Symptoms of stomach ulcers, treatment regimens, drugs. The main scheme for the treatment of gastric and duodenal ulcers: treatment options Scheme for the treatment of peptic ulcer

Catad_tema Peptic ulcer disease - articles

Modern schemes of eradication therapy for Helicobacter pylori infection

To conduct eradication therapy for Helicobacter pylori infection, the doctor must choose the optimal treatment regimen for a particular patient. Often this is not so simple, since it is important to take into account a number of factors: it is necessary to choose a particular therapy regimen, select specific components of this regimen, set the duration of treatment, analyze the clinical situation, reasonably estimate the cost of drugs included in the regimen.

The basic principles of eradication therapy for H. pylori infection are known. We will quote them from the text of the "Recommendations for the diagnosis and treatment of Helicobacter pylori infection in adults with peptic ulcer stomach and duodenum" Russian Gastroenterological Association and the Russian group for the study of H. pylori: The basis of treatment is the use of combined (three-component) therapy:

• capable in controlled studies to destroy the bacterium Helicobacter pylori, at least, in 80% of cases;
• not causing forced withdrawal of therapy by a doctor, due to side effects(acceptable in less than 5% of cases) or the patient stopping the medication according to the regimen recommended by the doctor;
• effective with a course duration of not more than 7-14 days

The Second Maastricht Agreement establishes gastric ulcer and duodenal ulcer, regardless of the phase of the disease (exacerbation or remission), including their complicated forms, in the first place among the indications for anti-Helicobacter therapy. Eradication therapy for peptic ulcer is a necessary therapeutic measure, and the validity of its use in this disease is based on obvious scientific facts. The Second Maastricht Agreement emphasizes that in uncomplicated duodenal ulcers, there is no need to continue antisecretory therapy after a course of eradication therapy. Row clinical research showed that after a successful eradication course, the healing of the ulcer does not really require further prescription of medications. It is also recommended to diagnose H. pylori infection in patients with peptic ulcer receiving maintenance or course therapy with antisecretory agents, with the appointment antibacterial treatment. Carrying out eradication in these patients gives a significant economic effect, which is associated with the cessation of long-term use of antisecretory drugs.

MALT-lymphoma, atrophic gastritis, condition after gastric resection for cancer are also named as indications for eradication therapy. In addition, anti-Helicobacter therapy can be indicated to persons who are the closest relatives of patients with gastric cancer, and carried out at the request of the patient (after detailed consultation with the doctor).

The outcome document of the Maastricht Conference (2000) proposes for the first time that treatment for H. pylori infection be planned with the possibility of failure. Therefore, it is proposed to consider it as a single block, providing not only first-line eradication therapy, but also in the case of H. pylori persistence - the second line at the same time (see Table 1).

It is important to note that the number of possible anti-Helicobacter therapy regimens has been reduced. For triple therapy, only two pairs of antibiotics are offered. For quadruple therapy, only tetracycline and metronidazole are provided as antibacterial agents.

First line therapy: Inhibitor proton pump(or ranitidine bismuth citrate) at a standard dose of 2 times a day metronidazole 500 mg 2 times a day.

Triple therapy is prescribed for at least 7 days.

If treatment is not successful, a second line therapy: Proton pump inhibitor at standard dose 2 times a day + Bismuth subsalicylate/subcitrate 120 mg 4 times a day + metronidazole 500 mg 3 times a day + tetracycline 500 mg 4 times a day. Quadrotherapy is prescribed for at least 7 days.

If bismuth preparations cannot be used, triple treatment regimens based on proton pump inhibitors are offered as a second course of treatment. In the absence of success of the second course of treatment, further tactics are determined in each case.

The final thesis of the Consensus Report is that H. pylori-specific antibiotics, probiotics, and vaccines may be part of the H. pylori therapy arsenal in the future, but these drugs and treatment approaches are currently under development and no practical recommendations exist.

The treatment regimen of a proton pump blocker + amoxicillin + a nitroimidazole derivative (metronidazole) was excluded from the recommendations of the Second Maastricht Agreement. This combination is customary for Russia, where metronidazole, due to its low cost and "traditional" use as a "reparant" for peptic ulcer disease, is a practically unchanged anti-Helicobacter agent. Unfortunately, in the presence of a strain of H. pylori resistant to nitroimidazole derivatives, the effectiveness of this treatment regimen is significantly reduced, which has been proven not only in European studies, but also in Russia. According to the results of a randomized controlled multicenter study, the eradication of infection in the group treated with metronidazole 1000 mg, amoxicillin 2000 mg and omeprazole 40 mg per day for 7 days was achieved in 30% of cases (confidence interval for a probability of 95% was 17% - 43%) ( V. T. Ivashkin, P. Ya. Grigoriev, Yu. V. Vasiliev et al., 2001). Thus, one can only join the opinion of European colleagues, who excluded this scheme from the recommendations.

Unfortunately, eradication therapy for H. pylori infection is not 100% effective. Not all the provisions of the Second Maastricht Agreement can be unequivocally agreed, and without thoughtful analysis they can be transferred to our country.

So Russian doctors often use bismuth-based triple therapy regimens as a first-line treatment. A multicenter study of the Russian group for the study of H. pylori (2000) showed the availability and effectiveness of this approach in our country, including the example of the colloidal bismuth subcitrate + amoxicillin + furazolidone regimen.

Anti-Helicobacter therapy must be improved, and the Second Maastricht Agreement is essential for its optimization.

Table 1. SCHEMES OF ERADICATION THERAPY FOR Helicobacter pylori INFECTION
under the Maastricht Agreement (2000)

Literature

1. Recommendations for the diagnosis of Helicobacter pylori in patients with peptic ulcer and methods of their treatment. // Russian Journal of Gastroenterology, Hepatology and Coloproctology. - 1998. - No. 1. – pp.105-107.
2. Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. //Gut. - 1997. - Vol. 41. – P.8-13.

The human body needs constant care, as it is prone to many diseases and failures.

Often people ignore various symptoms indicating failures in the body, due to which the pathology becomes chronic.

A stomach ulcer is a common disease that affects the gastrointestinal tract and deforms its mucosa.

Diagnosis and symptoms

Diagnosis of stomach ulcers is carried out using different methods. After determining the severity of the disease, the condition of the mucosa and other information, the doctor prescribes a specific treatment regimen.

Ulcers of the stomach and duodenum lead to severe pathology.

The most common symptoms that people experience are:

1. The abdominal pain is quite sharp and severe, which is difficult to endure.
2. Burning in the abdomen, due to increased acidity.
3. Bleeding as a result of damage to small vessels.

In a particular case, a specific treatment regimen for gastric ulcers is selected. For an accurate assessment of the condition, laboratory diagnostic methods are used.

For this, the patient is sent for blood, feces, and urine tests. A histological examination may be required.

After collecting information on the analyzes, the doctor describes in accessible words clinical picture to the patient himself.

If the diagnosis cannot be established due to vague indicators, then other diagnostic methods and tests are used. For example, tests to detect blood in stools or hormones in the blood can be used.

There are more instrumental methods surveys to find out general state mucosa, gastric juice.

For this, intragastric pH-metry is performed.

Ultrasound treatment

After examining the patient, the doctor can choose the necessary therapy. Often, doctors use ultrasound.

This procedure allows you to speed up recovery and full recovery, and also helps to assess the degree of development of the ulcer.

In addition to the ultrasound, the patient is admitted to the hospital for inpatient treatment.

This scheme allows the doctor to receive full control over the process so that the scheme cannot be deviated from.

But ultrasonic exposure does not give the results that we would like. Therefore, with a stomach ulcer, this is an additional method that can enhance the effect of medications.

Priority Medicines

Everyone who has undergone peptic ulcer disease is interested in which drugs should be used first.

In modern medicine, there are 3 treatment regimens for ulcers. All of them give good results, but the selection of drugs should be carried out only by a doctor.

The information provided is for informational purposes only.

Bismuth circuit

This scheme for the treatment of gastric ulcers involves the complex use of tablets. Among the main drugs in this group are:

1. De-Nol.
2. Flemoxin.
3. Clarithromycin.
4. Erythromycin.

Denol treatment gives positive results. It contains bismuth, which has minimal side effects, but it can destroy Helicobacter pylori bacteria.

At the same time, the microorganism itself does not get used to bismuth salts, therefore it gradually dies. It is this bacterium that is considered the main provocateur of peptic ulcer and gastritis.

The course of treatment according to this scheme consists of several days, sometimes weeks. The doctor prescribes the rules for taking pills, and the patient must strictly follow his instructions.

The main course is 7 days, after which the doctor assesses the condition and may extend therapy. On the first day, Denol and Flemoxin are treated, after which the drugs begin to be supplemented and alternated.

Scheme on inhibitors

This scheme for the treatment of stomach ulcers consists of 3 main drugs:

1. Omeprazole.
2. Flemoxin.
3. Clarithromycin.

The doctor also chooses exact dosage, the course of treatment and the time of taking the tablets. Often, with a disease, it is necessary to use drugs in the same sequence as those listed in the list.

Scheme of histamine blockers

it new technique treatment that uses other drugs. Among them are:

1. Famotidine.
2. Ranitidine.
3. Flemoxin.

quadruple therapy

For the treatment of gastric and duodenal ulcers, a complex of 4 drugs is used, which includes only antibiotics.

For therapy, the main tablets Tetracycline and Metronidazole are used. The course does not exceed one week.

Enhanced treatment regimen

Most often, ulcers are determined during their exacerbations, when the condition begins to deteriorate sharply, characteristic symptoms appear.

To improve the condition of patients, doctors use powerful drug treatment followed by prophylaxis to avoid recurrence.

The enhanced therapy regimen includes a course of 7-10 days. During this time, it is necessary to observe bed rest, try not to worry and normalize the emotional and mental background.

For an enhanced scheme, tablets of different groups are used:

1. Antibiotics are most commonly prescribed Amoxicillin, Metronidazole, or Clarithromycin.
2. Apply drugs based on bismuth salts to reduce the negative effect of acid, pepsin. For this, the doctor prescribes De-Nol, Vikalin and other analogues.
3. Proton pump inhibitors are necessary to normalize the secretory capacity of the stomach. Therapy includes Omeprazole, Lansoprazole or analogues.

The more drugs are used, the faster the effect can be obtained. It must be remembered that antibiotics should not be used for more than 10 days, otherwise severe side effects and complications may occur.

A correct assessment of the lesion is required from the doctor so that the enhanced therapy regimen cannot harm the person.

Light pills are more often used, and if a person tolerates them normally, stronger medicines are used.

The combination of Omeprazole with 2 antibacterial agents gives the fastest results.

After intensive therapy, a re-diagnosis is carried out, and if everything is fine, then the patient is transferred to a diet menu in which foods that irritate the gastrointestinal tract will be excluded.

Perhaps the doctor will advise the use of folk remedies.

Physiotherapy

The described methods of treatment can eliminate the ulcer or reduce, possibly, its development in the future.

In addition to the prescribed methods, there is an equally popular scheme that often causes controversy - physiotherapy.

Some experts refer to the procedure as an auxiliary one, but its role in peptic ulcer has not been precisely studied.

We can say for sure that physiotherapy procedures will not be superfluous, but will only help to consolidate the result.

Effectively use the technique during remission and for this apply:

1. Magnetotherapy.
2. Electrosleep.
3. Hydrotherapy.
4. Heat treatment.

Although the role is not fully known, after the course patients give positive reviews, as the desired tone appears and the general state of health improves.

Surgery

Surgery for an ulcer is performed in extreme cases, when the gastrointestinal tract is severely affected, and conservative treatment does not give results or you can not use powerful drugs.

For example, the scheme is used urgently if a person has bleeding or perforation.

During the operation, doctors need to remove part of the stomach and intestines that will be affected.

The procedure itself is complex, can lead to unpleasant consequences that appear in the patient immediately or after a certain period.

Among the absolute indications are:

1. The appearance of a malignant tumor.
2. Stenosis at the last stage.
3. Heavy bleeding.
4. Low efficiency from tablets.
5. Changes in the mucosa and the presence of scars.

Surgical intervention does not give positive results if the ulcer appears due to bacteria, since organisms live not only at the site of the lesion, but also on the entire mucosa.

Persistent relapses and overt symptoms, strong pain often indicate the development of tumors.

It is important to carry out a preventive examination after treatment from time to time.

Food

Regardless of the chosen treatment regimen, it is important to use proper nutrition. The effectiveness of the entire treatment depends on it.

Therefore, even during the examination and collection of tests, doctors indicate what you can and cannot eat.

The basic rules are:

1. When adjusting the diet, any products must be steamed, boiled, in some cases baked and stewed.
2. It is necessary to remove from the diet all junk food that can irritate the stomach. This category includes various spices, spicy and salty dishes, smoked meats.
3. You can not eat hot or cold dishes, all foods should be moderately warm.
4. Food is used in a fractional form - frequent use food, but in small portions.
5. It is best to make porridge-like dishes, mashed soups and more. This will not irritate the mucous membrane, food can leave the stomach faster and is generally more beneficial for the body.
6. Breaks between meals are small for 2-3 hours.

During treatment, it is necessary to observe the drinking regimen and consume up to 2 liters of fluid every day.

Among the permitted products for peptic ulcer are:

1. Mucous soups, pureed soups based on vegetables or light meat broth.
2. You can use cereals, rice, oatmeal, buckwheat are especially useful. They are recommended to be made on water, but milk can be used.
3. Vegetables cannot be eaten raw, they must be boiled, stewed or steamed.
4. Meat and fish of dietary varieties are allowed.
5. Eggs are used for steam omelets or soft-boiling.
6. Any dairy product is allowed.
7. From bread you can only white, but not fresh.
8. As a dessert, use jelly, fruit puree.

It is strictly forbidden to use:

1. Fatty animal products.
2. Mushrooms.
3. Semi-finished products, canned food.
4. Bean cultures.
5. cabbage.
6. Sour fruits and vegetables.
7. Various sauces.
8. Strong tea, coffee, alcohol, soda.
9. Sweets, muffins.

For prevention, it is necessary to monitor the cleanliness of hands, dishes and food. This will prevent bacteria from entering the stomach.

Be sure to follow proper nutrition, do not eat on the go, exclude fast foods and other junk food.

Many problems with the gastrointestinal tract appear due to stress, so you need to avoid them, you may need to learn relaxation techniques.

Maintaining correct and healthy lifestyle life can significantly improve the state of health, eliminate the development of peptic ulcer.

If the symptoms of the pathology have already appeared, then you should not hesitate, but immediately contact the doctors for diagnosis and assistance.

Useful video

Modern drug treatments for gastric and duodenal ulcers have four different schemes in their arsenal.

1-, 2-, 3-, 4-component schemes for the treatment of peptic ulcer

Monotherapy and each of the subsequent therapeutic protocols that provide effective peptic ulcer treatment, 2, 3, 4 component scheme, used today for the eradication of Helicobacter pylori. The task of treatment is to stop the symptoms, and provide conditions for rapid scarring.

1-component scheme for the treatment of peptic ulcer

1-component treatment regimen involves the use of:

• de nola,
• macrolides,
• semi-synthetic penicillin,
• metronidazole.

It is effective only in 30% of episodes of peptic ulcer of the stomach and duodenum, so experts prefer complex drug treatment as monotherapy.

2-component scheme for the treatment of peptic ulcer

The 2-component scheme for the treatment of peptic ulcer of the stomach and duodenum has several variations: for example, a specialist prescribes a combination of:

• de-nol and metronidazole;
• de-nol and amoxicillin.

It only works half the time. Often the failure is due to the resistance of the pathological flora to metronidazole. According to medical studies, between 1991 and 1995 alone, the effectiveness of metronidazole fell by more than half.

3-component scheme for the treatment of peptic ulcer

"Classic" 3 component scheme for the treatment of peptic ulcer stomach and duodenum also has several options:

• de-nol, metronidazole, tetracycline;
• de-nol, metronidazole, amoxicillin.

Those. two main components de-nol and metronidazole are unchanged. And the duet can be supplemented either by synthetic penicillin, or macrolides, or tetracycline, or fluoroquinolones. The efficacy of trivalent ulcer therapy is estimated at 70%.

In addition to antibiotic therapy, its combination with antisecretory drugs - omeprazole and H2-blockers gives good results. The use of omeprazole makes it possible to increase the effectiveness of the three-component scheme to 95%, and to reduce the intake of antibiotics to 2 times a day. The use of ranitidine or its combination with bismuth increases the effectiveness of therapy up to 94%.

4-component scheme for the treatment of peptic ulcer

In order to completely eliminate resistance to antibiotics and metronidazole, it is preferable to use quadrivalent therapy. Only 5% of patients subsequently return to the doctor with relapses.

Modern 4-component scheme for the treatment of peptic ulcer includes:

• omeprazole,
• metronidazole,
• tetracycline,
• de-nol.

For citation: Lapina T.L., Ivashkin V.T. Modern approaches to the treatment of peptic ulcer of the stomach and duodenum // RMJ. 2001. No. 1. S. 10

The historical stages of the treatment of gastric and duodenal ulcers reflect not only the social significance of the disease, but also the development scientific progress, which armed modern doctors with powerful antiulcer drugs (Table 1). It is important to note that today some treatment approaches have lost their significance, others have found a certain “niche” among various methods treatment, the third, in fact, determine the current level of treatment of peptic ulcer.

Control of gastric acid production is the cornerstone of peptic ulcer treatment. The classic formula of the beginning of the 20th century “no acid - no ulcer” has not lost its relevance, the most effective groups of drugs in their mechanism of action are aimed at combating acidity.
Antacids
Antacids have been known since ancient times. This group of drugs that reduce the acidity of gastric contents due to chemical interaction with the acid in the stomach cavity. Currently, preference is given to non-absorbable antacids, which are relatively insoluble salts of weak bases. Non-absorbable antacids usually contain a mixture of aluminum hydroxide and magnesium hydroxide (Almagel, Maalox) or are aluminum phosphate (Phosphalugel). Unlike absorbable antacids (soda), they have far fewer side effects. They interact with hydrochloric acid, forming non-absorbable or poorly absorbed salts, thereby increasing the pH inside the stomach. Above pH 4, pepsin activity decreases and it can be adsorbed by some antacids. Acid production in duodenal ulcer fluctuates between 60 and 600 meq/day, in two-thirds of patients - between 150 and 400 meq/day. The total daily dose of antacids should be in the range of 200-400 meq in neutralizing capacity, in case of gastric ulcer - 60-300 meq.
Deciphering the mechanism of work of parietal cells and the regulation of acid secretion made it possible to create new classes of drugs. Hydrochloric acid secretion is under the stimulatory control of three classes of parietal cell receptors: acetylcholine (M), histamine (H2), and gastrin (G) receptors. The path of pharmacological action on muscarinic receptors turned out to be historically the earliest. Non-selective M-anticholinergics (atropine) and selective M1-antagonists (pirenzepine) have lost their importance in the treatment of peptic ulcer with the progress of other classes of drugs that act at the molecular level, interfering with intimate intracellular processes and providing a more powerful antisecretory effect.
Histamine H2 receptor blockers
Through clinical studies, it has been established that there is a direct relationship between ulcer healing and the ability of drugs to suppress acidity. Ulcer healing is determined not only by the duration of administration of antisecretory agents, but also by their ability to “keep” intragastric pH above 3 for a given time. The meta-analysis made it possible to establish that a duodenal ulcer will heal in 4 weeks in 100% (!) cases if intragastric pH is maintained above 3 for 18-20 hours during the day.
Despite the fact that patients with gastric ulcer have moderate rates of gastric secretion, antisecretory therapy is also mandatory for them. A stomach ulcer is characterized by slower healing than a duodenal ulcer. Therefore, the duration of the appointment of antisecretory drugs should be longer (up to 8 weeks). It is assumed that we can expect gastric ulcer scarring in 100% of cases if the intragastric pH is maintained above 3 for 18 hours a day for about 8 weeks.
It was possible to achieve such control of acid secretion thanks to blockers of H2-receptors of histamine of parietal cells. These drugs significantly affected the course of peptic ulcer: the time of scarring of the ulcer was reduced, the frequency of ulcer healing increased, and the number of complications of the disease decreased.
Ranitidine with exacerbation of peptic ulcer is prescribed at a dose of 300 mg per day (once in the evening or 2 r / day, 150 mg each), with duodenal ulcer usually for 4 weeks, with gastric ulcer for 6-8 weeks. To prevent early recurrence of the disease, it is advisable to continue taking a maintenance dose of ranitidine 150 mg / day.
Famotidine (Kvamatel) - is used in a lower daily dose than ranitidine (40 and 300 mg, respectively). The antisecretory activity of the drug is more than 12 hours with a single dose. Famotidine is prescribed at a dose of 40 mg for the same periods as ranitidine. For the prevention of recurrence of gastric ulcer - 20 mg / day.
Of particular importance are histamine H2 receptor blockers in the treatment of bleeding from the upper gastrointestinal tract. Their effect is due to the inhibition of the production of hydrochloric acid and a mediated decrease in fibrinolysis. With massive bleeding, preparations with parenteral forms of administration (Kvamatel) have an advantage.
The effectiveness of histamine H2 receptor antagonists is primarily due to their inhibitory effect on acid secretion. The antisecretory effect of cimetidine lasts up to 5 hours after taking the drug, ranitidine - up to 10 hours, famotidine, nizatidine and roxatidine - 12 hours.
proton pump inhibitors
A new step in the creation of antisecretory drugs was the inhibitors of H +, K + -ATPase of parietal cells - an enzyme that actually ensures the transfer of hydrogen ions from the parietal cell into the lumen of the stomach. These benzimidazole derivatives form strong covalent bonds with the sulfhydryl groups of the proton pump and permanently disable it. Acid secretion is restored only when new molecules of H +, K + -ATPase are synthesized. The most powerful drug inhibition of gastric secretion today is provided by this group of drugs. This group includes drugs: omeprazole (Gastrozole), pantoprazole, lansoprazole and rabeprazole.
Derivatives of benzimidazole keep the pH values ​​in the range favorable for the healing of gastric or duodenal ulcers for a long period of time in 1 day. After a single dose of a standard dose of a proton pump inhibitor, a pH above 4 is maintained for 7-12 hours. The consequence of such an active decrease in acid production is the amazing clinical efficacy of these drugs. Data from numerous clinical trials regarding omeprazole therapy are shown in Table 2.
Antihelicobacter therapy
In parallel with the development of the latest generation of antisecretory drugs, there was an accumulation of scientific data and clinical experience, which testified to the decisive importance of the Helicobacter pylori world organism in the pathogenesis of peptic ulcer. Treatment that destroys H. pylori is effective not only in healing the ulcer, but also in preventing the recurrence of the disease. Thus, the strategy for treating peptic ulcer disease by eradicating H. pylori infection has an undeniable advantage over all groups of antiulcer drugs: this strategy provides a long-term remission of the disease, and a complete cure is possible.
Anti-Helicobacter Therapy Is Well Established According To Standards evidence-based medicine. A large number of controlled clinical trials gives grounds to confidently use certain eradication schemes. The clinical material is extensive and allows for a meta-analysis. I will cite the results of only one of the meta-analyses conducted under the auspices of the Administration for medicines and Food USA: R.J. Hopkins et al. (1996) concluded that in duodenal ulcer after successful H. pylori eradication, long-term follow-up relapses occur in 6% of cases (compared to 67% in the group of patients with bacterial persistence), and in gastric ulcer - in 4 % of cases versus 59%.
Modern approaches to the diagnosis and treatment of H. pylori infection that meet the requirements of evidence-based medicine are reflected in the final document of the conference, which was held in Maastricht on September 21-22, 2000. The European Helicobacter pylori Study Group organized an authoritative meeting for the second time to adopt modern guidelines on the problem of H.pylori. The first Maastricht Agreement (1996) played a significant role in streamlining the diagnosis and treatment of H. pylori in the countries of the European Union. Over 4 years, significant progress has been made in this area of ​​knowledge, which forced the updating of previous recommendations.
The Second Maastricht Agreement puts in the first place among the indications for anti-Helicobacter therapy gastric ulcer and duodenal ulcer, regardless of the phase of the disease (exacerbation or remission), including their complicated forms. It is especially noted that eradication therapy for peptic ulcer disease is a necessary therapeutic measure, and the validity of its use in this disease is based on obvious scientific facts.
Indeed, the destruction of H. pylori infection radically changes the course of the disease, preventing its recurrence. Anti-helicobacter therapy is accompanied by successful healing of the ulcer. Moreover, the ulcer-healing effect is due not only to the active anti-ulcer components of eradication regimens (for example, proton pump inhibitors or ranitidine bismuth citrate), but also to the actual elimination of H. pylori infection, which is accompanied by the normalization of proliferation and apoptosis processes in the gastroduodenal mucosa. The Second Maastricht Agreement emphasizes that in uncomplicated duodenal ulcers, there is no need to continue antisecretory therapy after a course of eradication therapy. A number of clinical studies have shown that after a successful eradication course, the healing of the ulcer does not require further medication. It is also recommended to diagnose H. pylori infection in patients with peptic ulcer receiving maintenance or course therapy with antisecretory agents, with the appointment of antibacterial treatment. Carrying out eradication in these patients gives a significant economic effect due to the cessation of long-term use of antisecretory drugs.
The outcome document of the 2000 Maastricht Conference proposes for the first time that treatment for H. pylori infection be planned with the possibility of failure. Therefore, it is proposed to consider it as a single block, providing not only first-line eradication therapy, but also in the case of H. pylori preservation - the second line at the same time (Table 3).
It is important to note that the number of possible anti-Helicobacter therapy regimens has been reduced. For triple therapy, only two pairs of antibiotics are offered; for quadruple therapy, only tetracycline and metronidazole are provided as antibacterial agents.
First-line therapy: Proton pump inhibitor (or ranitidine bismuth citrate) at the standard dose 2 times a day + clarithromycin 500 mg 2 times a day + amoxicillin 1000 mg 2 times a day or metronidazole 500 mg 2 times a day. Triple therapy is prescribed for at least 7 days.
The combination of clarithromycin with amoxicillin is preferable to clarithromycin with metronadzol, as it can achieve a better result when prescribing second-line treatment - quadruple therapy.
If treatment is not successful, second-line therapy is prescribed: Proton pump inhibitor at a standard dose 2 times a day + bismuth subsalicylate / subcitrate 120 mg 4 times a day + metronidazole 500 mg 3 times a day + tetracycline 500 mg 4 times a day. Quadrotherapy is prescribed for at least 7 days.
If bismuth preparations cannot be used, triple treatment regimens based on proton pump inhibitors are offered as a second course of treatment. In case of failure during the second course of treatment, further tactics are determined in each case.
The treatment regimen of a proton pump blocker + amoxicillin + a nitroimidazole derivative (metronidazole) was excluded from the recommendations of the Second Maastricht Agreement. This combination is common in Russia, where metronidazole, due to its low cost and “traditional” use as a “reparant” for peptic ulcer disease, is an almost unchanged anti-Helicobacter pylori agent. Unfortunately, in the presence of a strain of H. pylori resistant to nitroimidazole derivatives, the effectiveness of this treatment regimen is significantly reduced, which has been proven not only in European studies, but also in Russia. According to the results of a randomized controlled multicenter study, the purpose of which was to evaluate and compare the effectiveness of two regimens of triple therapy: 1) metronidazole, amoxicillin and 2) omeprazole and azithromycin, amoxicillin and omeprazole in the eradication of H. pylori infection in exacerbation of duodenal ulcer. Eradication of infection in the group treated with metronidazole 1000 mg, amoxicillin 2000 mg and omeprazole 40 mg per day for 7 days was achieved in 30% of cases (confidence interval for the probability of 95% was 17% -43%). One can only join the opinion of European colleagues, who excluded this scheme from the recommendations.
Unfortunately, eradication therapy for H. pylori infection is not 100% effective. Not all the provisions of the Second Maastricht Agreement can be unambiguously agreed and transferred to our country without thoughtful analysis.
Bismuth-based eradication therapy regimens are currently not widely used in Europe. However, the frequency of use of bismuth preparations in H. pylori eradication schemes varies by country and continent. In particular, in the United States, bismuth-containing triple therapy regimens are used to treat about 10% of patients. In China, regimens with bismuth and two antibiotics are the most prescribing regimens. In his editorial in the European Journal of Gastroenterology and Hepatology, Wink de Boer (1999) rightly noted that “bismuth-based triple therapy is perhaps the most widely used in the world, as it is the only anti-Helicobacter pylori therapy that is effective and affordable in developing countries. countries of the world where the majority of the world's population is concentrated. Bismuth is also recommended for widespread use in the treatment of H. pylori infection in children.
In Russia, of the bismuth preparations, colloidal bismuth subcitrate (De-nol) is most widely used; studies are being conducted to determine the effectiveness and safety of eradication schemes with its use. In 2000, the results of a study by the Russian H. pylori Study Group were published. AT this study eradication therapy included colloidal bismuth subcitrate (240 mg 2 times a day) + clarithromycin (250 mg 2 times a day) + amoxicillin (1000 mg 2 times a day). The duration of therapy was 1 week, eradication of H. pylori was achieved in 93% of patients. A list of other possible regimens based on data from various clinical studies is provided in Table 4.
Anti-Helicobacter therapy must be improved, and these recommendations are essential for its optimization.
H. pylori-specific antibiotics, probiotics, and vaccines may be part of the H. pylori therapy arsenal in the future, but these drugs and treatment approaches are currently under development and no practical recommendations exist.
Of great interest are some of the new antibacterial drugs, which have every chance to soon take their rightful place in the generally accepted schemes of eradication therapy. A good example to illustrate the possibilities of optimizing a triple therapy regimen is azithromycin - new drug from the group of macrolides. Macrolide antibiotics, represented in triple eradication schemes mainly by clarithromycin, are perhaps the most effective. Therefore, azithromycin has been tried for a number of years as one of the possible components of therapy, but in early studies a relatively low dose of the drug was used. An increase in the course dose to 3 g led to an increase in the effectiveness of the standard seven-day triple regimen based on a proton pump inhibitor to the required level of more than 80%. At the same time, the undoubted advantage is that as part of a weekly course, the full dose of azithromycin is taken for three days, and once a day. This is convenient for the patient and reduces the percentage of side effects. In addition, in Russia the cost of azithromycin is lower than other modern macrolides.
Ributin, a derivative of rifamycin S, has demonstrated very high activity against H. pylori in vitro. In combination with amoxicillin and pantoprazole, ributin led to an 80% eradication in patients treated at least twice (!) according to the standard triple regimen.
Despite the fact that the reputation of nitroimidazoles is “tarnished” due to the high percentage of H. pylori strains resistant to them, research on this group of drugs continues. In experiments in vitro, a new nitroimidazole - nitazoxanide was highly effective against H. pylori, and the development of secondary resistance was not observed. In vivo studies should show how this drug can compete with metronidazole.
As an alternative to multicomponent schemes, several theoretical approaches have long been proposed, for example, drug blockade of urease, an enzyme without which the existence of a bacterium is impossible, or blockade of the adhesion of a microorganism to a surface. epithelial cells stomach. A drug that inhibits urease has already been created, its activity in laboratory studies has been shown, including in relation to enhancing the effect of antibiotics used in anti-Helicobacter pylori therapy.
Drugs that inhibit H. pylori adhesion - such as rebamipide or ecabet - have been investigated in combination with traditional H. pylori drugs. They statistically significantly increased the percentage of eradication compared to the same regimen without mucoprotective support. The use of dual therapy (proton pump inhibitor + amoxicillin) was abandoned due to low efficiency, and the addition of rebamipide or ecabet significantly increases the percentage of infection eradication. When isolating strains with the phenomenon of multiresistance, resistant to both metronidazole and clarithromycin, the combination of ecabet or rebamipide with dual therapy may be the treatment of choice.
The opportunities that a successful human vaccination against H. pylori infection can open up are difficult to assess because of their magnitude. Advances in the field of vaccine development allow us to hope that vaccination will be available in the coming years. Tested vaccines in experiments on animals protect them from infection with H. pylori and related species of the genus Helicobacter, and in some cases lead to the elimination of the microorganism. Several H. pylori antigens have been found to be required for successful immunization. Thanks to the complete decoding of the genome of the microorganism, the selection of these antigens is greatly simplified. In addition, a number of studies are aimed at improving the adjuvant system, which is essential for improving vaccine tolerability.

Aluminum hydroxide + magnesium hydroxide-
Almagel (trade name)
(Balkanpharma)

Omeprazole-
Gastrozol (trade name)
(ICN Pharmaceuticals)

Colloidal bismuth subcitrate-
De-nol (trade name)
(Yamanouchi Europe)

Famotidine-
Kvamatel (trade name)
(Gedeon Richter)

In traditional medical practice, a treatment regimen is a balanced set of drugs selected to combat a specific ailment. In everyday speech, such an expression often denotes all measures, from medication to folk.

Our site is designed not so much for professionals as for ordinary patients, so we will try to give the most extensive information. Here is a description of the standard measures to combat peptic ulcer.

Principles of therapy for ulcers

Usually, the disease can be detected during the period of exacerbation: until the thunder breaks out, the patient will not go to the doctor. Accordingly, the doctor prescribes first enhanced therapy, and then - preventive treatment to prevent relapse.

Reinforced Program

Preparations are selected in order to destroy pathogenic bacteria (if any and the general condition of the patient is not too severe) and to suppress irritating factors. The following groups of drugs are usually prescribed:

• antibacterial drugs, antibiotics (clarithromycin, amoxicillin, metronidazole, tetracycline, furazolidone);
• bismuth preparations that counteract excessive activity of hydrochloric acid, pepsin (vicalin, bismuth subnitrate);
• proton pump inhibitors that correct the secretion of gastric juice (omeprazole, lansoprazole, etc.).

The stronger the antibacterial agent, the faster the result can be achieved. However, the abuse of antibiotics is fraught with side effects and complications. The task of the doctor is to adequately assess the general condition of the patient, not to harm the latter with too intensive treatment.

Usually, the simplest scheme is prescribed first, and then, with good tolerance of medications, more serious pills are recommended to the patient. The combination of omeprazole with two antibiotics (for example, clarithromycin and amoxicillin) gives a quick result almost always.

At the end of the intensive course, control tests are usually carried out.

Prevention of new exacerbations

Then the patient switches to a moderate diet - avoids those foods that are contraindicated for him. He is often advised to be treated by reliable folk remedies, decoctions of herbs, and also make it a habit to perform special gymnastic exercises.

Helps reduce the effects of irritants mineral water(not any, but selected taking into account the nature of the disease!).

Medicines are offered already sparing. Read more about medications used in the treatment of ulcers in a separate article on our website.

The effectiveness of the treatment of peptic ulcer

Surgery is now much less common than in past decades. If before every second ulcer was operated on, today only two patients per thousand are subjected to this procedure.

Treatment has become more effective due to successful scientific research aimed at studying the bacterium Helicobacter pylori.

In 35% of cases, professionally selected medication allows you to almost completely eliminate the symptoms of a painful illness, in 60% of situations it greatly lengthens the periods of remission.

ulcer treatment drugs for ulcer stomach ulcer

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The principle of treatment of peptic ulcer of the stomach and 12 duodenal ulcer

The human body is a vulnerable structure that requires constant care. Unfortunately, often people do not attach due importance to changes in health. In the majority, gradually developing into a chronic form.

Ulcers in the stomach and duodenum are very common. The development of the disease leads to the inevitable formation of a gastrointestinal defect, which turns into a constant hindrance to normal functioning. internal organs.

People who want to avoid the disease will benefit from knowledge of methods that prevent development. For patients suffering from this disease, one should list the methods, indicate the course of treatment that is beneficial in the prevention of ulcer attacks.

Are there paraclinical methods and treatment regimens for the disease?

Diagnosis of duodenal ulcer is considered a problematic task. Modern doctors are constantly looking for drugs and techniques that can help an ever-growing list of patients.

Unfortunately, the defeat of these two organs entails a severe course of the disease. People complain of a number of symptoms: unbearable pain caused by perforation of internal organs, burning abdominal cavity gastric juice, affected intestines, constant bleeding. It is believed that doctors offer a limited list of methods of assistance in such a situation.

Laboratory research

Some patients are not satisfied with the scope of the treatment. They become sources of gossip that the list of methods is small. Any medically educated person will be able to prove otherwise.

For example, laboratory research is gaining popularity. Manipulations are considered mandatory, the patient undergoes a series of studies. You will need to submit:

• blood test (general);
• stool analysis;
• coprocytogram (results cytological examination feces);
• urine;
• histological diagnosis;
• analysis for HP.

The listed procedures are carried out under the supervision of people who collect the necessary biomaterials and present the results to the patient in an understandable form. In some cases, doctors may independently prescribe additional tests. For example, research on occult blood in feces, the procedure for determining the level of hormones in the blood.

Instrumental Research

Among instrumental research allocate the general study of internal secretion. The stomach and duodenum are subjected to a series of tests. For example, we are talking about intragastric pH-metry. The doctor needs a procedure to observe the pathological nature of the "behavior" of the body.

These organs represent a complex system, any violation in the communication between parts of the body will lead to the formation of malfunctions. Defense mechanisms and aggression factors enter into a "conflict" in which the doctor will need immediate intervention. The doctor should be guided by endoscopic criteria for the stages of duodenal ulcer.

Typical diagnostic criteria

In the study, the physician identifies the phase of exacerbation. The first stage of the gap is the manifestation of an acute duodenal ulcer, in the process of pathology development, there are sharp changes in the functioning of the stomach and duodenum. For example, the round shape is broken, the walls reveal an unequal structure, the surrounding organs resemble edema due to severe inflammation of the tissues. The second stage is considered the beginning of epithelialization. During the application of individual regimens for the treatment of PU, the inflammatory area is smoothed and gradual remission, which is considered an important step in healing.

Remission

After the patient undergoes a biopsy, a diagnosis is carried out similar to that carried out at the beginning of treatment. More preference is given X-ray research, which at the stage of application of these treatment regimens is auxiliary in nature. Such procedures will help the specialist to carry out a complete and effective diagnostics confirming the absence of pathologies.

Peptic ulcer treatment: will ultrasound help?

The methods described above are sufficient to draw up the correct course of treatment for a particular patient. Often doctors insist on ultrasound intervention - a procedure that brings the patient's recovery closer, helping in making the correct diagnosis and the degree of development of the ulcer.

An additional diagnostic method is inpatient treatment of gastric ulcer, which contributes to the full monitoring of the patient. Without the treatment regimens established by the doctor, the peptic ulcer will not recede. The methods described above are rather auxiliary methods of treatment that enhance the effect of drugs taken by a person.

What drugs are prescribed first

Patients are interested in the list of priority drugs for purchase at the pharmacy. Modern medicine offers three main treatment regimens that are effective for the patient.

Any use of the drug is consistent with the attending physician. The following information serves as a guide before visiting a specialized medical institution.

Bismuth circuit

The composition of the first scheme includes a multicomponent intake of drugs:

• denol;
• flemoxin;
• clarithromycin;
• erythromycin.

The course takes several days. The doctor establishes a certain order of admission medicines which the patient must follow for the next seven days. For example, on the first day, the body is treated with denol and flemoxin. The frequency and dosage are clearly prescribed by the attending physician.

Scheme based on inhibitors

For such a scheme, drug treatment of peptic ulcer is determined by drugs:

• ompeprazole;
• flemoxin;
• clarithromycin.

The assignment situation is the same as in the description of the first scheme. The doctor determines the dosage, method of handling medications and the time of administration. Often the treatment regimen for gastric and duodenal ulcers looks like this: ompeprazole + flemoxin + clarithromycin. Sometimes such an alternation undergoes changes, depending on the opinion of the employee of the medical institution.

Histamine blocker regimen

Other drugs are used in the context of the new treatment regimen. For example, a doctor prescribes the use of famotidine, ranitidine, flemoxin.

Often the structure of the treatment regimen looks like this: Fa + (Ra) + Phl. Changes are at the discretion of the attending physician.

quadruple therapy

For many representatives of the older generation, this term is unfamiliar. This therapy is already firmly established among the possible treatment regimens offered to the patient.

For conventional therapy, a four-component treatment regimen consisting of 4 antibiotics is considered characteristic. During quadruple therapy, two antibacterial drugs are used: tetracycline and metronidazole. The fears that are caused by a decrease in the effective treatment drugs will turn out to be groundless. For effective treatment these drugs quite enough.

The treatment regimen for peptic ulcer disease can be limited in duration to seven days, the result depends on how the doctor considers the therapy productive and suitable for a particular patient.

Is physical therapy necessary?

The described techniques will help many get rid of the disease or prevent further development. In addition to these schemes, a popular procedure is known, which is very controversial. It's about physical therapy.

The difficulty lies in the fact that some doctors consider this technique to be secondary. The role of physiotherapy is completely undefined, sometimes doctors do not see the need for procedures. Such therapy will not become superfluous, perhaps it will help to consolidate the result.

Physiotherapy is prescribed as an auxiliary procedure, for example, at the stage of remission. Suitable for prevention:

• magnetotherapy;
• electrosleep;
• hydrotherapy;
• thermotherapy.

Although the role of the technique is not defined, selected patients eventually recognize that in the course of these manipulations, the necessary tone was returned to the body. In any case, the treatment regimens do not negate the physiotherapeutic assistance, such measures will help to enhance the positive effectiveness of the treatment of PU.

What antibiotics should be taken for gastric and duodenal ulcers?

Without a well-designed drug treatment regimen, it will be difficult to cure a person from a stomach or duodenal ulcer.

In modern medical practice, the treatment regimen is formed using antibiotics, which are prescribed to suppress the growth and development of Helicobacter pylori.

After all, it is this microorganism that lives on the walls of the digestive organs that most often causes peptic ulcers.

In addition to choosing antibiotics, the doctor pays attention to the technical rules of treatment and selects drugs that can increase the effectiveness of therapy.

To be more precise, the specialist selects his own set of medicines for each clinical case.

Unfortunately, almost all ulcer patients fall into the hands of physicians only when they begin to feel acute attacks of pain in the stomach or duodenum.

Since the pathology of the gastric mucosa or duodenal mucosa has already become aggravated, the treatment regimen also provides for the use of dynamic principles of assistance.

After successful manipulations, the patient is prescribed preventive therapy, which may include not only pharmacological preparations but also folk remedies.

As a rule, with an exacerbation of a stomach or duodenal ulcer, enhanced treatment, which is usually distributed over ten days.

During this period, the patient must comply with bed rest and strict dietary nutrition.

As for the list of medicinal compositions, the list includes funds, focusing on the causes that provoked the occurrence of peptic ulcer.

They also prescribe means that will eliminate the irritating effect on the body of external and internal factors.

For the treatment of ulcerative formations, drugs of the following type are prescribed:

• antibiotics - allow you to completely suppress the growth and development of infectious microorganisms;
• antiulcer agents containing bismuth;
• antisecretory drugs to normalize the acidic environment.

Intensive antibiotic therapy can result in severe complications for the body weakened by the disease.

Therefore, the primary task of the attending physician is to assess the state of the patient's body and draw up an adequate treatment plan.

Should gastritis be treated with antibiotics?

With gastritis, as with a stomach or duodenal ulcer, a complex treatment scheme is used.

Previously, with gastritis, drugs such as Metronidazole (Metronidazole) and Bismuth subsalicylate (Bismuth subsalicylate) were prescribed.

The effectiveness of these drugs has been time-tested, but more and more often completely new antibiotics have been used in the treatment of gastritis:

• antibiotics made on the basis of the active substance clarithromycin: Klacid, Clarexide and Bionclar;
• antibiotics made on the basis of omeprazole: "Omez", "Omefez" and "Ultop";
• antibiotics containing amoxicillin: Ecobol, Amoxicar and Amoxicillin.

It is possible to treat gastritis with the means listed in the list according to different schemes, it all depends on the degree of complexity of the disease and the body's reaction to the constituent components.

Since bacteria tend to get used to active substance antibiotic, then with gastritis, drugs from different groups can be prescribed.

For example, "Metronidazole" can be combined with the funds from the third paragraph.

With gastritis, as with a stomach or duodenal ulcer, the attending physician develops a medication regimen. Moreover, all therapy takes place directly under his control.

For gastritis, strong antibacterial drugs are prescribed for 7 days, and weak drugs for a longer period.

In addition to antibiotics, given the symptoms of pathology, other drugs are also prescribed for gastritis.

With gastritis with low acidity, the patient is credited with the use of artificial or natural gastric juice during meals.

The tool is necessary, since during this period it is not produced enough by the cells of the stomach, it contains substances that promote the digestion of food.

With gastritis with high acidity, the patient is prescribed acid blockers. As a rule, the following drugs are used: Vikalin, Maalox, Rennie and Atropine.

Since the disease of the gastrointestinal tract is rarely accompanied by pain, nausea and vomiting, then, accordingly, painkillers are prescribed.

In this case, these are analgesics and antispasmodics: Baralgin and Analgin, No-shpa and Papaverine, as well as the antiemetic drug Motilium and psychopharmacological agents: Valerian Extract and Sanason.

Propolis - a natural antibiotic against ulcers and gastritis

Sometimes standard antibiotics for gastric and duodenal ulcers are replaced or supplemented with natural antibacterial agents.

In this case, we are talking about natural propolis, which is also called bee glue.

Unlike drugs of chemical origin, propolis in the treatment of gastritis and peptic ulcers alleviates the symptoms of inflammation without suppressing immune system person, but, on the contrary, strengthening it.

You can treat stomach and duodenal ulcers with propolis using the following advice: it is recommended to start the treatment course with propolis oil, which covers the mucous membrane with a protective film digestive organ and removes the symptoms of inflammation.

Butter recipe: butter (95 g) is combined with 5 g of propolis, put on a steam bath and stirred for 15 minutes, not allowing to boil. The cooled medicine is taken 3 times a day for 1 tsp.

To remove the symptoms of peptic ulcer, you can use propolis tincture, which is made with alcohol.

The tool has antimicrobial properties, allows you to normalize acidity, improves the functioning of the liver and gallbladder, and also relieves painful spasms and promotes healing of ulcers. Tincture is purchased at a pharmacy.

If treatment with tincture of gastric and duodenal ulcers does not cause discomfort, but gives positive result, then in a week you can switch to 20 - 30% propolis tincture.

The course of treatment is accompanied by a diet, which is made by a doctor, and lasts 1-2 months.

This medicine is also taken 3 times a day, 30 minutes before meals. If, using the above two drugs, it was not possible to completely cure gastritis or gastric and duodenal ulcers, then the course of treatment must be repeated.

Since bee glue is not only a strong natural antibiotic, but also the strongest allergen, it cannot be used to treat peptic ulcers without a doctor's recommendation.

In order for propolis treatment to be most effective, it is recommended to accompany it with a properly formed nutrition system and maintaining a healthy and stress-free lifestyle.