It has long been believed that the gastric environment is sterile with respect to the microflora living in it. In the stomach with its internal content - acid, just not a single organism can survive. The discovery in the digestive tract of Helicobacter pylori revolutionized the idea of the nature of gastrointestinal diseases: gastritis, duodenitis, gastric and duodenal ulcers, gastrointestinal oncology and their treatment. In this article, we will consider in detail what eradication is. This is a specific treatment that has become very popular lately.
An excursion into the history of Helicobacter pylori
In fact, the bacterium was discovered a long time ago, and more than once. For the first time this happened at the end of the century before last. It was 1886. Professor of the Jagiellonian University V. Yavorsky discovered a characteristic spiral-shaped bacterium in gastric materials. He gave the bacteria the name Vibrio rugula, and suggested that it plays a role in the development of gastric diseases.
However, the work of Yavorsky did not receive due attention in medical circles. Seven years later, the Italian scientist D. Bidzodzero extracted a similar microorganism from the digestive tract of the dog. The next who noted the presence of bacteria in the cells of the stomach in the operated ulcer patients was Professor I. Morozov from Moscow. This was the end of the 70s of the last century.
Further attempts to somehow describe, classify, grow under laboratory conditions and study the nameless bacterium were made in 1979 and 1981 by the Australians Marshall and Warren. And they succeeded. Marshall conducted a successful experiment on the self-infection of Helicobacter pylori and the treatment of acquired Helicobacter pylori gastritis using a two-week course of taking Metronidazole and bismuth salts.
This method formed the basis of the modern eradication of Helicobacter pylori. And brave researchers in 2005 received the Nobel Prize in medicine.
The microorganism received the name Helicobacter pylori in 1989, as well as a full description and classification. The spiral-shaped bacterium, which chose the pylorus of the stomach as its habitat (the pylori is from the Greek pylorus), infects all areas of the duodenum and gastric. In a significant percentage of all gastritis, duodenitis, intestinal and duodenal ulcers up to their cancer, this microorganism is guilty.
What is the danger of infection with Helicobacter pylori?
Helicobacter pylori, living in the digestive tract of a human or animal, behaves approximately for the time being. At the slightest malfunction in the immune system or with the cumulative effect of malnutrition or bad habits, the bacterium becomes more active and becomes aggressive. How is this dangerous? Inhabited in the mucous membrane of the internal organs - the stomach and duodenum - the microorganism pathogenically affects it.
Increased secretion begins, which adversely affects the gastrointestinal tract. Their mucous membrane becomes loose, is destroyed, highly inflamed areas appear with the formation of ulcerations. Chronic gastritis caused by a pathogenic microorganism of the Helicobacter pylori group, unlike ordinary mechanical gastritis, cannot be cured by the usual methods.
Helicobacter pylori penetrates into deeper tissue layers, as a result of which it does not respond to the majority of antibiotics (antibiotics are unstable to acidity). Such her vandal actions cause irreversible processes in the mucosa, for example, a precancerous condition, and, directly, the development of oncology. To prevent this, Helicobacter eradication is used.
Diagnosis Helicobacter pylori in the digestive tract
If the patient complains of nausea and indigestion, heartburn, pain, stool problems, painful discomfort in the epigastric region - this is a direct indication to take tests for the presence of Helicobacter pylori in the body. Analyzes pass such:
- blood, general analysis for antibodies, including the presence of Helicobacteria;
- feces, analysis for the presence of waste bacteria;
- breath test based on a certain concentration of ammonia in the exhale;
- cytological analysis.
The most reliable method for diagnosing infection is a biopsy of the tissues of the gastric mucosa and duodenum. The tissue is taken for analysis by endoscopy.
Indications for the use of eradication
As mentioned above, eradication is a way to deal with a gastric bacterium.
Eradication is carried out by patients with such pathologies:
- ulcerative manifestations in the stomach and duodenum;
- post-resection condition (surgery to remove a cancerous tumor);
- precancerous conditions with organ tissue atrophy;
- lymphoma
The risk group includes people whose relatives have suffered cancer. Eradication therapy is recommended for patients with gastroesophageal reflux and functional dyspepsia.
Eradication methods
Eradication is destruction, eradication. This is a measure designed to destroy Helicobacter pylori in the digestive tract. The treatment method is indicated for patients with severe gastric or duodenal ulcers. Its essence lies in the course of taking medications according to a certain scheme.
Before the start of the course, an additional study of the tissues of the gastric mucosa for the presence of malignant cells is performed.
Helicobacter pylori eradication has several types:
- mono, where only one drug is used in treatment, usually it is a medicine based on bismuth salts or an antibiotic;
- duo, dual therapy (bismuth-containing substance plus antibiotic);
- a triplet, as the name implies, is a three-agent treatment (bismuth, antibiotic and representative of the imidazole group);
- quadriplet, a four-component form, where IPN (hydrochloric acid blockers) is added to the triplet therapy complex.
Mono-eradication is a practically non-applied method of therapy due to its inefficiency (below 50%). He was in use at the dawn of discovery and the first experiments on the treatment of Helicobacter pylori infection.
Eradication with the use of two medicines has an efficiency of getting rid of Helicobacter pylori about 60%, and it is also practiced little in modern realities. What eradication is used today? Treatment regimens are used such.
Triplet therapy includes a bismuth compound, an antibiotic (more often used amoxicillin and clarithomycin) and imidazoles (these are fungicides).
A course of four drugs is all of the above drugs plus proton pump inhibitors (this is an anti-ulcer group of drugs aimed at reducing the production of acid by the stomach). Methods in their effectiveness have performance indicators of 90% and 95%, respectively. This is how effective Helicobacter eradication can be.
Medicines used for eradication
Due to the fact that the acidic environment nullifies the effect of most antibiotics, the list of medicines for eradication is quite short:
- antibiotics
- anti-infectious agents;
- bismuth-containing drugs;
- proton pump inhibitors;
- probiotics and prebiotics.
Antibiotics most commonly used in eradication therapy
How does eradication begin? Antibiotics are prescribed as follows:
- “Amoxicillin” or “Flemoxin Solutab” is a penicillin group, suitable for most patients, not recommended for use in pregnancy, renal failure.
- "Amoxiclav" is a combination of amoxicillin and cavulonic acid, a broad spectrum antibiotic, it is recommended to use it carefully in the patient's renal pathologies, during pregnancy this antibiotic causes serious dysbiosis.
- "Clarithromycin" or "Klacid" is a low-toxic antibiotic of the erythromycin group of a wide spectrum, the most popular for eradication, is contraindicated in infants up to six months, pregnant women, use caution in patients with renal and hepatic insufficiency.
- "Azithromycin" is an alternative to "Clarithomycin" with minimal side effects, however, it is less effective relative to Helicobacter pylori.
Antibiotics "Tetracycline" and "Levofloxacin" are used less often and in cases where the above drugs did not have the proper result. The drugs of the tetracycline group have an aggressive effect in terms of side effects after Helicobacter eradication, therefore they are used less often.
Anti-bacterial and anti-infectious drugs for eradication
Metronidazole is an anti-infective chemotherapeutic agent of the nitromidazole group, very toxic, strictly incompatible with alcohol and prohibited during pregnancy.
"Macmirror" or "Nufuratel" is an antibacterial drug, it is used in case of inefficiency of "Metronidazole".
Bismuth-containing preparations
“De-Nol” - it was this medicine that showed the highest degree of neutralizing effect on Helicobacter pylori. "De-Nol" dissolves and penetrates into the bile mucus into the deepest layers of the affected organ. Virtually no adverse side effects, as well as contraindications (except, traditionally, pregnancy).
Less commonly used in the treatment of helicobacter salts are bismuth compounds:
- bismuth subsalicylate ;
- bismuth subnitrate.
Preparations based on bismuth salts were used to treat gastrointestinal tract diseases even before the discovery of Helicobacter pylori. These compounds are resistant to the acidic environment of the stomach. On the damaged surface of the mucosa, bismuth compounds form a protective film from an aggressive environment, reduce acidity and contribute to the speedy scarring of affected surfaces.
At the discovery of Helicobacter pylori, bismuth compounds showed a tremendous effect on the inhibition and destruction of this particular bacterium.
Drugs of the IPN group used for eradication
Proton pump inhibitors (PPIs) are indispensable in the complex effect on Helicobacter pylori. IPN drugs have a kind of antacid effect that reduces the aggressiveness of the acidic environment. Studies of the bacteria showed that it dies outside the acidic environment. Consequently, IDUs create intolerable conditions for the comfortable existence of bacteria, which in combination with bismuth, Metronidazole and an antibiotic increases the success of Helicobacter pylori eradication to 95% and higher. These drugs include:
- Omez (Omeprazole);
- "Nolpaza";
- Rabeprazole
- Pantoprazole, etc.
Most often, it is Omez. Proton pump blockers or IPNs inhibit digestive secretion.
Normalization of the microflora of the gastrointestinal tract after eradication Helicobacter
The effects of antibiotics in most cases are detrimental to the intestines and stomach. Therefore, after the eradication procedure, it is necessary to minimize the damage caused to the body. For this, there are useful products such as probiotics or prebiotics, indicated for dysbiosis, flatulence, diarrhea, etc. These include:
- Hilak Forte
- "Bifidumbacterin";
- Acipol, etc.
Probiotics and prebiotics are fundamentally different cultures that harmoniously complement each other's work. Both groups have a beneficial effect on the body by normalizing the intestinal microflora. The difference between the two is that probiotics are a living culture of beneficial microorganisms. Prebiotics are organic chemical compounds. The former directly "grow" the killed microflora, the latter create favorable conditions for this. They must be taken after eradication.
Disease prevention
Everyone can be a latent carrier of Helicobacter pylori. The microorganism lives in the stomach, intestines and oral cavity of a person or animal and has not manifested itself for years.
Activation of the bacterium occurs as a result of immune failure, with stress, bad habits (alcohol, smoking), an unbalanced diet and manifests itself as epigastric pain. Some types of helicobacteria are able to affect the liver.
Conclusion
Infection from the carrier of infection occurs by contact or through household items. The rules of personal hygiene should be carefully observed in order to minimize third-party infection. Then Helicobacter pylori eradication is not required.