Mogu li probiotici poboljšati efikasnost i bezbednosni profil trostruke eradikacione terapije za Helicobacter pylori? Prospektivna randomizirana studija
Sažetak
Uvod/Cilj. Pojedine studije ukazuju na dobrobit primene različitih probiotskih sojeva u kombinaciji sa antibioticima u eradikaciji infekcije prouzrokovane bakterijom Helicobacter pylori (H. pylori). Cilj ove studije bio je da se proceni efekat koadministracije multiplih probiotskih sojeva i trostruke eradikacione terapije za H. pylori. Metode. U ovu prospektivnu studiju bilo je uključeno 167 bolesnika sa dispeptičkim simptomima i hroničnim gastritisom kod kojih je dijagnostikovana H. pylori infekcija i koji su randomizirani u dve grupe. Grupa I, od 77 bolesnika, podvrgnuta je trostrukoj eradikacionoj terapiji u trajanju od 7 dana, sa lansoprazolom 2 × 30 mg pola sata pre obroka, amoksicilinom 2 × 1 000 mg na 12 sati i klaritromicinom 2 × 500 mg na 12 sati. Posle 7. dana nastavljena je terapija lansoprazolom u dozi od 30 mg pola sata pre doručka još 4 nedelje. Grupa II, sastavljena od 90 bolesnika, podvrgnuta je istoj terapiji kao i bolesnici grupe I, uz dodatak kulture probiotika u vidu jedne kapsule, koja je sadržala Lactobacillus Rosell-52, Lactobacillus Rosell-11, Bifidobacterium Rosell-1755 i Saccharomyces boulardii, od početka eradikacione terapije, u trajanju od 4 nedelje. Kontrola eradikacije H. pylori infekcije izvršena je 8 nedelja nakon terapije brzim ureaza testom i patohistološkom procenom endoskopskih biopsija ili testom antigena u stolici na H. pylori. Rezultati. Eradikacija H. pylori infekcije postignuta je kod 93,3% bolesnika koji su dobijali probiotik uz eradikacionu terapiju i kod 81,8% bolesnika koji su bili samo na eradikacionoj terapiji bez probiotika. Razlika u uspehu eradikacije H. pylori bila je statistički značajna, (p < 0,05). Učestalost ispoljavanja neželjenih efekata eradikacione terapije bila je veća u grupi I bolesnika koji nisu bili na probiotiku (28,6%), nego u grupi II koja je dobijala probiotik (17,7%), ali razlika nije bila statistički značajna. Zaključak. Dodatkom multiplih probiotiskih kultura trostrukoj eradikacionoj terapiji H. pylori infekcije postiže se značajno bolji stepen eracikacije sa manje neželjenih efekata primene antibiotika.
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