Læknablaðið - 15.09.1994, Blaðsíða 47

LÆKNABLAÐIÐ 1994; 80
317
Meltingarsár og Helicobacter pylori
Árangur þriggja lyfja meðferðar
Kristján Óskarsson1’, Ásgeir Theodórs1,2’, Kjartan Örvar1), Ingigerður Ólafsdóttir11
Óskarsson K, Theodórs Á, Örvar K, Ólafsdóttir I
Peptic ulcer discase and Helicobacter pylori. A com-
parative study of two different threc-drug regimens
Læknablaðið 1994; 80:317-25
Helicobacterpylori (H. pylori) is now known to
be strongly associated with gastritis type B, duode-
nal ulcer, gastric ulcer and perhaps gastric cancer.
To cure peptic ulcer disease has become reality.
This prospective study included 60 patients, 41
male and 19 females, with long history of peptic
ulcer disease (1 - 41 yr, mean 16.5 yr), diagnosed with
active duodenal ulcer (50) or gastric ulcer (10) dur-
ing endoscopy of the upper gastrointestinal tract.
After a positive CLO test and histologic confirma-
tion as well as positive culture of H. pylori from the
antral mucosa, patients were treated with conven-
tional anti-ulcer therapy. After ulcers were healed
(usually in 4 - 6 weeks) patients were randomized to
take one of two regimens: 1) colloid bismuth sub-
citrate 120 mg, four times a day for 28 days, met-
ronidazole 400 mg, three times a day for 10 days and
tetracyclin (DMT) 250 mg, four times a day for 14
days, 2) De-Nol 120 mg, four times a day for 28 days,
metronidazole 400 mg, three times a day for 10 days
and ampicillin 500 mg, four times a day for 14 days
(DMA). Careful monitoring of compliance, symp-
toms, side effects, H. pylori status and ulcer recur-
rence by endoscopy was performed at one, two, six
and 12 months after completion of triple therapy.
Duodenal ulcer recurred in all six patients, that
remained H. pylori positive (10%). Eradication of
H. pylori was achieved in all patients (30) treated
with DMT, and they remained H. pylori negative
throughout the 12 months follow-up period. The
Frá 11 lyflækningadeild St. Jósefsspítala í Hafnarfirði, og
2,lyflækningadeild Borgarspítalans. Fyrirspurnir, bréfaskipti:
Ásgeir Theodórs M.D. Department of Gastroenterology,
The Cleveland Clinic Foundation, 9500 Euclid Avenue,
Cleveland, Ohio 44195-5164 .
compliance to the treatment regimens was excellent
(<95%). Sideeffects werefrequent (38%),but mild
in most cases, mainly soft stool and nausea. One
patient had to discontinue the treatment. Re-in-
fection rate was 2% (one patient) during the 12
months follow-up period.
A triple therapy with DMT was 100% effective in
eradicating H. pylori and statistically superior (p =
0.0105) to DMA at 12 months follow-up. No ulcer
recurrence occured in H. pylori negative patients.
The importance of persistent and marked symp-
tomatic improvement observed in this study as com-
pared to conventional maintenance treatment has
not been emphasized enough in the recent debates
on ulcer treatment modalities.
The ultimate benefit of H. pylori eradication in
peptic ulcer disease should be evaluated by long
term follow up studies.
Ágrip
Meltingarsár eru langvinnur sjúkdómur.
Bráðameðferð hefur verið hefðbundin og
árangursrík síðustu áratugi. Eftir að meðferð
lýkur er endurkomutíðni sáranna há, sem hef-
ur orðið til þess að viðhaldsmeðferð er beitt í
vaxandi mæli.
Tengsl Helicobacter pylori (H. pylori) við
tilurð magabólgu, skeifugarnarsárs og maga-
sárs hefur gjörbreytt viðhorfum til orsaka og
meðferðar á þessum sjúkdómum. Vonir um
raunverulega lækningu hafa nú vaknað og
beinist meðferðin að því að uppræta bakter-
íuna. Lyf og samsetningar lyfja, tímalengd
meðferðar, árangur og aukaverkanir eru til
rannsóknar.
í þessari framskyggnu rannsókn var borinn
saman árangur lyfjasamsetninga með colloid
bismuth subcitrate (CBS, De-Nol®), metróní-
dazól og ampicillín (DMA) annars vegar og
colloid bismuth subcitrate (CBS, De-Nol®),
metrónídazól og tetracýklín (DMT) hins veg-
ar. Markmið rannsóknarinnar var að athuga
upprætingu á H. pylori, aukaverkanir lyfjanna,
meðferðarheldni, klínískan bata, nýgengi end-