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- Title
Ustalenia Grupy Roboczej PTG-E dotyczące postępowania w zakażeniu Helicobacter pylori- consensus 2008.
- Authors
Dzieniszewski, Jan; Jarosz, Miroslaw
- Abstract
Introduction: The most recent Polish guidelines on the management of the Helicobacter pylori (H. pylori) infection were published in 2004. Due to a progressive understanding the epidemiology of H. pylori infection, a better understanding of the relationship between the microorganism and its host, the critical need for evaluating the effect of H. pylori infection on diseases outside the digestive tract, and the constant need to evaluate changes in its susceptibility to antibacterial treatment; it is necessary to perform regular updates of the H. pylori treatment guidelines. In Poland, the percentage of the infected adult population is very high and amounts to more than 84%. The H. pylori resistance to medicines is one of the main factors affecting the effectiveness of the eradication treatment. The studies that have been carried out in Poland, in the recent years show strong resistance of the H. pylori strains to clarithromycin (CL) and metronidazole (MTZ) and full sensitivity to amoxicillin (AMX), ciprofloxacin, and tetracycline. The total sensitivity to CL is 28%, whereas the primary and secondary sensitivity - 22% and 54%, respectively. The primary sensitivity to CL is much higher with respect to the strains isolated from children (28%) than those isolated from adults (15%) and it is diversified in various geographical regions (0-33%). The total of 46% H. pylori strains is resistant to MTZ, with the primary and secondary resistance of 41% and 68%, respectively. As much as 20% strains are resistant to CL and MTZ simultaneously. In 2005, the European Helicobacter pylori Study Group developed updated guidelines (Maastricht III) that were published in 2007. The current study includes the revised guidelines on the treatment of H. pylori in Poland, in children and adults recommended by the Polish Society of Gastroenterology. The tests recommended in the diagnosis of H. pylori infection: If it is planned to perform an endoscopy, a biopsy of the mucous membrane for rapid urease test or histological examination should be taken. In other group of patients by means of non-invasive tests, quantitative evaluation of the H. pylori-specific IgG antibodies, 13C-urea breath test (13C-UBT), and Helicobacter pylori stool antigen test (SAT) should be performed. Indications for the eradicative treatment of H. pylori infection in adults: 1. active or previous stomach or duodenal ulcer (in case of a bleeding ulcer, the eradication is possible after stopping the bleeding), 2. peptic ulcer operation, 3. gastritis (exacerbated by aphthae), 4. preneoplastic changes (atrophic inflammation, metaplasia, dysplasia), 5. gastric resection due to premature cancer, 6. gastric cancer in the family (up to the second degree of consanguinity), 7. adenomatous and hyperplastic polyps in the stomach (after removing them), 8. gastric MALT lymphoma, 9. Menetrier's disease, 10. functional dyspepsia, 11. long-term NSAID treatment, 12. anaemia due to iron deficiency for unknown reasons, 13. idiopathic thrombocytopenia, 14. at patient's request (after consulting a doctor). Indications not recommended for the eradication treatment: 1. patients without any clinical symptoms (and with no risk factors of gastric cancer), 2. GERD treatment (except for patients with a projected long-term proton pump inhibitor (PPI) treatment), 3. superficial, chronic gastritis, 4. diseases outside the digestive tract (except for the idiopathic thrombocytopenia and anaemia due to iron deficiency for unknown reasons).…
- Subjects
POLAND; HELICOBACTER pylori; ALIMENTARY canal; METRONIDAZOLE; AMOXICILLIN; CIPROFLOXACIN; TETRACYCLINE
- Publication
Gastroenterologia Polska / Gastroenterology, 2008, Vol 15, Issue 5, p323
- ISSN
1232-9886
- Publication type
Article