RESULTS OF STUDY ON TREATMENT EFFICACY OF HELICOBACTER PYLORI ASSOCIATED GASTRITIS
- VernacularTitle:HELICOBACTER PYLORI-ИЙН ШАЛТГААНТ ХОДООДНЫ ҮРЭВСЛИЙН ЭМЧИЛГЭЭНИЙ ҮР ДҮНГИЙН ХАРЬЦУУЛАЛТ
- Author:
Byambajav Ts
1
;
Oyuntsetseg Kh
1
;
Choijav G
2
;
Bira N
1
Author Information
1. Department of Internal Medicine I, MNUMS,
2. Otoch -Manaramba University
- Publication Type:Journal Article
- Keywords:
Helicobacter pylori;
antibiotic resistance;
disease eradication
- From:Innovation
2017;1(1):28-36
- CountryMongolia
- Language:Mongolian
-
Abstract:
BACKGROUND
Helicobacter pylori (H.pylori), the main cause of gastric and duodenal ulcer, is considered
as a type 1 carcinogen. The primary prevention of gastric cancer is eradicating chronic
H.pylori infection. However, the antimicrobial eradication rates are decreasing as low as
80% in some countries, less than 70% in Europe and are inversely correlated with antibiotic
resistance rates reported worldwide.
The current international guidelines recommended several regimens with higher success
rate including sequential, combined, bismuth-containing and resistance-guided
treatment and states that the local susceptibility testing in H.pylori should be studied.
The research data that is covering correlation between H.pylori associated gastric
changes and precancerous diseases, evaluation of H.pylori eradication rate are sparse
in Mongolia.
METHODS
Totally, 495 eligible candidates were enrolled into this study. 225 patients who visited
to endoscopy unit, received gastroscopy with multiple biopsies for rapid urease test,
histology and H.pylori culturing. Out of these, 131 (52.2%) patients were positive for H.pylori
infection. These were further tested for antibiotic resistance. 76 patients were treated with
targeted therapy based on antibiotic resistance testing. Another 270 eligible patients
with confirmed H.pylori associated gastritis were randomized into the following 1st line
therapy regimen groups clarithromycin-based triple therapy (CBTT, n=90); bismuth-based
quadruple therapy (BBQT, n=90) and sequential therapy (ST, n=90). In 43 patients that
were not responded to 1st line therapy, levofloxacin-based triple therapy (LBTT) was
prescribed as a second line treatment. Eradication rates were assessed using H.pylori
stool antigen test 28 days of therapy just subsequent to termination of treatment.
RESULTS
During the gastroscopy, presence of active gastritis, nodular change and atrophy were
32.9%, 12% and 52.9% respectively. Epigastric pain was reported in 73.3%, 62.2%, 60-80%
and 41.3% of patients with normal mucosa, nodular change, stomach and duodenal
ulcer and antral atrophy (p<0.05). Abdominal fullness was more common among
patients with extensive gastric atrophy (69.2%, p<0.05). In <40 age group gastritis was
predominantly in the prepylori, while in the >50 age group it was predominantly the
corpus region. H.pylori resistance rates to amoxicillin, clarithromycin, metronidazole and
more than 2 antibiotics were 8.4%, 37.4%, 74% and 30.5%. On ITT analysis, eradication
rates of 1st line H.pylori targeted treatment, CBTT, BBQT and ST were 92.1%, 71.1%, 87.8%
and 67.8% (p<0.0001); on PP analysis, that were 94.6%, 72.7%, 89.8% and 68.5% (p<0.0001)
respectively. Eradication rates of 2nd line treatment LBTT were 55.8% and 60% by ITT and
PP analysis. Higher side-effects were reported during the second line treatment.
CONCLUSION
H.pylori infection rate was high among the dyspeptic patients resulting chronic gastritis
and atrophic change. H.pylori resistance rate to metronidazole and clarithromycin was
high. Among 1st line therapies; the eradication rates of CBTT and ST were poor, while
BBQT and Targeted therapy had a higher success rate. 2nd line therapy showed higher
failure rate.
