State of acid-producing function of the stomach in patients with helicobacter pylori-associated gastroduodenal ulcer disease and no response to eradication therapy

This paper deals with the second phase of the prospective, randomized comparative study of the efficacy and safety of the hybrid eradication therapy (ET) regimen in patients with H. pylori-associated gastroduodenal ulcer. Objective: Evaluation of the acid-forming function of the stomach with a pharmacological proton pump inhibitor (PPI) test in patients with H. pylori-associated gastroduodenal ulcer disease and no response to eradication therapy. Materials and methods. 19 patients were enrolled in this study after the failed ET using any of the following three regimens: standard triple regimen, four-component therapy with bismuth agents, hybrid regimen; in all regimens, omeprazole (20 mg b.i.d.) was used as an IPP. All patients underwent a 48-hour intragastric pH-meter (Gastroscan-GEM device, Istok-System, Russia) to assess the initial state of the acid-forming function of the stomach during the first day and the subsequent pharmacological PPI test (omeprazole 20 mg b.i.d.) on the second day. The minimum, maximum and average pH values in the cardia and body of the stomach, as well as the time with pH> 4 in the body of the stomach during the entire study period (48 hours) were analysed. Results. Median time average with pH> 4 in the body of the stomach for the first day of the study (before PPI administration) was 1.0 hour (IQR from 0.0 to 1.5), and against a pharmacological test – 15.5 hours (IQR from 11.1 to 16.5). At the same time, an adequate alkalization of the gastric environment under pressure of IPP therapy was identified in 12 patients, when the pH level> 4 in the body of the stomach was maintained for 16–17 hours. In 7 patients, pH> 4 was maintained for less than 16 hours, which is a symptom of insufficient antisecretory effect. During this study, no PPI resistance was revealed. The conclusion. Evaluation of the state of the acid-forming function of the stomach with pharmacological tests upon conduct of the 48-hour pH-metry makes it possible to evaluate the antisecretory effect of the used PPI and, thus, to predict the probability of effective eradication.