anonymous, Female, 25 years old

Hello, according to FGD, the diagnosis was gastritis, gastroduenopathy and cardial insufficiency without reflux. They prescribed Nolpaza. 40 mg 2 times a day with antibiotics. I only took antibiotics for 2 days, then I felt sick from them. And I drank only Nolpaza. Against the course for 2 weeks, I just realized that it was too much high dose. First I did it, then I thought about it. Now I'm scared that I drank so much. Now I take Nolpaza 20 mg in the morning. Continue or cancel? Thanks for the answer

Good afternoon. Judging by the fact that antibiotics were prescribed, you were diagnosed with Helicobacter pylori infection and eradication therapy was prescribed? In this case, it was necessary to either complete the course or see the doctor in person - so that he would decide whether to cancel or continue treatment, perhaps add some drug or replace the antibiotic. can be taken at a dosage of 20 mg 1 time per day, and 20 mg 2 times a day, it all depends on what clinical picture, what are the results of the study and what was the doctor’s task when he prescribed his treatment. If side effects no, you can take it in the dosage and for the period of time that your doctor prescribed to you.

anonymously

Hello again. It was Helicobacter that I was treated for. The first time I took flemoxin and vilprofen, but Helicobacter remained as it was +++ (after long-term use omez and de nol passed for me erosive gastritis, which was in the month of December). I had an FGS done in February - gastroduenopathy and cardiac insufficiency. And in May the same conclusion, after the FGDS. then I took Alpha Normix with Omez d. And so the 3rd eradication regimen was Nolpaza, Flemoxin and Klacid, which made me feel sick. Now my stomach doesn’t bother me, but after taking Nolpaza my tongue turns a little white, so I’m afraid to continue taking Nolpaza. Please tell me, is it necessary to do a repeat FGD? Thank you very much for your answer

Good afternoon. FGDS can be done again now, but judging by previous diagnoses, there will be nothing new there, and a test for Helicobacter can be done at least (!) 4-6 weeks after completion of the course. If there is no clinical relief right now (pain, heartburn, discomfort), you can discuss with your doctor the withdrawal of Nolpaza (you have already stopped antibiotics anyway), and simply monitoring your condition under the control of a diet. Try to stick healthy eating with the limitation of harmful substances (alcohol, smoking), fast food, spicy, pickled, smoked, fatty, sour vegetables, fruits, berries, drinks, foods that irritate the gastric mucosa, carbonated drinks.

Consultation with a gastroenterologist on the topic “Am I taking my medications correctly” is given for informational purposes only. Based on the results of the consultation received, please consult a doctor, including to identify possible contraindications.

About the consultant

Omeprazole (romesec) 20 mg x 2 times a day. Omeprazole is taken morning and evening. Daily dose 20 mg is usually taken in the morning.

The interval between twice taking H2 blockers or omeprazole should not be less than 12 hours.

Can be used complex drug Piloride (ranitidine, bismuth subcitrate): 400 mg x 2 times a day for 30 minutes. before meals or 60 minutes after meals for 7-14 days.

Triple therapy:

Typically a combination antibacterial drugs used for 7 days, antisecretory drugs for 2-3 weeks, de-nol for 2 weeks, although the time of taking all drugs can be limited to 7 days.

Triple AHT options:

Gold standard AChT, classical triple therapy:

De-Nol 1t x 3 times a day 30-60 minutes before or 60 minutes after meals and 1t at night – 2 weeks,

Tetracycline 500 mg x 4 times a day with meals or immediately after meals – 7 days,

Metronidazole 250 mg x 4 times a day – 7 days.

It is indicated, as a rule, in cases where the pain syndrome is mild and when the doctor is confident that the patient will take at least 2 g of tetracycline daily.

Or:

in the presence of erosions, with pronounced pain syndrome, at accompanying symptoms GER give preference to:

Omeprazole (romesec) – 20 mg 2 times a day for 1 week, 20 mg in the morning – 1 week

Clarithromycin (Crixan) – 500 mg x 2 times a day – 7 days, or amoxicillin 1000 mg x 2 times a day or 500 mg 4 times a day – 7 days, or tetracycline 500 mg x 2 times a day – 7 days

Metronidazole – 400 mg x 3 times a day – 7 days, or 500 mg x 2 times a day, or 250 mg x 5 times a day.

Or:

Omeprazole (romesec) – 20 mg 2 times a day – 1 week, 20 mg in the morning – 1 week

Clarithromycin (Crixan) 500 mg x 2 times a day – 7 days

Tinidazole 500 mg x 2 times a day – 7 days

The introduction of omeprazole into anti-helicobacter therapy regimens is due to the fact that the life activity of HP occurs in acidic environments, and a significant decrease in secretion associated with the use of inhibitors proton pump, leads to a significant deterioration in the living conditions of this microorganism, etc. also has a kind of anti-Helicobacter effect. But these schemes have the most pronounced clinical effect in a patient with gastritis where, among clinical manifestations gastritis, fasting pain or symptoms of gastroesophageal reflux (severe heartburn, pain in the projection) come to the fore lower third sternum, a feeling of pressure in the projection of the sternum, sometimes coughing, suffocation, worsening in horizontal position). These symptoms can be combined with endoscopic symptoms of esophagitis, including erosions. According to some scientists, in triple therapy regimens using the antisecretory drug omeprazole (romesec) can be replaced with H2 blockers:

H-based ternary circuits 2 -blockers

Ranitidine (Histac) – 150 mg x 2 times a day – 1-2 weeks, 150 mg in the evening – 1 week, or Famotidine – 40 mg in the evening – 1-2 weeks, 20 mg in the evening – 1 week

Clarithromycin (Crixan) – 500 mg x 2 times a day – 7 days, or amoxicillin 1000 mg x 2 times a day for 7 days or tetracycline 500 mg x 4 times a day – 7 days

Metronidazole – 400 mg x 3 times a day – 7 days, or 250 mg x 5 times a day or 500 x 2 times a day immediately after meals.

Or:

Ranitidine (Histac) – 150 x 2 times a day – 1-2 weeks, 150 mg in the evening – 1 week, or Famotidine – 40 mg in the evening – 1-2 weeks, 20 mg in the evening – 1 week

Tinidazole – 500 mg x 2 times a day – 7 days

Ranitidine (Gistac) – 150 mg x 2 times a day – 1-2 weeks, 150 mg in the evening – 1 week, or Famotidine – 40 mg in the evening – 1-2 weeks, in the evening – 1 week

Amoxicillin – 1000 mg x 2 times a day or 500 mg x 4 times a day – 7 days

Clarithromycin – 500 mg x 2 times a day – 7 days

Triple schemes based on pylorid:

Pilorid – 400 mg x 2 times a day – 7 days

Amoxicillin – 1000 mg x 2 times a day or Tetracycline – 500 mg x 4 times a day

Clarithromycin (Crixan) – 250 mg x 2 times a day – 7 days

Metronidazole – 400 mg x 3 times a day – 7 days.

Anti-Helicobacter quadruple therapy:

Omeprazole (romesec) - 20 mg x 2 times a day - 2 weeks, then 20 mg in the morning - 1-2 weeks

De-Nol – 120 mg x 3 times a day 30-60 minutes before meals or 60 minutes after meals and 120 mg at night – 10-14 days

Clarithromycin (Crixan) – 500 mg x 2 times a day – 7 days, or amoxicillin 1000 mg x 2 times a day, or tetracycline 250 mg x 5 times a day – 10 days

Metronidazole – 250 x 5 times a day – 10 days

Or:

Omeprazole, zerocid – 20 mg x 2 times a day – 2 weeks, then 20 mg in the morning – 2 weeks

De-Nol – 120 mg x 3 times a day 30-60 minutes before meals or 60 minutes after meals and 120 mg at night – 2 weeks

Clarithromycin (Crixan) – 500 mg x 2 times a day – 7 days

Amoxicillin – 100 mg x 2 times a day – 7 days

Less commonly, quadruple therapy is offered in combination with an H2 blocker:

Ranitidine (Histac) 150 mg x 2 times a day or famotidine 20 mg x 2 times a day for 10 days, then ranitidine 150 mg in the evening

Famotidine 20 mg in the evening for 7 days

De-Nol 120 mg x 3 times a day 30-60 minutes before meals or 60 minutes after meals and 120 mg at night - 10 days

Amoxicillin 1000 mg x 2 times a day or 500 mg x 4 times a day or

Tetracycline 500 mg x 4 times a day or 250 mg x 5 times a day or

Clarithromycin 500 mg x 2 times a day with food – 10 days

Metronidazole 250 mg x 5 times a day with food - 10 days

Quadruple therapy is considered as a reserve therapy in the treatment of chronic gastritis. It is used when triple therapy is insufficiently effective.

If the applied regimen is ineffective, a repeat course of therapy should be prescribed.

The following rules for re-treatment have been developed.

1. Do not repeat a regimen that did not lead to eradication. 2. In case of resistance, determine the sensitivity of the strain to the entire range of antibiotics used. 3. If HP appears within a year after eradication, the condition should be regarded as a relapse of infection and more effective schemes treatment.

It should be said that patients with gastritis associated with the presence of HP are subject to dispensary observation. It consists in the fact that once a year the patient undergoes an FGDS with a biopsy and histological visualization of the NR and, depending on the results obtained and clinical data, further tactics are determined, followed by endoscopic and histological determination of the results obtained. In case of recurrent erosions, persistent detection of atrophy in the antrum, a tendency for atrophy to spread to other parts of the stomach, in the presence of metaplasia, dysplasia - ACT should be carried out until eradication of HP is achieved.

Thus, schematically various forms chronic gastritis can be presented as follows:

Catad_tema Heartburn and GERD - articles

Evaluation of the effectiveness and safety of omez monotherapy at a dose of 20 mg twice daily in the treatment of gastroesophageal reflux disease

HE. Minushkin, L.V. Maslovsky, A.G. Shuleshova, L.I. Sorokina
(Training and Research Center Medical center Administration of the President of the Russian Federation, Moscow)

Using the example of omeza - a blocker proton pump- an assessment of the effectiveness and safety of monotherapy with this drug at a dose of 20 mg 2 times a day in patients with gastroesophageal reflux disease grade 0-IV for 4 weeks is given.

Keywords: gastroesophageal reflux disease, treatment, proton pump blockers, omez.

Interest in gastroesophageal reflux disease (GERD) is determined primarily by its prevalence and the increasing number of patients with GERD. At the VI United Gastroenterological Week (Birmingham, 1997), the position “The 20th century is the century of peptic ulcer disease, the 21st century is the century of GERD” was put forward.

Prevalence GERD symptoms in the adult population reaches 40-50%. In 10% of patients with reflux esophagitis, Barrett's esophagus is detected. At the same time, the risk of developing adenocarcinoma of the esophagus increases by 30-125 times.

GERD develops when there is excessive and prolonged exposure of the lining of the esophagus to acidic stomach contents. Normal indicators The pH in the esophagus is 6-7.

Gastroesophageal reflux is understood as a decrease in pH in the esophagus to less than 4. The total duration of a decrease in pH to less than 4 during the day, characteristic of GERD, exceeds 1 hour - 5% of the time from 24 hours. The damaging effect of acid is central, despite the fact that it is primary in the pathogenesis of GERD impaired motility of the esophagus was recognized.

Currently, various drugs and methods are used in the treatment of GERD. Most effective group drugs are considered proton pump inhibitors (PPIs), which allow as soon as possible eliminate the clinical manifestations of the disease and achieve endoscopic remission. Subsequently, drugs from other groups (H2 blockers, prokinetics, antacids) can be used for maintenance therapy. This approach is called tapering therapy.

Another approach to the treatment of GERD is the prescription of certain drugs depending on the degree of reflux esophagitis. The most common is the modified Savary-Miller classification (Table 1).

Table 1.

Classification of reflux esophagitis according to Savary-Miller as modified by Carisson et al. (1996)

In an approach that takes into account the severity of reflux esophagitis in grades 0-1, treatment begins with H 2 blockers and (or) prokinetics, antacids; in grades I-II, II-III and IV, half, full and double doses of PPI are used, respectively.

Another step-by-step treatment scheme has been developed depending on the severity of reflux esophagitis. According to this scheme, already at 0-1 degree of reflux esophagitis, it is recommended to begin treatment with a full dose of PPI for 2-4 weeks.

In case of clinical remission, switch to a maintenance dose. If there is no effect, treatment is continued for another 1-2 weeks. With a more pronounced degree of GERD, they focus on the symptoms of the disease. Their persistence serves as a basis for doubling the PPI dose. If there is no effect from conservative treatment In this category of patients, the question of antireflux surgery is raised.

Thus, PPIs occupy a leading role among other groups of drugs used for GERD treatment. A large number of drugs - PPIs - available on the domestic market pharmaceutical market, creates certain difficulties in justifying the choice of the most preferable ones. The pharmacoeconomic aspects of treatment make this problem particularly acute.

Due to this special attention deserves omez (omeprazole), manufactured by Dr. Reddy's Laboratories" is one of the most accessible and popular antisecretory drugs in Russia.

The purpose of our study was to evaluate the effectiveness and safety of omez monotherapy at a dose of 20 mg 2 times a day in patients with GERD grades 0-4 for 4 weeks.

Evaluation options
1. Assessment of the subjective state of patients, based on an analysis of their complaints during follow-up visits and data from an individual diary.
2. Assessment of the condition of the esophageal mucosa based on the results of dynamic endoscopic observation.
3. Assessment of the safety of treatment, based on the registration of all adverse events that occurred during the study.
4. Daily pH-metry with measurement of pH in the body of the stomach while taking the first dose of the drug.

At the first visit, esophagogastroduodenoscopy (EGD) was performed to assess the degree of esophageal damage in accordance with the new Savary-Miller endoscopic scale. The collection of medical history was carried out taking into account possible concomitant pathology other organs and systems and their drug correction and medical history (duration and previous therapy), were given clinical assessment patient's condition.

The main symptoms of the disease - heartburn, epigastric pain (behind the breastbone) and belching - were considered taking into account their frequency, time of occurrence, intensity and duration.

The total score for each symptom was determined as the sum of the frequency, time of onset, intensity, and duration of episodes. Minimum general indicator- 0 points, maximum - 10 points.

Characteristics of patients

A total of 40 patients (25 men, 15 women) aged from 20 to 74 years were studied. All of them belonged to the European race. The body weight of patients varied from 56 to 103 kg, height - from 157 to 193 cm, duration of illness - from 4 months to 20 years.

Concomitant diseases were noted peptic ulcer duodenum in remission, gallbladder polyps, chronic gastritis, cholelithiasis, chronic acalculous cholecystitis, chronic pancreatitis, osteochondrosis various departments spine, hypertonic disease, ischemic disease hearts.

Concomitant pathology at the time of the study did not require drug correction in any case. The endoscopy results are presented in table. 2.

Table 2.

Distribution of patients depending on the degree of reflux esophagitis, n=40

As can be seen from the data in table. 2, the predominant number of patients (85%) with erosive reflux esophagitis of I-III degree.

Clinical manifestations are presented in table. 3.

Table 3.

Intensity and frequency of the main clinical manifestations of reflux esophagitis

The most prominent symptom was heartburn ( GPA- 7.3), which was observed in 35 patients. Pain in epigastric region(behind the sternum) were observed in 32 patients (average score - 6.6) and belching in 31 of 40 patients (average score - 5.3).

After starting the drug, symptoms were recorded in an individual diary. During 1 week of treatment, daytime and nighttime symptoms were noted separately (2 times a day). Subsequently, they were assessed once a week.

During the second visit - after 4 weeks of treatment - a control endoscopy was performed, the patient’s condition, complaints, adverse events, results of analysis of diary data and concomitant therapy.

Research results

The results of endoscopic monitoring after 4 weeks of treatment are presented in table. 4.

Table 4.

The rate of complete healing after 4 weeks of treatment in patients with I-IV degrees reflux-zzophagitis

From the data in table. Figure 4 shows that after 4 weeks the erosions had completely healed in 31 (88.6%) of 35 patients with erosive reflux esophagitis.

When analyzing clinical data, it was found that after 4 weeks of treatment with omez, heartburn was completely relieved in 97.1% of patients, of which in 77.1% within 48 hours from the start of treatment. Pain was completely relieved in 84.3% of cases, of which in the first 2 days - in 68.7%. Belching after 4 weeks of treatment stopped in 51.6% of patients, decreased by 2 points in 29%, and persisted in the rest.

Omez was well tolerated in almost all patients. Only 1 patient developed headache. Discontinuation of the drug and its subsequent administration was again accompanied by headache.

In 10 patients, before treatment, 24-hour pH measurements were performed to study the pH of the body of the stomach under basal conditions for 1.5-2 hours, after which the patients took Omez for the first time. The latent period and duration of action of the drug with an increase in the pH of the body of the stomach above 3 were determined.

The latent period after taking the first dose of omez ranged from 30 minutes to 7 hours and averaged 12 minutes. The duration of its action also varied - from 7 to 17 hours, on average - 11 hours 36 minutes.

Resistance to the first dose of omez, that is, the lack of effect from the first dose, was observed in 1 (10%) patient.

The results of the study showed high efficiency(according to clinical, endoscopic indicators and 24-hour pH-metry data) and a good safety profile of omez monotherapy at a dose of 20 mg 2 times a day.

The frequency of taking omez 2 times a day is explained by the fact that average duration its action lasted approximately 12 hours. The main group consisted of patients with I-III degree reflux esophagitis. By the 4th week of treatment, complete healing was observed in 91.7, 81.8 and 90.9% of cases, respectively.

A small (1) number of patients with stage IV reflux esophagitis does not allow full confidence to say that in this situation, omez monotherapy will be sufficient and effective for everyone, despite the complete epithelization of erosions in this particular patient.

In general, the effectiveness of omez leaves a favorable impression. Its advantages are the rapid achievement of stable clinical effect, good endoscopic dynamics and safety of use.

Bibliography
1. Ivashkin V.T., Trukhmanov A.S. Diseases of the esophagus. - M.: Triada-X, 2000. - 179 p.
2. Kalinin A.V. Acid-dependent diseases upper sections gastrointestinal tract. Drug correction of secretory disorders // Klin. prospects in gastroeterol, hepatol. - 2001. - No. 2. - P. 16-22.
3. Dent J., Brun J., Fendrick A.M. et al. An evidence-based appraisal of reflux disease management - the Genval Worshop Report // Gut. - 1999. - Vol. 44, suppl. 2. - P. S1-S16.
4. Hetzel D. Acid pump inhibitors. The treatment of gastroesophageal reflux // Austr. Fam. Phys. - 998. - Vol. 27, N 6. - P. 487-491.

Which are effective against Helicobacter pylori . It is recommended to use three-component and four-component treatment regimens, which include two antibiotics, gastroprotectors and antisecretory drugs.

Currently international standard Treatment options for helicobacteriosis are the following:

• First line therapy, which is used at the first attempt at treatment. This regimen includes an antisecretory drug in usual dose 2 times a day, antibiotics Clarithromycin 500 mg 2 times a day, and Amoxicillin 1000 mg 2 times a day. Duration of therapy is 7 – 14 days.


• Second line therapy, which is used when first-line therapy has failed. This treatment regimen includes an antisecretory drug at the usual dose 2 times a day, Peptobismol 120 mg 2 times a day, and antibiotics Metronidazole 500 mg 3 times a day + Tetracycline 500 mg 4 times a day. The duration of the course of therapy is 7 – 14 days.

Let's consider three-component circuits, which provide cure for helicobacteriosis in at least 90% of cases:
1. Omeprazole 20 mg 2 times a day, Amoxicillin 500 mg 4 times a day and Clarithromycin 250 mg 4 times a day. Duration of therapy – 1 week;
2. Omeprazole 20 mg 2 times a day, Metronidazole 250 mg 4 times a day, Clarithromycin 250 mg 4 times a day. Duration of therapy – 1 week;
3. Omeprazole 20 mg 2 times a day, Metronidazole 250 mg 4 times a day, Tetracycline 300 mg 4 times a day. Duration of therapy – 1 week;
4. Pilorid 400 mg 2 times a day, Clarithromycin 250 mg 4 times a day, Tinidazole 500 mg 2 times a day. Duration of therapy – 1 week;
5. Piloride 400 mg 2 times a day, Clarithromycin 250 mg 4 times a day, Amoxicillin 500 mg 4 times a day. Duration of therapy – 1 – 2 weeks;
6. Piloride 400 mg 2 times a day, Tetracycline 300 mg 4 times a day, Metronidazole 250 mg 4 times a day. Duration of therapy – 1 – 2 weeks;
7. Omeprazole 20 mg 4 times a day, Clarithromycin 500 mg 2 times a day, Amoxicillin 1000 mg 2 times a day. The duration of taking antibiotics is 1 week, and Omeprazole is 3 – 4 weeks;
8. Omeprazole 20 mg 2 times a day, Clarithromycin 250 mg 4 times a day, Metronidazole 250 mg 4 times a day. The duration of taking antibiotics is 2 weeks, and Omeprazole is 3 - 4 weeks.

In addition, four-component treatment regimens are used, which cure helicobacteriosis in 95–98% of cases. These regimens are highly effective and are therefore used to treat helicobacteriosis that is resistant to other treatment options.

Let's consider four-component circuits treatment of helicobacteriosis:
1. Omeprazole 20 mg once a day in the morning, Clarithromycin 500 mg 2 times a day, De-Nol 240 mg 2 times a day, Tinidazole 500 mg 2 times a day. The duration of the course of taking Omeprazole is 2 weeks, the other drugs are 1 week;
2. Omeprazole 20 mg 2 times a day, De-Nol 120 mg 4 times a day, Metronidazole 250 mg 4 times a day, Tetracycline 500 mg 4 times a day. Duration of therapy – 1 week;
3. Omeprazole 20 mg 2 times a day, De-Nol 120 mg 4 times a day, Amoxicillin 500 mg 4 times a day, Metronidazole 250 mg 4 times a day. Duration of therapy is 10 days.