H. pylori: Implicações atuais e a resistência à terapia antimicrobiana – revisão de literatura
Treatment and therapeutic resistance of H. pylori: review of literature
Thiago Celeira de Sousa, Ursula Tatiane de Farias Hounsell Almeida, Dauana Arruda de Oliveira Bastos
Resumo
Objetivo: Realizar uma revisão sobre os tratamentos e a resistência do H. pylori. Método: A pesquisa foi desenvolvida no período de Fevereiro a Junho de 2018, e realizada a partir das bases de dados: Medline, SciELO, LILACS, PubMed, e Bireme por meio dos descritores: Helicobacter Pylori, Resistência Antimicrobiana, Prevalência e Câncer Gástrico. Resultados: A busca por literatura produziu um total de 85 artigos que foram submetidos a avaliação por dois avaliadores independentes. Destes, 20 atenderam critérios de inclusão previamente estabelecidos. Conclusão: A totalidade dos estudos envolvidos nesta pesquisa nos mostram uma elevada prevalência da infecção por H. pylori e alta taxa de resistência para muitos antibióticos, tendo isto um impacto preocupante em um continente com áreas de alta prevalência de contaminação e também com altas taxas de incidência de doenças graves relacionadas a infecção, como lesões pré-neoplásicas e o adenocarcinoma gástrico. As taxas de resistência á claritomicina variaram entre 11,1% a 47% nos resultados dos artigos selecionados para este estudo, sendo portando o antimicrobiano que apresentou a maior taxa de resistência. Em relação ao tratamento, os 3 principais guidelines utilizados (Colégio Americano, Consenso Brasileiro e Consenso Europeu) concordam em relação á primeira linha de tratamento, porém os consensos Europeu e Americano propõem o uso de metronidazol como alternativa á amoxicilina nesta linha de tratamento.
Palavras-chave
Abstract
Purpose: Reviewer of the treatments and resistance of H. pylori. Method: The research was carried from February to June 2018, and performed from the databases: Medline, SciELO, LILACS, PubMed, and Bireme by means of the descriptors: Helicobacter Pylori, Antimicrobial Resistance, Prevalence and Gastric Cancer. Results: The search for literature produced a total of 85 articles that were submitted to evaluation by two independent evaluators. Of these, 20 met previously established inclusion criteria. Conclusion: All the studies involved in this study show a high prevalence of H. pylori infection and a high resistance rate for many antibiotics. This has a worrying impact in a continent with areas of high contamination prevalence and also with high rates of incidence of serious infection-related diseases such as pre-neoplastic lesions and gastric adenocarcinoma. The rates of resistance to clarithromycin ranged from 11.1% to 47% in the results of the articles selected for this study, with the antimicrobial having the highest resistance rate. Regarding treatment, the 3 main guidelines used (American College, Brazilian Consensus and European Consensus) agree on the first line of treatment, but the European and American consensus proposes the use of metronidazole as an alternative to amoxicillin in this treatment line.
Keywords
Referências
1. Park JY, Forman D, Waskito LA, Yamaoka Y, Crabtree JE. Epidemiology of Helicobacter pylori and CagA-Positive infections and global variations in gastric cancer. Toxins (Basel). 2018;10(4):163. http://dx.doi.org/10.3390/toxins10040163. PMid:29671784.
2. Passos MCF. Drug resistance in Helicobacter pylori. Arq Gastroenterol. 2016;53(4):213-4. http://dx.doi.org/10.1590/S0004-28032016000400001. PMid:27706448.
3. Teixeira TF, Souza IKF, Rocha RDR. Helicobacter pylori: Infecção, diagnóstico laboratorial e tratamento. Percurso Acadêmico. 2016;6(12):481- 504. http://dx.doi.org/10.5752/P.2236-0603.2016v6n12p481.
4. Crabtree JE, Wessler S. Special Issue “H. pylori Virulence Factors in the Induction of Gastric Cancer”. Toxins (Basel). 2018;10(5):176. http:// dx.doi.org/10.3390/toxins10050176. PMid:29701631.
5. Vesga FJ, Moreno Y, Ferrús MA, Campos C, Trespalacios AA. Detection of Helicobacter pylori in drinking water treatment plants in Bogotá, Colombia, using cultural and molecular techniques. Int J Hyg Environ Health. 2018;221(4):595-601. http://dx.doi.org/10.1016/j. ijheh.2018.04.010. PMid:29709385.
6. Zamani M, Ebrahimtabar F, Zamani V, Miller WH, Alizadeh-Navaei R, Shokri-Shirvani J, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018;47(7):868-76. http://dx.doi.org/10.1111/apt.14561. PMid:29430669.
7. Coelho LG, Maguinilk I, Zaterka S, Parente JM, Passos MCF, Moraes-Filho JPP, et al. IVth Brazilian Consensus Conference on Helicobacter pylori infection. Arq Gastroenterol. 2018;55(2):97-121. http://dx.doi.org/10.1590/s0004-2803.201800000-20.
8. Luscenti RS, Gatti LL. Diagnóstico molecular da infecção pelo Helicobacter Pylori em mucosa gástrica. Rev Para Med. 2008;22(1):21-26.
9. Zagari RM, Rabitti S, Eusebi LH, Bazzoli F. Treatment of Helicobacter pylori infection: a clinical practice update. Eur J Clin Invest. 2018;48(1):128- 57. http://dx.doi.org/10.1111/eci.12857. PMid:29144559.
10. Long X, Chen Q, Yu L, Liang X, Liu W, Lu H. Bismuth improves efficacy of proton-pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance. China. Helicobacter. 2018;23(3):e12485. http://dx.doi. org/10.1111/hel.12485. PMid:29696736.
11. Abdoh Q, Kharraz L, Ayoub K, Khraim J, Awad W, Sbeah A, et al. Helicobacter pylori resistance to antibiotics at the An-Najah National University Hospital: a cross-sectional study. The Lancet. 2018;391(S32):32. http://dx.doi.org/10.1016/S0140-6736(18)30398-2.
12. Sanches BS, Martins GM, Lima K, Cota B, Moretzsohn LD, Ribeiro LT, et al. Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil: a national survey. World J Gastroenterol. 2016;22(33):7587-94. http://dx.doi.org/10.3748/wjg.v22.i33.7587. PMid:27672279.
13. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2016;66(1):6-30. PMid:27707777.
14. Crabtree JE, Wessler S. Special Issue “H. pylori Virulence Factors in the Induction of Gastric Cancer”. Toxins (Basel). 2018;10(5):176. http:// dx.doi.org/10.3390/toxins10050176. PMid:29701631.
15. Gatta L, Scarpignato C, Fiorini G, Belsey J, Saracino IM, Ricci C, et al. Impact of primary antibiotic resistance on the effectiveness of sequential therapy for Helicobacter pylori infection: lessons from a 5-year study on a large number of strains. Aliment Pharmacol Ther. 2018;47(9):1261-9. http://dx.doi.org/10.1111/apt.14597. PMid:29536561.
16. Muñoz N, Sánchez-Delgado J, Baylina M, Puig I, López-Góngora S, Suarez D, et al. Systematic review, meta-analysis, and meta-regression: Successful second-line treatment for Helicobacter pylori. Helicobacter. 2018;23(3):e12488. http://dx.doi.org/10.1111/hel.12488. PMid:29663581.
17. Georgopoulos SD, Papastergiou V, Martinez-Gonzalez B, Xirouchakis E, Familias I, Sgouras D, et al. Hybrid therapy as first-line regimen for Helicobacter pylori eradication in a high clarithromycin resistance area: a prospective open-label trial. Ann Gastroenterol. 2018;31(2):205-10. PMid:29507467.
18. Martins GM, Sanches BSF, Moretzsohn LD, Lima KS, Cota BDCV, Coelho LGV. Molecular detection of clarithromycin and fluoroquinolones resistance in Helicobacter pylori infection, directly applied to gastric biopsies, in an urban Brazilian population. Arq Gastroenterol. 2016;53(2):113-7. http://dx.doi.org/10.1590/S0004-28032016000200012. PMid:27305419.
19. Marin AC, McNicholl AG, Gisbert JP. A review of rescue regimens after clarithromycincontaining triple therapy failure (for Helicobacter pylori eradication). Expert Opin Pharmacother. 2013;14(7):843-61. http://dx.doi.org/10.1517/14656566.2013.782286. PMid:23537368.
20. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-39. http://dx.doi.org/10.1038/ajg.2016.563. PMid:28071659.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email