Helicobacter pylori infection and acid-related diseases against the background of metabolic-associated conditions: mechanisms of development and management

Abstract

The author presents data on the role of H. pylori infection in the initiation and progression of the changes in metabolic status of patients with type 2 diabetes mellitus (DM-2), insulin resistance, obesity, cardiovascular diseases. Evidence has been obtained indicating the contribution of H. pylori infection to an increase in the incidence of myocardial infarction and stroke in patients with DM-2. The duration of the use of proton pump inhibitors in the context of the H. pylori presence in metabolic-associated states, as well as their effects on the microbiota of the esophagus and stomach, has been substantiated. Decisions on the PPI therapy duration, not only at acid-dependent diseases, but also during eradication therapy, should be based on the available clinical recommendations and protocols for the treatment of these diseases, with account of patient’s age, individual characteristics, concomitant diseases, the dynamics of the disease course and the presence of complications. The use of PPI results in the changes in the stomach microbiota composition, in the pH increase up to 4.0 and higher, thus promoting the rapid multiplication of Lactobacillus spp. and Streptococcus spp. as well as other anaerobes. However, these investigations’ results of the usefulness or harm of such changes are contradictory and require further research. The expediency of the use of esomeprazole (Ezonexa) in these patients in view of the features of pharmacokinetics, pharmacodynamics, as well as clinical efficacy and safety has been substantiated. The peculiarity of esomeprazole metabolism is its stereoselectivity phenomenon, which provides better control of secretion, as well as a longer-lasting esomeprazole effects in patients who rapidly metabolized PPIs. To improve the results of treatment of patients with metabolic-associated conditions, the administration of Laktiale probiotic is justified.