Инфекция Helicobacter pylori при длительной терапии кислотозависимых заболеваний ингибиторами протонной помпы

Abstract

Aim of review. To present management approach for acid-related diseases in patients with Helicobacter pylori (H. pylori) infection, under long-term proton pump inhibitor therapy. Summary. There is no relation of gastroesophageal reflux disease (GERD) symptom severity, the pattern of relapses and treatment efficacy to the presence or absence of H. pylori infection; successful H. pylori eradication does not cause relapse of pre-existing GERD and does not induce its development. At the same time it is impossible to neglect the data on potential induction or aggravation of GERD after H. pylori eradication in separate population groups, including those in Asia. The presence of GERD could not prevent infection eradication in the presence of other indications (e.g., peptic ulcer, chronic gastritis). Monotherapy by proton pump inhibitors (PPI) in H. pylori-positive patients with GERD may lead to progression of gastric corpus atrophy that can be regarded as risk factor for stomach cancer development. H. pylori infection eradication promotes reduction of gastritis-like changes severity irrespective of maintaining of acid-suppressive treatment. The choice of specific PPI for treatment of patients with GERD and other acid-related diseases, carrying out H. pylori eradication therapy or substitution of one PPI agent to another are individualized and depend on the indications registered in the drugs administration instructions, features of its pharmacokinetics and pharmacodynamics, possible drug-to-drug interactions. Conclusion. Testing for H. pylori infection and carrying out the subsequent eradication therapy could allow to prevent progression of corpus mucosa atrophy in patients with acid-related disorders, first of all those with GERD, who received long-term PPI treatment. Estimation of duration of PPI treatment at acid-related disorders, and terms of H. pylori eradication therapy should be evaluated according to clinical guidelines and treatment protocols of these diseases taking into account age of the patient, clinical features, course of disease, presence of complications.