anonymous , Woman, 25

Hello, I was diagnosed with gastritis, gastroduenopathy and cardia insufficiency without reflux by FGDs. Nolpaza was prescribed. 40 mg 2 times a day with antibiotics. I drank antibiotics for only 2 days, then it became bad from them. And she drank only zeropazu. Against the course of 2 weeks, I just realized that this is too much large dose. First I did it, then I thought. Now I'm scared that I drank so much. Now I drink 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 finish the course or see the doctor in person - so that he would decide whether to cancel or continue the 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 task of the doctor when he prescribed his treatment. If side effects no, you can take it at the dosage and for the time that your doctor has prescribed for you.

anonymously

Hello again. It was from Helicobacter that I was treated. The first time I drank Flemoxin and Wilprofen, but Helicobacter, as it was +++, remained (after long-term use omez and de nol passed me erosive gastritis which was in the month of December). Has made FGS in February - a gastroduenopatiya and insufficiency ksrdia. And in May, the same conclusion, after the FGDs. then I drank alpha normix with omez d. And here is the 3rd eradication scheme was nolpaza, flemoxin and clacid, which made me feel bad. Now the stomach does not bother, but after taking Nolpaza, the tongue turns white a little, so I am afraid to continue drinking Nolpaza. Please tell me, do I need to do a second FGD? Thank you very much for your answer

Good afternoon. FGDS can be done again now, but judging by the previous diagnoses, there will be nothing new there, and a test for Helicobacter pylori can be done at least (!) 4-6 weeks after the completion of the course. If now there is no clinic (pain, heartburn, discomfort), you can discuss with your doctor the cancellation and nolpases (you have already canceled antibiotics anyway), and just monitoring your condition under diet control. Try to stick healthy eating with restriction of hazards (alcohol, smoking), fast food, spicy, pickled, smoked, fatty, sour vegetables, fruits, berries, drinks, foods irritating the gastric mucosa, carbonated drinks.

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

About consultant

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

The interval between two doses of H2-blockers or omeprazole should not be less than 12 hours.

Possible use 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 applied 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 AHT, classic 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 sure that the patient will take at least 2 g of tetracycline daily.

Or:

in the presence of erosion, with pronounced pain syndrome, at accompanying symptoms GER prefer:

Omeprazole (romesek) - 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 for 7 days, or amoxicillin 1000 mg x 2 times a day or 500 mg 4 times a day for 7 days, or tetracycline 500 mg x 2 times a day for 7 days

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

Or:

Omeprazole (romesek) - 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 vital activity of HP proceeds 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, and thus. 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, on an empty stomach pain, or symptoms of gastroesophageal reflux (severe heartburn, pain in the projection lower third sternum, a feeling of pressure in the projection of the sternum, sometimes coughing, suffocation, aggravated in horizontal position). These symptoms may be combined with endoscopic symptoms of esophagitis, including erosions. According to some scientists, in triple therapy regimens using the antisecretory drug omeprazole (romesek) can be replaced by H2-blockers:

Ternary circuits based on H 2 -blockers

Ranitidine (Gistak) - 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) 500mg x 2 times a day for 7 days or amoxicillin 1000mg x 2 times a day for 7 days or tetracycline 500mg x 4 times a day for 7 days

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

Or:

Ranitidine (Gistak) - 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 (Gistak) - 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 - 1000mg x 2 times a day or 500mg x 4 times a day - 7 days

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

Triple schemes based on pyloride:

Pyloride - 400mg 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.

Antihelicobacter quadruple therapy:

Omeprazole (romesek) - 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 (Histak) 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 500mg x 2 times a day with food - 10 days

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

Quadrotherapy is considered as a reserve therapy in the treatment of chronic gastritis. It is used when triple therapy is not effective enough.

If the applied scheme is ineffective, a second course of therapy should be prescribed.

The following rules for re-treatment have been developed.

1. Do not repeat the regimen that did not lead to eradication. 2. In case of resistance, determine the sensitivity of the strain to the entire spectrum of antibiotics used. 3. If HP appears within a year after eradication, the condition should be regarded as a relapse of the infection and more efficient 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 should undergo EGD with biopsy and histological visualization of HP and, depending on the results obtained and clinical data, further tactics are determined, followed by endoscopic and histological determination of the results obtained. With recurrence of erosions, persistent detection of atrophy in the antrum, a tendency to spread atrophy to other parts of the stomach, in the presence of metaplasia, dysplasia, AHT should be carried out until HP eradication is achieved.

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

Catad_tema Heartburn and GERD - Articles

Evaluation of the efficacy and safety of monotherapy with omez at a dose of 20 mg twice a day in the treatment of gastroesophageal reflux disease

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

On the example of using omez - blocker proton pump- an assessment of the efficacy and safety of monotherapy with this drug at a dose of 20 mg 2 times a day in patients with gastroesophageal reflux disease of 0-IV degree 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 an increase in the number of patients with GERD. At the VI Joint Gastroenterological Week (Birmingham, 1997), the statement "XX century - the century of peptic ulcer disease, XXI century - the century of GERD" was put forward.

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

GERD develops when the lining of the esophagus is exposed to excessive and prolonged acidic stomach contents. Normal performance pH in the esophagus is 6-7.

Gastroesophageal reflux is understood as a decrease in pH in the esophagus below 4. The total duration of a decrease in pH below 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.

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 of other groups (H 2 -blockers, prokinetics, antacids) can be used for maintenance therapy. This approach is called step-down therapy.

Another approach to the treatment of GERD is the appointment 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 modified by Carisson et al. (1996)

With an approach that takes into account the severity of reflux esophagitis at grade 0-I, treatment begins with H 2 blockers and (or) prokinetics, antacids; at I-II, II-III and IV degrees, 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 with 0-I degree of reflux esophagitis, it is recommended to start treatment with a full dose of PPI for 2-4 weeks.

With clinical remission, they 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 are guided by the symptoms of the disease. Their retention serves as a basis for doubling the PPI dose. With 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 pharmaceutical market, creates certain difficulties in substantiating the choice of the most preferred of them. This problem is particularly acute due to pharmacoeconomic aspects of treatment.

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

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

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

At the first visit, esophagogastroduodenoscopy (EGDS) was performed with an assessment of 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 the possible concomitant pathology other organs and systems and their drug correction and disease history (duration and previous therapy), gave clinical evaluation the patient's condition.

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

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

Characteristics of patients

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

Of the comorbidities, there were 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 medical correction in any case. The results of endoscopy 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 number of patients (85%) with erosive reflux esophagitis of I-III degree prevailed.

Clinical manifestations are presented in table. 3.

Table 3

Intensity and frequency of the main clinical manifestations of reflux esophagitis

Most severe symptom had heartburn GPA- 7.3), which was observed in 35 patients. Pain in epigastric region(behind the sternum) were observed in 32 patients (mean score - 6.6) and belching in 31 of 40 patients (mean score - 5.3).

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

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

Research results

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

Table 4

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

From the data in Table. 4 shows that after 4 weeks, the erosion 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 stopped in 97.1% of patients, of which 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 remained in the rest.

Omez was well tolerated in almost all patients. Only 1 patient after taking it developed headache. Cancellation of the drug followed by its appointment was again accompanied by a headache.

In 10 patients, before the start of treatment, daily pH-metry was carried out with the study of the pH of the body of the stomach in basal conditions for 1.5-2 hours, after which the patients took omez for the first time. The latent period and duration of the drug action were determined with an increase in the pH of the body of the stomach above 3.

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 was also different - from 7 to 17 hours, on average - 11 hours 36 minutes.

Resistance to taking 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 parameters and daily 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 was 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 grade IV reflux esophagitis does not allow full confidence to say that in this situation, monotherapy with omez will be sufficient and effective for everyone, despite the complete epithelialization of erosions in this particular patient.

In general, the effectiveness of omez leaves a favorable impression. Its advantages lie in 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 related diseases upper divisions gastrointestinal tract. Drug correction of secretory disorders // Klin. perspectives in gastroeterol, hepatol. - 2001. - No. 2. - S. 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, No. 6. - P. 487-491.

which are effective against Helicobacter pylori . At the same time, it is recommended to use three-component and four-component therapy regimens, which include two antibiotics, gastroprotectors and antisecretory drugs.

Currently international standard Helicobacter pylori treatment options are:

• First line therapy, which is used at the first attempt of treatment. This scheme 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. The 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.

Consider three-component schemes, which provide a 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. Pyloride 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. Pyloride 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. Pyloride 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. Duration of antibiotics - 1 week, and Omeprazole - 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. Duration of antibiotics - 2 weeks, and Omeprazole - 3 - 4 weeks.

In addition, four-component therapy regimens are used that cure helicobacter pylori in 95-98% of cases. These schemes are highly effective, therefore, they are used to treat helicobacteriosis resistant to other therapy options.

Consider four-component schemes Helicobacter pylori treatment:
1. Omeprazole 20 mg 1 time per 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 - 2 weeks, other drugs - 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. The duration of therapy is 10 days.