Recommendations to conduct diagnosis and treatment of infection helicobacter pylori in adults sufferred with gastric and peptic ulcer disease.

academician FI Komarov, academician VV Serov, academician VT Ivashkin, academician AV Kalinin, corresponding member IA Morozov, professor LI Aruin, professor PY Grigoriev, professor AR Zlatkina, professor SI Rapoport, professor GV Tsodikov, professor ON Minushkin, professor LP Miagkova, professor AA Sheptulin, professor VI Pogromov, MD VA Isakov, MD TL Lapina

Russian Gastroenterology AssociationRussian Group - Helicobacter pylori investigation

The development of the given recommendations were necessitated bythe following circumstances:
1.The Helicobacter pylori infecrion is one of the most spreadwidehuman infections nowadays.
2.The Helicobacter pylori bacterium is
· a cause for developing chronic gastritis associated by helicobacter
· the main factor for gastric and peptic ulcer pathogenesis
· the main factor for developing stomach limphoma of low degreemalignancy (maltoma)
· carcinoma of the stomach.
3.Extermination (eradication) of Helicobacter pylori in stomachmucousa in infected patients will lead to:
· vanishing inflammatory infiltrate in stomach mucousa;
· considerable reducing frequency of gastric and peptic ulcer recurrences;
· histologic remissing maltoma of the stomach;
· probably, considerably reducing risk for developing of carcinomaof the stomach.
4.The Helicobacter pylori eradication in mucous membrane of thestomach in infected patients - the most difficult problem in theclinical gastroenterology associated with handling comlicated organisationaltasks.
5.Nonadequate and/or incorrect treatment of the Helicobacter pyloriinfection brings to appearing amongst population a large numberof bacterium strains resistant to effect of well-known antibiotics.

The Helicobacter pylori infection diagnosis

Видео: Stomach Ulcer Animation - Peptic Ulcer Disease Causes, Symptoms, Treatment - Gastric Anatomy

Primary diagnosis
The Helicobacter pylori infection diagnosis should be conductedby methods revealing directly the bacterium or the products ofits activity in the patient`s organism. The following methodssatisfy above requirements:
1.Bacteriologic: inoculation of biopsy specimen of stomach mucousato the differential-diagnostic test medium.
2.Morphologic: "gold standard" in Helicobacter pyloridiagnosis: bacterium straining in the gistologic specimen of stomachmusousa by Gimsa, toluidine blue, Vartin-Starri, Genta:
· citologic - bacterium straining in smears of biopsy specimenof stomach mucouse by Gimsa, Gram.
3.Respiratory: identification of isotopes 14C or 13C in the airbreathed out by the patient- isotopes are identified as a resultof marked urea segregation in the patient`s stomach under theinfluence of the Helicobacter pylori bacterium urease.
4.Urease: identification of urease activity in biopsy spesimenof stomach mucousa by means of placing it in liqiud or gel mediumconsisting substrat, buffer and indicator.
While keeping to all requirements to conducting methods and duesterilisation of endoscopic equipment, the Helicobacter pyloriinfection primary diagnosis is sufficient to start anti-Helicobactertherapy after discovering the bacterium by one of described abovemethod.

Eradication diagnosis
Eradication means total extermination of the bacterium Helicobacterpylori (both vegetative and coccus forms) in the stomach and duodenum.
1.Eradication diagnosis should be conducted in 4-5 weeks afterquitting anti-Helicobacter therapy course, or after quitting treatmentof concomitant disease by any antibiotics or antisecretory medicines.
2.Eradication diagnosis is carried out by at least two methodsdescribes above. Using method of direct identification of thebacterium in biopsy specimen of the stomach mucousa (bacteriologic,morphologic, urease) it is important to investigate 2 biopsy specimentaken from the body of the stomach and 1 biopsy specimen takenfrom antral section.
3.Citologic method should not be used for eradicating.

Видео: What is Erosive Gastritis with H Pylori infection? - Dr. Nagaraj B. Puttaswamy

Screening and other methods allowing to reduce the cost of theHelicobacter pylori infection diagnosis
For screening they usually use methods based on identificationofspecific anti-Helicobacter antibodies class A and G in plasmaserum or in capillary blood of investigated patients.
1.Immunoenzyme analysis
2.Express-tests based on immunoprecipitation or immunocitochemieusing patients` capillary blood as a test and colour potentiatingreaction products.
Express-tests could be used for making cheaper the process ofprimary diagnosis of the Helicobacter infection, as positive testresult allows toexclude expensive equipmentand using methods ofdirect diagnosis. Express-tests can`t be used for identifyingeradication after treatment.

The Helicobacter pylori infection therapy

Indications to the Helicobacter pylori infection therapy
As Russian and foreign scientific and clinical experience showed,gastric and peptic ulcer diseases associated by Helicobacter pyloriis an indication to anti-Helicobacter therapy both in the periodof acute condition and in the period of remission.
Therapy principles
The basic pronciple of therapy is using combined (3-component)therapy:
· enable to eradicate the Helicobacter pylori bacterium min in80% cases during the investigations conducted under control;
· which has no noticable side effects thtat cause to stop usingthe medicines in more than 5% of cases;
· effective if the course duration is 7-14 weeks.

Schemes of treatment
· One-week 3-component therapy using H+-K+-AT Phase blockers standarddose2 times daily (foe example, omeprasol 20 mg 2 times daily,or pantaprasol 40 mg 2 times daily, or lansoprasol 30 mg 2 timesdaily) along with:
· metronodasol 400 mg 3 times daily (or tinidasol 500 mg 2 timesdaily) + claritromicin 250 mg 2 times daily
OR
· amoxicillin 1000 mg 2 times daily + claritromicin 500 mg 2 timesdaily
OR
· amoxicillin 500 mg 3 times daily + metronidasol 400 mg 3 timesdaily
· One-week 3-component therapy with bismuth:
bismush (colloid substrate bismuth, or gallat bismuth or subsalicilatebismuth) 120 mg 4 times daily along with
tetraciclin 500 mg 4 times daily + metronodasol 250 mg 4 timesdaily or tinidasol 500 mg 2 times daily
· One-week "quadro"-therapy which makes enable to eradicateHelicobacter pylori strains resistant to the action of well-knownantibiotics.
H+-K+-AT Phase blockers standard dose 2 times daily (for example,omeprasol 20 mg 2 times daily, or pantoprasol 40 mg 2 times daily,or lansoprasol 30 mg 2 times daily) along with
bismuth (colloid substrate bismuth, or gallat bismuth or subsalicilatebismuth) 120 mg 4 times daily along with