Current development of Helicobacter pylori eradication protocols

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Abstract

H. pylori is one of the most common commensal microorganisms in the human body, colonizing up to 60% of the inhabitants of all continents. Some strains of H. pylori have acquired virulent properties and their presence can significantly complicate the course of atrophic gastritis of type B, gastric ulcer and duodenal ulcer, as well as malignant diseases of the stomach. In such situations, eradication therapy seems to be pathogenetically justified. International recommendations for standard first-line triple eradication therapy, including a proton pump inhibitor (PPI), amoxicillin and clarithromycin in a course of 7–10 days, were proposed in 1996. Until the beginning of the XXI century, it was actively and with high efficiency (up to 90%) used everywhere, but later reports began to appear about a catastrophic decrease in results (up to 60%). Then it turned out that the effectiveness of the three-component (triple) therapy directly correlates with the resistance to clarithromycin, which has increased significantly in recent decades, and so necessitated the creation of new H. pylori elimination schemes. The results of various schemes for H. pylori eradication were analyzed, including variants of modified triple therapy associated with the inclusion of new drugs or an increase in the duration of eradication. In particular, it was proposed to replace amoxicillin with metronidazole. However, further studies have shown that the combination of clarithromycin with amoxicillin seems to be preferable, which is due to the high level of H. pylori resistance to metronidazole in many countries. Attempts to use probiotics in parallel, in particular cultures of various Lactobacillus species, were analyzed, which increases the level of eradication during standard triple therapy from 61.5 to 81.6%, and also significantly reduces the severity of side effects. It has been shown that a promising way to increase the effectiveness of 7-day first-line therapy schemes with clarithromycin is the use of modern effective PPIs (for example, esomeprazole or rabeprazole). The scheme of modified sequential therapy with the replacement of clarithromycin with tetracycline or levofloxacin, which has shown high efficiency, is considered. A variant of standard triple therapy modified into quadrotherapy with the addition of metronidazole or tinidazole was analyzed. It has been shown that the sequential therapy scheme is ineffective for eradication of multidrug-resistant strains. Ideally, the treatment of bacterial infections should be based on endoscopic sampling of gastric mucosa biopsies, followed by microbiological determination of the sensitivity of the isolated isolates to antibacterial drugs in vitro.

About the authors

A. O. Pozdeeva

Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education

Email: pozdeevoskar@rambler.ru

Assistant Professor, Department of Internal and Family Medicine, Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education.

Kazan.

Россия

O. K. Pozdeev

Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education

Email: pozdeevoskar@rambler.ru

PhD, MD (Medicine), Professor, Department of Microbiology, Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education

Kazan.

Россия

P. E. Gulyaev

Kazan State Medical University

Email: just-esteto@mail.ru

Assistant Professor, Department of Microbiology named after academician V.M. Aristovsky, Kazan State Medical University.

Kazan.

Россия

Yu. V. Valeeva

Kazan (Volga Region) Federal University

Author for correspondence.
Email: val_iulia@mail.ru
ORCID iD: 0000-0002-1029-4511

Yulia V. Valeeva - PhD (Medicine), Associate Professor, Department of Emergency and Simulation Medicine, Kazan (Volga Region) Federal University.

420008, Kazan, Kremlevskaya str., 18.

Phone: +7 937 611-11-55

Россия

A. N. Savinova

Kazan State Medical University

Email: kazan-55@mail.ru

PhD (Biology), Associate Professor, Department of Microbiology named after academician V.M. Aristovsky, Kazan State Medical University

Kazan.

Россия

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