Helicobacteriosis treatment: Helicobacter pylori eradication schemes (use of antibiotics, chemotherapeutic agents, bismuth preparations), folk remedies, nutritional habits. Complications during and after treatment. Modern treatment of Helicobacter-associated

V.F. Privorotsky, N.E. Luppova

Treatment

Therapeutic tactics in PU is based on several basic principles: reduction of acid-peptic aggression, HP eradication, creation of conditions for the repair of the ulcer. The solution of these problems is achieved with the help of regimen and dietary recommendations, as well as adequate drug therapy.

Non-drug treatment

Most patients with uncomplicated PU can receive treatment on an outpatient basis, provided that the child has an optimal daily regimen and nutrition. Hospitalization in a specialized gastroenterological department is indicated in cases of complicated PU course or for social reasons.

In the outpatient management of such patients, several rules must be observed: the removal of the child from school (before the control endoscopy), the provision of a gentle day regimen with the organization of a half-bed regimen, and the limitation of television and computer time. It also requires the creation of the most comfortable conditions from a psychological point of view and the careful implementation of all medical recommendations (especially for adolescents).

Diet

The basic principles of diet therapy do not differ from those in CHD. Appointed 1-to the table for a period of 3 months with a gradual transition to the general table. The previously recommended frequent fractional meals are now recognized as non-physiological; 4-5 times a meal at regular intervals is optimal.

Medical treatment

1. Treatment of HP-associated PU.

At the 1st stage of treatment, eradication therapy is prescribed.

Currently, the following drugs are recommended in pediatrics for this chain (daily dosages are given):

Colloidal bismuth subcitrate (De-nol) - 4 mg / kg,

Amoxicillin (Flemoxin-solutab) - 25 mg / kg (no more than 1 g / day)

Clarithromycin (Klacid) - 7.5 mg / kg (not more than 500 mg / day),

Roxithromycin - 5-8 mg / kg (no more than 300 mg / day),

Macmirror - 15 mg/kg

Furazolidone - 10 mg / kg,

Omeprazole (losek, chelol) - 0.5-1.0 mg / kg,

Rabeprazole (pariet) - 10-20 mg / day

Famotidine (kvamatel) - 20-40 mg / day

There are several modern regimens for the treatment of HP in children.

One-week triple scheme with de-nol:

1) de-nol:

Flemoxin-solutab (or roxithromycin, or azithromycin, or clarithromycin);

Macmirror (or furazolidone);

2) de-nol:

Amoxicillin (Flemoxin Solutab).

In the above schemes, there is no acid-suppressing drug, and in fact, in this case, the most formidable of the number of acid-dependent diseases, peptic ulcer, is being treated. The addition of such a drug (such as a PPI) will automatically convert triple therapy to quadruple therapy, which is very rarely indicated.

In this regard, other eradication schemes are most often used.

One week triple therapy with proton inhibitors

1) omeprazole (or rabeprazole);

Roxithromycin (or clarithromycin);

Macmirror (or furazolidoes).

2) omeprazole (or rabeprazole);

Roxithromycin (or clarithromycin);

Amoxicillin.

In our opinion, the following triple therapy option is very effective: rabeprazole (pariet), de-nol, flemoxin-solutab or omeprazole, de-nol, flemoxin-solutab.

The use of rabeprazole (pariet) in PPI eradication schemes is preferable, since it has its own anti-Helicobacter activity, which, in combination with antibacterial drugs, increases the effectiveness of eradication. In some cases, quadruple therapy is recommended. According to current recommendations, the indications for its implementation are the isolation of antibiotic-resistant strains of HP, the impossibility of determining the sensitivity of the strain to the antibiotic, as well as unsuccessful previous treatment (Shcherbakov P.L. et al., 2001).

The scheme of a one-week quadruple therapy looks like this:

De-nol;

Amoxicillin (or roxithromycin, or clarithromycin, or azithromycin);

- macmiror (furazolidone);

Omeprazole (rabeprazole or famotidine).

As a comment, it can be said that in most cases the pediatrician does not have the ability to determine either resistance or sensitivity of HP strains to an antibiotic. As a result, in our opinion, the indications for the appointment of quadruple therapy for PU in children is the identification of multiple bulbar and retrobulbar ulcers, as well as previous unsuccessful attempts to achieve eradication.

It is also not entirely justified to limit antiulcer therapy to only one (weekly) course. When using schemes with de-nol, it is advisable to extend the treatment with the latter up to 2 weeks, maximizing the reparative effect of the drug.

In the case of using schemes with INP, it is hardly justified to suddenly cancel it after a week's time, since in this case there remains a high degree of probability of the development of the "rebound" phenomenon. In our opinion, it is more correct to prolong antisecretory therapy for another 1-2 weeks with the gradual withdrawal of the drug and then the appointment of an antacid for a period of 10-14 days.

The issue of the program of the 2nd stage of the treatment of PU is decided after the control FEGDS (3-4 weeks after the initial detection of the ulcer) with the control of HP eradication in the same way that its colonization was confirmed.

Adequate healing of a peptic ulcer and associated erosions does not require a lot of drug activity from the doctor. It is enough to prescribe an antacid drug and a prokinetic (in case of detection of GER and (or) GHD), as well as a 3-4-week course of sedative therapy with herbal medicines (valerian, motherwort, peony, etc.). At the same stage, you can gradually connect drugs that regulate adequate bile flow, the exocrine function of the pancreas, and the activity of the ANS.

In case of delayed scar formation or epithelialization of the ulcer, preservation of a high degree of inflammation in the stomach and duodenum, residual erosive lesions, it is recommended to prescribe cytoprotectors at the 2nd stage of treatment - sucralfate, venter, methyluracil, etc. (see section CHG and CHL), and also drugs that improve microcirculation in the mucous membrane (trental).

In severe cases or with frequent recurrence of the disease, it is advisable to prescribe parenteral Solcoseryl or Actovegin (8-10 injections every other day).

Modern recommendations for the treatment of HP-associated diseases prescribe prebiotics and probiotics (Hilak-forte, Linex, Bifidum-bacterin, etc.) after eradication therapy to eliminate the negative effect of antibacterial drugs on intestinal microbiocenosis. The duration of treatment is set individually.

II. Treatment of HP-negative peptic ulcer

At the 1st stage, an antisecretory drug is prescribed, mainly from the H2-HB group (in severe cases, PPI) for 2-3 weeks with gradual withdrawal, as well as de-nol (for 2 weeks). Next, a control FEGDS is performed, based on the results of which a program for the 2nd stage of treatment is built. Its logic does not differ from that in the HP-positive variant of PU.

At the 3rd stage of treatment, balneo- and phytotherapy are prescribed, the principles of which are similar to those for CHD with high acidity.

Summarizing all of the above, it should be noted the factors affecting the rate of repair of ulcerative defects (Pimanov S.V., 2000). These factors came from "adult" gastroenterology, however, in our opinion, they are quite universal and can be, to a certain extent, applied in pediatric practice.

1. Acidity. Scarring of gastric and duodenal ulcers occurs in almost all cases, if during the day it is possible to maintain intragastric pH> 3.0 for at least 18 hours (rule D.W. Burget et al., 1990).

2. Age. In older people, the rate of reparation is less.

3. Gender. In females, the rate of reparation is less, and the duration of each stage of exacerbation of the ulcer is approximately 3 days longer in them than in men; at the same time, in women during pregnancy, ulcers heal faster.

4. Localization of the ulcer. The more proximal the ulcer is, the slower it heals.

5. Dimensions and depth. Ulcerative defects of large sizes and deep ones are repaired more slowly.

6. Quantity. Multiple ulcers heal more slowly than single ones.

7. Other factors. A long history of ulcers, the presence of chronic somatic pathology, stress, irregular nutrition, taking ulcerogenic drugs, etc. also slow down recovery.

Clinical examination

Taking into account the fact that peptic ulcer in children most often debuts in adolescence, the period of dispensary observation of patients, as a rule, is prolonged until they are transferred to the adult network. Supervision is carried out by the district pediatrician and the district gastroenterologist.

The task of these specialists is the planned appointment of anti-relapse treatment, the importance of which has not decreased over the years. It is usually prescribed 2-3 times a year (for example, in October and March).

In the phase of stable clinical and endoscopic remission, the anti-relapse course can be limited to the appointment of vitamins, herbal medicine, mineral waters. If a child has intermittent complaints from the gastrointestinal tract, 2-3 week courses of antacid, choleretic, sometimes enzymatic, prokinetic therapy are indicated. An increase in pain and dyspeptic syndrome may indicate the onset of a relapse of the disease and requires a control FEGDS.

Children with PU during the first year after the exacerbation of the disease are exempted from participating in sports competitions, they are recommended to do exercise therapy first, then physical education in the preparatory group.

Preventive vaccinations are not carried out during the period of exacerbation, in other periods there are no contraindications to their implementation.

The optimal completion of all stages of peptic ulcer therapy is a spa treatment.

Good day to all.

De-nol was prescribed to me twice, both times for very serious problems with the gastrointestinal tract.

5 years ago, I was diagnosed with a duodenal ulcer (DU). This was preceded by pain for 2 months, which I endured.

It was then that I met De-nol. He was prescribed to me as part of complex therapy (diet No. 1, klacid, trichopol, de-nol, sanpraz, linex).

Treatment of an ulcer implies mandatory therapy against the bacterium Helicobacter pylori, so the treatment consists of at least three antibacterial drugs (in my case, de-nol, trichopolum, klacid).

................................................................................................................................................................

Brief information about Helicobacter:

Helicobacter pylori is the main causative agent and culprit of chronic gastritis of the stomach and ulcers.
The occurrence of gastritis occurs due to the release of toxins by the bacterium, firstly, and secondly, the dissolution of protective mucus, as a result of which food enzymes and hydrochloric acid enter the gastric mucosa, corroding it to ulcers.
With a long-term (more than ten years) presence of a microorganism in the human stomach, severe consequences can develop, and degeneration into cancer is possible.
The infection is eliminated only with complex, eradication treatment with antibiotics.
Eradication involves the complete destruction of Helicobacter pylori bacteria in any form and contributes to a stable remission.

...........................................................................................................................................................

The treatment really quickly improved my condition, the main thing here is not to stop taking all the prescribed drugs.

Unfortunately, if an ulcer is found, it is not enough to treat it once (one course). Therapy against Helicobacter pylori is designed for at least 2 courses during the year, followed by control gastroscopy (only your doctor can tell you more precisely).

But I didn't listen to the doctor and that was my mistake. After the first course of treatment, the ulcer healed and I did not take the second course of antibiotics.

After scarring, the ulcer did not return, but periodically (1-2 times a year) there was an exacerbation of gastroduodenitis.

But since for the last 3 years I could not be treated with antibacterial drugs (due to pregnancy and HB), I was saved only by Omeprazole, Almagel and a sparing diet.

==============================================================================

Two months ago I had an exacerbation and I turned to a gastroenterologist with severe pain in my stomach.

At the time of treatment, the pain had lasted for 5 days. All 5 days I took Omeprazole and Almagel, as I usually do if stomach pains begin. But this time, the pain didn't go away.

My symptoms were the following:

Burning, pinching pains in stomach, heaviness after eating.

Pain in the intestines, which joined from the 3rd day.

There was no nausea.

At the appointment, I had an ultrasound scan of the digestive tract and prescribed treatment.

Oddly enough, on an ultrasound, the doctor saw that I did not have a duodenal ulcer (I thought that it was really visible only with gastroscopy).

And again I was assigned De-nol.

The cost of the drug: 56 tablets - 500 rubles, 112 tablets - 900 rubles.

Manufacturer:

What is De-nol:

A drug that is widely used in the treatment of the digestive system.
It contains bismuth - an enveloping agent, thanks to which it has protective properties - it covers the surface of an ulcer or an inflamed area of ​​the gastric and intestinal mucosa, thereby protecting it from the aggressive effects of gastric juice and accelerating the healing of damaged tissue.
In addition, it also has an antimicrobial effect in relation to Helicobacter pylori - the main culprit of gastritis, gastroduodenitis and peptic ulcer.
Therefore, the use of De-nol in combination with antibiotics significantly increases the possibility of complete recovery.

The advantages of the drug:

1) It has many properties: healing, antibacterial, anti-inflammatory.

2) The possibility of taking for prevention (when there are no symptoms), thereby avoiding exacerbation of diseases.

I confess that I didn’t do that (after all, the drug is expensive), I’m not used to taking medicines when nothing bothers me. But now I understand that prevention should not be neglected.

===============================================================================

Minuses:

1) The most expensive of the drugs based on bismuth.

The course of treatment is quite expensive (according to the instructions, the minimum course is 4 weeks).

Although this is debatable. Not all analogs can work like this drug. And if it is prescribed by a doctor, then you need to follow the appointment. Or ask the doctor to replace the drug with an analogue, if possible. But I would not recommend replacing the drug with a cheaper one on your own.

2) It fights Helicobacter pylori only as part of a complex of products, which includes two more powerful antibacterial agents. I had three drugs against Helicobacter in the complex: Flemoklav Solutab, Macmiror and De-nol.

3) The instructions say that the minimum course is 4 weeks, while doctors prescribe a course of 21 days. There are some inconsistencies.
Moreover, different doctors, both in the case of an ulcer and in case of exacerbation of gastroduodenitis, prescribed De-nol for a course of 21 days.

4) There is a dietary restriction at the time of taking the drug:

For successful treatment, it is necessary to exclude alcohol, tea, coffee, dairy products, carbonated drinks while taking this drug.

==============================================================================

Instructions for use.

Properties:

Compound:

Indications and contraindications:

Methods of application and doses:

Side effects:

Special instructions:

=============================================================================

Features of my treatment with De-nol:

● I took De-nol 2 times a day at regular intervals (that is, after 12 hours). For example at 8 and 20 hours.

● I cannot judge the side effects of De-nol, since I took it in combination with other drugs. In general, side effects were (pain in the intestines, headache).

● Pain in the stomach went away on the second day of treatment. But I can’t put it in the merit of only De-nol, since I was treated in a complex way.

==============================================================================

Don't repeat my mistakes:

● I didn’t cure Helicobacter 5 years ago when I had a duodenal ulcer.

The gastroenterologist told me so: I was treated badly, and this is aggravated from time to time.

● All subsequent years, until recently, with pain in the stomach, she did not turn to a gastroenterologist. I did gastroscopy only twice, but I never went to the doctor with the results.

● Engaged in relative self-medication.

Omeprazole and Almagel are not an integrated approach, and even with Helicobacter these drugs are powerless.

If they helped me, then as it turned out later, temporarily, because the main cause (helicobacter) was not eliminated.

==============================================================================

And now about the advice that the gastroenterologist gave me (by the way, professor, candidate of medical sciences).

Advice is mixed and not for everyone. They, I think, are more for people with gastrointestinal problems, so as not to aggravate the problems:

1) Do not have pets. He argued that animals are carriers of more than 60 types of bacteria that are dangerous to human health.

2) Drink boiled water.

When I said that I drink bottled water, he was negatively inclined towards such water (including baby water from 0 months).

He said that such water from plastic bottles (as he put it) contained onco chemicals.

To be honest, it scared me and I got on the Internet to study the issue. It would be better if I didn't know, I was even more upset.

Water from plastic containers is really very dangerous for health:

Daily consumption of drinks from plastic bottles increases the concentration of a special chemical substance bisphenol-A in the human body.

The action of this chemical is similar to the female sex hormone estrogen. Its high concentration in the blood leads to health problems in children, early puberty, and can even provoke the development of breast cancer in women and prostate cancer in men.

3) There is a lot of meat, a sick stomach loves it very much. But, only beef, turkey or rabbit.

==============================================================================

Let me summarize:

● De-nol is an indispensable drug in the treatment of ulcers and gastritis, but only in combination.

● You should not neglect its reception, even if it seems expensive to you. After all, undertreated Helicobacter will make itself felt again and again.

And judging by the "killer" antibiotics that are prescribed to get rid of this bacterium, this is still that stable infection. And if it is not taken seriously and not treated, the consequences can be disastrous.

Thank you all for your attention, stay healthy.

(equivalent to 120 mg Bi2O3), as well as potassium polyacrylate, povidone K30, corn starch, magnesium (Mg) stearate, macrogol 6000.

Tablet shell composition: hypromellose 5 mPa×s and macrogol 6000 (Opadry OY-S-7366).

Release form

Biconvex, round shaped film-coated tablets with imprint gbr 152 on one side and a square graphic with rounded corners and broken sides on the other. The color of the tablets is white with a creamy tint, the smell is light ammonia (may be absent).

Tablets are packaged in blisters of 8 pieces. One carton box contains 56 or 112 tablets.

pharmachologic effect

Bismuth drug. Renders antibacterial , antiulcer and gastroprotective action.

In accordance with the information provided in Wikipedia, bismuth subcitrate in the "Pharmacological index" is included in the group " Antacids and adsorbents «.

Pharmacodynamics and pharmacokinetics

Bismuthate tripotassium dicitrate is characterized by a multifaceted effect, due to which the drug De-Nol has an impact on all links of the origin and development peptic ulcer .

The astringent effect is due to the ability bismuth subcitrate precipitate proteins by forming chelate complexes with them. As a result, on the surface of the affected peptic ulcer plots mucous membrane of the stomach and duodenum a protective film is formed, which eliminates the possibility of the harmful effects of the acidic environment of the stomach on the affected mucosa. This, in turn, contributes to faster scarring of ulcers.

De-Nol manifests bactericidal properties in a relationship Gram (-) bacteria Helicobacter pylori . This effect is based on the ability of the active substance of the drug to suppress the enzymatic activity in the microbial cell, disrupt the microstructure and permeability of its membranes, as well as the course of vital intracellular processes, reduce the mobility and virulence of microorganisms, as well as their ability to adhere. All of the above leads to the death of microorganisms.

An important feature of the drug and its difference from other drugs used for treatment helicobacter pylori , it is believed that to date not a single strain has been identified that would be resistant to the action of bismuth subcitrate.

The substance dissolves very well, due to which the drug penetrates deep into the mucus layer and inactivates the microorganisms under the mucosa.

Thus, the use of De-Nol tablets can reduce the likelihood of relapse. peptic ulcer .

Gastrocytoprotective effect The drug is based on stimulation of the body's production prostaglandin E2 ; improvement of microcirculation in the mucous membrane of the antrum of the stomach and duodenum 12; a decrease in the amount of hydrochloric acid; inactivation of pepsin due to the fact that this digestive enzyme forms complex compounds with bismuth subcitrate.

Bismuth subcitrate after oral administration is practically not absorbed in the digestive tract. A small amount of the substance can enter the systemic circulation, and its plasma concentration increases with prolonged use. Bismuth subcitrate is eliminated with intestinal contents.

Indications for use De-Nol

Indications for the use of De-Nol are erosive and ulcerative lesions of the gastric and duodenal mucosa .

In particular, the drug is prescribed for gastropathy that are the result of taking NSAIDs or alcohol; at gastroduodenitis and with (including if the diseases occur in or are associated with Helicobacter pylori); with exacerbated (including if the disease is associated with Helicobacter pylori); with IBS ( irritable bowel syndrome ), as well as with functional, which is not associated with organic lesions of the gastrointestinal tract.

In some cases, it is considered appropriate to use De-Nol and when pancreatitis (especially with biliary-dependent). The drug is prescribed in complex therapy to eliminate gastroduodenostasis (hypomotor dyskinesia of the intestine), which is often observed in the chronic form of the disease.

Contraindications

The drug has contraindications. It is forbidden to prescribe De-Nol:

• sick with decompensated renal failure ;
• pregnant women;
• women who are breastfeeding;
• children under 4 years of age;
• with hypersensitivity to bismuth subcitrate or auxiliary components included in the tablets.

Side effects

Side effects of De-Nol on the part of the digestive system are manifested by nausea, vomiting, constipation or frequent stools. These phenomena do not pose a danger to the health of the patient and are transient.

In some patients, side effects of treatment may occur in the form of hypersensitivity reactions (for example, itching or skin rashes).

Long-term use of the drug in high doses can cause development due to the accumulation of bismuth in the central nervous system.

Tablets De-Nol, instructions for use (Method and dosage)

The manufacturer in the instructions for the use of De-Nol indicates that patients older than 12 years of age should take 4 tablets per day.

There are two alternative ways to use De-Nol:

• one tablet four times a day;
• two tablets twice a day.

Tablets are taken half an hour before meals. With what to take De-Nol? It is necessary to drink it with a small amount of water.

How to take De-Nol for children?

In accordance with the instructions for the use of De-Nol, for children older than 4 years of age, the optimal dose of the drug is calculated using the formula 8 mg / day. per 1 kg of body weight. Thus, depending on the weight of the child, the daily dose can be from 1 to 2 tablets. At the same time, it should be as close as possible to the calculated one (8 mg / kg / day). You can take the medicine once, or you can divide it into two doses.

The duration of the course is four to eight weeks. After completion of treatment, the use of bismuth-containing preparations should be avoided for the next eight weeks.

Recipe in Latin for tablets:
Rep.: Tab. "De-Nol" N.112
D.S. 2 tablets 2 r / day

Why drink and how to drink D-Nol in diseases associated with H. pylori?

De-Nol is characterized by the ability to accumulate in the cells of Helicobacter pylori bacteria, which leads to the destruction of their cytoplasmic membranes and the death of microorganisms.

This, as well as the ability of bismuth subcitrate to dissolve well in gastric or duodenal mucus and prevent H. pylori adhesion to the epithelial tissue of the gastrointestinal tract, makes it possible to use De-Nol in various schemes for the destruction of these microorganisms.

Frequent use antibacterial drugs and widespread use of anti-Helicobacter pylori therapy has caused doctors to note a significant increase in the number of patients with antibiotic-resistant strains of H. pylori. Therefore, to solve the problem of eradication, treatment regimens are involved, which include reserve funds.

The patient can often be prescribed De-Nol and, or.

• 240 mg of bismuth subcitrate (De-Nol) twice a day for 30 days + 400 mg metronidazole and 500 mg three times a day for a weekly course (eradication - 81%);
• 120 mg bismuth subcitrate, 500 mg and 400 mg metronidazole four times a day for a weekly course (eradication - 89%);
• 240 mg of bismuth subcitrate, 400 mg metronidazole and 250 mg clarithromycin twice a day for a 10-day course (eradication - 95%);
• 240 mg bismuth subcitrate twice daily, 500 mg Flemoxin Solutab , 100 mg furazolidone four times a day with a two-week course (eradication - 86%);
• 240 mg of bismuth subcitrate, 200 mg furazolidone and 750 mg tetracycline twice a day for a weekly course (eradication - 85%);
• 240 mg of bismuth subcitrate, 100 mg furazolidone and 250 mg clarithromycin twice a day for a weekly course (eradication - 92%);
• 240 mg of bismuth subcitrate, 1000 mg Flemoxin Solutab and 250 mg clarithromycin twice a day for a weekly course (eradication - 93%);
• 120 mg of bismuth subcitrate, 250 mg clarithromycin and 250 mg tetracycline four times a day for a 10-day course (eradication - 72%);
• 120 mg of bismuth subcitrate and 500 mg Flemoxin Solutab four times a day and twice a day 20 mg omeprazole two-week course (eradication - 77%);
• 120 mg bismuth subcitrate four times a day, 500 clarithromycin and 40 mg omeprazole twice a day for a weekly course (eradication - 83%).

The challenge of eradicating strains of H. pylori resistant to metronidazole , at the lowest cost allows you to decide the use of the drug De-Nol in combination with furazolidone .

The most effective from a clinical and economic point of view is considered to be the scheme " bismuth subcitrate +amoxicillin + furazolidone «.

Overdose

A symptom of an overdose of De-Nol is a violation of the functional activity of the kidneys. The phenomenon is reversible, kidney function is fully restored after discontinuation of the drug.

Treatment of an overdose involves a gastric lavage procedure, the appointment of saline laxatives and enterosorbents. Further therapy is symptomatic.

If renal dysfunction is accompanied by a sharp increase in the plasma concentration of bismuth, the patient is administered chelating agents (for example, or D-penicillamine ). With severe violations of renal function may be required.

Interaction

The effectiveness of De-Nol may change when taken simultaneously with other drugs, as well as food and liquids (in particular, with antacids , fruits, milk, fruit juices), from which it is considered optimal to take the tablets half an hour before and half an hour after eating or taking any other medicines.

The use of the drug in combination with tetracyclines reduces the absorption of the latter.

Terms of sale

Non-prescription drug.

Storage conditions

Keep away from children, exposure to sunlight and moisture. The optimum temperature for storage is 15-25 °C.

Shelf life

48 months.

special instructions

The annotation indicates that the maximum duration of the course of De-Nol is 8 weeks.

During treatment, you should not exceed the dose of the drug prescribed by the doctor and take other bismuth-containing drugs.

After completion of treatment with De-Nol, the plasma concentration of bismuth subcitrate ranges from 3 to 58 μg / l. Symptoms of intoxication appear only in cases where the concentration of the substance exceeds 100 μg / l.

During the period of use of the drug, black stools are possible. The reason for this phenomenon is the formation of Bi2S3 (bismuth sulfide). Sometimes the tongue may darken slightly.

There are no data on the effect of De-Nol on the ability to drive machinery and a car.

Sometimes you can find the names De-Nol and Di-Nol, however, it is still correct to write De-Nol.

De-Nol - an antibiotic or not?

Despite their antimicrobial properties De-Nol does not belong to the group of antibiotics and, therefore, is devoid of their inherent side effects.

For specialists, the tool is interesting primarily because H. pylori does not have even the slightest possibility of forming resistance to it. The inclusion of De-Nol in the combined scheme antihelicobacter therapy allows you to significantly increase its effectiveness and in most cases, completely get rid of the infection.

In addition, the drug enhances the protection of the gastric mucosa from the damaging effects of the digestive juice contained in it and contributes to its restoration. These effects develop due to the fact that De-Nol turns into a colloidal solution in the stomach.

The solution particles form a protective film on the damaged and inflamed areas of the mucous membrane, which accelerates the healing of tissues and prevents the formation of a rough scar. The latter is very important to prevent exacerbations of the disease.

Analogues of De-Nol

Coincidence in the ATX code of the 4th level:

What can replace De-Nol? Synonyms for the drug are Vitridinol and .

Import analogues of the drug are cheaper than its cost: (Biofet, Bulgaria), (Reckitt Benckiser France S.A.), (Dr. Reddy's lab, India).

Domestic analogues: (JSC KhFK Akrikhin), (JSC Pharmstandard-Tomskhimfarm), (Irbitsky KhPZ), Flax seeds medicinal raw materials (JSC Evalar, LLC Faros-21).

The price of De-Nol analogues is from 20 Russian rubles.

Alcohol compatibility

During treatment with the drug, alcohol should be avoided.

Taking De-Nol during pregnancy

De-Nol is contraindicated during pregnancy. It should also be avoided in breastfeeding women.

Reviews about De-Nol

Reviews about De-Nol on the forums are mostly positive. Many patients call the drug a salvation from diseases caused by H. pylori. At the same time, the medicine effectively eliminates not only the symptoms (a feeling of fullness in the stomach after eating, gastralgia, loss of appetite, belching and diarrhea), but also the cause of the disease.

De-Nol suppresses the activity of pathogenic flora, restores the protective properties of the stomach and reduces the likelihood of relapse.

Doctors in reviews of De-Nol note that the best result can be achieved if the remedy is used as part of complex therapy. Quadruple schemes showed the greatest efficiency, in which, along with bismuth subcitrate tablets, Omeprazole ,

Thanks

Table of contents

1. What tests can a doctor prescribe for Helicobacter pylori?
2. The main methods and regimens for the treatment of helicobacteriosis
   • Modern treatment of Helicobacter-associated diseases. What is the Helicobacter pylori eradication scheme?
   • How to kill Helicobacter pylori safely and comfortably? What requirements are met by the standard modern regimen for the treatment of diseases such as Helicobacter pylori-associated gastritis and gastric and / or duodenal ulcers?
   • Is it possible to cure Helicobacter pylori if the first and second lines of eradication therapy were powerless? susceptibility of bacteria to antibiotics
3. Antibiotics are the number one drugs for the treatment of Helicobacter pylori
   • What antibiotics are prescribed for Helicobacter pylori infection?
   • Amoxiclav - an antibiotic that kills particularly resistant bacteria Helicobacter pylori
   • Azithromycin - a "reserve" drug for Helicobacter pylori
   • How to kill Helicobacter pylori if the first line of eradication therapy failed? Treatment of infection with tetracycline
   • Treatment with fluoroquinolone antibiotics: levofloxacin
4. Chemotherapeutic antibacterial drugs against Helicobacter pylori
5. Helicobacter pylori eradication therapy with bismuth preparations (De-nol)
6. Proton pump inhibitors (PPI) as a cure for helicobacteriosis: Omez (omeprazole), Pariet (rabeprazole), etc.
7. What is the optimal treatment regimen for gastritis with Helicobacter pylori?
8. What complications can occur during and after the treatment of Helicobacter pylori if a multicomponent course of eradication therapy with antibiotics is prescribed?
9. Is it possible to treat Helicobacter pylori without antibiotics?
   • Bactistatin - a dietary supplement as a remedy for Helicobacter pylori
   • Homeopathy and Helicobacter pylori. Feedback from patients and doctors
10. Helicobacter pylori bacterium: treatment with propolis and other folk remedies
    • Propolis as an effective folk remedy for Helicobacter pylori
    • Treatment of Helicobacter pylori with antibiotics and folk remedies: reviews
11. Folk recipes for the treatment of Helicobacter pylori infection - video

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Which doctor should I contact with Helicobacter pylori?

If there is pain or discomfort in the stomach, or if Helicobacter pylori is detected, you should contact Gastroenterologist (make an appointment) or to a pediatric gastroenterologist if the child is sick. If for some reason it is impossible to get an appointment with a gastroenterologist, then adults should contact therapist (sign up), and to children - to pediatrician (make an appointment).

What tests can a doctor prescribe for Helicobacter pylori?

With Helicobacter pylori, the doctor needs to assess the presence and amount of Helicobacter pylori in the stomach, as well as assess the condition of the mucous membrane of the organ in order to prescribe adequate treatment. To do this, a number of methods are used, and in each case, the doctor may prescribe any of them or a combination of them. Most often, the choice of research is based on what methods the laboratory of a medical institution can perform or what paid analyzes a person can afford in a private laboratory.

As a rule, if helicobacteriosis is suspected, an endoscopic examination is mandatory by the doctor - fibrogastroscopy (FGS) or (FEGDS) (make an appointment), during which a specialist can assess the condition of the gastric mucosa, identify the presence of ulcers, swelling, redness, edema, flattening of folds and cloudy mucus on it. However, endoscopic examination can only assess the condition of the mucosa, and does not give an accurate answer to the question of whether there is Helicobacter pylori in the stomach.

Therefore, after an endoscopic examination, the doctor usually prescribes some other tests that allow, with a high degree of certainty, to answer the question of whether Helicobacter is present in the stomach. Depending on the technical capabilities of the institution, two groups of methods can be used to confirm the presence or absence of Helicobacter pylori - invasive or non-invasive. Invasive involves taking a piece of stomach tissue during endoscopy (make an appointment) for further tests, and for non-invasive tests, only blood, saliva or feces are taken. Accordingly, if an endoscopic examination was carried out and the institution has technical capabilities, then any of the following tests is prescribed to detect Helicobacter pylori:

• bacteriological method. It is a sowing on a nutrient medium of microorganisms located on a piece of the gastric mucosa taken during endoscopy. The method allows with 100% accuracy to detect the presence or absence of Helicobacter pylori and determine its sensitivity to antibiotics, which makes it possible to prescribe the most effective treatment regimen.
• Phase contrast microscopy. It is a study of a whole untreated piece of the gastric mucosa, taken during endoscopy, under a phase-contrast microscope. However, this method allows you to detect Helicobacter pylori only when there are a lot of them.
• histological method. It is a study of a prepared and stained piece of mucosa taken during endoscopy under a microscope. This method is highly accurate and allows you to detect Helicobacter pylori, even if they are present in small quantities. Moreover, the histological method is considered the "gold standard" in the diagnosis of Helicobacter pylori and allows you to determine the degree of contamination of the stomach with this microorganism. Therefore, if it is technically possible, after endoscopy to identify the microbe, the doctor prescribes this particular study.
• Immunohistochemical study. It is the detection of Helicobacter pylori in a piece of mucous taken during endoscopy using the ELISA method. The method is very accurate, but, unfortunately, it requires highly qualified personnel and technical equipment of the laboratory, therefore it is not carried out in all institutions.
• Urease test (sign up). It is an immersion of a piece of mucosa taken during endoscopy into a solution of urea and subsequent fixation of a change in the acidity of the solution. If during the day the urea solution turns crimson, this indicates the presence of Helicobacter pylori in the stomach. Moreover, the rate of appearance of raspberry color also allows you to establish the degree of seeding of the stomach with a bacterium.
• PCR (polymerase chain reaction), carried out directly on the taken piece of the gastric mucosa. This method is very accurate and also allows you to detect the amount of Helicobacter pylori.
• Cytology. The essence of the method is that prints are made from a taken piece of mucous, stained according to Romanovsky-Giemsa and studied under a microscope. Unfortunately, this method has low sensitivity, but is used quite often.

If an endoscopic examination was not performed, or a piece of mucous (biopsy) was not taken during it, then to determine whether a person has Helicobacter pylori, the doctor may prescribe any of the following tests:

• Urease breath test. This test is usually performed during the initial examination or after treatment, when it is necessary to determine whether Helicobacter pylori is present in the stomach of a person. It consists in taking samples of exhaled air and then analyzing the content of carbon dioxide and ammonia in them. First, background samples of exhaled air are taken, and then the person is given breakfast and labeled carbon C13 or C14, after which 4 more samples of exhaled air are taken every 15 minutes. If in test air samples taken after breakfast, the amount of labeled carbon is increased by 5% or more compared to the background, then the result of the analysis is considered positive, which undoubtedly indicates the presence of Helicobacter pylori in the human stomach.
• Analysis for the presence of antibodies to Helicobacter pylori (sign up) in blood, saliva or gastric juice by ELISA. This method is used only when a person is examined for the first time for the presence of Helicobacter pylori in the stomach, and has not previously been treated for this microorganism. This test is not used to control the treatment carried out, since antibodies remain in the body for several years, while Helicobacter pylori itself is no longer there.
• Analysis of feces for the presence of Helicobacter pylori by PCR. This analysis is rarely used due to the lack of necessary technical capacity, but it is quite accurate. It can be used both for the primary detection of infection with Helicobacter pylori, and for monitoring the effectiveness of the therapy.

Usually, a single analysis is selected and assigned, which is performed in a medical institution.

How to treat Helicobacter pylori. The main methods and regimens for the treatment of helicobacteriosis

Modern treatment of Helicobacter-associated diseases. What is the Helicobacter pylori eradication scheme?

After the discovery of the leading role of bacteria helicobacter pylori in the development of diseases such as type B gastritis and peptic ulcer of the stomach and duodenum, a new era began in the treatment of these diseases.

The latest treatments have been developed based on the removal of Helicobacter pylori from the body by ingestion of drug combinations (so-called eradication therapy ).

The standard Helicobacter pylori eradication scheme necessarily includes drugs that have a direct antibacterial effect (antibiotics, chemotherapeutic antibacterial drugs), as well as drugs that reduce the secretion of gastric juice and thus create an unfavorable environment for bacteria.

Should Helicobacter pylori be treated? Indications for the use of eradication therapy for helicobacteriosis

Not all carriers of Helicobacteriosis develop pathological processes associated with Helicobacter pylori. Therefore, in each specific case of detection of Helicobacter pylori in a patient, consultation with a gastroenterologist is necessary, and often with other specialists, in order to determine medical tactics and strategy.

However, the global community of gastroenterologists has developed clear standards governing the cases when eradication therapy for helicobacteriosis using special schemes is an absolute necessity.

Schemes with antibacterial drugs are prescribed for the following pathological conditions:

• peptic ulcer of the stomach and / or duodenum;
• condition after resection of the stomach, performed for gastric cancer;
• gastritis with atrophy of the gastric mucosa (precancerous condition);
• stomach cancer in close relatives;

In addition, the global council of gastroenterologists strongly recommends eradication therapy for Helicobacter pylori in the following diseases:

• functional dyspepsia;
• gastroesophageal reflux (a pathology characterized by the throwing of the contents of the stomach into the esophagus);
• diseases requiring long-term treatment with non-steroidal anti-inflammatory drugs.

How to kill Helicobacter pylori safely and comfortably? What requirements are met by the standard modern regimen for the treatment of diseases such as Helicobacter pylori-associated gastritis and gastric and / or duodenal ulcers?

Modern Helicobacter pylori eradication schemes meet the following requirements:

1. High efficiency (according to clinical data, modern eradication therapy schemes provide at least 80% of cases of complete elimination of helicobacteriosis);
2. Safety for patients (regimen are not allowed into general medical practice if more than 15% of the subjects experience any adverse side effects of the treatment);
3. Convenience for patients:

• the shortest possible course of treatment (today, regimens involving a two-week course are allowed, but 10 and 7-day courses of eradication therapy are generally accepted);
• reducing the number of drug intakes due to the use of drugs with a longer half-life of the active substance from the human body.

4. The initial alternative schemes for the eradication of Helicobacter pylori (you can replace the "inappropriate" antibiotic or chemotherapeutic drug within the selected scheme).

First and second line eradication therapy. Three-component scheme for the treatment of Helicobacter pylori with antibiotics and quadruple therapy for Helicobacter pylori (4-component scheme)

Today, the so-called first and second lines of eradication therapy for Helicobacter pylori have been developed. They were adopted during conciliation conferences with the participation of the world's leading gastroenterologists.

The first such world council of doctors on the fight against Helicobacter pylori was held in the city of Maastricht at the end of the last century. Since then, several similar conferences have taken place, all of which have been called Maastricht, although the last meetings took place in Florence.

World luminaries have come to the conclusion that none of the eradication schemes gives a 100% guarantee of getting rid of Helicobacteriosis. Therefore, it has been proposed to formulate several "lines" of regimens so that a patient treated with one of the first line regimens can turn to second line regimens in case of failure.

First line schemes consist of three components: two antibacterial substances and a drug from the group of so-called proton pump inhibitors that reduce the secretion of gastric juice. In this case, the antisecretory drug, if necessary, can be replaced by a bismuth drug that has a bactericidal, anti-inflammatory and cauterizing effect.

Second line schemes They are also called Helicobacter quadrotherapy, since they consist of four drugs: two antibacterial drugs, an antisecretory substance from the group of proton pump inhibitors, and a bismuth drug.

Is it possible to cure Helicobacter pylori if the first and second lines of eradication therapy were powerless? susceptibility of bacteria to antibiotics

In cases where the first and second line of eradication therapy turned out to be powerless, as a rule, we are talking about a strain of Helicobacter pylori that is especially resistant to antibacterial drugs.

To destroy the harmful bacterium, doctors conduct a preliminary diagnosis of the sensitivity of the strain to antibiotics. To do this, during fibrogastroduodenoscopy, a culture of Helicobacter pylori is taken and sown on nutrient media, determining the ability of various antibacterial substances to suppress the growth of colonies of pathogenic bacteria.

The patient is then given third line eradication therapy , the scheme of which includes individually selected antibacterial drugs.

It should be noted that the increasing resistance of Helicobacter pylori to antibiotics is one of the main problems of modern gastroenterology. Every year more and more new schemes of eradication therapy are being tested, designed to destroy especially resistant strains.

Antibiotics are the number one drugs for the treatment of Helicobacter pylori

What antibiotics are prescribed for Helicobacter pylori infection to treat: amoxicillin (Flemoxin), clarithromycin, etc.

Back in the late eighties, the sensitivity of cultures of Helicobacter pylori bacteria to antibiotics was studied, and it turned out that in a test tube colonies of the causative agent of Helicobacter-associated gastritis can be easily destroyed using the 21st antibacterial agent.

However, these data have not been confirmed in clinical practice. So, for example, the antibiotic erythromycin, which is highly effective in a laboratory experiment, turned out to be absolutely powerless to expel Helicobacter pylori from the human body.

It turned out that the acidic environment completely deactivates many antibiotics. In addition, some antibacterial agents are not able to penetrate into the deep layers of mucus, in which most Helicobacter pylori bacteria live.

So the choice of antibiotics that can cope with Helicobacter pylori is not so great. Today, the most popular are the following medications:

• amoxicillin (Flemoxin);
• clarithromycin;
• azithromycin;
• tetracycline;
• levofloxacin.

Amoxicillin (Flemoxin) - tablets from Helicobacter pylori

The broad-spectrum antibiotic amoxicillin is included in many Helicobacter pylori eradication therapy regimens, both first and second line.

Amoxicillin (another popular name for this medication is Flemoxin) refers to semi-synthetic penicillins, that is, it is a distant relative of the first antibiotic invented by mankind.

This drug has a bactericidal effect (kills bacteria), but acts exclusively on multiplying microorganisms, so it is not prescribed together with bacteriostatic agents that inhibit the active division of microbes.

Like most penicillin antibiotics, amoxicillin has a relatively small number of contraindications. The drug is not prescribed for hypersensitivity to penicillins, as well as for patients with infectious mononucleosis and a tendency to leukemoid reactions.

With caution, amoxicillin is used during pregnancy, renal failure, and also with indications of past antibiotic-associated colitis.

Amoxiclav - an antibiotic that kills particularly resistant bacteria Helicobacter pylori

Amoxiclav is a combination drug consisting of two active ingredients - amoxicillin and clavulanic acid, which ensures the effectiveness of the drug against penicillin-resistant strains of microorganisms.

The fact is that penicillins are the oldest group of antibiotics, with which many strains of bacteria have already learned to fight, producing special enzymes - beta-lactamase, which destroy the core of the penicillin molecule.

Clavulanic acid is a beta-lactam and takes the brunt of the beta-lactamase of penicillin-resistant bacteria. As a result, penicillin-destroying enzymes are bound, and free amoxicillin molecules destroy bacteria.

Contraindications to taking Amoxiclav are the same as in the case of amoxicillin. However, it should be noted that Amoxiclav causes serious dysbacteriosis more often than regular amoxicillin.

Antibiotic clarithromycin (Klacid) as a remedy for Helicobacter pylori

The antibiotic clarithromycin is one of the most popular drugs used against the bacterium Helicobacter pylori. It is used in many first-line eradication regimens.

Clarithromycin (Klacid) refers to antibiotics from the erythromycin group, which are also called macrolides. These are broad-spectrum bactericidal antibiotics with low toxicity. So, taking second-generation macrolides, which include clarithromycin, causes adverse side effects in only 2% of patients.

Of the side effects, nausea, vomiting, diarrhea are most common, less often - stomatitis (inflammation of the oral mucosa) and gingivitis (inflammation of the gums), and even less often - cholestasis (bile stasis).

Clarithromycin is one of the most powerful drugs used against the bacterium Helicobacter pylori. Resistance to this antibiotic is relatively rare.

The second very attractive quality of Klacid is its synergy with antisecretory drugs from the group of proton pump inhibitors, which are also included in eradication therapy regimens. Thus, jointly prescribed clarithromycin and antisecretory drugs mutually reinforce each other's actions, contributing to the speedy expulsion of Helicobacter pylori from the body.

Clarithromycin is contraindicated in patients with hypersensitivity to macrolides. This drug is used with caution in infancy (up to 6 months), in pregnant women (especially in the first trimester), with renal and hepatic insufficiency.

Antibiotic azithromycin - a "reserve" drug for Helicobacter pylori

Azithromycin is a third-generation macrolide. This drug causes unpleasant side effects even less frequently than clarithromycin (only 0.7% of cases), but is inferior to the named fellow in the group in terms of effectiveness against Helicobacter pylori.

However, azithromycin is indicated as an alternative to clarithromycin in cases where side effects, such as diarrhea, prevent the use of the latter.

The advantages of azithromycin over Klacid are also an increased concentration in gastric and intestinal juice, which contributes to a targeted antibacterial action, and ease of administration (only once a day).

How to kill Helicobacter pylori if the first line of eradication therapy failed? Treatment of infection with tetracycline

The antibiotic tetracycline has a relatively greater toxicity, so it is prescribed in cases where the first line of eradication therapy was powerless.

It is a broad-spectrum bacteriostatic antibiotic, which is the ancestor of the group of the same name (tetracycline group).

The toxicity of drugs from the group of tetracyclines is largely due to the fact that their molecules do not have selectivity and affect not only pathogenic bacteria, but also the multiplying cells of the macroorganism.

In particular, tetracycline is able to inhibit hematopoiesis, causing anemia, leukopenia (a decrease in the number of leukocytes) and thrombocytopenia (a decrease in the number of platelets), disrupt spermatogenesis and cell division of epithelial membranes, contributing to the occurrence of erosions and ulcers in the digestive tract, and dermatitis on the skin.

In addition, tetracycline often has a toxic effect on the liver and disrupts protein synthesis in the body. In children, antibiotics of this group cause dysplasia of bones and teeth, as well as neurological disorders.

Therefore, tetracyclines are not prescribed to small patients under the age of 8 years, as well as to pregnant women (the drug crosses the placenta).

Tetracycline is also contraindicated in patients with leukopenia, and pathologies such as renal or hepatic insufficiency, gastric and / or duodenal ulcers require special care when prescribing the drug.

Treatment of Helicobacter pylori bacteria with fluoroquinolone antibiotics: levofloxacin

Levofloxacin belongs to the fluoroquinolones, the newest group of antibiotics. As a rule, this drug is used only in second-line and third-line regimens, that is, in patients who have already undergone one or two unsuccessful attempts to eradicate Helicobacter pylori.

Like all fluoroquinolones, levofloxacin is a broad-spectrum bactericidal antibiotic. Limitations of the use of fluoroquinolones in Helicobacter pylori eradication schemes are associated with increased toxicity of drugs in this group.

Levofloxacin is not prescribed to minors (under 18 years of age), as it can adversely affect the growth of bone and cartilage tissue. In addition, the drug is contraindicated in pregnant and lactating women, patients with severe lesions of the central nervous system (epilepsy), as well as in case of individual intolerance to drugs in this group.

Nitroimidazoles, in cases where they are prescribed for short courses (up to 1 month), rarely have a toxic effect on the body. However, when taking them, such unpleasant side effects as allergic reactions (itchy skin rash) and dyspeptic disorders (nausea, vomiting, decreased appetite, metallic taste in the mouth) can occur.

It should be borne in mind that metronidazole, as well as all drugs from the nitroimidazole group, is not compatible with alcohol (causes severe reactions when taking alcohol) and stains urine in a bright red-brown color.

Metronidazole is not prescribed in the first trimester of pregnancy, as well as with individual intolerance to the drug.

Historically, metronidazole was the first antibacterial agent successfully used in the fight against Helicobacter pylori. Barry Marshall, who discovered the existence of Helicobacter pylori, conducted a successful experiment on infection with Helicobacter pylori, and then cured type B gastritis that developed as a result of the study with a two-component regimen of bismuth and metronidazole.

However, today an increase in the resistance of the bacterium Helicobacter pylori to metronidazole is recorded all over the world. So, clinical studies conducted in France showed resistance of helicobacter pylori to this drug in 60% of patients.

Treatment of Helicobacter pylori with Macmirror (nifuratel)

Macmirror (nifuratel) is an antibacterial drug from the group of nitrofuran derivatives. Medicines of this group have both bacteriostatic (bind nucleic acids and prevent the reproduction of microorganisms) and bactericidal effects (inhibit vital biochemical reactions in the microbial cell).

With a short-term intake of nitrofurans, including Macmirror, they do not have a toxic effect on the body. Of the side effects, allergic reactions and dyspepsia of the gastralgic type are occasionally encountered (pain in the stomach, heartburn, nausea, vomiting). Characteristically, nitrofurans, unlike other anti-infective substances, do not weaken, but rather enhance the body's immune response.

The only contraindication to the appointment of Macmirror is increased individual sensitivity to the drug, which is rare. Macmirror crosses the placenta, so it is prescribed to pregnant women with great care.

If there is a need to take Macmirror during lactation, it is necessary to temporarily stop breastfeeding (the drug passes into breast milk).

As a rule, Macmirror is prescribed in the schemes of eradication therapy for Helicobacter pylori of the second line (that is, after an unsuccessful first attempt to get rid of Helicobacteriosis). Unlike metronidazole, Macmirror is characterized by higher efficiency, since Helicobacter pylori has not yet developed resistance to this drug.

Clinical data show high efficacy and low toxicity of the drug in four-component regimens (proton pump inhibitor + bismuth drug + amoxicillin + Macmirror) in the treatment of helicobacteriosis in children. So many experts recommend prescribing this drug to children and adults in first-line regimens, replacing metronidazole with Macmirror.

Helicobacter pylori eradication therapy with bismuth preparations (De-nol)

The active substance of the medical antiulcer drug De-nol is bismuth tripotassium dicitrate, which is also called colloidal bismuth subcitrate, or simply bismuth subcitrate.

Bismuth preparations have been used in the treatment of gastrointestinal ulcers even before the discovery of Helicobacter pylori. The fact is that, getting into the acidic environment of gastric contents, De-nol forms a kind of protective film on the damaged surfaces of the stomach and duodenum, which does not allow aggressive factors of gastric contents.

In addition, De-nol stimulates the formation of protective mucus and bicarbonates, which reduce the acidity of gastric juice, and also contributes to the accumulation of special epidermal growth factors in the damaged mucosa. As a result, under the influence of bismuth preparations, erosion quickly epithelizes, and ulcers undergo scarring.

After the discovery of helicobacteriosis, it turned out that bismuth preparations, including De-nol, have the ability to inhibit the growth of Helicobacter pylori, providing both a direct bactericidal effect and transforming the habitat of bacteria in such a way that Helicobacter pylori is removed from the digestive tract.

It should be noted that De-nol, unlike other bismuth preparations (such as, for example, bismuth subnitrate and bismuth subsalicylate), is able to dissolve in gastric mucus and penetrate into the deep layers - the habitat of most Helicobacter pylori bacteria. In this case, bismuth gets inside the microbial bodies and accumulates there, destroying their outer shells.

The medical drug De-nol, in cases where it is prescribed in short courses, does not have a systemic effect on the body, since most of the drug is not absorbed into the blood, but transits through the intestines.

So contraindications to the appointment of De-nol is only an increased individual sensitivity to the drug. In addition, De-nol is not taken during pregnancy, during lactation and in patients with severe kidney damage.

The fact is that a small part of the drug that enters the blood can pass through the placenta and into breast milk. The drug is excreted by the kidneys, therefore, serious violations of the excretory function of the kidneys can lead to the accumulation of bismuth in the body and the development of transient encephalopathy.

How to safely get rid of the bacterium Helicobacter pylori? Proton pump inhibitors (PPI) as a cure for helicobacteriosis: Omez (omeprazole), Pariet (rabeprazole), etc.

Medications from the group of proton pump inhibitors (PPIs, proton pump inhibitors) are traditionally included in the Helicobacter pylori eradication therapy regimens, both first and second line.

The mechanism of action of all drugs in this group is the selective blockade of the activity of the parietal cells of the stomach, producing gastric juice containing such aggressive factors as hydrochloric acid and proteolytic (protein-dissolving) enzymes.

Thanks to the use of drugs such as Omez and Pariet, the secretion of gastric juice is reduced, which, on the one hand, sharply worsens the conditions for the habitat of Helicobacter pylori and contributes to the eradication of bacteria, and, on the other hand, eliminates the aggressive effect of gastric juice on the damaged surface and leads to early epithelialization of ulcers and erosions. In addition, reducing the acidity of gastric contents allows you to save the activity of acid-sensitive antibiotics.

It should be noted that the active ingredients of drugs from the PPI group are acid-resistant, so they are produced in special capsules that dissolve only in the intestines. Of course, for the medicine to work, the capsules must be consumed whole, without chewing.

The absorption of the active ingredients of drugs such as Omez and Pariet occurs in the intestine. Once in the blood, PPIs accumulate in the parietal cells of the stomach in a fairly high concentration. So their therapeutic effect persists for a long time.

All drugs from the PPI group have a selective effect, therefore, unpleasant side effects are rare and, as a rule, consist in the appearance of headache, dizziness, development of signs of dyspepsia (nausea, bowel dysfunction).

Medicines from the group of proton pump inhibitors are not prescribed during pregnancy and lactation, as well as in case of increased individual sensitivity to drugs.

Children's age (up to 12 years) is a contraindication to the appointment of the drug Omez. As for the drug Pariet, the instruction does not recommend the use of this drug in children. Meanwhile, there are clinical data from leading Russian gastroenterologists, indicating good results in the treatment of helicobacteriosis in children under the age of 10 years with schemes that include Pariet.

What is the optimal treatment regimen for gastritis with Helicobacter pylori? This bacterium was found in me for the first time (helicobacter test is positive), I have been suffering from gastritis for a long time. I read the forum, there are a lot of positive reviews about De-nol treatment, but the doctor did not prescribe this drug to me. Instead, he prescribed amoxicillin, clarithromycin, and Omez. The price is impressive. Can the bacterium be removed with fewer drugs?

The doctor prescribed you a regimen that is considered optimal today. The effectiveness of the combination of a proton pump inhibitor (Omez) with the antibiotics amoxicillin and clarithromycin reaches 90-95%.

Modern medicine categorically opposes the use of monotherapy for the treatment of Helicobacter-associated gastritis (that is, therapy with only one drug) due to the low effectiveness of such schemes.

For example, clinical studies have shown that monotherapy with the same De-nol drug makes it possible to achieve complete eradication of Helicobacter pylori in only 30% of patients.

What complications can occur during and after the treatment of Helicobacter pylori if a multicomponent course of eradication therapy with antibiotics is prescribed?

The appearance of unpleasant side effects during and after the course of eradication therapy with antibiotics depends on many factors, primarily on such as:

• individual sensitivity of the body to certain drugs;
• the presence of concomitant diseases;
• the state of intestinal microflora at the time of initiation of anti-Helicobacter therapy.

The most common side effects and complications of eradication therapy are the following pathological conditions:
1. Allergic reactions to the active substances of the medicines that are part of the eradication scheme. Similar side effects appear in the very first days of treatment and completely disappear after the withdrawal of the drug that caused the allergy.
2. Gastrointestinal dyspepsia, which may consist in the appearance of such unpleasant symptoms as nausea, vomiting, unpleasant taste of bitterness or metal in the mouth, stool disorder, flatulence, discomfort in the stomach and intestines, etc. In cases where the described signs are not very pronounced, doctors advise to be patient, because after a few days the condition can normalize on its own against the background of ongoing treatment. If the signs of gastrointestinal dyspepsia continue to bother the patient, corrective drugs (antiemetics, antidiarrheals) are prescribed. In severe cases (vomiting and diarrhea that cannot be corrected), the eradication course is canceled. This happens infrequently (in 5-8% of cases of dyspepsia).
3. Dysbacteriosis. An imbalance in the intestinal microflora most often develops with the appointment of macrolides (clarithromycin, azithromycin) and tetracycline, which have the most detrimental effect on E. coli. It should be noted that many experts believe that relatively short courses of antibiotic therapy, which are prescribed during the eradication of Helicobacter pylori, are not able to seriously disrupt the bacterial balance. Therefore, the appearance of signs of dysbacteriosis should rather be expected in patients with an initial dysfunction of the stomach and intestines (concomitant enterocolitis, etc.). To prevent such complications, doctors advise after eradication therapy to undergo treatment with bacterial preparations or simply consume more lactic acid products (bio-kefir, yogurt, etc.).

Is it possible to treat Helicobacter pylori without antibiotics?

How to cure Helicobacter pylori without antibiotics?

It is possible to do without Helicobacter pylori eradication schemes, which necessarily include antibiotics and other antibacterial substances, only with a small seeding of Helicobacter pylori, in cases where there are no clinical signs of a pathology associated with Helicobacter pylori (type B gastritis, gastric and duodenal ulcers, iron deficiency anemia). , atopic dermatitis, etc.).

Since eradication therapy is a serious burden on the body and often causes adverse side effects in the form of dysbacteriosis, patients with asymptomatic carriage of Helicobacter pylori are advised to choose lighter drugs, the action of which is aimed at normalizing the gastrointestinal microflora and strengthening the immune system.

Bactistatin - a dietary supplement as a remedy for Helicobacter pylori

Bactistatin is a dietary supplement designed to normalize the state of the microflora of the gastrointestinal tract.

In addition, the components of bactistatin activate the immune system, improve digestive processes and normalize intestinal motility.

A contraindication to the appointment of bactistatin is pregnancy, lactation, as well as individual intolerance to the components of the drug.

The course of treatment is 2-3 weeks.

Homeopathy and Helicobacter pylori. Reviews of patients and doctors about the treatment with homeopathic medicines

There are a lot of positive patient reviews on the network about the treatment of Helicobacter pylori with homeopathy, which, unlike scientific medicine, considers Helicobacter pylori not an infectious process, but a disease of the whole organism.

Homeopathic experts are convinced that the general improvement of the body with the help of homeopathic remedies should lead to the restoration of the microflora of the gastrointestinal tract and the successful elimination of Helicobacter pylori.

Official medicine, as a rule, treats homeopathic medicines without prejudice, in cases where they are prescribed according to indications.

The fact is that with asymptomatic carriage of Helicobacter pylori, the choice of treatment method remains with the patient. As clinical experience shows, in many patients Helicobacter pylori is an accidental finding and does not manifest itself in any way in the body.

Here opinions of doctors were divided. Some doctors argue that Helicobacter must be removed from the body at any cost, since it poses a danger of developing many diseases (pathology of the stomach and duodenum, atherosclerosis, autoimmune diseases, allergic skin lesions, intestinal dysbacteriosis). Other experts are confident that in a healthy body, Helicobacter pylori can live for years and decades without causing any harm.

Therefore, turning to homeopathy in cases where there are no indications for the appointment of eradication schemes, from the point of view of official medicine, is quite justified.

Symptoms, diagnosis, treatment and prevention of Helicobacter pylori - video

Helicobacter pylori bacterium: treatment with propolis and other folk remedies

Propolis as an effective folk remedy for Helicobacter pylori

Clinical studies of the treatment of gastric and duodenal ulcers using alcohol solutions of propolis and other bee products were carried out even before the discovery of Helicobacter pylori. At the same time, very encouraging results were obtained: patients who, in addition to conventional antiulcer therapy, received honey and propolis alcohol setting, felt much better.

After the discovery of helicobacteriosis, additional studies were carried out on the bactericidal properties of bee products in relation to helicobacter pylori and a technology for preparing an aqueous propolis tincture was developed.

The Geriatric Center has carried out clinical trials on the use of an aqueous solution of propolis for the treatment of helicobacteriosis in the elderly. For two weeks, patients took 100 ml of an aqueous solution of propolis as an eradication therapy, while in 57% of patients a complete cure for helicobacteriosis was achieved, and in the rest of the patients a significant decrease in the contamination of helicobacter pylori was observed.

The scientists came to the conclusion that multicomponent antibiotic therapy can be replaced by taking propolis tincture in such cases as:

• advanced age of the patient;
• the presence of contraindications to the use of antibiotics;
• proven resistance of the Helicobacter pylori strain to antibiotics;
• low contamination of Helicobacter pylori.

Is it possible to use flax seed as a folk remedy for Helicobacter pylori?

Traditional medicine has long used flaxseed in acute and chronic inflammatory processes in the gastrointestinal tract. The basic principle of the effect of preparations from flax seed on the affected surfaces of the mucous membranes of the digestive tract consists of the following effects:
1. Enveloping (formation on the inflamed surface of the stomach and / or intestines of a film that protects the damaged mucosa from the effects of aggressive components of gastric and intestinal juice);
2. Anti-inflammatory;
3. Anesthetic;
4. Antisecretory (decreased secretion of gastric juice).

However, preparations from flax seed do not have a bactericidal effect, therefore they are not able to destroy Helicobacter pylori. They can be considered as a kind of symptomatic therapy (treatment aimed at reducing the severity of signs of pathology), which in itself is not able to eliminate the disease.

It should be noted that flax seed has a pronounced choleretic effect, so this folk remedy is contraindicated in calculous cholecystitis (inflammation of the gallbladder, accompanied by the formation of gallstones) and many other diseases of the biliary tract.

I have gastritis and was diagnosed with Helicobacter pylori. I took home treatment (De-nol), but to no avail, although I read positive reviews about this drug. I decided to try folk remedies. Will garlic help with helicobacteriosis?

Garlic is contraindicated in gastritis, as it will irritate the inflamed stomach lining. In addition, the bactericidal properties of garlic will clearly not be enough to destroy Helicobacteriosis.

You should not experiment on yourself, contact a specialist who will prescribe an effective Helicobacter pylori eradication scheme that suits you.

Treatment of Helicobacter pylori with antibiotics and folk remedies: reviews (materials taken from various forums on the Internet)

There are a lot of positive reviews on the network about the treatment of Helicobacter pylori with antibiotics, patients talk about healed ulcers, normalization of the stomach, and improvement in the general condition of the body. However, there is evidence of the lack of effect of antibiotic therapy.

It should be noted that many patients ask each other to provide an "effective and harmless" regimen for the treatment of Helicobacter. Meanwhile, such treatment is prescribed individually, the following factors are taken into account:

• the presence and severity of pathology associated with Helicobacter pylori;
• the degree of seeding of the gastric mucosa, Helicobacter pylori;
• treatment previously taken for helicobacteriosis;
• general condition of the body (age, presence of concomitant diseases).

So the scheme, which is ideal for one patient, can bring nothing but harm to another. In addition, many "efficient" schemes contain gross errors (most likely for the reason that they have been circulating in the network for a long time and have undergone additional "finishing").

Evidence of terrible complications of antibiotic therapy, which for some reason patients constantly scare each other (“antibiotics are only in the most extreme case”), we have not found.

As for the reviews on the treatment of Helicobacter pylori with folk remedies, there is evidence of a successful cure for Helicobacter pylori with propolis (in some cases, we are even talking about the success of "family" treatment).

At the same time, some so-called "grandmother's" recipes are striking in their illiteracy. For example, with gastritis associated with Helicobacter pylori, it is advised to take blackcurrant juice on an empty stomach, and this is a direct road to a stomach ulcer.

In general, from a study of reviews on the treatment of Helicobacter pylori with antibiotics and folk remedies, the following conclusions can be drawn:
1. The choice of the method of treatment for Helicobacter pylori should be carried out in consultation with a specialist gastroenterologist, who will make the correct diagnosis and, if necessary, prescribe a suitable treatment regimen;
2. In no case should you use "health recipes" from the network - they contain many gross errors.

Folk recipes for the treatment of Helicobacter pylori infection - video

A little more about how to successfully cure helicobacter pylori. Diet in the treatment of Helicobacter pylori

The diet in the treatment of Helicobacter pylori is prescribed depending on the severity of the symptoms of diseases caused by the bacterium, such as type B gastritis, gastric and duodenal ulcers.

With asymptomatic carriage, it is enough just to follow the correct diet, refusing to overeat and foods that are harmful to the stomach (smoked food, fried "crust", spicy and salty foods, etc.).

With peptic ulcer and type B gastritis, a strict diet is prescribed, all dishes that have the properties to increase the secretion of gastric juice, such as meat, fish and strong vegetable broths, are completely excluded from the diet.

It is necessary to switch to fractional meals 5 or more times a day in small portions. All food is served in a semi-liquid form - boiled and steamed. At the same time, the consumption of table salt and easily digestible carbohydrates (sugar, jam) is limited.

Very good help to get rid of stomach ulcers and type B gastritis whole milk (with good tolerance up to 5 glasses a day), mucous milk soups with oatmeal, semolina or buckwheat. The lack of vitamins is compensated by the introduction of bran (one tablespoon per day - taken after steaming with boiling water).

For the speedy healing of mucosal defects, proteins are needed, so you need to eat soft-boiled eggs, Dutch cheese, non-acidic cottage cheese and kefir. You should not refuse meat food - meat and fish soufflés, cutlets are shown. The missing calories are supplemented with butter.

In the future, the diet is gradually expanded, including boiled meat and fish, lean ham, non-acidic sour cream and yogurt. Side dishes are also diversified - boiled potatoes, cereals and vermicelli are introduced.

As ulcers and erosions heal, the diet approaches table number 15 (the so-called recovery diet). However, even in the late recovery period, one should give up smoked meats, fried foods, seasonings, and canned foods for quite a long time. It is very important to completely eliminate smoking, alcohol, coffee, carbonated drinks.

There are contraindications. Before use, you should consult with a specialist.

In today's world, there are many different diseases. In this article, I would like to talk about how Helicobacter can be treated: a treatment regimen and getting rid of this problem.

What it is?

At the very beginning, you need to understand the concepts that will be used in this article. What is Helicobacter pylori? spiral-shaped, which lives either in the duodenum or in the stomach. The danger of Helicobacter is that it can cause various diseases, such as gastritis, polyps, hepatitis, ulcers and even cancer. It is also worth saying that the majority of the inhabitants of our planet, approximately 60%, are infected with this microorganism. Scientists say that it is in second place in terms of prevalence after herpes infection. It can be contracted through contaminated food or water, as well as during contact with a sick person through sputum or even saliva, which can be released during coughing or sneezing.

Requirements

It is very important to consider the schemes as well. So, it is worth saying that there are several simple but important requirements for therapy:

1. The main goal of therapy is to destroy (it is far from always possible to do this completely) these harmful bacteria.
2. You need to try to avoid side effects. In case of their occurrence, the drug can be changed.
3. It is very important that the treatment gives positive results within 7-14 days.

Important rules that involve the treatment of Helicobacter

The treatment regimen must meet very simple, but very important rules. What should be remembered not only by every doctor, but also by the patient:

1. If the treatment regimen does not produce the desired effect on the patient, it is not worth repeating it.
2. If the regimen is ineffective, this may mean that the bacterium has acquired immunity to one of the components that were used in therapy.
3. If no treatment regimen has a positive effect on a person, it is necessary to check the sensitivity of the disease strain to the entire spectrum of antibiotics.
4. If a year after recovery, a person becomes infected again, it should be considered as a relapse, but not as a reinfection.
5. If there was a relapse of the disease, you need to apply a more stringent treatment regimen.

Medications

What steps can be taken if Helicobacter treatment is foreseen? The treatment regimen may consist of the following medications:

1. Their main goal is to reduce the acidity of the stomach and envelop its walls.
2. You will also need substances that suppress the production of gastric juice. In this case, it is customary to talk about proton pump blockers and H2-histamine blockers.
3. Antibacterial agents - antibiotics. Their main goal is to destroy the harmful organism.

Scheme 1. Seven-day

How can Helicobacter pylori be treated with antibiotics? The scheme can be seven days (the so-called first line therapy). In this case, all medications are taken for a week twice a day. In this case, the doctor will most likely prescribe the following drugs to the patient:

1. proton pump inhibitors. This may be one of the following drugs: Omez, Lansoprazole, Esomeprazole.
2. Bactericidal agents, for example, a drug such as Klacid.
3. You can also use the antibiotic "Amoxiclav" (a group of penicillins).

Scheme 2. Ten- or fourteen-day treatment

For two weeks, Helicobacter pylori can be treated with antibiotics. The scheme in this case may be as follows:

1. Proton pump inhibitors are taken twice a day. These will again be drugs such as Omeprazole, Pariet, Nexium.
2. Four times a day, you will need to take a medication such as De-nol (bismuth subcitrate).
3. The drug "Metronidazole" is prescribed three times a day.
4. Four times a day, you will also need to take the drug "Tetracycline", which is a broad-spectrum antibiotic, for a complete cure.

Post-Treatment Actions

After the basic treatment regimen for Helicobacter pylori is completed, you should not relax. Next, you need to support your body with the help of medicines for a certain time:

1. Five weeks, if we are talking about the duodenal localization of the microorganism.
2. Seven weeks if its localization is gastric.

The subsequent antibiotic treatment regimen for Helicobacter pylori includes the use of one of the following drugs:

1. Proton pump inhibitors - drugs "Omez", "Rabeprazole". You need to take these funds 1-2 times a day.
2. Histamine H2 receptor blockers. These can be drugs such as Ranitidine, Famotidine. Taken twice a day.
3. Antibiotic "Amkosiklav" - 2 times a day.

Helicobacter pylori gastritis

Now the scheme of treatment of gastritis with Helicobacter will be considered. What drugs in this case can the doctor prescribe? These can be such drugs as "De-Nol", as well as "Metronidazole", "Clarithromycin", "Amoxicycline". To work more efficiently, the drug "Omeprazole" may be prescribed. To improve the recovery processes in the stomach, you can take medicines such as Solcoseryl, Gastrofarm.

Main Side Effects

If the Helicobacter pylori treatment regimen described above was used, it is worth saying that the drugs can also cause some side effects. I would like to talk about some of them separately:

1. If the patient took "Omeprazole", bismuth, "Tetracycline", flatulence, diarrhea, dizziness, dark stools, an increase in renal failure are possible.
2. If the patient was taking a medication such as Metronidazole, there may be the following side symptoms: vomiting, headache, fever.
3. During the reception of "Amoxicycline" pseudomembronous colitis may develop, there may be diarrhea, a rash.
4. When taking Clarithromycin, nausea, vomiting, diarrhea, headache, pseudomembranous colitis are possible.

Efficiency mark

What is important if Helicobacter treatment is supposed? The scheme of treatment, as well as an assessment of its effectiveness:

1. An important indicator is the disappearance of the pain syndrome.
2. The dyspeptic syndrome (unpleasant sensations in the upper abdomen) should disappear.
3. Well, the most important thing is the complete disappearance of the causative agent of the disease - Helicobacter pylori.

Small Conclusions

Separately, it should be said that doctors are still arguing about which treatment regimen is best to choose. After all, the complete extermination of the Helicobacter pylori bacterium is possible only with the use of a large number of various antibiotics (the microorganism can be resistant to most). And this is very harmful to the body. If the patient has previously taken a certain antibiotic, their treatment will already be completely ineffective. In addition, this can lead to the death of the intestinal microflora, which in itself is also very harmful to the patient's health.