamine receptor blockers or a proton pump inhibitor) after completing a 7-day course of Helicobacter pylori eradication, which was considered as the “consolidation phase remission." The Maastricht-2 consensus cancels these recommendations as insufficiently substantiated and not improving either the immediate or long-term results of treatment. Replacing omeprazole in eradication regimens with lanso or pantoprazole, etc. gives a generally comparable eradication effect.

Recently, the most important problem that has arisen during the practical implementation of the Maastricht program for total eradication of HP has been the secondary (acquired) resistance of Helicobacter pylori to the action of the applied triple antibacterial treatment regimens, which is increasing from year to year, entailing a significant decrease in their effectiveness. The expansion of resistant Helicobacter pylori strains, insensitive to the effects of eradication therapy, reached 40-65% in relation to metronidazole, 40.7-49.2% - in relation to clarithromycin, 27.9-36.1% - in relation to amoxicillin.

G. Realdi et al. provide somewhat different data: resistance to metronidazole is 59.7%, to clarithromycin - 23.1%, to amoxicillin - 26%, to tetracycline - 14%, to doxycycline - 33.3%. The differences apparently depend on the prevalence of HP infection in different countries, on the length of time that specific antibiotics have been used in eradication therapy regimens, and on the informativeness of methods for determining HP resistance, etc. In countries

On the European continent, where triple eradication regimens began to be used earlier, over the past 5 years, resistance to nitroimidazoles (metronidazole, tinidazole) has increased from 21.3 to 74%, and to clarithromycin - from 1-2% to 17.8%. It is important to note that resistance to clarithromycin increases every 2 years by 2-4 times and, therefore, after 2 years it will reach 30% or more, and after 4-6 years it will approach 100%. Helicobacter pylori multiresistance to antibacterial therapy regimens, which is now detected in 7.9% of cases, has a particularly negative effect on the eradication effect. This is a very dangerous trend, since it is extremely difficult to achieve HP eradication in such cases. It has been established that resistance to clarithromycin occurs due to a decrease in its binding to the Helicobacter pylori ribosome, which is caused by a point mutation in the 23SrRNA gene in sections 2142 and 2143, and to metronidazole - with a point mutation in the nitroreductase gene rdxa.

According to M.R. Dore et al., with initial resistance of Helicobacter pylori to metronidazole and clarithromycin, the effect of triple eradication therapy regimens, including these drugs, is reduced by 37.7 and 55.1%, respectively, which is the main reason for unsatisfactory treatment results. An increasing number of researchers on this problem understand that a passive attitude towards the processes of emergence and spread of resistant Helicobacter pylori strains in the population will inevitably lead to a person’s loss in the fight against HP infection.

These data forced the recommendations of the Maastricht Consensus 2 to provide for the use of reserve eradication therapy regimens to overcome the emerging secondary resistance of HP to the treatment. This “second-line” therapy includes a proton pump inhibitor, three antibacterial agents and is called quadruple therapy. Quad therapy includes a proton pump inhibitor in usual doses, a colloidal bismuth preparation - 120 mg 4 times a day, tetracycline - 750 mg 2 times a day (or doxycycline - 100 mg 4 times a day) and metronidazole - 750 mg 2 times a day day. Instead of metronidazole, furazolidone can be prescribed - 200 mg 2 times a day. All drugs, except de-nol, are taken for 7 days, and de-nol - 4 weeks. It is fundamentally important that quadruple therapy regimens do not include drugs to which Helicobacter pylori resistance has been established based on the results of initial testing.

Initial course of eradication therapy. They should be replaced with reserve ones, since after ineffective eradication, secondary (acquired) resistance of Helicobacter pylori, as a rule, increases. According to various data, the use of a reserve Helicobacter pylori eradication regimen (quad therapy) is effective in an average of 74.2% of patients (range from 56.7 to 84.5%). Instead of proton pump inhibitors, quadruple therapy regimens sometimes include the combined drug piloride: ranitidine-bismuth citrate. However, this replacement seems to us to be insufficiently justified, since after ranitidine is discontinued, a “rebound” symptom develops with a sharp increase in the aggressiveness of gastric juice, and in terms of the severity and duration of the antisecretory effect, it is inferior to proton pump inhibitors.

We believe that it is necessary to limit the indications for Helicobacter pylori eradication only to those diseases in which the etiological and/or pathogenetic role of HP infection has been strictly scientifically established. These are HP-associated forms of gastric and duodenal ulcers and chronic gastritis, low-grade gastric MALT lymphoma, as well as patients who have undergone resection for gastric cancer. At the same time, Helicobacter pylori eradication should be abandoned in HP-negative forms of gastric and duodenal ulcers, the frequency of which reaches 40-50 and 20-30%, respectively; with functional dyspepsia syndrome and NSAID gastritis, since in this category of patients eradication therapy is not only ineffective, but even worsens treatment results. Empirically carried out unsystematic treatment aimed at the total destruction of Helicobacter pylori, including in healthy bacteria carriers, contributes to an increasing decrease in the effectiveness of eradication therapy and the selection of mutant strains (cagA-, vacA- and iceA-positive) with multidrug resistance and cytotoxic properties. It is ineffective eradication that is the main factor responsible for the development of secondary (acquired) resistance of Helicobacter pylori to anti-HP treatment regimens.

What are the prospects for overcoming secondary resistance of Helicobacter pylori to eradication therapy regimens? Summarizing the available recommendations and our own data, we can propose the following ways to solve this problem:
justification and testing of improved anti-HP treatment regimens by selecting optimal doses, combinations of pharmacological agents and duration of treatment; finding ways to maximize the duration of action of antibacterial drugs used in modern eradication therapy regimens;
creation (synthesis) of fundamentally new anti-HP agents that provide a high eradication effect (90-95%);
increasing the lower threshold of effectiveness of Helicobacter pylori eradication schemes from 80 to 90-95%, since it is those who survive HP eradication therapy that increase the potential risk of selection of resistant and cytotoxic strains of these microorganisms;
when identifying signs of secondary immunodeficiency - stimulation of the immunobiological properties of the human body with the help of immunomodulators, as an important factor preventing the possibility (in the presence of HP infection) of the development of HP-associated gastroduodenal diseases and helping to overcome the secondary resistance of Helicobacter pylori to therapy;
determination before the start of treatment of the sensitivity of Helicobacter pylori strains isolated from the gastric mucosa to the action of antibacterial agents used in eradication schemes;
identification of independent predictors (predict) of ineffective eradication of Helicobacter pylori and, if possible, their elimination before treatment;
instilling in patients adherence to strict adherence to the treatment protocol (adherence).

In order to increase the effect of eradication (Helicobacter pylori) therapy, it is proposed to replace omeprazole (lanso or pantoprazole) with a new generation of proton pump inhibitors: rabeprazole or the monoisomer of omeprazole - esomeprazole at a dose of 10 and 20 mg, respectively, 1-2 times a day, 7 days. At the same time, they refer to the fact that new proton pump inhibitors are more quickly converted into the active form, and therefore their inhibitory effect on acidic gastric secretion manifests itself within an hour after administration and persists throughout the day; they do not cause a “rebound symptom” after their withdrawal, and do not interact with the cytochrome P450 system involved in the metabolism of proton pump inhibitors. These features of the action of rabe- and esomeprazole are important in the treatment of gastroesophageal reflux disease, but do not give them any special advantages compared to omeprazole when included in eradication regimens (Helicobacter pylori) therapy: the eradication percentage is 86 and 88%, respectively, but the cost of a course of treatment is this increases significantly. Some authors recommend returning to the classic Helicobacter pylori eradication scheme, in which colloidal bismuth preparations: de-nol or Ventrisol were used as a basic agent instead of proton pump inhibitors, since Helicobacter pylori resistance does not develop to them. They diffuse deep into the gastric mucosa and exhibit their bactericidal effect for a long time (4-6 hours). However, firstly, colloidal bismuth preparations do not have a significant inhibitory effect on acid formation in the stomach, and some antibiotics partially lose their activity in an acidic environment. Secondly, they are known to be included in backup eradication regimens (quad therapy). Thirdly, when treating, for example, HP-associated forms of duodenal ulcer, inhibition of gastric acid secretion is no less important than eradication of Helicobacter pylori. It is known that proton pump inhibitors potentiate the eradication (Helicobacter pylori) effect of antibiotics. In addition to the fact that de-nol is included in quadruple therapy, it is part of combination drugs for the eradication of Helicobacter pylori: pilorid (ranitidine-bismuth citrate) and gastrostat (de-nol + tetracycline + metronidazole), produced in the form of monocapsules. It should also be taken into account that drugs containing bismuth are prohibited in a number of countries due to their side effects.

There have been proposals to replace clarithromycin, to which Helicobacter pylori resistance is rapidly increasing, in eradication schemes, with another antibiotic from the macrolide group - azithromycin at a dose of 500 mg 1-2 times a day, for 3 days, in combination with amoxicillin (1000 mg 2 times a day) or tinidazole (500 mg 2 times a day) and proton pump inhibitors (lanso or pantoprazole), 7 days. At the same time, the efficiency of Helicobacter pylori eradication reaches 75-79 and 82-83%, which is not significantly different from the effect of triple regimens with clarithromycin. Instead of clarithromycin, it is also proposed to use other macrolide antibiotics in Helicobacter pylori eradication regimens, in particular roxithromycin at a dose of 150 mg 2 times a day, 7 days and spiramycin at 3 million IU 2 times a day, which supposedly provides eradication of Helicobacter pylori at a level of 95 -98%, however, these data need to be confirmed by evidence-based medicine. In case of unsuccessful first-line eradication therapy (Helicobacter pylori), it is advisable to use a regimen including rifabutin (a derivative of rifamycin-S) at a dose of 150 mg 2 times a day, 10 days, which is called “rescue therapy”, since it ensures the eradication of resistant Helicobacter pylori strains (reeradication) in 86.6% of cases. A similar regimen of salvage eradication therapy with the inclusion of rifabutin, but lasting 14 days, is proposed by J.P. Gisbert et al.: the eradication rate after two previous unsuccessful attempts reaches 57-82%, and side effects develop in 21% of cases. The authors call it “third line” therapy. However, we must not forget that rifabutin has pronounced myelotoxicity, which requires monitoring the patient’s hematopoietic state; in addition, Helicobacter pylori resistance to it is rapidly increasing.

Data on the effectiveness of Helicobacter pylori eradication schemes using new antibiotics from the group of fluoroquinolones (III generation) deserve a comprehensive study: levofloxacin 500 mg 2 times a day, in combination with rabeprazole and amoxicillin or tinidazole in the usual dosage, 7 days, as well as sparfloxacin - 500 mg once a day, 7 days (Helicobacter pylori eradication >90%), which should be considered as a possible alternative to clarithromycin and other macrolides in Helicobacter pylori eradication regimens.

In the “Maastricht Consensus-4” (MK-4, 2010), it is levofloxacin that is recommended as a “reserve antibiotic” in Helicobacter pylori eradication regimens, but growing resistance of the microorganism to it is noted. Recently, the promising use of antibiotics from the group of ketolides, which suppress the vital activity of resistant strains of Helicobacter pylori, as well as nitazoxanide from the group of nitrothiazolamides (500 mg 2 times a day, 3 days), which is effective against HP infection occurring against the background of secondary immunodeficiency, has been noted. and does not cause the development of Helicobacter pylori resistance. Their effectiveness is being studied. Encouraging data are presented by F. Di Mario et al. who studied the effect of including bovine lactoferrin in standard eradication regimens. In the groups of patients who received additional lactoferrin, the eradication effect was close to 100%, and in the control groups it did not exceed 70.8-76.9%.

S. Park et al. proposed to increase the protective effect against cytotoxicity and DNA damage to cells of the gastric mucosa induced by Helicobacter pylori, the use of red ginseng extract (Panax), which prevents the adhesion of Helicobacter pylori on epithelial cells of the gastric mucosa, has antimicrobial activity and reduces the expression of proinflammatory cytokines stimulated by Helicobacter pylori type IL-8 as a result of transcriptional regression of NF-kB.

The proposal to use the probiotic Lactobacillus GO in Helicobacter pylori eradication regimens is quite justified, which improves the tolerability of standard triple regimens (pantoprazole + clarithromycin + tinidazole) and quadruple therapy, prevents the development of side effects (diarrhea, flatulence, nausea, impaired taste, etc. .) and secondary colonic dysbiosis, developing in almost 100% of patients after a course of eradication (Helicobacter pylori) therapy.

It is certainly justified to recommend determining, before the start of Helicobacter pylori eradication, the sensitivity of strains of these bacteria isolated from the gastric mucosa to the action of anti-HP drugs included in the eradication therapy regimen. It can be determined, for example, using an epsilometer test (E-test). This should significantly increase the efficiency of Helicobacter pylori eradication. However, conducting such studies before starting a course of eradication is a complex, time-consuming process that requires additional funds and effort, significantly increasing the cost of treatment, which will become inaccessible to a significant part of patients. Therefore, empirically based treatment will unfortunately continue to dominate in the coming years. An alternative to preliminary determination of Helicobacter pylori sensitivity to eradication therapy regimens may be to identify predictors of unsuccessful Helicobacter pylori eradication. Independent predictors of ineffective eradication of Helicobacter pylori are: age after 45-50 years, smoking and especially high density of contamination of the gastric mucosa with Helicobacter pylori according to histological examination of biopsy specimens and UDT test.

We consider equally important the data on the reduced effect of eradication therapy when Helicobacter pylori is detected in the oral cavity. It has been established that the deterioration of the results of Helicobacter pylori eradication and the increase in relapses of HP infection are directly related to infection of the oral cavity by Helicobacter pylori. HP urease gene fragments were amplified using polymerase chain reaction for DNA isolated from saliva and dental plaque.

The effectiveness of shorter-than-usual (3-5 days instead of 7), as well as prolonged (up to 10-14 days) Helicobacter pylori eradication therapy regimens is ongoing: the first - in order to reduce the frequency and severity of side effects and the cost of the course of treatment, secondly, to overcome the secondary resistance of Helicobacter pylori to anti-HP treatment regimens. S. Chahine et al. studied in a comparative aspect the effect of 3- and 5-day Helicobacter pylori eradication regimens, including lansoprazole (30 mg 2 times a day), amoxicillin (1000 mg 2 times a day) and azithromycin (500 mg 2 times a day). 4 weeks after the end of the course of treatment, eradication of Helicobacter pylori did not exceed 22-36%, which can be explained by the resistance of Helicobacter pylori strains colonizing the gastric mucosa to the antibacterial agents used. This assumption is indirectly confirmed by the effectiveness of another shortened (4-day) eradication regimen of a different composition (omeprazole + clarithromycin + metronidazole): 92% versus 95-96% when prescribing 7- and 10-day eradication regimens, which turned out to be quite comparable. When comparing the effect of Helicobacter pylori eradication using 3-day quadruple therapy: lansoprazole 30 mg 2 times a day + clarithromycin 500 mg 2 times a day + metronidazole 500 mg 2 times a day + de-nol 240 mg 2 times a day and standard The results of the 7-day triple regimen were identical - 87 and 88%. Conflicting results on the effectiveness of shortened Helicobacter pylori eradication regimens do not currently allow them to be recommended for practical use: additional research is required. At the same time, when comparing 7- and 14-day triple Helicobacter pylori eradication regimens (pantoprazole 40 mg 2 times a day + metronidazole 500 mg 2 times a day + clarithromycin 500 mg 2 times a day), a matching effect was obtained ( 84 and 88%), but lengthening the course of treatment to 14 days was accompanied by an increase in the frequency and severity of side effects. The authors consider a 14-day course of eradication justified only if there is a high index of contamination of the gastric mucosa with Helicobacter pylori (grade 3 according to histological examination of biopsy specimens and UDT test).

An original basic scheme for Helicobacter pylori eradication has been proposed, called the “5 + 5” scheme, which provides for treatment in 2 stages. At the first stage, patients take omeprazole (20 mg 2 times a day) and amoxicillin (500 mg 2 times a day) for 5 days, and at the second stage (the next 5 days) - the same drugs + tinidazole (500 mg 2 times a day ). Eradication of Helicobacter pylori is achieved in 98% of cases. These data need confirmation.

In accordance with our concept of the relationship between the human body and HP infection, increasing the effect of Helicobacter pylori eradication depends largely on the state of the immunological defense of the human body. As our studies have shown, the inclusion of immunomodulatory drugs in quadruple therapy when signs of secondary immunodeficiency are detected in patients increases the effect of Helicobacter pylori eradication from 55 to 84%, and also significantly reduces the frequency of reinfection and relapses of HP-associated diseases.

It is important to emphasize that none of the proposed anti-HP treatment regimens provides 100% eradication of Helicobacter pylori. More importantly, after several years, reinfection and relapse of HP-associated diseases are naturally observed. According to A. Rollan et al., the cumulative rate of reinfection (Kaplan-Meier) one year after successful eradication of Helicobacter pylori was 8 ± 3%, and after 3 years it reached 32 ± 11%. For some reason, it is generally accepted that during the 1st year after eradication therapy, it is not reinfection that occurs, but the revival of a previously existing HP infection. Thus, it is recognized that the established fact of successful eradication of Helicobacter pylori using two different methods for identifying HP infection does not deserve confidence. I.I. Burakov, over a 5-year observation period after eradication of Helicobacter pylori, found reinfection in 82-85% of patients, and after 7 years - in 90.9%, and against the background of reinfection, a significant part of them (71.4%) had a relapse of HP- associated diseases (primarily peptic ulcer). Prospective observation of patients with peptic ulcer proves that in real conditions, after 10 years, reinfection with Helicobacter pylori is detected in at least 90% of patients, and relapse of peptic ulcer in 75%. Thus, the possibility of curing HP-associated peptic ulcer disease remains elusive.

Concluding a review of the literature on the effectiveness of modern methods and means of Helicobacter pylori eradication, as well as ways to overcome the secondary (acquired) resistance of these bacteria to eradication therapy, we should once again briefly formulate the main recommendations arising from the analysis of the data presented.

Currently, the standard of eradication therapy for HP-associated diseases should be recognized as triple regimens based on proton pump inhibitors lasting 7 days. The use of shortened Helicobacter pylori eradication regimens (3-5 days) has not yet received convincing scientific justification. Prolonged Helicobacter pylori eradication regimens (10-14 days) are justified only in case of high density of Helicobacter pylori contamination of the gastric mucosa (according to histological examination of biopsy specimens and UDT test), but they increase the eradication effect by only 5%.

The most important problem that researchers faced when implementing a strategy for total eradication of Helicobacter pylori based on the recommendations of the Maastricht Consensus (we consider it erroneous) is the rapidly increasing secondary resistance of Helicobacter pylori to the antibacterial drugs and treatment regimens used. To overcome the acquired resistance of Helicobacter pylori, second-line therapy was recommended - quadruple therapy, which also could not solve this problem.

Promising ways to solve the problem of acquired resistance of Helicobacter pylori to modern eradication therapy are:
inclusion in Helicobacter pylori eradication regimens of new antibacterial drugs with high anti-HP activity (azithromycin, rock-sithromycin, spiramycin, rifabutin, levofloxacin, sparfloxacin, nitazoxanide, etc.), as well as lactoferrin and antibiotics from the ketolide group, but they can cause a new round of selection of resistant Helicobacter pylori strains;
exclusion from the list of diseases for which eradication of Helicobacter pylori is recommended, HP-independent forms of gastric and duodenal ulcers and chronic gastritis, functional dyspepsia syndrome, NSAID gastritis and gastroesophageal reflux disease, as well as healthy bacteria carriers and healthy blood relatives of patients with gastric cancer, since eradication of Helicobacter pylori in them has no scientific justification and promotes the selection of Helicobacter pylori strains that are resistant to eradication therapy and have cytotoxic properties;
increasing the lower threshold of effective eradication from 80 to 90-95%, which will reduce the potential risk of the emergence of treatment-resistant Helicobacter pylori strains, which are recruited mainly from among the microorganisms that survived the course of eradication (up to 20%);
determination before the start of treatment of the sensitivity of Helicobacter pylori strains isolated from the gastric mucosa to antibacterial drugs included in the eradication scheme, which, however, will significantly complicate the examination of patients and increase the cost of the course of eradication therapy;
identifying and taking into account the presence of independent predictors of unsuccessful eradication in HP-infected patients (age over 45-50 years, smoking, high density of Helicobacter pylori contamination in the gastric mucosa, detection of HP infection in the oral cavity);
inclusion in Helicobacter pylori eradication regimens of gastroprotectors that prevent Helicobacter pylori colonization of the gastric mucosa and increase the effect of Helicobacter pylori eradication therapy;
additional prescription of probiotics to prevent side effects of antibiotic therapy;
in the presence of signs of immunodeficiency, the use of immunomodulatory agents in combination with eradication therapy, which significantly increases the effect of Helicobacter pylori eradication and prevents reinfection;
educating patients’ readiness to strictly adhere to the treatment protocol.

The implementation of these recommendations, in our opinion, will help to increase the effect of eradication (Helicobacter pylori) therapy, as well as to prevent secondary resistance of Helicobacter pylori to the treatment and the selection of cytotoxic strains of Helicobacter pylori that threaten human health.

Helicobacter pylori infection, discovered in 1982 by Australians B. Marshall and R. Warren, is the culprit of peptic ulcers in various parts of the stomach and intestines. To combat it, the international medical community has developed various eradication therapy regimens.

Dangerous neighbor

At present, there is no doubt about the high degree of association of peptic ulcers with the activity of Helicobacter pylori in the gastric mucosa. For treatment, complex eradication therapy is used - these are actions aimed at complete freedom from infection, which minimize the likelihood of recurrence of ulcers.

In the years following the discovery of H. pylori, reports appeared that this bacterium is an etiological factor in a number of other diseases: chronic active antral gastritis (type B), atrophic gastritis (type A), non-cardiac cancer, MALT lymphoma, idiopathic iron deficiency anemia , idiopathic thrombocytopenic purpura and anemia due to vitamin B12 deficiency. The relationship between the spiral-shaped bacterium and allergic, respiratory and other extra-gastric diseases continues to be studied.

Eradication therapy in children

The need for eradication of H. pylori infection in children has been demonstrated in numerous clinical studies and their meta-analyses, which served as the basis for the compilation and regular updating of an international consensus document, well known to practicing gastroenterologists as the Maastricht Consensus. Currently, issues of diagnosis and treatment of Helicobacter-associated diseases are regulated by the fourth Maastricht consensus, adopted in 2010.

In developed countries of Europe, America and Australia, where since the discovery of the etiological role of H. pylori, methods for diagnosing and treating this infection have been systematically developed and put into practice, a decline in the incidence of peptic ulcers and chronic gastritis has been noted. In addition, in these countries, for the first time in decades, there has been a downward trend in the incidence of stomach cancer, which is also facilitated by eradication therapy.

Mysterious bacteria

Based on the results of numerous randomized placebo and comparative studies, the effectiveness of probiotic agents in various clinical situations, including Helicobacter pylori infection in children, has been determined. However, despite some advances in understanding the effect of probiotics on the bacterium H. pylori, its subtle mechanisms remain poorly understood.

The main inhibitory and bactericidal factor of Lactobacillus is lactic acid, which they produce in large quantities. Lactic acid inhibits H. pylori urease activity and is thought to exert its antimicrobial effect by lowering the pH in the gastric lumen space. However, it has been found that lactic acid, which is produced by gastric mucosal cells (GMC), promotes the growth of the H. pylori colony. In addition to lactic acid, lactobacilli and some other probiotic strains produce antibacterial peptides.

Complex therapy

The concept of eradication therapy is based on a combination of drugs. PPIs (proton pump inhibitors) block the enzyme urease and the accumulation of energy inside H. pylori, and also increase the pH of the gastric mucosa, creating conditions for the action of antibacterial drugs. Bismuth salts, accumulating in bacteria, interfere with the enzyme system of the pathogen, allowing the child’s immune system to more effectively cope with the “invader.” Finally, the most diverse group is the group of antibacterial drugs.

Eradication therapy for peptic ulcers in children (as well as for gastritis) often involves the use of nitroimidazoles, macrolides, lactams, tetracycline and nitrofurans. Helicobacter develops resistance specifically to antibacterial components, which reduces the effectiveness of eradication therapy. And the relevance of this problem is growing every decade.

Antibiotic resistance

The development of antibiotic resistance is a common feature shared by all pathogenic microorganisms. This is an evolutionary mechanism that ensures their survival in changing conditions. H. pylori resistance is divided into:

• Primary (consequence of previous treatment).
• Secondary (acquired mutation of a microorganism, which is “spurred on” by eradication therapy).

Causes of treatment resistance

Among the main reasons for the formation of acquired resistance in H. pylori, scientists name:

• Increase in prescriptions of antibacterial drugs of the same groups for other indications.
• Uncontrolled self-medication with antibiotics in countries where they are sold without a prescription.
• Inadequately prescribed eradication therapy for gastritis or ulcers (prescription of low doses of antibiotics, reduction of courses of treatment, incorrect combination in the drug regimen).
• Failure to comply with doctor's orders by patients.
• The appearance of low quality drugs on pharmaceutical markets.

As a result of all of the above, the increase in H. pylori resistance reduces the already limited number of antibiotics active against this microorganism.

The problem of antibiotic resistance is especially relevant for children who are indicated for eradication therapy for peptic ulcer disease. Most often, they are infected with primary resistant microorganisms from parents and close relatives.

In addition, in the pediatric population, the unjustified use of antibiotics for the treatment of other diseases, most often respiratory infections, is especially common, which also contributes to the selection of primarily resistant strains. Violation of the eradication therapy regimen, as in adults, leads to the formation of secondary resistance. The development of pathogenic resistance is also associated with mutations of various Helicobacter genes.

Diagnostics

Eradication therapy in adolescents begins after a comprehensive diagnosis. The primary goal of evaluating a child who has gastrointestinal symptoms is to determine the cause of the symptoms, not just the presence of H. pylori. However, tests to detect Helicobacter are not recommended in children with functional abdominal pain. Tests to identify the pathogen may be considered:

• in patients with a family history of stomach cancer in a first-degree relative;
• for refractory iron deficiency anemia (if other causes of the disease are excluded).

There is a lack of sufficient practical evidence of the involvement of H. pylori in otitis media, URT infections, periodontitis, food allergies, sudden infant death syndrome, idiopathic thrombocytopenic purpura, and short stature. But there are suspicions.

Diagnostic tests

Eradication therapy for peptic ulcers and gastritis is determined by diagnostic tests. The testing methodology depends on many factors:

• To diagnose Helicobacter during esophagogastroduodenoscopy, it is recommended to perform a biopsy of the antrum of the stomach for further histological analysis.
• It is recommended that the initial diagnosis of H. pylori be based on the following findings: positive histology and a positive urease test (alternatively, positive culture results).
• The C-urease breath test is a reliable, noninvasive method for determining whether H. pylori has been eradicated.
• Stool enzyme immunoassay is also a reliable non-invasive test for determining whether the bacteria have been eradicated.
• Tests based on the detection of antibodies to Helicobacter in serum, whole blood, urine and saliva, on the contrary, are not reliable.

Indications

What are the indications for eradication therapy:

• In the presence of peptic ulcer and Helicobacter infection.
• If there is no peptic ulcer, and H. pylori infection is detected by testing samples taken by biopsy, eradication of the pathogen is not necessary, but is possible.

Epidemiology

Determining the level of resistance in a single country, region or population is a complex task that requires large material and human resources. It is even more difficult to compare data from different countries due to differences in research methodology. For example, according to long-term studies in Europe (2003-2011), pathogen resistance to Clarithromycin ranged from 2 to 64% in different countries. According to Russian authors, resistance to Clarithromycin varies from 5.3 to 39%.

Of the drugs that are used in eradication regimens, amoxicillin forms the least resistance to resistance, and Metronidazole forms the greatest resistance. The resistance of H. pylori to the drug Clarithromycin continues to increase.

Problems with using Metronidazole and Furazolidone

Eradication therapy was previously often carried out with the above drugs. However, the increased adaptability of bacteria to Metronidazole has sharply reduced the effectiveness of treatment regimens using it. For this reason, Metronidazole is now excluded from treatment regimens in many countries.

An alternative to Metronidazole has become drugs of the nitrofuran series, in particular Furazolidone. The eradication efficiency based on it in combination with bismuth is 86%. However, Furazolidone is toxic and is not used in pediatric therapy in many clinics. The disadvantages of Furazolidone include hepato-, neuro- and hematotoxicity, suppression of microflora, and unsatisfactory organoleptic properties. To achieve the required concentration of the active substance in the body, this drug must be taken four times a day. These qualities of Furazolidone significantly reduce the beneficial effect of the entire treatment regimen and, as a consequence, the effectiveness of eradication.

New generation drug

Many laboratories of pharmaceutical companies are developing drugs that are less toxic but effective against Helicobacter. A real breakthrough was the drug "Makmiror", containing nifuratel as an active ingredient. A modern alternative to Furazolidone was developed and synthesized by the research company Polichem (Italy). "Makmiror" has a wide spectrum of antibacterial, antifungal and antiprotozoal effects. Eradication therapy for children has become safer.

The use of Macmiror makes it possible to improve existing Helicobacter eradication schemes in children, increase their effectiveness and safety. "Nifuratel" is included in the updated protocols for the treatment of H. pylori - associated chronic gastritis, gastroduodenitis and peptic ulcers in children.

The use of the drug "Makmiror" is accompanied by high compliance, since due to its twelve-hour half-life it can be prescribed twice a day. It is used in children from the age of six, the daily dose for the treatment of giardiasis and in Helicobacter eradication schemes is 30 mg per day per kilogram of the child’s weight.

Eradication therapy regimens

Examples of first line therapy. One-week triple regimens with bismuth preparation:

• Colloidal bismuth subcitrate (CBS) is supplemented with Amoxicillin (Roxithromycin) or Clarithromycin (Azithromycin) plus Nifuratel (Furazolidone).
• In the second scheme, Nifuratel is replaced by Famotidine (Ranitidine), the rest of the drugs are the same.

One-week triple regimens with proton pump inhibitors:

• Omeprazole (Pantoprazole) is supplemented with amoxicillin or Clarithromycin plus Nifuratel (Furazolidone).
• The same thing, but “Nifuratel” is replaced by SWR.

As a second-line treatment, eradication therapy with four components is used: SWR works together with Omeprazole (Pantoprazole), Amoxicillin (or Clarithromycin) and Nifuratel (Furazolidone).

Doses

The protocols also regulate the doses of drugs that should be used in eradication regimens in children (daily per kilogram of weight):

• SWR - 48 mg (maximum 480 mg per day).
• "Clarithromycin" - 7.5 mg (maximum 500 mg).
• "Amoxicillin" - 25 mg (maximum 1 g).
• "Roxithromycin" - 10 mg (maximum 1 g).
• "Furazolidone" - 10 mg.
• "Nifuratel" - 15 mg.
• "Omeprazole" - 0.5-0.8 mg (maximum 40 mg).
• "Pantoprazole" - 20-40 mg (excluding weight).
• "Ranitidine" - 2-8 mg (maximum 300 mg).
• "Famotidine" - 1-2 mg (maximum 40 mg).

Features of treatment

What treatment should be used in a particular situation:

• Children infected with H. pylori who have a family history of gastric cancer in a first-degree relative may be given eradication therapy.
• It is recommended to monitor the prevalence of antibiotic-resistant Helicobacter strains in different regions.
• In regions/populations where the prevalence of Helicobacter resistance to Clarithromycin is high (> 20%), it is recommended to determine sensitivity to this antibiotic before starting triple therapy involving the use of Clarithromycin.
• The recommended duration of triple therapy is 7-14 days. Costs, adherence, and side effects should be considered when considering this issue.
• To assess the results of eradication therapy, it is recommended to use reliable non-invasive tests 4-8 weeks after treatment.

If it doesn't help

• Esophagogastroduodenoscopy followed by culture and determination of sensitivity to antibiotics, including alternative ones, if this was not done before treatment.
• Fluorescent in situ hybridization (FISH) to determine clarithromycin resistance using paraffin-embedded samples from the first biopsy if susceptibility testing to this antibiotic was not performed before treatment.
• Modification of treatment: add an antibiotic, prescribe a different antibiotic, add a bismuth drug and/or increase the dose, and/or increase the duration of therapy.

Conclusion

Eradication therapy is an effective (sometimes the only) means of combating the most dangerous bacterium Helicobacter pylori, which can cause ulcers, gastritis, colitis and other gastrointestinal diseases.