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  • 1 Ferencvárosi Egészségügyi Szolgáltató Kiemelkedően Közhasznú Non-Profit Kft. Gasztroenterológiai szakrendelés Budapest Mester utca 45. 1095
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A 27 éve felfedezett Helicobacter pylori az eltelt évtizedekben a földkerekség leggyakoribb fertőzése maradt. A szerző feltételezi, hogy a peptikus fekély gyakoriságának XIX–XX. századi emelkedését a gyomorszondázás széles körű elterjedése segíthette elő, amelynek során a baktérium iatrogén átvitelével a patogén törzsek terjedhettek el. Új virulenciatényezőket mutattak ki: a Helicobacter pylori törzsek membránfehérjéket (outer membrane protein, OMP), valamint dupA (duodenal ulcer promoting) fehérjét kódoló géneket tartalmaznak, amelyek egyrészt proinflammatorikus citokinek termeléséhez vezetnek, másrészt a jövőben terápiás célpontok lehetnek. A fertőzés első vonalbeli kezelésében ideális módszer nincs, szakértők szerint ezek hatékonysága az utóbbi években elfogadhatatlan szintre csökkent, bár ez a jelenség a szerző adatai szerint multifaktoriális és nem általánosítható. Alternatív kezelésként a levofloxacin, furazolidon és rifabutin hatékonyságát metaanalízisek igazolták. A szekvenciális és a bizmutmentes négyes kezelés nemzetközileg még nem terjedt el. A fertőzés rekurrenciájának aránya 2,67%/év a fejlett és 13,0%/év a fejlődő országokban. Gyermekekben 8–20%-ban, felnőttekben 5–11%-ban spontán eradikáció lép fel. A clarithromycinrezisztencia gyakorisága világszerte növekedőben van, hazai adatok szerint országosan vidéki nagyvárosokban 10,9%, Budapest IX. kerületében 2005–2009 között 16–22% között volt, növekedési tendencia nélkül. Új terápiás célpontként a rezisztenciát nem okozó enzimgátlók (ureáz, karboanhidráz és gamma-glutamil-transzpeptidáz), módosított antibiotikum és effluxpumpagátlók kifejlesztése van folyamatban: emberi alkalmazásra még egyik sem került. Orv. Hetil., 2010, 49, 2003–2010.

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