POSSIBILITY OF HELICOBACTER PYLORI ERADICATION THERAPY IN PATIENTS WITH CHRONIC HEPATITIS C

Derbak M. A., Dankanych Ye. E., Ganich O. T.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The work shows the possibility of H. pylori (Hp) eradication therapy in patients with chronic hepatitis C (CHC). The aim is to evaluate the efficacy and safety of HP eradication therapy in patients with CHC. The study included 94 patients with chronic hepatitis C, who for various reasons did not receive specific antiviral therapy. Patients were divided into three groups: A – 32 people received standard eradication therapy (SET), which included Rabeprazole 20 mg + Amoxicillin 1000 mg + Clarithromycin 500 mg 2 times a day for 10 days; B – 30 people received CET + probiotic Saccharomyces boulardii orally 1 capsule x 1 g per day for 10 days; C – 32 patients received SET + Saccharomyces boulardii + ursodeoxycholic acid 500 mg/day at night for 1 month. Research results. Analyzing the obtained results, it was found that at the end of SET in all groups of patients there was an improvement in general well-being and a decrease in complaints. The positive effect of the combined use of the probiotic Saccharomyces boulardii and UDCA on the manifestations of asthenovegetative syndrome, characteristic for almost all of patients at the beginning of the observation, was established. After 4 weeks of treatment, manifestations of asthenovegetative syndrome disappeared in 84.4% of patients with group C, which is significantly higher than in groups A and B (65.6% and 68.9%; p <0, 05). Almost at all of patients receiving concomitant probiotic Saccharomyces boulardii and UDCA on the background of SET disappeared the phenomenon of cholestasis, namely subicteric sclera and itchy skin. The percentage of patients with clinical manifestations of cholestasis syndrome in group C at the end of treatment is significantly lower than in groups A and B (6.3%; 12.5% and 10.0%, respectively; p <0.05). Positive changes are registered not only in the well-being of patients, but also in the biochemical parameters of the blood. Addition of probiotic Saccharomyces boulardii and UDCA to SET increases the efficiency of H. pylori eradication by more than 20.0%. The incidence of SET adverse events was significantly lower in patients receiving additional probiotics and UDCA. Conclusion. The effectiveness of eradication therapy in patients with CHC is higher when it includes the probiotic Saccharomyces boulardii and UDCA, which simultaneously reduces the incidence of side effects such as diarrhea, nausea, loss of appetite and flatulence.

chronic hepatitis C, Helicobacter pylori, Saccharomyces boulardii, ursodeoxycholic acid.

1. Ford AC, Axon AT. Epidemiology of Helicobacter pylori infection and public health implications. Helicobacter. 2010 Sep15;1:1-6. DOI: 10.1111/j
2. Nakajima S, Nishiyama Y, Yamaoka M. Takashi Y, Eisai C. Changes in the prevalence of Helicobacter pylori infection and gastrointestinal diseases in the past 17 years. J. Gastroenterol. Hepatol. 2010 Apr 25;1:99-110. DOI: 10.1111/j.1440-1746.2009.06214.x
3. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut. 2010 Aug;59(8):1143-53. DOI: 10.1136/ gut.2009.192757
4. Graham DY, Fischbach L. Helicobacter pylori infection. N Engl J Med. 2010 Aug 5;363(6):595-6. DOI: 10.1056/NEJMc1006158
5. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin. Microbiol. Rev. 2006 Yul 19;3:449-90. DOI: 10.1128/CMR.00054- 05
6. Molina-Infante J, Gisbert JP. Optimizing clarithromycin-containing therapy for Helicobacter pylori in the era of antibiotic resistance. World J. Gastroenterol. 2014 Aug 14;20(30):10338-47. DOI: 10.3748/wjg.v20.i30.10338
7. Villoria A, Garcia P, Calvet X, Gisbert J, Vergara M. Meta-analysis: high-dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication. Aliment. Pharmacol. Ther. 2008 Oct 1;28(7):868-77. DOI: 10.1111/j.1365-2036.2008.03807.x
8. Yang JC, Lin CJ, Wang HL, Chen JD, Kao JY, Shun CT, et al. High-dose dual therapy is superior to standard first-line or rescue therapy for Helicobacter pylori infection. Clin. Gastroenterol. Hepatol. 2015 May;13(5):895-905. DOI: 10.1016/j.cgh.2014.10.036
9. Мiyoshi M, Mizuno M, Ishiki K, Nagahara Y, Maga T, Torigoe T, et al. A randomized open trial for comparison of proton pump inhibitors, omeprazole versus rabeprazole, in dual therapy for Helicobacter pylori infection in relation to CYP 2C19 genetic polymorphism. J. Gastroenterol. Hepatol. 2001 Jul;16(7):723-8. DOI: 10.1046/j.1440-1746.2001.02526.x
10. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection the Maastricht V/Florence Consensus Report. Gut. 2017 Jan;66(1):6-30. DOI: 10.1136/gutjnl-2016-312288
11. Broutet N, Tchamgoué S, Pereira E, Lamouliatte H, Salamon F, Megraud F. Risk factors for failure of Helicobacter pylori therapy – results of an individual data analysis of 2751 patients. Aliment. Pharmacol. Ther. 2003 Febr;17(1):99-109. DOI: 10.1046/j.0269-2813.2003.01396.x
12. De Francesco V, Zullo A, Hassan C, Della Vaiie N, Pietrini L, Minenna MF, et al. The prolongation of triple therapy for Helicobacter pylori does not allow reaching therapeutic outcome of sequential scheme: a prospective, randomised study. Dig. Liver Dis. 2004 May 1;36(5):322-6.
13. Camargo MC, Piazuelo MB, Mera RM, Fontham ETH, Delgado AG, Yepez MC, et al. Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia. Acta Gastroenterol. Latinoam. 2007 Dec;37(4):238-45.
14. Zhou D, Guan WB, Wang JD, Zhang Y, Gong W, Quan ZW. A comparative study of clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa. PLoS One. 2013 July 30;22:70265. Available from: https://doi.org/10.1371/journal. pone.0070265

«Bulletin of problems biology and medicine» Issue 4 (158), 2020 year, 113-117 pages, index UDK 616.36-002.2-022.7:578.833.2+616.33-022.7:579.835.12]-08-039.76

10.29254/2077-4214-2020-4-158-113-117