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  • 1 Ferencvárosi Egészségügyi Szolgáltató Kiemelkedően Közhasznú Nonprofit Kft. Gasztroenterológiai szakrendelés Budapest Mester utca 45. 1095
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A szerző áttekinti az utóbbi két év Helicobacter pylori-val kapcsolatos irodalmának egyes kérdéseit. A genetikai kutatások azonosították a baktérium, illetve a gazdaszervezet azon polimorfizmusait, amelyek a Helicobacter pylori-infekció klinikai kimenetelében (peptikus fekély, gyomorrák) szerepet játszanak. A vizsgálatokat kutatási központokban végzik, de a költségek csökkenésével helyet kaphatnak a diagnosztikában és az egyénre szabott kezelésben. Az antibiotikum-rezisztencia továbbra is emelkedik a dél-európai országokban. Jelenleg Budapesten a clarithromycinrezisztencia 17–33%, a levofloxaciné 27%. Az antibiotikum-fogyasztás felmérésével a rezisztencia részben kiküszöbölhető és az eradikációs eredmények javíthatók. A migráció világszerte problémát jelent: ausztrál, kanadai és texasi adatok szerint a bevándorlók fertőzöttsége meghaladja a befogadó országét. Olaszországban a bevándorlóknál végzett eradikáció eredményei rosszabbak, mint az olaszoké. Összefüggést vélnek a női/férfi meddőség, a habituális abortusz és a Helicobacter pylori-fertőzés között, nincs azonban adat, hogy az ilyen indikációval végzett sikeres eradikációs kezelést követi-e kihordott terhesség. A Maastricht IV/Firenze konszenzusban a bizonyíték- és evidenciaszintek újraértékelésével meghatározták a diagnosztika és eradikációs kezelés indikációit és módszereit. A nem invazív vizsgálatok a fertőzés „test and treat” kimutatásában javasoltak, endoszkópos vizsgálat alarm panaszok, szövődményes fekély, malignus elváltozás, MALT-lymphoma gyanúja esetén indokolt. A terápia kiválasztásakor figyelemmel kell lenni a helyi clarithromycin- és levofloxacinrezisztenciára, 15–20% felett e szerek kerülendők. 15%-os rezisztencia alatt az első vonalbeli standard hármas kezelés adható, ennek alternatívája a négyes bizmutalapú kezelés. Sikertelen harmadik kezelés után ajánlott az antibiotikum-rezisztencia meghatározása. A második/harmadik kezelésben a szekvenciális, bizmutalapú vagy bizmutmentes négyes vagy hibrid kezelésnek is szerepe van. A Helicobacter pylori-diagnosztika és a kezelés hazai gyakorlata néhány részletében eltér az európai konszenzustól. Orv. Hetil., 2012, 153, 1407–1418.

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