20 bs bùi chí nam evaluation of the effect of pac, ptmb, pla regimen for hp eradication 2016 1

Evaluation of the effect of PAC, PTMB, PLA regimen for Helicobacter pylori eradication Bui Chi Nam, Nguyen Thi Cam Tu, Pham Thi Thu Huong, Nguyen Thanh Cong, Nguyen Xuan Thuy Departmen

Evaluation of the effect of PAC,

PTMB, PLA regimen for Helicobacter

pylori eradication

Bui Chi Nam, Nguyen Thi Cam Tu, Pham Thi Thu Huong,

Nguyen Thanh Cong, Nguyen Xuan Thuy Department of Internal Medicine Gastroenterology – VINMEC

Hospital Hà Nội

CONTENT

1.Rationale

2.Subjects and research methods 3.Research results

4.Discussion & conclusion.

- Gastric and duodenal ulcers caused by Helicobacter

pylori (HP) is a common disease in the world as well

as in Vietnam

- HP is the cause of gastric and duodenal ulcers and

gastric cancer

- Successful HP eradication would benefit from

medical treatment and prevention of complications from ulcers and gastrointestinal bleeding, malignization

First line regimens of HP

eradication

- 3 or 4 drugs regimen of proton pump inhibitor (PPI)

with two antibiotics (Amoxycillin + clarithromycin (PAC) 7 to 10 days.

- 4 drugs regimen: combined with Tetracycline PPI +

Metronidazole + Bithmus (PTMB) in 14 days.

The results of the initial regimen Hp eradication depends heavily on the rate of drug resistance in different geographical regions Rate of resistance to Metronidazole, clarithromycin and amoxycillin fluctuated from 38.1%, 85.7%; 38.6% and 18.1% respectively

Patients after initial treatment for Hp eradication need

a second treatment.

To assess the therapeutic effect of 3 Hp eradication

regimens of PCA, PTMB (First line) and PPI + levofloxacin and Amoxyciline: PLA (Second line)

to make strategic choices reasonable regimen for anti-Hp treatment.

We conducted a study entitled "Evaluation of the

effect of treatment of Helicobacter pylori eradication by PAC, PTMB, PLA regimen"

Objects and methods of research

- Time: 3 years from April / 2013-4 / 2016.

-  Sample size: 451 eligible patients.

-  Subjects of study: Patients> = 18 years, meet following criteria:

• Inflammatory lesions, gastric duodenal - (Endoscopy and or histopathology).

• HP bacteria (urease test, or UBT and histopathology)

• Post-treatment follow-up in an interval of 6-8 weeks and no antibiotic and PPI use prior 4-week before the re-examination.

Objects and methods of research

Subjects excluded from the study:

-Patients taking antibiotics or PPI less than 4 weeks by the time of endoscopy

-Patients undergoing active gastrointestinal bleeding.

- Cancerous lesions chemical ulcers.

- No adherence to HP eradication regimen, no follow-up appointments.

Research Methods:

Prospective combined analysis of the data using a retrospective.

Materials research:

Endoscopes Olympus CV 180, HP breath test machine, slicing machine cell, according to a standard process and dyeing read by experienced doctors.

Research process as follows:

Patients> = 18 years of age are diagnosed gastro-duodenum ulcers through endoscopy and histopathological diagnosis of HP infection by urease test and histology, patients used regimen for

HP eradication by Maastricht 4

Research Methods:

Group 1: included 145 patients who had never

eradicated HP

Apply PPI therapy + Clarithromycine 1gram + Amoxicilline 2gram (PCA) x 10 days.

The effectiveness of HP eradication by UBT (urea breath test) after 6-8 weeks with the threshold Cut off> 2.5 for positive samples, = <2.5 for the negative form

Research Methods:

Group 2: included 306 patients who had never

eradicated HP.

Apply 4 drug regimen: PPI + Trymo 480mg + Tetracycline 2gram + Flagyl 1 gram (PTMT) x 14 days.

 The rating is effective against HP in test breathing UBT (urea breath test) after 6-8 weeks, if the threshold Cut off> = 2.5, the positive samples, and <2.5, the negative sample.

Research Methods:

Group 3:

Of 80 patients failed by: PPI + 1 gram Clarithromycine + Amoxicilline 2gram x 10 days regimen.

3-drug regimen is applied regimen: PPI + 1 gram Amoxicilline + 2gram Tavanic (PLA) x 10 days.

The effectiveness evaluation as same as to the group

1, 2.

Regimen Success

(n)

Failed (n)

Sum (n)

PPI + Klacid 1gram +

Amox 2gram x 10

days

Percentage 34.5 65.5 100

Table 1 Results of HP eradication (group 1)

Regimen Success

(n)

Failed (n)

Sum (n)

PPI + Tetra 2gram +

Flagyl 1gram + Trymo

480 mg x 14 days

Percentage 88.56 11.44 100

Table 2 Results of HP eradication(group 2).

Regimen Success (n) Failed

(n)

Sum (n)

PPI + Tavanic 1 g +

Amox 2gram x 10 days

Table 3 Results of HP eradication (group 3).

RESULTS

Regimen Tired,

Nausea Dizziness Anorexia (%)

Table 4: Side effects of the combine regimen for Hp eradication.

- PCA x 10-day regimen and therapy PPI + Tetra 2gram +

1 gram + Trymo Flagyl 480 mg x 14 days, the rate of

success of HP destroy 4 drug regimen is 88.56%;

- The percentage of successful HP eradication by PCA regimen is 34.5%

- The rate of failure was 65.5% PCA regimen

- The rate of success of anti-HP therapy PPI + Tavanic 1g + Amox 2gram x 10 day is 60%

CONCLUDE: