Alto índice de erradicación de Helicobacter pylori en pacientes con úlcera duodenal tras fracaso de un tratamiento previo
High eradication rates in Helicobacter pylori infection in patients with duodenal ulcer who failed previous eradication therapy
Beatriz Sicilia, Eva Sierra, Amelia Lago, Margarita Villar, Fernando Gomollón
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fgomollong@meditex.es
Correspondencia: Dr. F. Gomollón. Condes de Aragón, 18, 2. O B. 50009 Zaragoza.
Correspondencia: Dr. F. Gomollón. Condes de Aragón, 18, 2. O B. 50009 Zaragoza.
Servicio de Aparato Digestivo. Hospital Universitario Miguel Servet. Zaragoza.
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"apellidos" => "Teresa Díaz González-Blanco" ] 7 => array:2 [ "nombre" => "Marciano" "apellidos" => "Sánchez Bayle" ] 8 => array:2 [ "nombre" => "Máximo" "apellidos" => "Sandín Domínguez" ] 9 => array:2 [ "nombre" => "Vicente" "apellidos" => "Bosch Giménez" ] 10 => array:2 [ "nombre" => "Esther" "apellidos" => "Gorostiza Garai" ] 11 => array:2 [ "nombre" => "Darwin R." 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Hospital Universitario Miguel Servet. Zaragoza." ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. F. Gomollón. Condes de Aragón, 18, 2. O B. 50009 Zaragoza." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "High eradication rates in <span class="elsevierStyleItalic">Helicobacter pylori</span> infection in patients with duodenal ulcer who failed previous eradication therapy" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-05-10" "fechaAceptado" => "2000-09-05" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec223111" "palabras" => array:4 [ 0 => "Helicobacter pylori" 1 => "Erradicación" 2 => "Úlcera duodenal" 3 => "Fracaso del tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar la efectividad de un segundo tratamiento en pacientes diagnosticados de úlcera duodenal en los que ha fracasado un primer intento de erradicación de Helicobacter pylori.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo, observacional, abierto y no aleatorizado pero protocolarizado. Se incluyeron 30 pacientes consecutivos con diagnóstico previo endoscópico de úlcera duodenal y fracaso de un intento de erradicación de Helicobacter pyloridefinido por un test del aliento positivo o confirmación en nueva endoscopia por test de la ureasa e histología de infección activa. Se asignaba el tratamiento de acuerdo con la pauta inicial. Si ésta había incluido claritromicina, se prescribía un tratamiento con omeprazol (20 mg/12 h), bismuto (120 mg/6 h), tetraciclina (500 mg/6 h), y metronidazol (500 mg/8 h) (OBTM); si por el contrario el tra-tamiento previo no había incluido claritromicina, la pauta incorporaba omeprazol (20 mg/12 h), claritromicina (500 mg/12 h) y amoxicilina (1g/12 h) (OCA). En ambos casos el tratamiento duraba 10 días. Se evaluaba la erradicación mediante un test del aliento a los 2 meses de la última dosis. Se exponen los datos con intervalos de confianza (IC) del 95%.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En un caso se suspendió el tratamiento por efectos adversos y 2 pacientes no acudieron al control del test del aliento (los 3 enfermos pertenecían al grupo OBTM). La erradica-ción fue eficaz en 25 de 27 pacientes (92,6%) en el análisis por protocolo y en 25 de 30 (83,3%) en el análisis por intención de tratamiento. Si se analizan por separado los dos grupos de tratamiento, la combinación OCA consiguió la erradicación en 5 de 6 pacientes (83,3%; IC del 95%, 35,9-99,6), mientras que con la opción OBTM se consiguió la erradicación en 20 de 21 pacientes evaluables (95,2%; IC del 95%, 76,2-99,9). En este caso, efectuamos el análisis según intención de tratamiento, y se erradicaron 20 de 24 casos (83,3%; IC del 95%, 62,6-95,3).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mediante la prescripción de una segunda pauta de erradicación de H. pylorique incluye antibióticos no utilizados en la primera ocasión, sin cultivo previo, se obtiene una tasa de erradicación adecuada, lo que hace recomendable en esta situación.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the effectiveness of a second-line treatment of Helicobacter pyloriinfection in patients with duodenal ulcer based on previous antibiotic regimen.</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Open, prospective, uncontrolled study, but guided by protocol including 30 consecutive patients with endoscopic diagnosis of active duodenal ulcer and failure of a first-line H. pylorieradication treatment diagnosed by urea breath test or a new endoscopy with histology and positive urease test. Treatment consisted in 10 days with omeprazole (20 mg/12 h), bismuth subcitrate (120 mg/6 h), tetracycline (500 mg/6 h) and metronidazole (500 mg/8 h) (OBTM) if previous regimen was with clarithromycin; or 10 days with omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and amoxycillin (1g/12 h) (OCA) if previous regimen did not include clarithromycin; using metronidazole (500 mg/8 h) instead of amoxycillin (OCM) in case of allergy. Eradication was defined as a negative13 C-urea breath test 2 months after the end of therapy.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">One patient had to stop treatment due to the side effects and in 2 patients urea breath test was not performed (3 patients due to the OBTM group). Per protocol eradication was achie-ved in 25 out of 27 patients (92.6%) and by intention-to-treat eradication was attained in 25 out of 30 cases (83.3%). When both groups analyzed separaty, the OCA combination was successful in 5 from 6 patients (83.3%; 95% CI 35.9-99.6); while the OBTM combination was successful in 20 from 21 valuable patients (95.2%; 95% CI 76.2-99.9). In this second case we make an intention to treat analysis and eradication was achieved in 20 from 24 (83.3%; 95% CI 62.6-95.3).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The eradicative treatment for H. pylori based in different antibiotics used in subse-quent attempts get high eradication rates in patients with duodenal ulcer. Med Clin (Barc)2000; 115: 641-643</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 0 | 1 | 1 |
| 2024 Septiembre | 0 | 7 | 7 |
| 2024 Julio | 0 | 2 | 2 |
| 2024 Junio | 0 | 2 | 2 |
| 2024 Mayo | 0 | 2 | 2 |
| 2024 Abril | 0 | 5 | 5 |
| 2024 Marzo | 0 | 9 | 9 |
| 2024 Febrero | 0 | 4 | 4 |
| 2024 Enero | 0 | 4 | 4 |
| 2023 Noviembre | 0 | 1 | 1 |
| 2023 Octubre | 0 | 7 | 7 |
| 2023 Julio | 0 | 5 | 5 |
| 2023 Junio | 0 | 2 | 2 |
| 2023 Mayo | 0 | 1 | 1 |
| 2023 Abril | 0 | 7 | 7 |
| 2023 Marzo | 0 | 2 | 2 |
| 2023 Enero | 0 | 1 | 1 |
| 2022 Diciembre | 0 | 6 | 6 |
| 2022 Noviembre | 0 | 8 | 8 |
| 2022 Septiembre | 0 | 16 | 16 |
| 2022 Agosto | 0 | 6 | 6 |
| 2022 Julio | 0 | 3 | 3 |
| 2022 Mayo | 0 | 12 | 12 |
| 2022 Abril | 0 | 9 | 9 |
| 2022 Marzo | 0 | 2 | 2 |
| 2022 Febrero | 0 | 8 | 8 |
| 2022 Enero | 0 | 7 | 7 |
| 2021 Diciembre | 0 | 2 | 2 |
| 2021 Septiembre | 0 | 3 | 3 |
| 2021 Agosto | 0 | 14 | 14 |
| 2021 Junio | 0 | 2 | 2 |
| 2021 Mayo | 0 | 9 | 9 |
| 2021 Abril | 0 | 3 | 3 |
| 2021 Marzo | 0 | 2 | 2 |
| 2021 Febrero | 0 | 3 | 3 |
| 2021 Enero | 0 | 1 | 1 |
| 2020 Diciembre | 0 | 3 | 3 |
| 2020 Noviembre | 0 | 5 | 5 |
| 2020 Octubre | 0 | 10 | 10 |
| 2020 Septiembre | 0 | 1 | 1 |
| 2020 Julio | 0 | 2 | 2 |
| 2020 Mayo | 0 | 1 | 1 |
| 2020 Abril | 0 | 2 | 2 |
| 2020 Marzo | 0 | 3 | 3 |
| 2020 Febrero | 0 | 1 | 1 |
| 2020 Enero | 0 | 8 | 8 |
| 2019 Diciembre | 0 | 3 | 3 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 3 | 3 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 4 | 4 |
| 2019 Junio | 0 | 2 | 2 |
| 2019 Mayo | 0 | 28 | 28 |
| 2017 Octubre | 2 | 2 | 4 |
| 2017 Septiembre | 6 | 7 | 13 |
| 2017 Agosto | 2 | 3 | 5 |
| 2017 Julio | 7 | 2 | 9 |
| 2017 Junio | 11 | 13 | 24 |
| 2017 Mayo | 16 | 3 | 19 |
| 2017 Abril | 10 | 4 | 14 |
| 2017 Marzo | 24 | 28 | 52 |
| 2017 Febrero | 16 | 3 | 19 |
| 2017 Enero | 4 | 1 | 5 |
| 2016 Diciembre | 18 | 3 | 21 |
| 2016 Noviembre | 34 | 3 | 37 |
| 2016 Octubre | 47 | 4 | 51 |
| 2016 Septiembre | 29 | 2 | 31 |
| 2016 Agosto | 12 | 1 | 13 |
| 2016 Julio | 14 | 0 | 14 |
| 2016 Junio | 21 | 2 | 23 |
| 2016 Mayo | 17 | 0 | 17 |
| 2016 Abril | 18 | 3 | 21 |
| 2016 Marzo | 22 | 0 | 22 |
| 2016 Febrero | 21 | 1 | 22 |
| 2016 Enero | 13 | 0 | 13 |
| 2015 Diciembre | 21 | 0 | 21 |
| 2015 Noviembre | 20 | 0 | 20 |
| 2015 Octubre | 30 | 0 | 30 |
| 2015 Septiembre | 23 | 0 | 23 |
| 2015 Agosto | 13 | 0 | 13 |
| 2015 Julio | 12 | 0 | 12 |
| 2015 Junio | 12 | 0 | 12 |
| 2015 Mayo | 6 | 0 | 6 |
| 2015 Abril | 16 | 0 | 16 |
| 2015 Marzo | 15 | 0 | 15 |
| 2015 Febrero | 14 | 0 | 14 |
| 2015 Enero | 13 | 0 | 13 |
| 2014 Diciembre | 21 | 0 | 21 |
| 2014 Noviembre | 6 | 0 | 6 |
| 2014 Octubre | 12 | 0 | 12 |
| 2014 Septiembre | 20 | 0 | 20 |
| 2014 Agosto | 13 | 0 | 13 |
| 2014 Julio | 6 | 0 | 6 |
| 2014 Junio | 12 | 0 | 12 |
| 2014 Mayo | 6 | 0 | 6 |
| 2014 Abril | 4 | 0 | 4 |
| 2014 Marzo | 6 | 0 | 6 |
| 2014 Febrero | 7 | 0 | 7 |
| 2014 Enero | 2 | 0 | 2 |
| 2013 Diciembre | 6 | 0 | 6 |
| 2013 Noviembre | 7 | 0 | 7 |
| 2013 Octubre | 8 | 0 | 8 |
| 2013 Septiembre | 6 | 0 | 6 |
| 2013 Agosto | 2 | 0 | 2 |
| 2000 Noviembre | 2599 | 0 | 2599 |
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