Læknablaðið - 15.04.1995, Blaðsíða 19

LÆKNABLAÐIÐ 1995; 81
303
Árangur þriggja lyfja meðferðar
gegn Helicobacter pylori
hjá sjúklingum með skeifugarnarsár
Hallgrímur Guðjónsson, Herdís Ástráðsdóttir, Bjarni Þjóðleifsson
Guðjónsson H, Astráðsdóttir H, Þjóðleifsson B
Helicobacler pylori infection: The efficacy of bis-
muth-tetracyclin-metronidazole triple therapy in
patients with duodenal ulcer.
Læknablaðið 1995; 81: 303-7
The aim of the study was to assess the efficacy of two
bismuth-tetracyclin-metronidazole „triple therapy"
regimes for Helicobacter pylori and their effect of
eradication of the bacteria on duodenal ulcer dis-
ease. Eighty-two patients (52 males and 30 females,
mean age 49 years) with a history of recurrent duo-
denal ulcer and H. pylori postitive gastritis were
included in the study.
Treatment I, 35 patients, received colloid bismuth
subcitrate (De-Nol®) 120 mg q.i.d, tetracyclin 500
mg q.i.d. and metronidazole 400 mg t.i.d. for 14
davs. Most patients received omeprazole or H2
blocker during the treatment.
Treatment II. 47 patients, received omeprazole 20
mg o.d. on days 1-14 and colloid bismuth subcitrate
120 mg q.i.d., tetracyclin 250 mg q.i.d. and met-
ronidazole 250 mg q.i.d. on days 4-14. Eradication
was regarded successful if gastric biopsy was H.
pylori negative by urease test three months or more
after treatment. All patients were able to complete
the treatment. Eradication of H. pylori was success-
ful in 34 (97%) in group I and in 43 (92%) in group
II. The mean endoscopic follow-up period was 9.4
months in group I and 16.0 in group II. Follow-up
with regard to subjective symptoms was on average
20 months long. Five patients in group I and eight in
Frá rannsóknarstofu í meltingarsjúkdómum og lyflækninga-
deild Landspítala. Fyrirspurnir og bréfaskipti: Bjarni Þjóð-
leifsson, lyflækningadeild Landspítalans, 101 Reykjavík.
group II had a mild symptom recurrence without
reinfection. Two (2.5%) patients (one in each
group) had a recurrent ulcer. Adverse effects were
common in both groups and four patients, all in
group I, had severe symptoms. It was estimated that
the successful H. pylori eradication and excellent
symptom response in most of the patients had saved
seven million Icelandic krónur in drug expenses in
the whole group.
Ágrip
Tilgangur rannsóknarinnar var að meta
virkni tveggja mismunandi útfærslna á þriggja-
lyfja meðferð, bisniút, tetracýklín og metróní-
dazól, við Helicobacter pylori sýkingu. Enn-
fremur að kanna áhrif upprætingar á H. pylori
á sjúkdómsgang skeifugarnarsárs. Rannsóknin
náði til 82 sjúklinga (50 karla og 32 kvenna,
meðalaldur 49 ár), sem allir höfðu sögu um
þrálát skeifugarnarsár og H. pylori sýkingu.
Hópur I (35 sjúklingar) fengu collóíd bismút
subcítrat (De-Nol®) 120mg x 4, tetracýklín
500 mg x 4 og metrónídazól 400 mg x 3 í 14
daga. Flestir fengu einnig H; blokka eða óm-
eprazól meðan á meðferð stóð. Hópur II (47
sjúklingar) fékk ómeprazól 20 mg á fyrsta degi
til 14. dags, collóíd bismút subcítrat 120 mg x 4,
tetracýklín 250 mg x 4 og metrónídazól 250 mg
x 4 á fjórða degi til 14. dags. Uppræting á H.
pylori var talin hafa tekist ef magasýni var H.
pylori neikvætt á úreasa prófi þremur mánuð-
um eða síðar eftir meðferð. Uppræting tókst
hjá 34 (97%) í hópi I og 43 (92%) í hópi II.
Meðaltími frá meðferð til speglunar var 9,4
mánuðiríhópi I og lómánuðiríhópi II. Eftirlit
með tilliti til einkenna var að meðaltali 20 mán-
uðir. Fimm sjúklingar í hópi I og átta í hópi II