Nuevas estrategias terapéuticas en la infección por helicobacter pylori

Abstract

The articles included in this thesis are a part of the research of the applicant Jordi Sánchez Delgado in relation to the Helicobacter pylori (H. pylori) infection. Under the title "New therapeutic strategies for the H. pylori infection” the author show his contribution in the sphere of treatment by proposing new alternatives to the commonly used triple scheme._x000D_ In the introduction of this thesis there is an extensive and, most of all, updated review of the epidemiology, diagnosis and treatment of the H. pylori infection. It is documented in the scientific evidence reported in recent studies published on this topic. The knowledge of the infection grows exponentially over the years. In the sphere of treatment, the therapeutic arsenal has expanded with the use of new antibiotics; it has been demonstrated the utility of extending the duration of therapy as well as the benefit of a strong acid inhibition among other changes._x000D_ The aim of my thesis was to provide new therapies to improve the low eradication rates obtained with traditional triple scheme, with acceptable dosage and with minimal side effects._x000D_ In the first article “Ten-day sequential treatment for Helicobacter pylori eradication in clinical practice " we assess the efficacy of a new therapeutic regimen. Sequential regime consisted of a 10-day treatment including a proton pump inhibitor (PPI) b.d. plus amoxicillin 1 g b.d. for the first 5 days, followed by a PPI b.d. clarithromycin 500 mg b.d. and metronidazole 500 mg b.d for the next 5 days. Cure rates were 88.2% per protocol and 82.4% by intention to treat. Higher eradication rates than with the triple classical scheme._x000D_ In the second article "High-dose, ten day esomeprazole, amoxicillin and metronidazole triple therapy achieves high H. pylori eradication rates” we used antibiotics commonly used in H. pylori treatment but using a physiologically-correct schedule three times a day and strong acid inhibition. Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazole 500 mg both three times a day with the scientific evidence that we administrate the antibiotics taking into account their half-lives and the correct tolerance demonstrated in other infectious diseases. This scheme also showed higher eradication rate than standard treatment._x000D_ The importance and applicability of these new therapeutic approaches are remarkable since both studies evaluate therapeutic schemes with an excellent ability to eradicate H. pylori, an infection that has clearly demonstrate its responsibility in many diseases such as peptic ulcer, dyspepsia, gastric lymphoma (MALT), gastric carcinoma and other illnesses.

Date of Award	29 Nov 2013
Original language	Undefined/Unknown
Supervisor	Javier Calvet Calvo (Director) & Emilio Miguel Gené Tous (Director)