Effectiveness of the modified scheme for treatment of Н.pylori-associated peptic ulcer of the duodenum in children

Abstract

Background. None of the known regimens for the treatment of H.pylori-associated peptic ulcer of the duodenum (PUD) is 100 % effective. The purpose was to evaluate the effectiveness of the modified comprehensive therapy for Н.pylori-associated peptic ulcer of the duodenum in children. Materials and methods. The study included 66 patients aged 7 to 18 years with Н.pylori-associated PUD in the acute stage. Serum vitamin D levels were measured using the electrochemiluminescence method (Roche Diagnostics GmbH, Mannheim, Germany). The classical method of stool culture was used. The children were divided into three groups: the first — 20 patients who received protocol eradication therapy, the second — 23 children who received modified comprehensive therapy with the inclusion of vitamin D3, the third — 23 patients who received modified comprehensive therapy with the inclusion of vitamin D3 and a synbiotic. Results. The average length of stay in the hospital for patients who received modified therapy with the inclusion of vitamin D3 was reduced by 18.8 %, and in those who received synbiotic additionally — by 23.8 % compared to the first group. During the endoscopic examination conducted after 1 month, the presence of an elongated red scar at the site of the ulcer defect was observed significantly more often in group I (65.5 %) than in groups II (47.8 %) and III (39.1 %), χ2 = 3.87, p < 0.05; after 1 year, 33.3 % of children in group I, 17.3 % in group II, and 8.7 % in group III (p < 0.01) had a recurrence of the disease. The determination of the main indicators for the effectiveness of PUD treatment using a modified scheme showed that the relative risk of disease recurrence will decrease by 0.42 times (χ2 = 3.96, p < 0.05) when vitamin D3 preparation is included in the treatment scheme and by 0.52 times (χ2 = 4.06, p < 0.01) when using vitamin D3 and a synbiotic. Conclusions. 1. Children with Н.pylori-associated peptic ulcer of the duodenum have vitamin D3 deficiency and various disturbances of the intestinal microbiota, which can complicate the course, increase the chronicity of the process, and reduce the effectiveness of anti-Helicobacter therapy. 2. The use of a modified comprehensive treatment for duodenal ulcer associated with H.pylori leads to a reduction in the duration of the main clinical manifestations of the disease, the duration of inpatient treatment of sick children and a decrease in the frequency of recurrence of the disease.