Treatment regimens for gastritis and peptic ulcers. Complete list of medications for stomach ulcers

For quotation: Lapina T.L., Ivashkin V.T. Modern approaches to the treatment of gastric and duodenal ulcers // RMZh. 2001. No. 1. P. 10

The historical stages of treatment of gastric and duodenal ulcers reflect not only the social significance of the disease, but also the development of scientific progress, which has armed modern doctors with powerful antiulcer drugs (Table 1). It is important to note that nowadays some therapeutic approaches have lost their significance, others have found a certain “niche” among various treatment methods, and still others, in fact, determine the current level of treatment for peptic ulcer disease.

Control of gastric acid production is the cornerstone of peptic ulcer treatment. The classic formula of the early 20th century “no acid - no ulcer” has not lost its relevance; the most effective groups of drugs, according to their mechanism of action, are aimed at combating acidity.
Antacids
Antacid drugs have been known since ancient times. This is a group of drugs that reduce the acidity of gastric contents through chemical interaction with acid in the stomach cavity. Currently, preference is given to non-absorbable antacids, which are relatively insoluble salts of weak bases. Non-absorbable antacids usually contain a mixture of aluminum hydroxide and magnesium hydroxide (Almagel, Maalox) or are aluminum phosphate (Phosphalugel). Unlike absorbable antacids (soda), they have much fewer side effects. They interact with hydrochloric acid, forming non-absorbable or poorly absorbed salts, thereby increasing the pH inside the stomach. At a pH greater than 4, pepsin activity decreases and it can be adsorbed by some antacids. Acid production in duodenal ulcers ranges between 60 and 600 mEq/day, in two thirds of patients - between 150 and 400 mEq/day. The total daily dose of antacids should be in the range of 200-400 mEq for neutralizing ability, for gastric ulcers - 60-300 mEq.
Deciphering the mechanism of parietal cells and the regulation of acid secretion has made it possible to create new classes of drugs. The secretion of hydrochloric acid is under the stimulatory control of three classes of parietal cell receptors: acetylcholine (M), histamine (H2), gastrin (G) receptors. The path of pharmacological action on muscarinic receptors turned out to be historically the earliest. Non-selective M-anticholinergic blockers (atropine) and selective M1-antagonists (pirenzepine) have lost their importance in the treatment of peptic ulcers with the progress of drugs of other classes that act at the molecular level, interfere with intimate intracellular processes and provide a more powerful antisecretory effect.
Histamine H2 receptor blockers
Thanks to clinical studies, it has been established that there is a direct relationship between ulcer healing and the ability of drugs to suppress acidity. Ulcer healing is determined not only by the duration of administration of antisecretory agents, but also by their ability to “hold” intragastric pH above 3 for a given time. The meta-analysis made it possible to establish that a duodenal ulcer will heal within 4 weeks in 100% (!) of cases if the intragastric pH is maintained above 3 for 18-20 hours during the day.
Despite the fact that patients with gastric ulcer have moderate levels of gastric secretion, antisecretory therapy is mandatory for them as well. Gastric ulcers are characterized by slower healing than duodenal ulcers. Therefore, the duration of prescription of antisecretory drugs should be longer (up to 8 weeks). It is assumed that we can expect scarring of gastric ulcers in 100% of cases if intragastric pH is maintained above 3 for 18 hours a day for about 8 weeks.
Such control of acid secretion was achieved thanks to blockers of histamine H2 receptors in parietal cells. These drugs significantly influenced the course of peptic ulcer disease: the duration of ulcer scarring was reduced, the frequency of ulcer healing increased, and the number of complications of the disease decreased.
Ranitidine for exacerbation of peptic ulcer is prescribed at a dose of 300 mg per day (once in the evening or 2 times a day, 150 mg), for duodenal ulcers, usually for 4 weeks, for gastric ulcers for 6-8 weeks. To prevent early relapses of the disease, it is advisable to continue taking a maintenance dose of ranitidine 150 mg/day.
Famotidine (Quamatel) is used in a lower daily dose than ranitidine (40 and 300 mg, respectively). The antisecretory activity of the drug is more than 12 hours with a single dose. Famotidine is prescribed at a dose of 40 mg for the same duration as ranitidine. To prevent relapses of gastric ulcer - 20 mg/day.
Histamine H2 receptor blockers are of particular importance in the treatment of bleeding from the upper gastrointestinal tract. Their effect is due to inhibition of hydrochloric acid production and an indirect decrease in fibrinolysis. In case of massive bleeding, drugs with parenteral forms of administration (Kvamatel) have an advantage.
The effectiveness of histamine H2 receptor antagonists is primarily due to their inhibitory effect on acid secretion. The antisecretory effect of cimetidine lasts up to 5 hours after taking the drug, ranitidine - up to 10 hours, famotidine, nizatidine and roxatidine - 12 hours.
Proton pump inhibitors
A new step in the creation of antisecretory drugs was the inhibitors of H+,K+-ATPase of parietal cells - the enzyme that actually ensures the transfer of hydrogen ions from the parietal cell into the lumen of the stomach. These benzimidazole derivatives form strong covalent bonds with the sulfhydryl groups of the proton pump and permanently disable it. Acid secretion is restored only when new H+,K+-ATPase molecules are synthesized. The most powerful drug inhibition of gastric secretion today is provided by this group of drugs. This group includes drugs: omeprazole (Gastrozole), pantoprazole, lansoprazole and rabeprazole.
Benzimidazole derivatives maintain pH values ​​in a range favorable for the healing of gastric or duodenal ulcers for a long period of time in 1 day. After a single dose of a standard dose of a proton pump inhibitor, the pH above 4 is maintained for 7-12 hours. The consequence of such an active reduction in acid production is the amazing clinical effectiveness of these drugs. Data from numerous clinical trials regarding omeprazole therapy are summarized in Table 2.
Anti-helicobacter therapy
In parallel with the development of the latest generation of antisecretory drugs, there was an accumulation of scientific data and clinical experience, which indicated the decisive importance of the Helicobacter pylori organism in the pathogenesis of peptic ulcer disease. Treatment that kills H. pylori is effective not only in healing the ulcer, but also in preventing recurrence of the disease. Thus, the strategy for treating peptic ulcer disease by eradicating H. pylori infection has an undeniable advantage over all groups of antiulcer drugs: this strategy provides long-term remission of the disease, and possible complete cure.
Anti-Helicobacter therapy has been well studied in accordance with the standards of evidence-based medicine. A large number of controlled clinical trials provide grounds for confident use of certain eradication regimens. The clinical material is extensive and makes it possible to conduct meta-analysis. I will cite the results of just one of the meta-analyses conducted under the auspices of the US Food and Drug Administration: R.J. Hopkins et al. (1996) concluded that in case of duodenal ulcer after successful eradication of H. pylori, relapses during long-term observation occur in 6% of cases (compared to 67% in the group of patients with persistent bacteria), and in case of gastric ulcer - in 4 % of cases versus 59%.
Modern approaches to the diagnosis and treatment of H. pylori infection, meeting the requirements of evidence-based medicine, are reflected in the final document of the conference, which took place in Maastricht on September 21-22, 2000. For the second time, the European Helicobacter pylori Study Group organized an authoritative meeting to adopt modern guidelines on the problem of H. pylori. The first Maastricht Agreement (1996) played a significant role in regulating the diagnosis and treatment of H. pylori in the European Union. Over the past 4 years, significant progress has been made in this area of ​​knowledge, which has forced the updating of previous recommendations.
The Second Maastricht Agreement puts gastric ulcer and duodenal ulcer in first place among the indications for anti-helicobacter therapy, regardless of the phase of the disease (exacerbation or remission), including their complicated forms. It is especially noted that eradication therapy for peptic ulcer disease is a necessary therapeutic measure, and the validity of its use in this disease is based on obvious scientific facts.
Indeed, eradication of H. pylori infection radically changes the course of the disease, preventing its relapse. Anti-helicobacter therapy is accompanied by successful healing of the ulcer. Moreover, the ulcer-healing effect is due not only to the active antiulcer components of eradication regimens (for example, proton pump inhibitors or ranitidine bismuth citrate), but also to the actual elimination of H. pylori infection, which is accompanied by the normalization of the processes of proliferation and apoptosis in the gastroduodenal mucosa. The Second Maastricht Agreement emphasizes that in case of uncomplicated duodenal ulcer there is no need to continue antisecretory therapy after a course of eradication therapy. A number of clinical studies have shown that after a successful eradication course, ulcer healing actually does not require further medication. It is also recommended to diagnose H. pylori infection in patients with peptic ulcer disease who are receiving maintenance or course therapy with antisecretory drugs, with the prescription of antibacterial treatment. Carrying out eradication in these patients provides a significant economic effect due to the cessation of long-term use of antisecretory drugs.
The outcome document of the 2000 Maastricht Conference suggested for the first time that treatment for H. pylori infection should be planned without excluding the possibility of failure. Therefore, it is proposed to consider it as a single block, providing not only first-line eradication therapy, but also in case of persistence of H. pylori - second line at the same time (Table 3).
It is important to note that the number of possible anti-helicobacter therapy regimens has been reduced. For triple therapy, only two pairs of antibiotics are offered; for quadruple therapy, only tetracycline and metronidazole are provided as antibacterial agents.
First-line therapy: Proton pump inhibitor (or ranitidine bismuth citrate) at a standard dose 2 times a day + clarithromycin 500 mg 2 times a day + amoxicillin 1000 mg 2 times a day or metronidazole 500 mg 2 times a day. Triple therapy is prescribed for at least 7 days.
The combination of clarithromycin with amoxicillin is preferable to clarithromycin with metronadzole, as it can help achieve a better result when prescribing second-line treatment - quadruple therapy.
If treatment is unsuccessful, second-line therapy is prescribed: Proton pump inhibitor at a standard dose 2 times a day + bismuth subsalicylate/subcitrate 120 mg 4 times a day + metronidazole 500 mg 3 times a day + tetracycline 500 mg 4 times a day. Quad therapy is prescribed for at least 7 days.
If bismuth preparations cannot be used, triple treatment regimens based on proton pump inhibitors are proposed as a second course of treatment. If the second course of treatment fails, further tactics are determined on a case-by-case basis.
The treatment regimen of proton pump blocker + amoxicillin + nitroimidazole derivative (metronidazole) was excluded from the recommendations of the Second Maastricht Agreement. This combination is common in Russia, where metronidazole, due to its low cost and “traditional” use as a “reparant” for peptic ulcer disease, is an almost unchanged anti-Helicobacter agent. Unfortunately, in the presence of a H. pylori strain resistant to nitroimidazole derivatives, the effectiveness of this treatment regimen is significantly reduced, which has been proven not only in European studies, but also in Russia. Based on the results of a randomized controlled multicenter study, the purpose of which was to evaluate and compare the effectiveness of two triple therapy regimens: 1) metronidazole, amoxicillin and 2) omeprazole and azithromycin, amoxicillin and omeprazole in the eradication of H. pylori infection during exacerbation of duodenal ulcer. Eradication of infection in the group receiving metronidazole 1000 mg, amoxicillin 2000 mg and omeprazole 40 mg per day for 7 days was achieved in 30% of cases (confidence interval for the 95% probability was 17%-43%). We can only join the opinion of our European colleagues who excluded this scheme from the recommendations.
Unfortunately, eradication therapy for H. pylori infection is not 100% effective. Not all provisions of the Second Maastricht Agreement can be unequivocally agreed with and without thoughtful analysis they can be transferred to our country.
Bismuth-based eradication therapy regimens are currently not very widely used in Europe. However, the frequency of use of bismuth preparations in H. pylori eradication regimens varies across countries and continents. In particular, in the United States, triple therapy regimens containing bismuth are used to treat about 10% of patients. In China, regimens with a bismuth preparation and two antibiotics are in first place in terms of frequency of prescription. In his editorial in the European Journal of Gastroenterology and Hepatology, Wink de Boer (1999) rightly noted that “bismuth-based triple therapy is perhaps the most widely used in the world, as it is the only anti-Helicobacter therapy that is effective and economically accessible in developing countries.” countries of the world in which the majority of the world's population is concentrated.” Bismuth is also recommended for widespread use in the treatment of H. pylori infection in children.
In Russia, the most widely used bismuth preparation is colloidal bismuth subcitrate (De-nol); Research is being conducted to determine the effectiveness and safety of eradication regimens using it. In 2000, the results of a study conducted by the Russian group studying H. pylori were published. In this study, eradication therapy included colloidal bismuth subcitrate (240 mg 2 times a day) + clarithromycin (250 mg 2 times a day) + amoxicillin (1000 mg 2 times a day). The duration of therapy was 1 week, eradication of H. pylori was achieved in 93% of patients. A list of other possible regimens based on data from various clinical trials is given in Table 4.
Anti-Helicobacter therapy must be improved, and these recommendations are essential for its optimization.
Antibiotics specifically directed against H. pylori, probiotics and vaccines may be included in the arsenal of anti-Helicobacter therapy in the future, but at present these drugs and treatment approaches are under development, and practical recommendations do not exist.
Of great interest are some new antibacterial drugs, which have every chance of soon taking their rightful place in generally accepted eradication therapy regimens. A good example to illustrate the possibilities of optimizing a triple therapy regimen is azithromycin, a new drug from the macrolide group. Macrolide antibiotics, presented in triple eradication regimens mainly with clarithromycin, are perhaps the most effective. Therefore, azithromycin has been tried for a number of years as one of the possible components of therapy, but in early studies a relatively low dose of the drug was used. Increasing the course dose to 3 g led to an increase in the effectiveness of the standard seven-day triple regimen based on a proton pump inhibitor to the required level of more than 80%. In this case, the undoubted advantage is that as part of a weekly course, the full dose of azithromycin is taken for three days, once a day. This is convenient for the patient and reduces the percentage of side effects. In addition, in Russia the cost of azithromycin is lower than that of other modern macrolides.
Ributin, a derivative of rifamycin S, has demonstrated very high activity against H. pylori in vitro. In combination with amoxicillin and pantoprazole, ributin led to 80% eradication in patients treated at least twice (!) with a standard triple regimen.
Despite the fact that the reputation of nitroimidazoles is “tarnished” due to the high percentage of H. pylori strains resistant to them, research into this group of drugs continues. In in vitro experiments, the new nitroimidazole, nitazoxanide, proved to be highly effective against H. pylori, and the development of secondary resistance was not observed. In vivo studies should show how this drug can compete with metronidazole.
As an alternative to multicomponent regimens, several theoretical approaches have long been proposed, for example, drug blockade of urease, an enzyme without which the existence of bacteria is impossible, or blockade of the adhesion of a microorganism to the surface of epithelial cells of the stomach. A drug that inhibits urease has already been created; its activity has been shown in laboratory studies, including in enhancing the effect of antibiotics used in anti-Helicobacter therapy.
Drugs that inhibit H. pylori adhesion - such as rebamipide or ekabet - have been studied in combination with traditional anti-Helicobacter drugs. They statistically significantly increased the percentage of eradication compared to the same regimen without mucoprotective support. The use of dual therapy (proton pump inhibitor + amoxicillin) was abandoned due to low efficiency, and the addition of rebamipide or ecabet significantly increases the percentage of infection eradication. When strains with the phenomenon of multidrug resistance are isolated that are resistant to both metronidazole and clarithromycin, the combination of ecabet or rebamipide with dual therapy may become the treatment of choice.
The opportunities that successful human vaccination against H. pylori infection may offer are difficult to assess due to their magnitude. Progress in the field of vaccine creation allows us to hope that vaccination will be available in the coming years. Tested vaccines in animal experiments protect them from infection by H. pylori and related species of the genus Helicobacter, and in some cases lead to the elimination of the microorganism. It has been established that several H. pylori antigens are required for successful immunization. Thanks to the complete decoding of the genome of the microorganism, the selection of these antigens is greatly simplified. In addition, a number of studies are aimed at improving the adjuvant system, which is essential for improving vaccine tolerability.

Aluminum hydroxide + magnesium hydroxide-
Almagel (trade name)
(Balkanpharma)

Omeprazole-
Gastrozol (trade name)
(ICN Pharmaceuticals)

Colloidal bismuth subcitrate
De-nol (trade name)
(Yamanouchi Europe)

Famotidine-
Kvamatel (trade name)
(Gedeon Richter)

Treatment of gastric and duodenal ulcers requires the use of both drug and non-drug regimens. Medication options include the prescription of antibacterial, anti-Helicobacter drugs, gastroprotectors, prokinetics, agents containing bismuth, and antisecretory drugs.

During the acute period, the patient undergoes a course of therapy in a hospital; during the remission stage, he takes prescribed medications at home in order to eliminate clinical manifestations and prevent relapse. During an exacerbation, the patient must remain in bed and avoid emotional stress to increase the effectiveness of therapy. The treatment regimen is determined by the doctor after diagnostic measures, the approach depends on the stage, symptoms,.

There are standard “first line” and “second line” schemes. “First line” involves the prescription of inhibitors, drugs containing bismuth, clarithromycin and amoxicillin are used. The second regimen is indicated in case of ineffectiveness of the first line: PPI, bismuth, metronidazole, tetracycline are used.

Treatment begins with eliminating the cause, then symptomatic therapy is carried out.

The main reasons for the expression of the disease are hereditary predisposition, bad habits, and dietary habits. The source of the disease is Helicobacter, which irritates the gastric mucosa, provokes inflammation, then an ulcer. An advanced disease without treatment can lead to malignancy.

Other reasons and factors:

1. Long-term treatment with anti-inflammatory drugs, painkillers that have an irritating effect.
2. Chronic fatigue and prolonged stress as causes of the disease occur in people with mental disorders, instability of the nervous system, and mild excitability.
3. Poor nutrition: predominance of spicy foods and sour foods in the diet. Eating only once or twice a day, overeating, irregular eating disrupts juice production, acidity, which further leads to ulcers.
4. Taking and smoking lead to poor circulation and irritation of the gastric mucosa.

It is quite difficult to detect the disease at an early stage, since symptoms appear only after serious organ damage.

The causes may be related to internal diseases of the gastrointestinal tract, endocrine system, kidneys or liver. Diabetes mellitus, tuberculosis, pancreatitis, hepatitis often lead to dyspepsia (diarrhea or constipation), irritation of the intestines and stomach, which can later develop into an ulcer. Traumatic injury and surgery are also causes of pathology.

Symptoms

1. Penicillins are prescribed - Amoxicillin.
2. Tetracycline, Metronidazole.
3. Macrolides are used - Clarithromycin.

In addition to antibacterial treatment, the patient is advised to take the following groups of drugs:

1. Drugs that inhibit secretion (antisecretory drugs): their action is aimed at reducing the production of secretions and reducing its aggressiveness. For this purpose, inhibitors, histamine receptor blockers, and anticholinergics are indicated. Representatives: Nexium, Ranitidine, Gastrocepin.
2. Bismuth medications are prescribed for ulcers caused by the bacterium Helicobacter pylori: De-Nol, Ventrisol, Pilocid.
3. Prokinetic drugs: Motilium, Trimedat. They improve peristalsis, prevent vomiting, constipation, heartburn, and heaviness in the stomach after satiety.
4. Antacids: Phosphalugel, Maalox. Indicated for heartburn. They neutralize aggressive gastric juice and have an adsorbing effect, eliminating diarrhea.

Treatment of ulcers lasts from 14 days to 2 months, it depends on the severity of the pathological process and the body’s sensitivity to certain groups of drugs.

Triple therapy

An ulcer due to increased acidity is treated with a three-component regimen: BPN, antacids, and antibacterial agents are prescribed.

Components of therapy:

1. Antibiotic Amoxicillin or Tetracycline.
2. Antimicrobial agent Tinidazole.
3. Inhibitors or bismuth-containing substances.

Additional drugs for drug treatment are sedatives necessary to normalize the psychological state, antidepressants, antispasmodics, prokinetics and probiotics (when there is constipation).

Physiotherapy

Drug therapy is accompanied by the use of physiotherapeutic techniques.

At the stage of exacerbation of the disease, when the symptoms intensify, the doctor recommends the following measures:

• heat treatment: a warming alcohol compress is prepared, which relieves pain and improves local blood circulation;
• Electrical treatment is carried out to relieve pain and relieve inflammation; this procedure improves trophic processes, normalizes digestion, eliminating constipation;
• electrophoresis with painkillers;
• ultrasound therapy for antisecretory action.

When the disease is accompanied by constipation, the doctor prescribes suppositories or an enema, supplemented with medicinal laxatives.

Diet therapy

An important stage of therapy is the correct diet, which is determined by the attending physician and nutritionist. All products have two main requirements: a gentle effect on the mucous membrane and complete saturation with the intake of all important microelements and vitamins.

During an exacerbation, a patient with an ulcer should exclude from the diet alcoholic beverages, flour, any fried and smoked foods, canned food, coffee, and strong tea. You need to eat often, in small portions, this will help control pain. Slimy soups, pureed porridges, dairy products and honey, which has a beneficial effect on microflora, will be beneficial for a sick stomach.

Complications of ulcers

Without timely treatment, an ulcer will become more complicated, which will require a radical approach. Among the complications, experts note the following:

1. Bleeding is manifested by blood in vomit, if the patient is constipated, blood is released from the rectum or along with feces.
2. The formation of scars and narrowing of the pylorus disrupts the passage of food through the intestine.
3. Penetration - rupture of the intestine is noted, and the patient has pronounced symptoms of pain.

Treatment of ulcers with complications is only surgical. After removal of part of the intestine, drug therapy continues, taking into account signs of complications during the postoperative rehabilitation period.

The human body is a vulnerable structure that requires constant care. Unfortunately, people often do not pay due attention to the changes occurring in their health. In the majority, gradually developing into a chronic form.

Any use of the medicine is agreed with the supervising physician. The information below is for informational purposes before visiting a specialized medical facility.

Bismuth based circuit

The first regimen includes a multicomponent drug intake:

• denol;
• flemoxin;
• clarithromycin;
• erythromycin.

The course takes several days. The doctor establishes a certain procedure for taking medications, which the patient must follow for the next seven days. For example, on the first day the body is treated with denol and flemoxin. The frequency and dosage are clearly prescribed by the attending physician.

Inhibitor-based regimen

For an e-like regimen, drug treatment of peptic ulcer is determined by the following drugs:

• ompeprazole;
• flemoxin;
• clarithromycin.

The situation with the assignment is similar to that in the description of the first scheme. The doctor determines the dosage, method of handling medications and time of administration. Often the treatment regimen for stomach and duodenal ulcers looks like this: ompeprazole + flemoxin + clarithromycin. Sometimes such alternation undergoes changes depending on the opinion of the employee of the medical institution.

Regimen based on histamine blockers

In the context of the new treatment regimen, other drugs are used. For example, a doctor prescribes the use of famotidine, ranitidine, flemoxin.

Often the structure of the treatment regimen looks like this: Fa+(Ra)+Fl. Changes are at the discretion of the attending physician.

Quad therapy

For many members of the older generation, such a term is unfamiliar. This therapy is already firmly established among the possible treatment regimens offered to the patient.

For conventional therapy, a four-component treatment regimen consisting of 4 antibiotics is considered typical. During quadruple therapy, two antibacterial drugs are used: tetracycline and metronidazole. Fears caused by the reduction of existing treatment drugs will turn out to be unfounded. For effective treatment, these drugs are quite enough.

The duration of the treatment regimen for peptic ulcer disease can be limited to seven days; the result depends on how productive the doctor considers the therapy to be productive and suitable for a particular patient.

Is physical therapy necessary?

The described techniques will help many people get rid of the disease or prevent further development. In addition to these schemes, there is a popular procedure that is very controversial. We are talking about physiotherapy.

The difficulty is that some doctors consider this technique to be of secondary importance. The role of physical therapy is completely undefined; sometimes doctors do not see the need for procedures. Such therapy will not be superfluous, and may help consolidate the results obtained.

Physiotherapy is prescribed as an auxiliary procedure, for example, at the stage of remission. Suitable for prevention:

• magnetic therapy;
• electrosleep;
• hydrotherapy;
• heat therapy.

Although the role of the technique is not defined, selected patients eventually recognize that during these manipulations the necessary tone is returned to the body. In any case, treatment regimens do not negate physiotherapeutic assistance; such measures will help enhance the positive results of treatment for ulcer.

Every year, scientists invent innovative methods for treating gastrointestinal pathologies. Quad therapy for gastric and duodenal ulcers, in addition to acid-lowering drugs, includes a complex of antibiotics to suppress the pathogen - Helicobacter pylori. Thanks to this course of treatment, not only the symptoms are eliminated, but also the factor that provoked the occurrence of the pathology.

What is quad therapy?

This concept includes the use of 4 drugs for a purpose that provoked the appearance of an ulcer in the gastric mucosa. Taking these medications makes it possible to eat well without resorting to strict diets recommended for diseases of the gastrointestinal tract. The convenience of frequency of use allows you not to disturb the previously established rhythm of life.

The use of combination drugs eliminates polypharmacy, and the use of long-acting forms of drugs allows you to reduce the number of daily doses.

Indications for quadruple therapy

The action of antibacterial drugs is aimed at eliminating pathogenic microorganisms.

The use of these 4 drugs is indicated in such cases as:

• The diagnosis of “peptic ulcer of the stomach or duodenum”, which was made based on the results of laboratory and instrumental research methods.
• Malt lymphoma of the stomach.
• The diagnosis of “atrophic gastritis” was established using esophagogastroduodenoscopy (EFGDS).
• The period after removal of a malignant tumor of the stomach.
• Gastrocarcinoma previously detected in close relatives of the patient.

How is quadruple therapy performed for peptic ulcer disease?

It lasts no more than 2 weeks. The scheme for using the components of quadruple therapy, as well as the nuances of dosage, are updated from time to time. This is due to new data coming from practitioners observing their patients and taking into account the results of clinical studies. According to the latest scheme, certain combinations of drugs and their dosages are used.

Any antacid

These include gastric proton pump inhibitors, which reduce acidity by blocking the release of hydrochloric acid from gastric juice. They are taken orally for a week and a half, twice a day. The dose is selected individually and depends on the physiology of the patient’s gastrointestinal tract. Antacid dosages are described in more detail in the table:

Bismuth subsalicylate

The drug stabilizes high acidity of the stomach.

This is a colloidal substance that comprehensively reduces acidity, inhibits bacterial growth and has an anti-inflammatory effect on the gastric mucosa. Used four times a day for one and a half weeks. Bismuth subsalicylate directly affects Helicobacter pylori by inhibiting the activity of the urease enzyme, which is actively involved in the metabolic processes of the bacterial cell.

Antibiotics "Metronidazole" and "Tetracycline"

This is an antibacterial and antiprotozoal substance belonging to the group of nitroimidazoles. This also includes the drugs Tinidazole and Ornidazole. Metronidazole is used 0.5 g three times a day for one and a half weeks. The mechanism of action includes the effect on the life activity of Helicobacter pylori. “Tetracycline” belongs to the series of the same name and has the property of suppressing the formation of proteins in the bacterial wall. This bactericidal feature provides a lytic effect on Helicobacter pylori. Take Tetracycline 0.5 g four times a day for a week and a half.

Eradication therapy for ulcers

The concept of “eradication” implies the complete destruction of the pathogen in order to treat the disease that it provoked. For stomach ulcers, such a pathogen is Helicobacter pylori. Eradication therapy for peptic ulcer disease is carried out with the help of bacteria to which the bacterium is sensitive. In 80% of cases it is successful. Triple therapy contains all the components to destroy the pathogen, except for bismuth preparations, which are contained in quadruple therapy.

Contraindications and side effects

Who is contraindicated for quadruple therapy?

The quadruple therapy method is not used during pregnancy and lactation.

Hypersensitivity to any of the 4 components of therapy is a direct contraindication for use. The risk group also includes:

• patients with organic lesions of the central nervous system;
• pregnant women, especially in the second and third trimesters;
• women during lactation;
• patients with renal and liver failure.