Treatment of Helicobacter pylori infection for medical professionals

Objective. To study the frequency of the presence of Helicobacter pylori (HP), the effectiveness of eradication treatment, the factors that determine the failure of treatment among doctors in Chita. Material and methods. The study involved 164 people aged 19 to 73 years (average age 45.34 ± 13.15 years), including 93 doctors and 71 patients not related to medical activities. The presence of HP infection in 112 people was investigated by determining the antigen (AH) in the feces. 98 people were examined for the presence of HP DNA in gastric biopsies and A2142G, A2143G, and T2717C mutations in the bacterial genome, providing its resistance to clarithromycin by PCR. 59 doctors performed eradication treatment for HP with different schemes. Control of eradication was carried out 6-8 weeks after the end of therapy by determining AH HP in feces. Genetic testing was carried out in 30 doctors for the carriage of polymorphic genes CYP2C19 * 2: G681A (P227P), CYP2C19 * 3: G636A (W212X), CYP2C19 * 17: C-806T, MDR1 (ABCB1: C3435T) by PCR and the effect of the revealed genetic characteristics on the results of treatment. Statistical processing was carried out using descriptive statistics, x2 test and Fisher’s test for small samples (Biostatistics software). Results. A positive AH of HP in feces was registered in 62.5% of the examined: 66.3% of doctors and 50% in the compared population (p = 0.187). HP DNA in the gastric mucosa was detected in 49 people, which was 50% of the examined people. HP DNA was detected in 73.8% of doctors and in 32.1% of non-medical workers (p < 0.001). Subject to the treatment regimen, the effectiveness of all eradication regimens was 72.5% (regimens with clarithromycin - 72.7%, with josamycin - 100%, with tetracycline and metronidazole - 43%, with levofloxacin - 85.7%). Non-compliance with the therapy regimen was noted in 8 people. The effectiveness in this group was 12.5% (p≤0.01). Mutations in the HP genome, providing resistance to clarithromycin, were found in 38.8%: in the group of doctors - 45.2%, in non-medical workers - 27.8% (p = 0.368). In the absence of genotypic resistance, effective eradication took place in 42.1%, in the presence of resistant strains - in 16.7% (p = 0.364). When genotyping CYP2C19, ultrarapid (UM) and rapid metabolizer (RM) accounted for 30%, normal - 46.7%, intermediate - 20% and poor metabolizers (PM) - 3.3%. The effectiveness of all eradication regimens among UM and RM was 55.5%, the clarithromycin regimen - 16.7% (p > 0.05). In the CT and TT MDR1 mutant alleles, the effectiveness of all eradication schemes was 69.2% - 70%, of the clarithromycin scheme - 37.5% (p> 0.05). Conclusion. Doctors are at risk for Helicobacter pylori infection. In doctors, the infection is determined 1.3-2.3 times more often (when examined by different methods) than in patients not associated with medical activities. The effectiveness of all eradication schemes was 72.5%. The worst results were demonstrated by the scheme with tetracycline and metronidazole (43%). In case of non-adherence to the therapy regimen, the probability of successful treatment was reduced by 5.8 times. There is a tendency to a decrease in the level of eradication with genotypic resistance to clarithromycin in the genome of Helicobacter pylori, in carriers of mutant alleles with UM and RM of CYP2C19 and in the TT MDR1 genotype. The revealed reasons for the ineffectiveness of HP eradication in the doctors of Chita did not differ from the general population. The exception was the genotypic resistance of Helicobacter pylori to clarithromycin, which tended to develop more frequently in doctors.

Helicobacter pylori, doctors, prevalence, treatment efficacy, genotypic resistance to clarithromycin, polymorphism CYP2C19, MDR1

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