Eradication of Helicobacter pylori: what determines the effectiveness antihelicobacter pharmacotherapy (according to the results of the analysis of urease breath tests performed in 2006-2019 in Vinnytsia region)

Abstract

Annotation. One of the global challenges of modern gastroenterology, which prevents the provision of acceptable levels of eradication of Helicobacter pylori, is the problem of increasing resistance of Helicobacter pylori to previously effective antibiotic regimens. The aim of the study – evaluate the effectiveness of Helicobacter pylori eradication depending on the chosen antihelicobacter pharmacotherapy regimen and the used proton pump inhibitors. We analyzed the results of 906 urea breath tests, which were conducted to monitor the effectiveness of antihelicobacter therapy for the period from 2006 to 2019. To analyze the results obtained, the examined patients were divided into groups depending on the scheme of Helicobacter pylori eradication of and the proton pump inhibitors used. Doses, multiplicity and duration of Helicobacter pylori eradication regimens met the requirements of the then valid Maastricht Consensus. We used Student's t-test for relative values to assess significant differences between the study groups. During the period 2006-2019, there is a significant level (32.1% of all tests conducted to control antihelicobacter pharmacotherapy) of the Helicobacter pylori eradication schemes use by doctors in Vinnytsia region that do not meet the criteria of the Maastricht Consensus and are characterized by low efficiency (eradication level of Helicobacter pylori 65 %), however, since 2016 there has been a significant (p <0.01) decrease in the following appointments: 2016 – 29.4%, 2017 – 22.7%, 2018 – 14.8%, 2019 – 8.2%, respectively. Among the schemes of antihelicobacter pharmacotherapy (2006-2019), doctors of Vinnytsia region prefer the appointment of PPI + Cl + Am and PPI + Cl + Am + B (61.6% and 20.7% among all tests performed to control the eradication of H.p. respectively) with a tendency to increase the purpose of the PPI + Cl + Am + B scheme since 2016: 2016 – 22.7%, 2017 – 22.7%, 2018 – 34.1%, 2019 – 29.2%. These schemes showed the highest efficiency during the entire observation period: PPI + Cl + Am – 81.6%, PPI + Cl + Am + B - 87%. The choice of omeprazole in the eradication scheme of Helicobacter pylori based on PPI + Cl + Am + B leads to significantly (p <0.01) worse eradication results compared to pantoprazole, lansoprazole, rabeprazole and esomeprazole: 68% vs. 87.1%, 100%, 100% and 88.9% respectively.