engleski

Eradication of Helicobacter pylori infection in type 2 diabetic patients

Background: Helicobacter pylori (HP) infection currently is the most important etiologic agent in the development of chronic active gastritis, gastric and duodenal ulcers, carcinoma and Malt lymphoma of the stomach. Moreover HP infection has also been associated with various extra digestive disease. A high prevalence of Helicobacter pylori infection in diabetic patients has been described in recent years. Aim: To evaluate efficacy of the HP eradication in patients with type 2 diabetes mellitus (DM) and compared it with non-diabetic patients. Methods and patients: In this study participated 44 dyspeptic patients (26 male and 14 female) mean age 46 yrs/ with diabetes mellitus and 40 non-diabetic dyspeptic patients (26 male and 14 female) mean age 42 yrs. All patients had upper gastro-intestinal endoscopy and the gastroduodenal pathology was identified. HP. infection was confirmed by gastric hystology. As metabolic control were measured fasting glucose and glucated haemoglobin (HbA1c), and was also observed duration of diabetes mellitus (>1 yr, 1-3 yr, >3 yr). A triple therapy with amoxycillin (1gr b i d), medazol (400 mg b i d), pantoprazol (40 mg b i d) as first cycle or amoxycillin (1gr b i d), claritromycin (500 mg b i d) and lanzoprazol (30 mg b i d) as second cycle (for patients in whom eradication was not successful in the first cycle) was given to both groups for 7 days. Cure was defined as the absence of H.P.infection 6 weeks after completing anti-microbial therapy and effects of H.P. eradication on gastrointestinal symptoms. Results: A higher HP infection was found in group of type 2 diabetic patients with dyspepsia (76%) versus 54% in non-diabetic patients with dyspepsia. (P< 0.001) and it's correlated with fasting glucose and HbA1c values and was directly related to the duration of DM (<1 yr 8%, 1-3 yr 26%, and >3 yr 56%). A higher prevalence correlated also with macroangiopathy and neuropathy and higher BMI and blood pressure. In patients with type 2 DM, eradication of H.P. infection was 61%, versus in non diabetic patients 82%. (P> 0.001). In patients with duration of DM >3 yr was eradication rate 47%. Conclusion: According to our results we found that H.P. infection was higher in group type 2 diabetic patients wih dispepsia than in control group. The rate of infection increases with DM duration. The eradication rate was significantly lower in patients with type 2 DM than in control group. It was not difference between HP infection and insulin dependent or nondependent diabetic patients. Our results could be explained by changes in microvasculature of the gastrointestinal tract and to frequent antibiotic usage for prevent recurrent infection in patients with DM especially in group with duration of DM more than 3 yr.

Helicobacter pylori; Diabetes mellitus; Eradication

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