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Hur bör H. pylori–associerad peptisk ulcussjukdom behandlas?

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Att eradikera bakterien är en effektiv metod att ”bota” peptisk ulcussjukdom och uppnå långvarig remission. 2 år efter det att bakterien eradikerats hos patienter med H. pylori-positivt duodenalsår var 93 % fortfarande i remission [8].

Bland dem som förblev infekterade med bakterien var det däremot endast 24 % som inte hade fått ett återfall efter 2 år.

Ett år efter eradikering av H. pylori har liknande höga remissionsfrekvenser observerats hos patienter med ventrikelsår som inte var NSAID-relaterade [9,10]. Olika riktlinjer för behandling har därför rekommenderat att H. pylori ska eradikeras från alla infekterade patienter med peptisk ulcussjukdom [6,11–15].

Diagrams: Eradication of H.pylori results in long-term remission of peptic ulcer disease

 


Referenser:

  1. Befrits R, Sjöstedt S, Tour R, Leijonmarck CE, Hedenborg L, Backman M; Stockholm United Study Group for Helicobacter Pylori. Long-term effects of eradication of Helicobacter pylori on relapse and histology in gastric ulcer patients: a two-year follow-up study. Scand J Gastroenterol 2004;39(11):1066-72.
  2. Peura D, Graham D. Helicobacter pylori: consensus reached: peptic ulcer is on the way to becoming an historic disease. Am J Gastroenterol 1994;89:1137–39.
  3. Rokkas T, Wotherspoon A. Carcinogenesis. Curr Opin Gastroenterol 1999;15 Suppl 1:S23–8.
  4. Asaka M, Dragosics B. Helicobacter pylori and gastric malignancies. Helicobacter 2004;9 Suppl 1:35–41.
  5. Huang J, Sridhar S, Chen Y, Hunt R. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology 1998;114:1169–79.
  6. Malfertheiner P, Mégraud F, O'Morain C, Hungin P, Jones R, Axon A et al. European Helicobacter Pylori Study Group. Current concepts in the management of H. pylori infection – The Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther 2002;16:167–80.
  7. Hunt R, Fallone C, Veldhuyzen van Zanten S, Sherman P, Smaill F, Flook N, et al. Canadian Helicobacter Study Group Consensus Conference: Update on the management of Helicobacter pylori – an evidence-based evaluation of six topics relevant to clinical outcomes in patients evaluated for H. pylori infection. Can J Gastroenterol 2004;18:547–54.
  8. Miehlke S, Bayerdörffer E, Lehn N, Mannes G, Sommer A, Hochter W, et al. Two year follow up of duodenal ulcer patients treated with omeprazole and amoxicillin. Digestion 1995;56:187–93.
  9. Axon AT, O’Morain CA, Bardhan KD, Crowe JP, Beattie AD, Thompson RP et al. Randomised double-blind controlled study of recurrence of gastric ulcer after treatment for eradication of Helicobacter pylori infection. BMJ 1997;314:565–8.
  10. Bell G, Powell U. Helicobacter pylori reinfection after apparent eradication – the Ipswich experience. Scand J Gastroenterol 1996;31 Suppl 215:96–104.
  11. European Helicobacter Pylori Study Group. Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut 1997;41:8–13.
  12. Howden C. For what conditions is there evidence-based justification for the treatment of H. pylori infection? Gastroenterology 1997;113 Suppl:S107–12.
  13. Lam S, Talley N. Helicobacter pylori consensus: Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol 1998;13:1–12.
  14. Hunt R, Thomson A. Canadian Helicobacter pylori consensus conference. Can J Gastroenterol 1998;12:31–41.
  15. Rubin G, Meineche-Schmidt V, Roberts A. The management of Helicobacter pylori infection in primary care: guidelines from the ESPCG. Eur J Gen Pract 1999;5:98–104.

Senast uppdaterad: 2010-01-12

 
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