Antibacterial drugs with anti-Helicobacter activity. Agent with anti-Helicobacter activity Antibiotics with anti-Helicobacter activity

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Table of contents

1. What tests can a doctor prescribe for Helicobacter pylori?
2. Basic methods and treatment regimens for helicobacteriosis
   • Modern treatment of Helicobacter-associated diseases. What is the Helicobacter pylori eradication scheme?
   • How to kill Helicobacter pylori reliably and comfortably? What requirements are met by the standard modern treatment regimen for diseases such as Helicobacter pylori-associated gastritis and gastric and/or duodenal ulcers?
   • Is it possible to cure Helicobacter pylori if the first and second lines of eradication therapy are powerless? Bacterial sensitivity to antibiotics
3. Antibiotics are the number one drug for treating Helicobacter pylori
   • What antibiotics are prescribed for Helicobacter pylori infection?
   • Amoxiclav is an antibiotic that kills particularly persistent bacteria Helicobacter pylori
   • Azithromycin is a “spare” drug for Helicobacter pylori
   • How to kill Helicobacter pylori if the first line of eradication therapy has failed? Treatment of infection with tetracycline
   • Treatment with fluoroquinolone antibiotics: levofloxacin
4. Chemotherapy antibacterial drugs against Helicobacter pylori
5. Eradication therapy of Helicobacter pylori using bismuth preparations (De-nol)
6. Proton pump inhibitors (PPIs) as a cure for helicobacteriosis: Omez (omeprazole), Pariet (rabeprazole), etc.
7. What treatment regimen for gastritis with Helicobacter pylori is optimal?
8. What complications can there be during and after treatment for Helicobacter pylori if a multicomponent course of eradication therapy with antibiotics is prescribed?
9. Is it possible to treat Helicobacter without antibiotics?
   • Bactistatin is a dietary supplement used as a remedy for Helicobacter pylori.
   • Homeopathy and Helicobacter pylori. Reviews from patients and doctors
10. Helicobacter pylori bacterium: treatment with propolis and other folk remedies
    • Propolis as an effective folk remedy for Helicobacter pylori
    • Treatment of Helicobacter pylori with antibiotics and folk remedies: reviews
11. Traditional recipes for treating Helicobacter pylori infection - video

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Which doctor should I contact if I have Helicobacter pylori?

What tests can a doctor prescribe for Helicobacter pylori?

As a rule, if helicobacteriosis is suspected, the doctor must prescribe an endoscopic examination - fibrogastroscopy (FGS) or fibrogastroesophagoduodenoscopy (FEGDS) (sign up), during which a specialist can assess the condition of the gastric mucosa, identify the presence of ulcers, bulges, redness, swelling, flattening of folds and cloudy mucus. However, endoscopic examination allows only to assess the condition of the mucosa, and does not give an exact answer to the question of whether Helicobacter pylori is present in the stomach.

Therefore, after an endoscopic examination, the doctor usually prescribes some other tests that make it possible to answer with a high degree of certainty the question of whether Helicobacter is present in the stomach. Depending on the technical capabilities of the institution, two groups of methods can be used to confirm the presence or absence of Helicobacter pylori - invasive or non-invasive. Invasive involves taking a piece of stomach tissue during endoscopy (sign up) for further tests, and for non-invasive tests, only blood, saliva or feces are taken. Accordingly, if an endoscopic examination was carried out and the institution has the technical capabilities, then to identify Helicobacter pylori, one of the following tests is prescribed:

• Bacteriological method. It is the inoculation of microorganisms on a nutrient medium found on a piece of the gastric mucosa taken during endoscopy. The method makes it possible to identify with 100% accuracy the presence or absence of Helicobacter pylori and determine its sensitivity to antibiotics, which makes it possible to prescribe the most effective treatment regimen.
• Phase contrast microscopy. It is the study of a whole unprocessed piece of the gastric mucosa, taken during endoscopy, under a phase-contrast microscope. However, this method allows you to detect Helicobacter pylori only when there are many of them.
• Histological method. It is the study of a prepared and stained piece of mucous membrane, taken during endoscopy, under a microscope. This method is highly accurate and allows you to detect Helicobacter pylori, even if they are present in small quantities. Moreover, the histological method is considered the “gold standard” in the diagnosis of Helicobacter pylori and allows one to determine the degree of contamination of the stomach with this microorganism. Therefore, if technically possible, after endoscopy to identify the microbe, the doctor prescribes this particular study.
• Immunohistochemical study. It is the detection of Helicobacter pylori in a piece of mucous membrane taken during endoscopy using the ELISA method. The method is very accurate, but, unfortunately, it requires highly qualified personnel and technical equipment of the laboratory, and therefore is not carried out in all institutions.
• Urease test (sign up). It involves immersing a piece of mucous membrane taken during endoscopy into a urea solution and then recording changes in the acidity of the solution. If within 24 hours the urea solution turns crimson, this indicates the presence of Helicobacter pylori in the stomach. Moreover, the rate of appearance of the crimson color also makes it possible to determine the degree of contamination of the stomach with bacteria.
• PCR (polymerase chain reaction), carried out directly on a collected piece of the gastric mucosa. This method is very accurate and also allows you to detect the number of Helicobacter pylori.
• Cytology. The essence of the method is that fingerprints are made from a taken piece of mucous membrane, stained according to Romanovsky-Giemsa, and examined under a microscope. Unfortunately, this method has low sensitivity, but is used quite often.

• Urease breath test. This test is usually performed during an initial examination or after treatment, when it is necessary to determine whether Helicobacter pylori is present in a person’s stomach. It consists of taking samples of exhaled air and subsequent analysis of the carbon dioxide and ammonia content in them. First, baseline breath samples are taken, and then the person is given breakfast and labeled C13 or C14 carbon, followed by 4 more breath samples taken every 15 minutes. If in test air samples taken after breakfast, the amount of labeled carbon is increased by 5% or more compared to the background, then the test result is considered positive, which undoubtedly indicates the presence of Helicobacter pylori in the human stomach.
• Test for the presence of antibodies to Helicobacter pylori (sign up) in blood, saliva or gastric juice using ELISA. This method is used only when a person is examined for the first time for the presence of Helicobacter pylori in the stomach, and has not previously been treated for this microorganism. This test is not used to monitor treatment, since antibodies remain in the body for several years, while Helicobacter pylori itself is no longer present.
• Analysis of stool for the presence of Helicobacter pylori using PCR. This analysis is rarely used due to the lack of necessary technical capabilities, but it is quite accurate. It can be used both for the initial detection of Helicobacter pylori infection and for monitoring the effectiveness of therapy.

How to treat Helicobacter pylori. Basic methods and treatment regimens for helicobacteriosis

Modern treatment of Helicobacter-associated diseases. What is the Helicobacter pylori eradication scheme?

New treatment methods have been developed based on the removal of Helicobacter pylori from the body by ingesting combinations of medications (the so-called eradication therapy ).

The standard Helicobacter pylori eradication regimen necessarily includes drugs that have a direct antibacterial effect (antibiotics, chemotherapeutic antibacterial drugs), as well as drugs that reduce the secretion of gastric juice and thus create an unfavorable environment for bacteria.

Should Helicobacter pylori be treated? Indications for the use of eradication therapy for helicobacteriosis

However, the global community of gastroenterologists has developed clear standards regulating cases when eradication therapy for Helicobacter pylori disease using special regimens is absolutely necessary.

Regimens with antibacterial drugs are prescribed for the following pathological conditions:

• peptic ulcer of the stomach and/or duodenum;
• condition after gastric resection for stomach cancer;
• gastritis with atrophy of the gastric mucosa (precancerous condition);
• stomach cancer in close relatives;

• functional dyspepsia;
• gastroesophageal reflux (a pathology characterized by the reflux of stomach contents into the esophagus);
• diseases requiring long-term treatment with non-steroidal anti-inflammatory drugs.

How to kill Helicobacter pylori reliably and comfortably? What requirements are met by the standard modern treatment regimen for diseases such as Helicobacter pylori-associated gastritis and gastric and/or duodenal ulcers?

1. High efficiency (as clinical data show, modern eradication therapy regimens provide at least 80% of cases of complete elimination of helicobacteriosis);
2. Safety for patients (regimens are not allowed into general medical practice if more than 15% of subjects experience any adverse side effects of treatment);
3. Convenience for patients:

• the shortest possible course of treatment (today, regimens involving a two-week course are allowed, but 10 and 7-day courses of eradication therapy are generally accepted);
• reducing the number of medications taken due to the use of medications with a longer half-life of the active substance from the human body.

First and second line of eradication therapy. Three-component regimen for the treatment of Helicobacter pylori with antibiotics and quadruple therapy for Helicobacter (4-component regimen)

The first such global consultation of doctors on the fight against Helicobacter pylori was held in the city of Maastricht at the end of the last century. Since then, several similar conferences have taken place, all of which were called Maastricht, although the last meetings took place in Florence.

World luminaries have come to the conclusion that none of the eradication schemes provides a 100% guarantee of getting rid of helicobacteriosis. Therefore, it has been proposed to formulate several “lines” of regimens, so that a patient treated with one of the first-line regimens can turn to second-line regimens in case of failure.

First line schemes consist of three components: two antibacterial substances and a drug from the group of so-called proton pump inhibitors, which reduce the secretion of gastric juice. In this case, the antisecretory drug, if necessary, can be replaced with a bismuth drug, which has a bactericidal, anti-inflammatory and cauterizing effect.

Second line circuits They are also called Helicobacter quadrotherapy because they consist of four drugs: two antibacterial medications, an antisecretory substance from the group of proton pump inhibitors and a bismuth drug.

Is it possible to cure Helicobacter pylori if the first and second lines of eradication therapy are powerless? Bacterial sensitivity to antibiotics

To destroy the harmful bacterium, doctors conduct a preliminary diagnosis of the strain's sensitivity to antibiotics. To do this, during fibrogastroduodenoscopy, a culture of Helicobacter pylori is taken and sown on nutrient media, determining the ability of various antibacterial substances to suppress the growth of colonies of pathogenic bacteria.

The patient is then prescribed third line eradication therapy , the regimen of which includes individually selected antibacterial drugs.

It should be noted that increasing resistance of Helicobacter pylori to antibiotics is one of the main problems of modern gastroenterology. Every year, more and more new eradication therapy regimens are tested, designed to destroy particularly resistant strains.

Antibiotics are the number one drug for treating Helicobacter pylori

What antibiotics are prescribed for Helicobacter pylori infection to treat: amoxicillin (Flemoxin), clarithromycin, etc.

However, these data have not been confirmed in clinical practice. So, for example, the antibiotic erythromycin, which is highly effective in a laboratory experiment, turned out to be absolutely powerless to expel Helicobacter from the human body.

It turned out that an acidic environment completely deactivates many antibiotics. In addition, some antibacterial agents are not able to penetrate the deep layers of mucus, where most Helicobacter pylori bacteria live.

So the choice of antibiotics that can cope with Helicobacter pylori is not so great. Today the most popular medications are the following:

• amoxicillin (Flemoxin);
• clarithromycin;
• azithromycin;
• tetracycline;
• Levofloxacin.

Amoxicillin (Flemoxin) - tablets for Helicobacter pylori

Amoxicillin (another popular name for this medication is Flemoxin) belongs to the semi-synthetic penicillins, that is, it is a distant relative of the first antibiotic invented by mankind.

This drug has a bactericidal effect (kills bacteria), but acts exclusively on reproducing microorganisms, so it is not prescribed together with bacteriostatic agents that inhibit the active division of microbes.

Like most penicillin antibiotics, amoxicillin has a relatively small number of contraindications. The drug is not prescribed for hypersensitivity to penicillins, as well as for patients with infectious mononucleosis and a tendency to leukemoid reactions.

Amoxicillin is used with caution during pregnancy, renal failure, and also when there are indications of previous antibiotic-associated colitis.

Amoxiclav is an antibiotic that kills particularly persistent bacteria Helicobacter pylori

The fact is that penicillins are the oldest group of antibiotics, which many strains of bacteria have already learned to fight by producing special enzymes - beta-lactamases, which destroy the core of the penicillin molecule.

Clavulanic acid is a beta-lactam and takes the hit of beta-lactamases from penicillin-resistant bacteria. As a result, enzymes that destroy penicillin are bound, and free amoxicillin molecules destroy bacteria.

Contraindications for taking Amoxiclav are the same as for amoxicillin. However, it should be noted that Amoxiclav more often causes serious dysbiosis than regular amoxicillin.

Antibiotic clarithromycin (Klacid) as a remedy against Helicobacter pylori

Clarithromycin (Klacid) belongs to the antibiotics from the erythromycin group, which are also called macrolides. These are broad-spectrum bactericidal antibiotics with low toxicity. Thus, taking second-generation macrolides, which include clarithromycin, causes adverse side effects in only 2% of patients.

The most common side effects are nausea, vomiting, diarrhea, less often - stomatitis (inflammation of the oral mucosa) and gingivitis (inflammation of the gums), and even less often - cholestasis (stagnation of bile).

Clarithromycin is one of the most powerful drugs used against the bacterium Helicobacter pylori. Resistance to this antibiotic is relatively rare.

The second very attractive quality of Klacid is its synergism with antisecretory drugs from the group of proton pump inhibitors, which are also included in eradication therapy regimens. Thus, clarithromycin and antisecretory drugs prescribed together mutually enhance each other’s actions, promoting the rapid expulsion of Helicobacter from the body.

Clarithromycin is contraindicated in case of increased individual sensitivity to macrolides. This drug is used with caution in infancy (up to 6 months), in pregnant women (especially in the first trimester), with renal and liver failure.

The antibiotic azithromycin is a “spare” drug for Helicobacter pylori

However, azithromycin is prescribed as an alternative to clarithromycin in cases where the use of the latter is prevented by side effects, such as diarrhea.

The advantages of azithromycin over Klacid are also increased concentration in gastric and intestinal juice, which promotes targeted antibacterial action, and ease of administration (only once a day).

How to kill Helicobacter pylori if the first line of eradication therapy has failed? Treatment of infection with tetracycline

This is a broad-spectrum bacteriostatic antibiotic, which is the founder of the group of the same name (tetracycline group).

The toxicity of drugs from the tetracycline group is largely due to the fact that their molecules are not selective and affect not only pathogenic bacteria, but also the reproducing cells of the macroorganism.

In particular, tetracycline can inhibit hematopoiesis, causing anemia, leukopenia (decreased number of white blood cells) and thrombocytopenia (decreased number of platelets), disrupt spermatogenesis and cell division of epithelial membranes, contributing to the occurrence of erosions and ulcers in the digestive tract, and dermatitis on the skin.

In addition, tetracycline often has a toxic effect on the liver and disrupts protein synthesis in the body. In children, antibiotics of this group cause impaired growth of bones and teeth, as well as neurological disorders.

Therefore, tetracyclines are not prescribed to small patients under 8 years of age, as well as to pregnant women (the drug crosses the placenta).

Tetracycline is also contraindicated in patients with leukopenia, and pathologies such as renal or liver failure, gastric and/or duodenal ulcers require special caution when prescribing the drug.

Treatment of Helicobacter pylori bacteria with fluoroquinolone antibiotics: levofloxacin

Like all fluoroquinolones, levofloxacin is a broad-spectrum bactericidal antibiotic. Restrictions on the use of fluoroquinolones in Helicobacter pylori eradication regimens are associated with the increased toxicity of drugs in this group.

Levofloxacin is not prescribed to minors (under 18 years of age) as it can negatively affect the growth of bone and cartilage tissue. In addition, the drug is contraindicated in pregnant and lactating women, patients with severe damage to the central nervous system (epilepsy), as well as in cases of individual intolerance to drugs in this group.

Nitroimidazoles, when they are prescribed in short courses (up to 1 month), extremely rarely have a toxic effect on the body. However, when taking them, unpleasant side effects may occur such as allergic reactions (itchy skin rash) and dyspeptic disorders (nausea, vomiting, loss of appetite, metallic taste in the mouth).

It should be borne in mind that metronidazole, like all drugs from the nitroimidazoles group, is not compatible with alcohol (causes severe reactions when taking alcohol) and turns the urine a bright red-brown color.

Metronidazole is not prescribed in the first trimester of pregnancy, as well as in case of individual intolerance to the drug.

Historically, metronidazole was the first antibacterial agent to be successfully used in the fight against Helicobacter pylori. Barry Marshall, who discovered the existence of Helicobacter pylori, conducted a successful experiment on himself with Helicobacter pylori infection, and then cured type B gastritis that developed as a result of the research with a two-component regimen of bismuth and metronidazole.

However, today an increase in the resistance of the bacterium Helicobacter pylori to metronidazole is being recorded all over the world. Thus, clinical studies conducted in France showed resistance of Helicobacteriosis to this drug in 60% of patients.

Treatment of Helicobacter pylori with Macmiror (nifuratel)

When taken for a short time, nitrofurans, including Macmiror, do not have a toxic effect on the body. Side effects rarely include allergic reactions and dyspepsia of the gastralgic type (stomach pain, heartburn, nausea, vomiting). It is characteristic that nitrofurans, unlike other anti-infective substances, do not weaken, but rather strengthen the body’s immune response.

The only contraindication to the use of Macmiror is increased individual sensitivity to the drug, which is rare. Macmiror crosses the placenta, so it is prescribed to pregnant women with great caution.

If there is a need to take Macmiror during lactation, you must temporarily stop breastfeeding (the drug passes into breast milk).

As a rule, Macmiror is prescribed in second-line Helicobacter pylori eradication therapy regimens (that is, after an unsuccessful first attempt to get rid of Helicobacter pylori). Unlike metronidazole, Macmiror is characterized by higher efficiency, since Helicobacter pylori has not yet developed resistance to this drug.

Clinical data show high efficiency and low toxicity of the drug in four-component regimens (proton pump inhibitor + bismuth drug + amoxicillin + Macmiror) in the treatment of helicobacteriosis in children. So many experts recommend prescribing this drug to children and adults in first-line regimens, replacing metronidazole with Macmiror.

Eradication therapy of Helicobacter pylori using bismuth preparations (De-nol)

Bismuth preparations were used in the treatment of gastrointestinal ulcers even before the discovery of Helicobacter pylori. The fact is that when De-nol gets into the acidic environment of the gastric contents, it forms a kind of protective film on the damaged surfaces of the stomach and duodenum, which prevents aggressive factors from the gastric contents.

In addition, De-nol stimulates the formation of protective mucus and bicarbonates, which reduce the acidity of gastric juice, and also promotes the accumulation of special epidermal growth factors in the damaged mucosa. As a result, under the influence of bismuth preparations, erosions quickly epithelialize, and the ulcers undergo scarring.

After the discovery of Helicobacter pylori, it turned out that bismuth preparations, including De-nol, have the ability to inhibit the growth of Helicobacter pylori, having both a direct bactericidal effect and transforming the habitat of bacteria in such a way that Helicobacter pylori is removed from the digestive tract.

It should be noted that De-nol, unlike other bismuth preparations (such as, for example, bismuth subnitrate and bismuth subsalicylate), is able to dissolve in gastric mucus and penetrate into the deep layers - the habitat of most Helicobacter pylori bacteria. In this case, bismuth gets inside microbial bodies and accumulates there, destroying their outer shells.

The drug De-nol, in cases where it is prescribed in short courses, does not have a systemic effect on the body, since most of the drug is not absorbed into the blood, but passes through the intestines.

So the only contraindications to prescribing De-nol are increased individual sensitivity to the drug. In addition, De-nol should not be taken during pregnancy, lactation and in patients with severe kidney damage.

The fact is that a small part of the drug that enters the blood can pass through the placenta and into breast milk. The drug is excreted by the kidneys, so serious violations of the excretory function of the kidneys can lead to the accumulation of bismuth in the body and the development of transient encephalopathy.

How to reliably get rid of the bacterium Helicobacter pylori? Proton pump inhibitors (PPIs) as a cure for helicobacteriosis: Omez (omeprazole), Pariet (rabeprazole), etc.

The mechanism of action of all drugs in this group is the selective blockade of the activity of the parietal cells of the stomach, which produce gastric juice containing such aggressive factors as hydrochloric acid and proteolytic (protein-dissolving) enzymes.

Thanks to the use of drugs such as Omez and Pariet, the secretion of gastric juice is reduced, which, on the one hand, sharply worsens the living conditions for Helicobacter pylori and promotes the eradication of bacteria, and, on the other hand, eliminates the aggressive effect of gastric juice on the damaged surface and leads to rapid epithelization of ulcers and erosions. In addition, reducing the acidity of gastric contents allows one to maintain the activity of acid-sensitive antibiotics.

It should be noted that the active ingredients of drugs from the PPI group are acid-labile, so they are produced in special capsules that dissolve only in the intestines. Of course, for the medicine to work, the capsules must be consumed whole, without chewing.

Absorption of the active ingredients of drugs such as Omez and Pariet occurs in the intestines. Once in the blood, PPIs accumulate in the parietal cells of the stomach in fairly high concentrations. So their therapeutic effect lasts for a long time.

All drugs from the PPI group have a selective effect, so unpleasant side effects are rare and, as a rule, consist of headache, dizziness, and the development of signs of dyspepsia (nausea, intestinal dysfunction).

Medicines from the group of proton pump inhibitors are not prescribed during pregnancy and lactation, as well as in cases of increased individual sensitivity to drugs.

Children (under 12 years of age) are a contraindication to the use of Omez. As for the drug Pariet, the instructions do not recommend using this drug in children. Meanwhile, there is clinical data from leading Russian gastroenterologists indicating good results in the treatment of helicobacteriosis in children under 10 years of age with regimens including Pariet.

What treatment regimen for gastritis with Helicobacter pylori is optimal? This is the first time this bacteria has been found in me (the test for Helicobacter is positive), I have been suffering from gastritis for a long time. I read the forum, there are a lot of positive reviews about treatment with De-nol, but the doctor did not prescribe this drug for me. Instead, he prescribed amoxicillin, clarithromycin and Omez. The price is impressive. Can the bacteria be removed with less medication?

The doctor prescribed you a regimen that is considered optimal today. The effectiveness of combining a proton pump inhibitor (Omez) with the antibiotics amoxicillin and clarithromycin reaches 90-95%.

Modern medicine is categorically against the use of monotherapy (that is, therapy with only one drug) for the treatment of Helicobacter-associated gastritis due to the low effectiveness of such regimens.

For example, clinical studies have shown that monotherapy with the same drug De-nol can achieve complete eradication of Helicobacter in only 30% of patients.

What complications can there be during and after treatment for Helicobacter pylori if a multicomponent course of eradication therapy with antibiotics is prescribed?

• individual sensitivity of the body to certain drugs;
• presence of concomitant diseases;
• the state of the intestinal microflora at the time of initiation of anti-Helicobacter therapy.

Is it possible to treat Helicobacter without antibiotics?

How to cure Helicobacter pylori without antibiotics?

Since eradication therapy represents a serious burden on the body and often causes adverse side effects in the form of dysbiosis, patients with asymptomatic carriage of Helicobacter are advised to choose “lighter” drugs, the action of which is aimed at normalizing the gastrointestinal microflora and strengthening the immune system.

Bactistatin is a dietary supplement used as a remedy for Helicobacter pylori.

In addition, the components of bactistatin activate the immune system, improve digestive processes and normalize intestinal motility.

Contraindications to the prescription of bactistatin are pregnancy, breastfeeding, as well as individual intolerance to the components of the drug.

The course of treatment is 2-3 weeks.

Homeopathy and Helicobacter pylori. Reviews from patients and doctors about treatment with homeopathic medicines

Homeopathy specialists are convinced that the general improvement of the body with the help of homeopathic remedies should lead to the restoration of the microflora of the gastrointestinal tract and the successful elimination of Helicobacter pylori.

Official medicine, as a rule, is without prejudice towards homeopathic medicines in cases where they are prescribed according to indications.

The fact is that with asymptomatic carriage of Helicobacter pylori, the choice of treatment method remains with the patient. As clinical experience shows, in many patients Helicobacter pylori is an accidental finding and does not manifest itself in any way in the body.

Here the opinions of doctors were divided. Some doctors argue that Helicobacter should be removed from the body at any cost, since it poses a risk of developing many diseases (pathology of the stomach and duodenum, atherosclerosis, autoimmune diseases, allergic skin lesions, intestinal dysbiosis). Other experts are confident that in a healthy body Helicobacter pylori can live for years and decades without causing any harm.

Therefore, turning to homeopathy in cases where there are no indications for prescribing eradication regimens is completely justified from the point of view of official medicine.

Symptoms, diagnosis, treatment and prevention of Helicobacter pylori - video

Helicobacter pylori bacterium: treatment with propolis and other folk remedies

Propolis as an effective folk remedy for Helicobacter pylori

After the discovery of Helicobacter pylori, additional research was carried out on the bactericidal properties of bee products against Helicobacter pylori and a technology for preparing an aqueous tincture of propolis was developed.

The Geriatric Center conducted clinical trials of the use of an aqueous solution of propolis for the treatment of helicobacteriosis in elderly people. Patients took 100 ml of an aqueous solution of propolis as eradication therapy for two weeks, while in 57% of patients complete healing from Helicobacter pylori was achieved, and in the remaining patients there was a significant decrease in the prevalence of Helicobacter pylori.

Scientists have concluded that multicomponent antibiotic therapy can be replaced by taking propolis tincture in such cases as:

• elderly age of the patient;
• presence of contraindications to the use of antibiotics;
• proven resistance of the Helicobacter pylori strain to antibiotics;
• low contamination with Helicobacter pylori.

Is it possible to use flax seed as a folk remedy for Helicobacter?

However, flax seed preparations do not have a bactericidal effect, and therefore are not able to destroy Helicobacter pylori. They can be considered as a kind of symptomatic therapy (treatment aimed at reducing the severity of signs of pathology), which in itself is not capable of eliminating the disease.

It should be noted that flax seed has a pronounced choleretic effect, therefore this folk remedy is contraindicated for calculous cholecystitis (inflammation of the gallbladder, accompanied by the formation of gallstones) and many other diseases of the biliary tract.

I have gastritis, Helicobacter pylori was discovered. I took treatment at home (De-nol), but without success, although I read positive reviews about this drug. I decided to try folk remedies. Will garlic help against helicobacteriosis?

You should not experiment on yourself; contact a specialist who will prescribe an effective Helicobacter pylori eradication regimen that suits you.

Treatment of Helicobacter pylori with antibiotics and folk remedies: reviews (materials taken from various forums on the Internet)

It should be noted that many patients ask each other to provide an “effective and harmless” treatment regimen for Helicobacter. Meanwhile, such treatment is prescribed individually, taking into account the following factors:

• the presence and severity of pathology associated with Helicobacter pylori;
• degree of contamination of the gastric mucosa with Helicobacter pylori;
• treatment previously taken for helicobacteriosis;
• general condition of the body (age, presence of concomitant diseases).

We found no evidence of the terrible complications of antibiotic therapy, with which patients for some reason constantly scare each other (“antibiotics are only a last resort”).

As for reviews of the treatment of Helicobacter pylori with folk remedies, there is evidence of successful treatment of Helicobacter with the help of propolis (in some cases we are even talking about the success of “family” treatment).

At the same time, some so-called “grandmother’s” recipes are striking in their illiteracy. For example, for gastritis associated with Helicobacter pylori, it is advised to take blackcurrant juice on an empty stomach, and this is a direct road to a stomach ulcer.

In general, from a study of reviews of the treatment of Helicobacter pylori with antibiotics and folk remedies, the following conclusions can be drawn:
1. The choice of treatment method for Helicobacter pylori should be made in consultation with a gastroenterologist, who will make the correct diagnosis and, if necessary, prescribe a suitable treatment regimen;
2. Under no circumstances should you use “health recipes” from the Internet - they contain many gross errors.

Traditional recipes for treating Helicobacter pylori infection - video

A little more about how to successfully cure helicobacteriosis. Diet for the treatment of Helicobacter pylori

In case of asymptomatic carriage, it is enough to simply follow the correct diet, refusing to overeat and foods harmful to the stomach (smoked food, fried “crust”, spicy and salty foods, etc.).

For peptic ulcers and type B gastritis, a strict diet is prescribed; all dishes that have the properties of increasing the secretion of gastric juice, such as meat, fish and strong vegetable broths, are completely excluded from the diet.

It is necessary to switch to fractional meals 5 or more times a day in small portions. All food is served in semi-liquid form - boiled and steamed. At the same time, limit the consumption of table salt and easily digestible carbohydrates (sugar, jam).

Whole milk (with good tolerance, up to 5 glasses a day), mucous milk soups with oatmeal, semolina or buckwheat help very well to get rid of stomach ulcers and gastritis type B. The lack of vitamins is compensated for by the introduction of bran (a tablespoon per day - taken after steaming with boiling water).

For the speedy healing of defects in the mucous membrane, proteins are needed, so you need to eat soft-boiled eggs, Dutch cheese, non-acidic cottage cheese and kefir. You should not give up eating meat - meat and fish soufflés and cutlets are recommended. The missing calories are supplemented with butter.

In the future, the diet is gradually expanded, including boiled meat and fish, lean ham, non-acidic sour cream and yogurt. The side dishes are also varied - boiled potatoes, porridge and noodles are included.

As ulcers and erosions heal, the diet approaches table No. 15 (the so-called recovery diet). However, even in the late recovery period, you should avoid smoked meats, fried foods, seasonings, and canned foods for quite a long time. It is very important to completely eliminate smoking, alcohol, coffee, and carbonated drinks.

Helicobacter pylori is one of the most “popular” microorganisms, widely studied by scientists from many countries and known as a microbe, the entry of which into the human body leads to the development of peptic ulcers and gastritis, and can contribute to the formation of gastric tumors (MALT lymphoma, adenocarcinoma).

It has been established that H. pylori is detected in approximately 30-35% of the population in childhood and 50-85% in the adult population. If there are indications for eradication therapy (absolute or relative) (Table 1), standard treatment regimens are traditionally used, in which include proton pump inhibitors (PPIs) and antibacterial drugs.

Table 1

Indications for eradication therapy.

As is known, eradication of H. pylori infection is considered to be in case of effectiveness of more than 80%. However, there are a number of problems that lead to a decrease in the effectiveness of anti-Helicobacter therapy. The main reasons contributing to the decrease in the percentage of successful eradication include:
1. Increased resistance of H. pylori to antibiotics
2. Side effects of PPIs and antibacterial drugs
3. Low compliance and patient’s reluctance to take antibiotics

Increased resistance of H. pylori to antibiotics.

It has been noted that an increase in H. pylori resistance to antibiotics leads to a catastrophic decrease in the effectiveness of eradication - from 80-90% to 30-60%. One of the main factors that has a negative impact on the success of anti-Helicobacter therapy is the tendency in many countries to increase the resistance of the microorganism to clarithromycin, the most important component of the standard triple first-line eradication regimen.

This was reflected in the recommendations of the Third Maastricht Consensus, which clearly stated that clarithromycin should be used in first-line eradication therapy regimens only if H. pylori resistance to this antibiotic in a given region does not exceed 15-20%].

Summarizing the results of 20 European studies that assessed the results of standard first-line triple therapy, which included a proton pump inhibitor (PPI), amoxicillin and clarithromycin in 2751 patients, we can conclude that in the case of sensitive strains, eradication is achieved on average in 87.8%, and with resistance to clarithromycin - only in 18.3% of patients, and according to some authors, in conditions of resistance to clarithromycin, the percentage of eradication decreases even to 14.3.

The recommendations of the Fourth Maastricht Consensus determined that for regions with high and low H. pylori resistance to clarithromycin, different treatment regimens for both first and second line are recommended (Table 2).

table 2

According to the materials of the International seminars organized by the European Group for the Study of Helicobacter pylori, the prevailing worldwide trend, although heterogeneous in different countries and on different continents, is towards an increase in the resistance of microorganism strains to clarithromycin (from 15% to 70%).

H. pylori resistance to antibiotics is also being actively studied in Russia. Most domestic studies show a tendency towards an increase in microorganism resistance to clarithromycin, which is consistent with known global data.

There are a number of domestic studies that have obtained data on extremely low resistance of H. pylori to macrolides and some other antibiotics: 7.6% to erythromycin (10 out of 133 strains), 3.8% to metronidazole (5 out of 133 strains), 8.3% - clevofloxacin (11 out of 133 strains).

Important new information for practicing doctors in St. Petersburg and the Northwestern Federal District is the data obtained by a group of researchers led by prof. IN AND. Simanenkova during an observational study in 2013-2014. in order to assess the sensitivity of H. pylori to antibacterial drugs recommended for use in eradication schemes in St. Petersburg.

According to the results of bacteriological analysis, the level of resistance of H. pylori to amoxicillin was 6.3%, clarithromycin - 25%, levofloxacin - 27%, metronidazole - 42.5%. The data obtained classify St. Petersburg as a region with high resistance of H. pylori to clarithromycin, dictating the need to search for new effective eradication regimens.

Thus, the diversity of the results obtained emphasizes the fact of significant regional characteristics of the resistance of the microorganism H. pylori and the impossibility of extrapolating the results of a single region to the whole of Russia.
It is relevant to evaluate the effectiveness of eradication therapy in conditions of microorganism resistance to clarithromycin. Thus, the results of one of the extensive meta-analyses (93 studies involving 10,178 patients were analyzed) showed that the effectiveness of triple therapy for the eradication of H. pylori infection in conditions of resistance of the microorganism to clarithromycin is reduced to an average of 50%.

Prof. E.A. Kornienko et al. conducted an analysis of the dependence of the effectiveness of eradication therapy on the sensitivity of the H. pylori strain to clarithromycin in children. In total, for all groups of patients whose eradication regimen included macrolides, clarithromycin-sensitive strains of H. pylori were isolated in 56.8% of cases, and clarithromycin-resistant strains were isolated in 43.2% of cases. Eradication therapy was significantly more effective in children with clarithromycin-sensitive strains: in 76.2% of cases, eradication of H. pylori was achieved. In contrast, the eradication rate in children with clarithromycin-resistant H. pylori strain was minimal and amounted to only 12.5%.

The main ways to optimize and increase the effectiveness of standard anti-Helicobacter therapy include:
1. Use of high doses of proton pump inhibitors
2. Increasing the duration of eradication therapy
3. Increasing the dose of traditionally used antibiotics
4. Replacement of an antibiotic to which there is high resistance of H. pylori in the region with a new antibacterial drug or a drug to which there is no primary and acquired resistance of the microorganism does not form (use of new antibiotics, bismuth preparations, nitrofurans)
5. Prescribing sequential eradication therapy
6. Inclusion in eradication therapy regimens of drugs that help increase the effectiveness of Helicobacter pylori eradication (probiotics, immunomodulators)

However, like standard eradication schemes, optimization schemes also have negative aspects.

Side effects of PPIs are associated with their acid-suppressive effect, because in conditions of hypo- and achlorhydria there is a risk of developing malabsorption of iron, calcium, zinc; the absorption of a number of drugs changes unpredictably when taken orally (pharmacokinetics of drugs is based on normal values ​​of acidity in the stomach): iron supplements, dipyridamole, fluconazole, thyroxine, calcium carbonate, theophylline, etc.; the risk of developing infections of the gastrointestinal tract and respiratory system increases; the stomach is colonized by microorganisms from the oropharyngeal region and intestines; the risk of oncological diseases increases (some of the microorganisms that are not inactivated in the stomach under conditions of hypo- and achlorhydria can produce carcinogens).

As a result, long-term use of PPIs may be a risk factor for the development of Clostridium difficile diarrhea and community-acquired Clostridium difficile associated pseudomembranous colitis; risk of developing candidiasis of the gastrointestinal tract; risk of developing pneumonia and hip fracture.

Increasing the dose of PPI increases the concentration of the drug in the blood and, therefore, enhances the antisecretory effect. When using high doses of drugs of this group in eradication regimens, serious side effects do not have time to occur due to the short course of taking the drugs. However, increasing the dose of antisecretory drugs is not always optimal in terms of price/quality ratio and does not reduce the incidence of complications of peptic ulcer disease - for example, bleeding.

The use of standard treatment regimens and optimization methods is limited by various side effects of antibacterial drugs, such as nausea, vomiting, deterioration of digestion, disruption of intestinal microflora up to the development of antibiotic-associated diarrhea, the possibility of developing complications from the liver and kidneys (changes in laboratory parameters of the liver and kidneys ), which is especially typical for elderly patients with severe comorbid diseases, the development of allergic reactions up to the formation of polyvalent allergies, headaches, changes in taste, etc.

The negative aspect of increasing the dose of drugs is that this method of increasing the effectiveness of treatment of helicobacteriosis can provoke the development of complications, especially intestinal dysbiosis (dose-dependent effect of antibiotics on the state of intestinal microflora). It should be noted that increasing the dose of a drug to which the microorganism has already become resistant does not significantly increase the percentage of successful eradication.

In some cases, the patient is not able to follow the doctor’s recommendations and take all components of eradication therapy as needed. This is due to the need to simultaneously take a large number of medications, as well as the patient’s reluctance to take antibiotics due to the risk of side effects and a history of allergic reactions.

A separate problem is the issue of reinfection, when after successful eradication of H. pylori over the next few years, invasion of the gastric mucosa by H. pylori is most often observed again, which, according to the cumulative Kaplan-Meier index, after 3 years is 32 ± 11 %, 5 years – 82-87%, 7 years – 90.9%.

Using probiotics.

One of the most promising areas for optimizing eradication therapy regimens is the additional use of probiotics in its composition, the possibility of use of which is indicated in the generally accepted standards for the treatment of H. pylori infection: Fourth Maastricht Agreement, Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of H. pylori in adults, 2013, Fifth Moscow Agreement - Standards for diagnosis and treatment of acid-dependent and Helicobacter pylori-associated diseases, 2013.

The use of various probiotics as components of eradication therapy is becoming increasingly widespread. As is known, the classification of probiotics is based on the number of microorganisms included in the drug, their genus or the presence of additional components in the composition of the drug.

Probiotics are divided into monocomponent (monoprobiotics), monocomponent sorbed, polycomponent (polyprobiotics), combined (synbiotics); in composition - into bifid-containing, lactose-containing, coli-containing and consisting of spore bacteria and saccharomycetes (self-eliminating antagonists).

The most promising is the use of both Lactobacilli spp. and Bifidobacteria spp. as additional means of eradication therapy, which secrete bacteriocins that can inhibit the growth of H. pylori and disrupt the adhesion of the microbe to the epithelial cells of the stomach.

Recent studies have shown that, in addition to standard eradication therapy, the administration of probiotic strains of Saccharomyces boulardii, Bacillus subtilis, Enterococcus faecium and Streptococcus faecium improves compliance, reduces the frequency and severity of side effects (intestinal dysbiosis, antibiotic-associated diarrhea), increases the efficiency of microbe eradication due to direct antagonistic effects against H. pylori and increasing the human immune response].

Preparations with probiotic action, in addition to correcting dysbiotic changes in the intestinal microflora, provide a number of additional positive effects: metabolic (positive effect on metabolic processes, normalization of lipid profile, blood sugar levels, etc.), immunological (improvement of humoral and cellular immunity, reduction of allergenicity of the body) , and also have an effect on H. pylori in the stomach due to a direct antagonistic effect and stimulation of local immunological defense (strengthening the mucous protective barrier and reducing the severity of inflammation of the gastric mucosa).

Thus, we can talk about the super-total positive effect of probiotic preparations. It was found that the administration of probiotics (based on bifidobacteria, lactobacilli, Bacillus subtilis, etc.) to patients with diseases associated with H. pylori has a protective effect on the state of the intestinal microflora and an antagonistic effect on fungi of the genus Candida, reduces side effects the effects of antibacterial therapy, including preventing the development of antibiotic-associated diarrhea, promotes the onset of faster clinical and endoscopic remission of the disease and increases the effectiveness of H. pylori eradication due to the direct antagonistic effect on H. pylori and increasing the immune response of the human body.

According to Prof. Yu.P. Uspensky (2010) probiotic therapy should be prescribed 3-4 weeks before eradication to implement the immunomodulatory effect and increase the predictability of the positive effect of eradication (pre-eradication probiotic therapy); simultaneously with eradication therapy for 10 days to increase the effectiveness of eradication and reduce the risk of side effects (co-eradication probiotic therapy); further within 3-4 weeks after eradication in order to restore the symbiont intestinal microflora and reduce the likelihood of reinvasion (recolonization) of H. pylori (post-eradication probiotic therapy). Thus, the recommended ratio of probiotic and anti-Helicobacter therapy is presented in Table 5.

Table 5

The relationship between probiotic and eradication therapy.

Basic principles for prescribing probiotics to patients with Helicobacter pylori-associated diseases (according to Uspensky Yu.P., 2010).

1. Probiotic therapy is not a component of eradication therapy; therefore, its use in patients for whom eradication is indicated cannot be limited to the framework of accepted consensuses, standards and recommendations
2. Unlike aggressive and unsafe standard eradication therapy, the duration of which does not exceed 7-10-14 days, the duration of probiotic therapy is not regulated by strict time frames
3. When prescribing probiotic therapy to patients in need of eradication, there is no need to fear the side effects of drug interactions of probiotics with other drugs and the accumulation of probiotics in the body
4. The main goals of using probiotic therapy during eradication are:

Protective effect in relation to one’s own symbiont microflora against the background of the use of antibiotics (cover therapy);

Strengthening the anti-Helicobacter effect of eradication therapy (adjuvant therapy).

Monotherapy with probiotics.

This method of treating H. pylori-associated diseases can be recommended for patients with chronic gastroduodenitis and duodenal ulcer without exacerbation, as well as for patients infected with low-pathogenic strains of the microorganism or with intolerance to antibiotics.

There are a number of both Russian and foreign studies confirming the effectiveness of probiotics as monotherapy for the eradication of H. pylori. Thus, when a probiotic based on lactic acid bacteria was used as monotherapy in patients with chronic gastroduodenitis associated with H. pylori in the acute stage, eradication was achieved in 48% of cases. Other authors have obtained data that the use of a probiotic based on L. acidophilus led to eradication in 6 out of 14 patients. These figures are quite high, especially if we remember that H. pylori develops resistance to antibacterial drugs.

According to our data, the use of monotherapy with probiotics is recommended if there is a history of allergic reactions to antibiotics included in eradication regimens or if the patient is categorically unwilling to take antibiotics; it can be prescribed to persons infected with H. pylori without clinical manifestations of helicobacteriosis, family members of patients infected with H. pylori.

The duration of monotherapy with probiotics should be at least a month. According to our data, monotherapy with synbiotics ensures the achievement of a level of successful eradication of H. pylori (39 and 41%), significantly exceeding the percentage of spontaneous eradication (3-5%). The administration of probiotics as monotherapy can be recommended as an alternative method of treating chronic gastroduodenitis associated with H. pylori, especially in cases of intolerance to the components of standard anti-Helicobacter therapy.

The results of recent studies have shown that it is not just innovative, but extremely relevant to use not probiotics based on living microorganisms, but the use of metabiotics - drugs based on metabolic products or structural components of probiotic microorganisms.

An extremely promising method for eliminating H. pylori from the human body is the use of a drug based on inactivated cells of probiotic bacteria Lactobacillus reuteri DSMZ 17648 (Pylopass™), isolated and processed biotechnologically. Lactobacillus reuter iDSMZ 17648 is a specially selected strain of lactobacilli that has the unique ability to specifically bind to H. pylori cells and form coaggregants (Fig. 1), without affecting other bacteria and normal intestinal flora. This specific binding reduces the mobility of Helicobacter, and pathogen aggregates cease to bind to the gastrointestinal mucosa and are “washed out” from the stomach, which results in a decrease in H. pylori colonization in the gastric mucosa, reducing the risk of developing gastritis and peptic ulcers.

Rice. 1. Co-aggregation between H. pylori and L. reuteri

Based on L. reuteri, a new drug with a unique anti-Helicobacter effect, Helinorm, was developed - an innovative over-the-counter anti-Helicobacter drug from the group of metabiotics. Pylopass™ (trademark LonzaLtd., Switzerland) is a substance that is part of Helinorm and contains a specific strain of Lactobacillus reuteri DSMZ 17648.

Studies on the effectiveness of Pylopass™ have shown that there is a reduction in H. pylori levels after a two-week course of taking Pylopass™ as measured by the urease breath test (UBT). The urea breath test (UBT) was used as a criterion for assessing the effectiveness of H. pylori elimination: H. pylori load after 2 weeks of taking Pylopass™. It was found that when taking placebo, there was a 3% change in MDT compared to the baseline, and when using Pylopass™, there was a 16% change in MDT compared to the baseline.

Thus, the use of Helinorm is promising in H. pylori-infected individuals. It should be noted that the development of new approaches to the safe and effective treatment of individuals who cannot undergo standard eradication therapy is relevant: this is important for individuals with a history of intolerance to antibiotics, the development of polyvalent allergies; elderly patients with liver and kidney damage; patients infected with multidrug-resistant strains of H. pylori, etc.); family members of H. pylori-infected patients; H. pylori-positive individuals who do not have clinical symptoms of damage to the upper gastrointestinal tract. In all these cases, the use of Helinorm may be a reasonable alternative to antibiotic therapy.

The drug Helinorm can be recommended:
In combination with standard eradication therapy
As a preparation for eradication therapy, 3-4 weeks
Simultaneously with eradication therapy 10-14 days
After eradication therapy 3-4 weeks
As monotherapy
When H. pylori is detected in people with dyspepsia in the absence of “alarm symptoms” (pain, ulcerative or erosive defects, aggressive strains of H. pylori, a history of peptic ulcer disease, unfavorable heredity, etc.), with chronic non-atrophic gastritis and functional dyspepsia
with H. pylori reinfection
in case of unsuccessful courses of standard eradication therapy
in case of accidental detection of H. pylori in practically healthy people
for preventive therapy during the inter-relapse period, including for the purpose of preventing reinfection
with multidrug resistance of H. pylori
for family prevention of helicobacteriosis
for the prevention of stress ulcers (surgeries, burns, injuries)
for the prevention of stomach cancer.

The role of genetic characteristics of H. pylori.

It should be noted that only a small number of H. pylori-infected people (less than 10-20%) develop H. pylori-associated diseases. This observation is explained by the fact that the H. pylori population is highly heterogeneous, and its strains differ significantly in virulence, therefore, not all of them are capable of causing clinical manifestations of diseases.

Already in the 90s, they talked about different strains of H. pylori, differing in their genome, and identified “ulcerogenic” (produce cytotoxins, associated with peptic ulcer disease, active gastritis) and “non-ulcerogenic” (do not produce cytotoxins, associated with simple gastritis) strains microorganism Today, when selecting treatment options, such an important factor as the genetic characteristics of H. pylori strains is not always taken into account.

It should be noted that if a patient is infected with low-virulent strains, it is also possible to use monotherapy with probiotics or Helinorm as an alternative to antibiotics and PPIs.

In conclusion, it should be noted that today, taking into account the genetic and regional characteristics of the pathogen, approaches to eradication therapy cannot be dogmatic. An innovative and promising approach to the prevention and treatment of helicobacteriosis is the use of the metabiotic Helinorm as a safe and effective drug to reduce the degree of H. Pylori contamination of the gastric mucosa.

Uspensky Yu.P., Baryshnikova N.V., Fominykh Yu.A.
First St. Petersburg State Medical University named after. I.P. Pavlova

Catad_tema Peptic ulcer - articles

Clarithromycin as an integral component of anti-Helicobacter therapy

The article is devoted to the consideration of modern treatment regimens for Helicobacter pylori infection and the place of clarithromycin in them. Current recommendations of the Maastricht international consensus are presented. Possible ways to solve the main problems associated with the increase in H. pylori resistance to antibiotics are discussed. The main reasons for its development are outlined. Particular attention is paid to the prospects for the use of new treatment regimens, in particular the sequential eradication regimen with the inclusion of clarithromycin, and the quality of antibacterial drugs.

Keywords: Helicobacter pylori, eradication, anti-Helicobacter therapy, clarithromycin, microbial resistance, generics

The discovery of Helicobacter pylori infection, the recognition of its important role in the etiopathogenesis of peptic ulcer (PU) of the stomach and duodenum, active chronic antral gastritis (type B), atrophic gastritis, non-cardiac cancer and gastric MALT lymphoma has in many ways fundamentally changed the previously established approaches to prevention and treatment of the listed common diseases of the upper gastrointestinal tract (GIT). In addition to previously widely used cytoprotectors and antisecretory drugs, primarily proton pump inhibitors (PPIs), antibacterial therapy has come to the fore.

The enormous attention paid to Helicobacter pylorus over the past decades has been fully justified by the clinical results obtained. In the countries of Europe, North America and Australia, where effective methods for diagnosing and treating H. Pylori infection were systematically developed and introduced into widespread practice, a significant decrease in the incidence of Helicobacter-associated peptic ulcer and chronic gastritis was noted, as well as a trend towards a decrease in the prevalence of gastric cancer.

Indications and conditions for anti-Helicobacter therapy

To date, a significant number of anti-Helicobacter therapy regimens, varying in composition and duration of treatment, have been proposed, an obligatory component of which are antibiotics. The positive effect of eradication of H. pylori infection on the course and prognosis of associated diseases has been proven in numerous randomized clinical trials and is reflected in meta-analyses of these studies and international consensuses Maastricht I-III.

The main indications for the diagnosis of H. pylori infection and anti-Helicobacter therapy are:

1. Peptic ulcer and duodenum:

For quotation: Khavkin A.I., Zhikhareva N.S. Modern principles of anti-Helicobacter therapy in children // RMJ. 2005. No. 3. P. 137

Human infection with H. pylori is currently very high. According to some authors, it reaches 80% of the population. However, the frequency of Helicobacter-associated diseases varies depending on the country (the lower the economic level of the country, the more often Helicobacteriosis occurs), on the age of the patient (H. pylori is most often infected at the age of 18-23 years in developed countries and at the age of 5-10 years in economically not prosperous countries). In Russia, the infection rate of children with HP is on average 70%. This high degree may be explained by the fact that studies for the presence of this microorganism were carried out mainly in children with various gastroenterological complaints. When examining children, regardless of the presence of dyspepsia or abdominal pain, the number of H. pylori-positive cases is determined much less frequently.
Helicobacter infection occurs mainly from person to person through the oral-oral and fecal-oral route. Most often, HP is transmitted within the family through hygiene items, dishes, and kissing.
Colonization of the gastrointestinal tract by Helicobacter does not always lead to the development of a pathological process (gastritis, ulcer duodenitis, etc.). The body's response to HP depends on the state of a person's immunity, the composition of mucus in the stomach and duodenum, as well as a decrease in the number of receptors on the surface of the stomach that promote adhesion of the microorganism and the virulence of the H. pylori strain (the ability to produce vacuolating toxin (VacA), as well as cytotoxin-associated protein ( CagA), which promote the rapid destruction of epithelial cells with the destruction of subepithelial tissues and extracellular matrix).
Retrospective studies have shown an association between H. pylori infection and gastric cancer, including gastric lymphoma. The risk of developing stomach cancer associated with H. pylori reaches 70% in industrial areas and 80% in rural areas. Recently, studies have been conducted showing the relationship between H. pylori infection and damage to other organs and systems, in particular, the influence of this microorganism on the development of coronary heart disease is discussed.
Clinically, Helicobacter infection manifests itself in a very diverse manner - from sharp frequent abdominal pain with severe dyspeptic symptoms (nausea, heartburn, heaviness in the stomach after eating, etc.) to asymptomatic carriage. Thus, in studies conducted in children with no complaints, additional examination methods revealed pronounced changes in the stomach and duodenum (from severe gastritis to peptic ulcers), as well as the presence of HP.
Thus, testing for HP is recommended for the following categories of people:
. the presence of recurrent abdominal pain (of varying localization, since many patients and especially children cannot localize the pain syndrome);
. long-term dyspeptic symptoms of any severity (nausea, vomiting, heaviness in the stomach after eating, pain in the epigastric region, heartburn, loss of appetite, perversion of taste, etc.);
. previously identified gastroduodenitis, peptic ulcer without definition of HP;
. the presence of relatives with gastroduodenal pathology (peptic ulcer of any location, gastritis, duodenitis, stomach cancer, lymphoma, etc.).
Invasive and non-invasive methods are used to diagnose Helicobacter pylori infection. The first include:
1. Endoscopic examination with visual assessment of the condition of the mucous membrane of the stomach and duodenum.
2. Morphological - determination of microorganisms in a mucous membrane preparation using special stains (Giemsa, tolluidine blue, Ghent, Warthin-Starr).
3. Bacteriological - determining the strain of a microorganism, identifying its sensitivity to the drugs used.
4. Detection of H. pylori in the mucous membrane of the stomach and duodenum using polymerase chain reaction.
Non-invasive methods:
1. Detection of specific anti-Helicobacter antibodies of classes A and G in the patient’s blood (enzyme immunoassay, rapid tests based on the precipitation reaction or immunocytochemistry using the capillary blood of patients) and other biological media (feces).
2. Breathing tests with registration of waste products of H. pylori (carbon dioxide, ammonia) in exhaled air.
3. Detection of H. pylori in analyzes of stool, saliva, and dental plaque using the polymerase chain reaction method.
In patients with gastroenterological complaints, dyspepsia, and abdominal pain, at least 2 non-invasive diagnostic tests should be performed to determine H. pylori.
When H. pylori is detected, the question arises about eradication of this microorganism. Previously, for the treatment of Helicobacter-associated diseases, antibacterial drugs (metronidazole, semi-synthetic penicillins) were used as monotherapy, and sometimes bismuth subcitrate was added. However, these schemes are currently not effective. HP is resistant to many antibacterial drugs. This was primarily due to the emergence of new strains of microorganisms. As microbiological studies conducted in Russia have shown, the number of resistant strains is growing exponentially. Thus, the number of strains resistant to metronidazole in the adult population of Russia exceeded 40%, which is significantly higher than the European average.
Currently, HP eradication schemes are determined by regional recommendations, which were created on the basis of the Maastricht consensus.
The following eradication regimens are recommended in Russia:
I. One-week triple therapy with bismuth preparation:
1. . Bismuth subcitrate

. Nifuratel/furazolidone
2. . Bismuth subcitrate
. Clarithromycin
. Amoxicillin
II. One-week triple therapy with proton pump inhibitor (PPI):
1. . Proton pump inhibitor (omeprazole, rabeprazole, lansoprazole, pantoprazole)
. Clarithromycin
. Nifuratel/furazolidone
2. . IPP
. Clarithromycin
. Amoxicillin
III. One-week quad therapy:
. Bismuth subcitrate
. Amoxicillin or clarithromycin
. Nifuratel/furazolidone
. IPP
Quad therapy is recommended for the treatment of antibiotic-resistant strains when previous treatment has failed or when determining the sensitivity of the microorganism strain is not possible.
It should be noted that antibiotics are used in their highest dosages, and therefore side effects of therapy often develop. In adults, the incidence of side effects is about 20%. It is necessary to cancel therapy in isolated cases. The frequency of side effects in children is not higher, but the tolerability of anti-Helicobacter therapy is much worse. Children often refuse to take medications due to severe nausea and an unpleasant taste in the mouth. Parents stop medications if diarrhea occurs.
The most common side effects of anti-Helicobacter therapy is the formation of dysbiotic changes in the colon. Such patients experience diarrhea syndrome (less often constipation), severe nausea, and sometimes vomiting. Pseudomembranous colitis rarely occurs. Among the side effects, it should be noted allergic reactions, stimulation of motility of the digestive tract by macrolides (motilin-like effect of 14-membered macrolides), direct toxic effect on the intestinal mucosa of tetracyclines.
The inclusion of probiotics in the treatment regimen can reduce the incidence of side effects and improve the tolerability of anti-Helicobacter therapy.
The probiotic preparation used in such regimens must meet the following requirements. The strains included in the drug are resistant to antibiotics, but do not have the ability to transfer resistance to pathogenic microflora. Microorganisms of the drug must have a pronounced ability to adhere to the mucous membrane of the gastrointestinal tract (to counteract removal from the intestine during peristaltic activity), the ability to produce active metabolites that “increase the chance” of survival of the therapeutic strain in the intestine; resistance to the bactericidal effects of gastric juice and bile. The drugs of choice are complex probiotic preparations, such as Linex. Linex contains antibiotic-resistant strains of three types of microorganisms (Bifidobacterium infantis, Lactobacillus acidophilius, Enterococcus faecium), which allows colonization of the intestines at different levels.
A study was conducted in our clinic. Children receiving standard anti-Helicobacter therapy were divided into two groups. One group (178 people) received only anti-Helicobacter therapy. Patients of the second group (156 people) were prescribed Linex in an age-specific dosage: from 2 to 12 children, 1-2 capsules 3 times a day, over 12 years, 2 capsules. 3 times a day, course duration - 14 days. In the group of patients not using Linex, the incidence of side effects was 14%. Of these, 61% had diarrhea, 9% had constipation and 31% had flatulence. In the group where Linex was added to standard anti-Helicobacter therapy, side effects were detected in only 6% of patients. At the same time, constipation was not detected in any patient, diarrhea syndrome was less pronounced and did not require discontinuation of antibacterial drugs.
When assessing the effectiveness of eradication in the first group, during a control examination, Helicobacter was detected in 17% of patients. The eradication efficiency in the second group was 93%. It is possible that the increase in eradication efficiency was due to the ability of lactobacilli to suppress the adhesion and proliferation of Helicobacter in the stomach. Thus, it is recommended to include the probiotic drug Linex in the anti-Helicobacter therapy regimen.
Considering the high frequency of side effects and the possibility of HP carriage, the question arises: who should carry out HP eradication. The Maastricht Consensus-2, the European Group for the Study of H. pylori, identified the following categories for mandatory eradication:
. Peptic ulcer of the stomach and duodenum, both in the acute and non-acute stages, as well as in the event of complications of the disease
. MALToma of the stomach
. Atrophic gastritis
. Early gastric cancer after resection
. Patients classified as risk group I for stomach cancer
. If desired by the patient (after consultation with your doctor)
The group of patients in whom therapy is desirable includes:
. Functional dyspepsia (eradication of H. pylori, as a possible choice, leads to long-term disappearance of symptoms in some patients)
. GERD
. Taking non-steroidal anti-inflammatory drugs (NSAIDs)
. Close relatives with diseases included in the first group.
Thus, the study of H. pylori continues, and new eradication patterns are being identified. It should be noted that none of the above treatment regimens leads to 100% eradication, which can be explained by various factors, however, the effectiveness of the recommended treatment regimens is currently at least 80%.

Literature
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The occurrence of gastritis and peptic ulcers is associated with many factors: poor diet, stress, smoking and alcohol abuse, long-term use of medications (non-steroidal, anti-inflammatory, anti-tuberculosis, antibacterial or hormonal therapy). However, the leading role in the etiology of these diseases is occupied by the infectious nature of inflammation associated with Helicobacter pylori, a gram-negative spiral-shaped bacterium.

Eradication of the pathogen without antimicrobial therapy is impossible.

However, eliminating concomitant factors that contribute to the development of ulcerative defects of the mucous membrane (alcoholic drinks, smoking, spicy, fried foods, stress, etc.) helps reduce the risk of relapses and accelerates the process of scarring of the ulcer.

The diet during an exacerbation should be as gentle as possible. It is preferable to consume all dishes in pureed, slimy form. Marinades, smoked meats, spicy and salty foods are completely excluded. Carbonated drinks, coffee, strong tea and alcohol are also prohibited.

During therapy with De-Nol, a dairy-free diet is indicated.

What is the difference between an ulcer and gastritis?

The term gastritis refers to an inflammatory process that affects the gastric mucosa and leads to atrophic changes in its structure, decreased regenerative capacity, impaired secretion and motility functions, as well as the evacuation of food. Just like peptic ulcers, gastritis has a chronic course, with periodic relapses (periods of exacerbation of the disease). Unlike gastric and duodenal ulcers, it is not accompanied by the formation of a defect in the wall of the organ.

Antibiotics for gastritis and stomach ulcers are prescribed precisely when infection with this pathogen is confirmed. You can become infected with Helicobacter directly from another person (kissing, sharing utensils) or by drinking low-quality water.

What antibiotics are used to treat Helicobacter pylori?

To eradicate the pathogen, use:

• amoxicillin (Flemoxin Solutab ®);
• metronidazole (Trichopol ®);
• tinidazole;
• (Klacin ®, Fromilid ®);
• levofloxacin (, Hyleflox ®);
• ciprofloxacin (, Tsiprobay ®, Tsifran ®);
• tetracycline ® .

For first-line therapy use:

• proton pump inhibitors (Omeprazole ® , the use of Lansoprazole ® or Esomeprazole ® is indicated if it is impossible to use the first drug);
• amoxicillin preparations and 5-nitroimidazole derivatives (metronidazole ® or tinidazole ®).

A combination of inhibitors, amoxicillin ® and clarithromycin ® is also possible.

Treatment regimen (three-component) with first-line drugs

The most effective combination is Omeprazole ® twenty milligrams twice a day, clarithromycin 0.5 grams every twelve hours and metronidazole ® 400-500 mg, or amoxicillin ® 1 gram twice a day.

First-line therapy was previously prescribed for seven days, but recent studies suggest that a two-week course of treatment is more effective. This is due to a decrease in the sensitivity of Helicobacter to the drugs used. Antibiotics for gastritis and ulcers in a 4-component treatment regimen are also used from 10 to 14 days.

Quadruple therapy is prescribed if there is no effect from first-line treatment!

To potentiate the anti-Helicobacter action of antimicrobial agents, cytoprotectors (bismuth salts) are added. Fluoroquinolone or tetracycline antibiotics for stomach ulcers are used if the pathogen is resistant to metronidazole ® , clarithromycin ® or amoxicillin ® .

The combination of metronidazole ® , De-Nol ® , Omeprazole ® and tetracycline (0.5 grams every six hours) is effective in more than 95% of cases.

If eradication has not been achieved, a ten-day regimen is used that combines: a proton pump inhibitor, amoxicillin ® and levofloxacin ® (0.25 grams every 12 hours).

Antibiotics for gastritis and stomach ulcers in a sequential therapy scheme

Therapy is carried out in a course of ten days. At the beginning, proton pump inhibitors and amoxicillin drugs are prescribed for five days, then for another five - inhibitors, clarithromycin and tinidazole ® (500 mg twice a day).

The use of a combination of clarithromycin and Pilorid ® is also effective.

Antibiotics for stomach and duodenal ulcers. Combined drugs with a description of their components

Pilobact ®

The Pilobact ® package contains seven blisters with a daily dose of omeprazole ® , tinidazole ® and clarithromycin ® (two tablets of each).

Not prescribed for pregnant and breastfeeding women, patients with intolerance to components, blood diseases, and severe renal impairment.

Children over sixteen years of age may be prescribed Pilobact-Neo ® .

Omeprazole ®

A proton pump inhibitor that suppresses the secretion of hydrochloric acid by blocking the last stage of its formation.

The effect of use occurs quickly (within an hour) and lasts for 24 hours after a single use.

Not prescribed for children (can be used from the age of five as prescribed by the attending physician for a short course as part of complex therapy), pregnant and breastfeeding women, and those with impaired kidney and liver function.

Tinidazole ®

A 5-nitroimidazole derivative that inhibits bacterial DNA synthesis.

It has high bioavailability and rapid absorption. Maximum therapeutic concentrations are achieved within two hours after administration. It is excreted from the body with bile and urine.

Able to penetrate the placental barrier. Strictly prohibited in the first trimester of pregnancy. In the second and third cases, it can be used only for health reasons in the absence of an alternative, due to the risk to the fetus. Also, Tinidazole passes into breast milk and is excreted within three days after administration.

Not prescribed for pathologies of the central nervous system, blood diseases and individual intolerance.

Clarithromycin ®

A semi-synthetic antimicrobial agent from the macrolide group, which is a derivative of erythromycin with improved oral bioavailability. The drug has good acid resistance and an extended spectrum of antimicrobial activity.

Cmax after administration is achieved within two hours. The antimicrobial effect is determined by the ability of clarithromycin ® to inhibit the synthesis of structural components of the bacterial cell wall.

The digestibility of the drug and the rate of absorption from the gastrointestinal tract do not depend on food intake.

The tablet form is not used until the age of twelve. If antibiotics against Helicobacter pylori are prescribed to young children, it is recommended to use a suspension.

Clarithromycin ® is contraindicated in case of porphyria, in the first trimester of pregnancy, during breastfeeding, in case of renal and liver failure.

Side effects may include dyspeptic disorders, diarrhea, colitis, candidiasis, disruption of the normal intestinal microflora, heart rhythm disturbances, anxiety and insomnia, allergies, hypoglycemia, and a decrease in the number of platelets and leukocytes.

Pilorid ®

An antiulcer drug that is a combination of ranitidine ® (a histamine receptor H2 blocker and bismuth citrate.

The mechanism of action is due to the gastrocytoprotective and bactericidal effect of bismuth, as well as the ability of ranitidine ® to suppress the secretion of gastric juice.

Not prescribed for pregnant women, children, patients with porphyria and patients with renal failure.

Treatment regimen for Helicobacter with antibiotics with de-nol ®

The most common treatment option is a combination of bismuth salts, amoxicillin and metronidazole ® .

De-Nol ®

An effective antiulcer agent with astringent, antimicrobial and gastrocytoprotective effects. The active component of the drug is bismuth subcitrate. De-Nol ® is practically not absorbed into the systemic circulation and is excreted from the body in feces.

The mechanism of action is due to the formation of a protective film on the surface of mucosal defects, increased mucus formation and bicarbonate secretion, and increased mucosal resistance to the action of hydrochloric acid and pepsin. Acceleration of regenerative processes occurs due to the normalization of microcirculation and restoration of the microstructure of the mucosa.

The bactericidal effect is due to inhibition of the enzymatic activity of Helicobacter pylori, which leads to disruption of intracellular reactions, decreased viability of the bacterium and, as a result, its death. De-Nol ® also reduces the mobility and virulence of Helicobacter.

Due to its high solubility, the product is able to inactivate bacteria located inside the mucous membrane, reducing the risk of relapse of the disease.

Contraindications for use are:

• individual intolerance to components;
• bearing a child and breastfeeding;
• severe kidney disease;
• under four years of age.

Also, this medicine is not prescribed together with other bismuth-containing drugs. Simultaneous use with tetracycline reduces the absorption of the antibiotic.

The duration of treatment should not exceed eight weeks.

Side effects may include darkening of the tongue and black stool. Dyspeptic disorders are sometimes observed. Encephalopathy, caused by the deposition of bismuth in the central nervous system, develops when the recommended dosages and duration of therapy are not observed.