Skip to main content
SpringerLink
Log in

Eradikation und chronische Säureblockade

Fortschritte und Pseudofortschritte

Eradication and chronic acid suppression—True advances?

  • Arzneimitteltherapie
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die medikamentöse Therapie einer Helicobacter-pylori-Infektion richtet sich nach den Empfehlungen der Maastricht-2/2000-Konferenz (Expertenkonferenz). Weitreichende Fortschritte wurden seither nicht erzielt. Die wenigen Fortschritte bestehen im Angebot an Therapiealternativen im Falle eines primären Therapieversagens. Evidenzbasierte Aussagen sind aufgrund unübersichtlicher Studienlage und zum Teil schlechten Studiendesigns nahezu unmöglich.

In der Therapie der Refluxerkrankung ist die chronische Säureblockade der Standard. Neuerungen konnten in letzter Zeit nicht errungen werden. Bedeutend für die tägliche klinische Praxis ist, dass sich Befürchtungen relevanter Nebenwirkungen, wie die Bildung von Karzinomen, Karzinoiden und Malabsorptionsstörungen, unter einer Langzeittherapie mit Protonenpumpenhemmern bisher nicht bestätigt haben.

Abstract

Guidelines for Helicobacter pylori therapy were proposed at the Maastricht 2/2000 conference. Since then no further major developments have been made. An evidenced based choice of treatment is thereby nearly impossible as large randomized trials have not been performed. Minor progress could be achieved in the areas of second-line and rescue treatment options after failure of the standard therapy.

At present proton pump inhibitors are the most powerful drugs for the treatment of gastro-oesophageal reflux disease. No additional progress has been achieved concerning therapy of reflux disease in the last years. Reasonable anxiety about the safety of long-term acid suppression with proton pump inhibitors diminished over years as no significant increase in cancer development could be detected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Birkner B, Hotz J, Labenz J et al. (2004) Kurzgefasste Leitlinie zum Dyspepsie-Management. Dtsch Med Wochenschr 129: 1032–1034

    Article  CAS  PubMed  Google Scholar 

  2. Dent J, Brun J, Fendrick, Fennerty MB et al. on behalf of the Genval Worhshop Group (1999) An evidence-based appraisal of reflux disease management—The Genval Workshop Report. Gut 44: Suppl 2

    Google Scholar 

  3. Edwards J, Lind T, Lundell L (2001) Systematic review of proton pump inhibitors for the acute treatment of reflux oesophagitis. Aliment Pharmacol Ther 15: 1729–1736

    Article  CAS  PubMed  Google Scholar 

  4. Fakheri H, Merat S, Hosseini V, Malekzadeh R (2004) Low-dose furazolidone in triple and quadruple regimens for Helicobacter pylori eradication. Aliment Pharmacol Ther 19: 89–93

    CAS  PubMed  Google Scholar 

  5. Gillen D, Wirz AA, McColl KEL (2001) Rebound maximal acid secretion after omeprazole persists to at least 11 months after treatment. Gastroenterology 120: A158

    Google Scholar 

  6. Gisbert JP, Calvet X, Bujanda L, Marcos S, Gisbert JL, Pajares JM (2003) Rescue therapy with rifubatin after multiple Helicobacter pylori treatment failures. Helicobacter 8: 90–94

    Article  CAS  PubMed  Google Scholar 

  7. Gisbert JP, Pajares JM (2001) Helicobacter pylori therapy: First-line options and rescue regimen. Dig Dis 19: 134–143

    Article  CAS  PubMed  Google Scholar 

  8. Graham DY, Hammoud F, El-Zimaity HMT, Kim JG, Osato MS, El-Serag HB (2003) Meta-analysis. Proton pump inhibitor or H2-receptor antagonist for Helicobacter pylori eradication. Aliment Pharmacol Ther 17: 1229–1236

    Article  CAS  PubMed  Google Scholar 

  9. Guo CY, Wu YB, Liu Hl, Wu JY, Zhong MZ (2004) Clinical evaluation of four one-week triple therapy regimens in eradicating Helicobacter pylori infection. World J Gastroenterol 10: 747–749

    CAS  PubMed  Google Scholar 

  10. Hatlebak JG (2003) Review article: gastric acidity—comparison of esomeprazole with other proton inhibitors. Aliment Pharmacol Ther 17 (Suppl): 10–15

    Article  PubMed  Google Scholar 

  11. Huang J, Hunt RH (1999) The importance of clarithromycin dose in the management of Helicobacter pylori infection: A meta-analysis of triple-therapies with a proton pump inhibitor, clarithromycin and amoxicillin or metronidazole. Aliment Pharmacol Ther 13: 719–729

    Article  CAS  PubMed  Google Scholar 

  12. Klinkenberg-Knoll EC, Nelis F, Dent J et al (2000) Long term study group. Long term omeprazole in resistant gastroesophageal reflux disease: Efficiacy, safety and influence on gastric mucosa. Gastroenterology 118: 661–669

    PubMed  Google Scholar 

  13. Kuipers EJ, Klinkenberg-Knoll EC, Meuwissen SGM (1999) Helicobacter pylori, proton pump inhibitors and gastroesophageal reflux disease. Yale J Biol Med 72: 211–218

    CAS  PubMed  Google Scholar 

  14. Labenz J (2001) Current role of acid suppressants in Helicobacter pylori eradication therapy. Best Pract Clin Gastroenterol 15: 413–431

    Article  CAS  Google Scholar 

  15. Labenz J, Petersen KU, Rösch W, Koelz HR (2003) A summary of Food and Drug Administration-reported adverse events and drug interactions occuring during therapy with omeprazole, lansoprazole and pantoprazole. Aliment Pharmacol Ther 17: 1015–1019

    CAS  PubMed  Google Scholar 

  16. Laine L, Schoenfeld P, Fennerty B (2001) Therapy for Helicobacter pylori in patients with non-ulcer dyspepsia—a meta-analysis of randomized, controlled trials. Ann Intern Med 134: 361–369

    CAS  PubMed  Google Scholar 

  17. Laine L, Ahnen D, McClain C, Solcia E, Walsh JH (2000) Review article: potential gastrointestinal effects of long term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther 14: 651–668

    Article  CAS  PubMed  Google Scholar 

  18. Lamberts R, Brunner G, Solcia E (2001) Effects of very long (up to 10 years) proton pump blockade on human gastric mucisa. Digestion 64: 205–213

    Article  CAS  PubMed  Google Scholar 

  19. Lind T, Megraud F, Unge P et al. (1999) The MACH-2-study: role of omeprazole ineradication of Helicobacter pylori with one-week triple-therapies. Gastroenterology 116: 258–253

    Google Scholar 

  20. Lind T, Veldhuyzen van Zanten S, Unge P et al. (1996) Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antibiotics: the MACH-I-Study. Helicobacter 1: 138–144

    CAS  PubMed  Google Scholar 

  21. Malfertheiner P, Megraud F, O’Morain C, Hungin AP, Jones R, Axon A, Graham DY, Tytgat G (2002) Current concepts in the management of Helicobacter pylori infection—the Maastricht 2–2000 concensus report. Aliment Pharmacol Ther 16: 167–180

    Article  CAS  Google Scholar 

  22. Malfertheiner P, Peitz U, Treiber G (2003) What constitutes failure of Helicobacter pylori eradication therapy? Can J Gastroenterol 17 (Suppl): 53B–57B

    PubMed  Google Scholar 

  23. Meuwissen SGM, Craanen ME, Kuipers EJ (2001) Gastric mucosal morphological consequences of acid suppression: a balanced view. Best Pract Res Clin Gastroenterol 15: 497–510

    Article  CAS  PubMed  Google Scholar 

  24. Miehlke S, Bayerdörffer E, Graham DY (2001) Treatment of Helicobacter pylori infection. Sem Gastrointest Dis 12: 167–179

    CAS  Google Scholar 

  25. Miehlke S, Kirsch C, Schneider-Brachert W et al. (2003) A prospective randomized study of quadruple therapy and high-dose dual therapy for treatment of Helicobacter pylori resistant to both Metronidazole and Clarithromycin. Helicobacter 8: 310–319

    Article  CAS  PubMed  Google Scholar 

  26. Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D (2003) An update of cochrane systematic review of helicobacter pylori eradication therapy in non-ulcer dyspepsia: resolving the discrepancy between systematic reviews. Am J Gastroenterol 98: 2621–2626

    PubMed  Google Scholar 

  27. Moayyedi P, Soo S, Deeks J et al. (2003) Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev (1) CD 002096

  28. Pantoflickova D, Dorta G, Ravic M, Jornod P, Blum AL (2003) Acid inhibition on the first day of dosing: comparison of four proton pump inhibitors. Aliment Pharmacol Ther 17: 1507–1514

    Article  CAS  PubMed  Google Scholar 

  29. Parente F, Cucino, Bonchi P (2003) Treatment options for patients with Helicobacter pylori infection resistant to one or more eradication attempts. Dig Liv Dis 35: 523–528

    Article  CAS  Google Scholar 

  30. Schilling D, Riemann JF (2003) Evidenzbasierte konservative Therapie der gastroösophagealen Refluxkrankheit. Internist 44: 21–27

    CAS  PubMed  Google Scholar 

  31. Stedman CAM, Barclay ML (2000) Review article: comparison of the pharmocokinetics, acid suppression and efficiacy of proton pump inhibitors. Aliment Pharmacol Ther 14: 963–978

    Article  CAS  PubMed  Google Scholar 

  32. Suerbaum S, Michetti P (2002) Helicobacter pylori infection. N Engl J Med 347: 1175–1186

    Article  CAS  PubMed  Google Scholar 

  33. Svoboda AC (2001) Increasing concerns about chronic proton pump inhibitor use. J Clin Gastroenterol 33: 3–10

    Article  PubMed  Google Scholar 

  34. Tam W, Dent J (2002) Oesophageal disorders: future developments. Best Pract Res Clin Gastroenterol 16: 811–833

    Article  PubMed  Google Scholar 

  35. Van Oijen AHAM, Verberek AL, Jansen JBMJ, De Boer WA (2000) Review article: treatment of Helicobacter pylori infection with ranitidine bismuth citrate- or proton pump inhibitor-based triple therapies. Aliment Pharmacol Ther 14: 991–999

    Article  PubMed  Google Scholar 

  36. Vergara M, Vallve M, Gisbert JP, Clavet X (2003) Meta-analysis: comparative efficiacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther 18: 647–654

    Article  CAS  PubMed  Google Scholar 

  37. Watanabe Y, Aoyama N, Shirasaka D et al. (2003) Levofloxacin based triple therapy as a second-line treatment after failure of helicobacter pylori eradication with standard triple therapy. Dig Liver Dis 35: 711–715

    Article  CAS  PubMed  Google Scholar 

  38. Xia HH, Yu Wong MC, Talley NJ, Lam SK (2002) Alternative and rescue treatment regimens for Helicobacter pylori eradication. Expert Opin Pharmacother 3: 1301–1311

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH

    S. Turi, D. Schilling &  J. F. Riemann

  2. Medizinische Klinik C, Klinikum der Stadt Ludwighafen gGmbH, Bremserstraße 79, 67063, Ludwigshafen am Rhein

    J. F. Riemann

Authors
  1. S. Turi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Schilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. F. Riemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. F. Riemann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turi, S., Schilling, D. & Riemann, J.F. Eradikation und chronische Säureblockade. Internist 45, 1305–1314 (2004). https://doi.org/10.1007/s00108-004-1237-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-004-1237-0

Schlüsselwörter

Keywords

Search

Navigation