Helicobacter pylori pozitif duodenal ülserli hastalarda lansoprazol+amoksisilin tedavisinin serum gastrin seviyeleri ve bakteri eradikasyonu üzerine etkileri

Effects of lansoprasole+amoxicillin combination on serum gastrin, pepsinogen-I levels and eradication in Helicobacter pylori positive duodenal ulcer disease

Bülent YALÇIN, İrfan SOYKAN, Bekir ÇAKIR, Hülya ÇETİNKAYA, Arif YÖNEM, Murat PALABIYIKOĞLU, Abdullah BÜYÜKÇELİK, Ali ÖZDEN

Özet

Klinik gah§malarda elde edilen veriler, Helicobacter pylori (Hp) eradikasyonunun illser hastahgini ortadan kaldirabilecegini gostermektedir. Literatilrde Hp infeksiyonunun, serum gastrin ve pepsinojen-I seviyelerini an-lamh sekilde arttirdigini gosteren bulgular olup, eradikasyon He serum gastrin ve pepsinojen-I dilzeylerinin an-lamh §ekilde azaldigt bildirilmistir. Yeni birproton pompa inhibitory, olan lansoprazoliln, amoksisilin He kom-bine edilerek, serum gastrin ve pepsinojen-I seviyeleri He Hp eradikasyonu uzerine olan etkisini arastirmak amactyla yapilan bu gahsmaya (Hp) pozitif duodenum ulserli hastalar ahndi. 20 hastadan olusan A grubu-na lansoprazol 60mg/gun/30gun + amoksisilin 2 g/giin/14 gun uygulandi, 20 hastadan olusan B grubunda-ki hastalara ise antiasit/30 gun + amoksisilin 2 g/giin/14 gun tedavisi verildi; ancak bu grupta hastalardan 12'si gahsmayi tamamladi. Tedavi bitiminden 4 hafta sonra, A grubunda Hp eradikasyonu %40 biilunurken B grubunda eradikasyon big gorulmedi. A grubunda eradike olan hastalann yansmda 6. ayda Hp niiksil iz-lenirken, geri kalan hastalann hepsinde de 12. ayda Hp niiksil saptandi. Tedavi oncesindeki aghk ve tokluk gastrin seviyeleri, tedavi sonrasmda A grubunda anlamh olarak artmisti. Tedavi bitiminden 4 hafta sonra ise, B grubuna gore anlamh olarak azalmi§ti. Tedavi oncesindeki pepsinojen-I seviyeleri, tedavi sonrasi A grubun¬da anlamh olarak artmis, tedavi bitiminden 4 hafta sonra ise, baslangig degerinin altina inmisti. Diger teda-vilerdeki eradikasyon oranlan gozoniine ahndiginda, lansoprazohamoksisilin kombinasyonu uygun bir sege-nek olarak goriinmektedir.

Abstract

Clinical trials have shown that eradication of Helicobacter pylori (Hp) might prevent peptic ulcer disease. Seve¬ral findings demonstrate that Hp infection increases serum gastrin andpepsinogen-I levels that drop dramati¬cally after eradication. Patients with Hp(+) active duodenal ulcer were included in this study which was desig-. ned to evaluate the effects of the new proton-pump inhibitor, lansoprasole, on Hp eradication, serum gastrin d oepsinogen-Ilevels in combination with amoxicittin. The first group (A) was composed of 20 patients rece-■ -no lansoprasole (60 mg/day/30 days) + amoxicillin (2g/day/14 days). Second group (B) with the same num-h r of patients received amoxicillin (2g/day/14 days) + anti-acid (30 days), but only 12 of them completed the therapy regimen. In group A, the eradication rate ofHp detected 4 weeks after discontinuation of therapy was found as 40%. However, half of the patients with Hp eradication showed Hp recurrence after 6 months where¬as all the remaining was Hp(+) after 12 months. In group B, no eradication was observed. Pre and post-test-meal gastrin levels were elevated significantly at the end of the treatment in group A and 4 weeks later, signifi¬cantly decreased measures were found when compared with group B. Similarly, significantly increased serum pepsinogen-I levels at the end of the therapy in group A were found to drop below the initial amounts (not sig¬nificant) 4 weeks after the end of the trial. When compared with the rates of other studies, lansoprasole + amo¬xicillin combination seems a convenient alternative for Hp eradication.