Lіkuvannya virazkovoi ailment Maastrichtian 5. Maastrichtian - IV: modern and radical schemes

Chergiv XXIV Session of the International Working Group on Helicobacter pylori and Native Bacteria in Chronic Ignition Processes herbal tractі shlunk cancer - XXIVth International Workshop on Helicobacter and related bacteria in chronic digestive inflammation and gastric cancer - was found in Dublin (Ireland) on September 11-13, 2011. A number of additional events and emergencies in the boules are attributed to the greatest hospitality for the international heliobacterium colossal problems - the build-up of resistance to infection to clarithromycin and levofloxacin, new adolescents for diagnostics See Dr. F. Megraud
(INSERM U853 & Universite de Bordeaux, Bordeaux, France) under the name "Management of Helicobacter pylori infection Maastricht-4" is based on the main solidarity of the fresh Maastrichs. On the basis of the theory of preconceptions, as well as the desire on Tverdzhennya of the Maastricht lands, like the bully present in the preconceptions of T.L. Lapin. (Clinic of propedeutics of internal ailments, gastroenterology and hepatology named after V.Kh. Vasilenko MMA named after I. M. Sechenov) at the 4th Ukrainian Gastronomic Week it is possible to get closer to the snake of the Fourth Maastricht. Vibrani slides of additional indications and keys of Tverdzhennya (Regulation) are published below:

FD position :
3. Eradication of HP onset and triviality of symptoms in 1 out of 12 patients with HP and FD with change in some cases with other types of disease.
4. HP can increase or decrease the secretion in fallowness as a pattern of firing into the shlunk.

Position on the coat of arms :
5. H. pylori does not infuse into the severity, frequency of symptoms and the effectiveness of therapy in HERH.
6. Epidemiological preliminaries demonstrate a negative association between the broadening of HP and GERD and adenocarcinoma in the duct.

Refinery regulations :
7. NR adolescents of accelerated and non-erect gastroduodenal virazok in taking non-steroidal anti-fatigue. Eradication of HP is a reducer of risik.
8. Eradication of NR is especially indicated for patients with a tight anamnesis for VC.
9. Eradication of HP itself does not by itself assimilate the risk of virality.

Position on intestinal metaplasia :
11. With the help of HP's improvement, the functional power of the slurry grows, but it is somewhat tied to the regressive atrophy, it becomes spirited.
11b... Overconfidence of proofs, but the improvement of HP has been preceded by regression of CM, as long as it has not been resolved.

Provision for extragastric disease :
13. Find and prove the connection НР і ЗДА, ІТП і віт.B12 SO.
There is still a lack of evidence of the link between HP and other HPV, including cardiovascular and neurological.
14. It has been reported that HP does not rob the protective action of BA and atopia, obesity and those who are associated with it.
15. In the HP (+) patient, HP will reduce the bioavailability of thyroxine.

Hardened 1:
DIAGNOSTIC ACCURACY OF ANTIGENOVA STILETS-TEST PRIOR UDT AT VALIDATION OF THE FIRST MONOCLONAL LABORATORY TEST.
- Level of proof: 1a
- Step of recommendation: А

Hardened 2:
Not all serological tests are real. At the connection with the variable accuracy of the commercial tests, the test results are obtained from the victorious ones and from the validated IgG serological tests.
- Level of proof: 1b
- Step of recommendation: B

Hardened 3:
Validated serology can be used to clarify the definition of antimicrobial and antisecretory drugs, in case of severe bleeding, atrophy and slunk powder.
- Level of proof: 1b
- Step of recommendation: B
* Expert thought (5D)

Hardened 4:
For the patients who love from the IPP stasis
1) As much as possible, the IPP is guilty of being guilty for 2 months before the test for additional cultural culture, histology, fast urease test, UDT, for example, for feces.
- Level of proof: 1b
- Step of recommendation: А
2) It’s not a good thing, maybe a validated serology was carried out.
- Level of proof: 2b
- Step of recommendation: B

Hardened 5:
1) It is important to carry out the identification of cultural and standard sensitivity to antimicrobial drugs:
- before the signs of the therapy of the first line, if the standard clarithromycin scheme is taken to respect the standard, as to revenge the consumer therapy, in regions where the population has high resistance to clarithromycin.
- before the therapy of another line in all regions, at the endoscopy for the reason, and
- the head rank, in times of the recent therapy of another line.
- Level of proof: 5
- Step of recommendation: D
2) Yaksho standard value Sleepiness is uncomfortable, there can be a molecular genetic test for the detection of H. pylori and resistance to clarithromycin and / or fluorcinol, without medication on biopsy material.
- Level of proof: 1b
- Step of recommendation: А

Hardened 6:
1) As well as H. pylori visions from shlunkovye biopsy, the test for sensitivity to antibiotics and for metronidazole is guilty.
-Riven of proof: 1b
-Step of recommendation: А
2) It is clear that the anti-clarithromycin resistance is molecular-genetic, and the cultural significance of the resistance to metronidazole is not valid.
-Riven of proof: 5
-Part of recommendation: D

Hardened 7:
It is seen as a form of emergency therapy with IPP and clarithromycin (without pre-delayed sensitivity to clarithromycin) with an increased resistance to clarithromycin in the region of more than 15-20%.
- Level of proof: 5
- Step of recommendation: D.

Hardened 8:
In regions with a low level of resistance to clarithromycin, regimens with clarithromycin are recommended as the first line of empirical therapy. An alternative is to serve as a sign of quadrotherapy with the preparation of bismuth.

- Step of recommendation: A.

How to polish the results of standard consumer therapy?

Hardened 9:
Appreciating a high dose of IPP (two per day) increases the effectiveness of the therapy.
- Level of proof: 1b
- Step of recommendation: A.
Hardened 10:
The improvement of the triviality of consumer therapy with IPP and clarithromycin from 7 to 10-14 days increases the level of successful radiation by 5%, which is followed by the recovery.
- The level of proof: 1a.
- Step of recommendation: A.
Hardened 11:
The effectiveness of the schemes "IPP - clarithromicin + metronidazole" and "IPP + clarithromicin + amoxicilin" is equivalent.
- The level of proof: 1a.
- Step of recommendation: A.

Yak polіpshiti results?
Statement 12:
Songs about prebiotics demonstrate promising results in the quality of adjuvant therapy and reduce side effects.
Hardened 13:
Standard schemes are not guilty but adapted to the particulars of the patient, except for the dose.

Therapy of another line
Hardened 14:
1) For a non-effective regimen with IPP and clarithromycin, it is recommended that quadrotherapy be used with Bismuth, or if necessary, with levofloxacin.
- Level of evidence: 1a.
- Step of recommendation: A.

- Level of evidence: 2b.
- Step of recommendation: B.

Therapy of the third line
Hardened 15:
For non-effective therapy of other lines, the sign of treatment may begin at the first-time tenderness of the sensitivity test to antibiotics.
- Level of proof: 1s
- Step of recommendation: A.

Region with high level of resistance to clarithromycin
Hardened 16:
In regions with a high level of resistance to clarithromycin, quadrotherapy with the drug bismuth is recommended in the first line of empirical therapy. Since the scheme is uncomfortable, it is recommended to follow the therapy or quadrotherapy without the preparation of Bismuth.
- The level of proof: 1a.
- Step of recommendation: A.

The study of the efficacy of the efficacy of the therapeutic regimens with clarithromycin in the prevalence of resistance to clarithromycin
Clarithromycin resistance 10% 30%
Standard consumer therapy 83% 69%
Post-mortem therapy 92% 87%

Therapy of other and third lines
Solidified 14b.:
1) In regions with a high resistance to clarithromycin, for failure of quadrotherapy with the drug Vismut, it is recommended to use levofloxacin.
- The level of proof: 5.
- Step of recommendation: D.
2) Slіd vrahovuvati іvnі іvnі resistance to levofloxacin.

- Step of recommendation: V.
Solidified 15b .:
The lack of therapy of another line of obsolescence of a given addiction is guilty of testing sensitivity to antibiotics.
- The level of proof: 1s.
- Step of recommendation: A.

In case of allergy to penicilin
Hardened 17:
In regions with low resistance to clarithromycin - IPP + K + M
In regions with high resistance to clarithromycin - quadrotherapy with bismuth - IPP + B + M + T.
- The level of proof: 2C.
- Step of recommendation: V.

Hardened 18:
Yak UDT (urea dichal test), as well as laboratory assessments of monoclonal style tests are recommended in the quality of non-invasive tests for the purpose of evaluating the success of medical therapy. Serology is not required.
- The level of proof: 1a.
- Step of recommendation: A.

Control of the therapy
hardened 19:
The interval for the completion of the effective therapy should be at least 4 times.
- Level of proof: 2b.
- Step of recommendation: V.

special recommendations
Hardened 20:
1) If YABDK is not flattened, it is not recommended to continue the IPP treatment.
- The level of proof: 1A.
- Step of recommendation: A.
2) In case of ID and accelerated DU, it is recommended to continue IPP.

- Step of recommendation: A.
hardened 21 :
Eradication therapy for bleeding from virazok is guilty at the moment of reintroduction of eating through the mouth.
- Level of proof: 1b.

A.A. Sheptulin

Olena Oleksandrivna Poluektova, Lykar, candidate of medical sciences:

- Infection of the Maastricht-IV. Modern and Radical Schemes ", Arkady Oleksandrovich Sheptulin.

Arkady Oleksandrovich Sheptulin, Professor, Doctor of Medical Sciences:

- Good day, shanovny colleagues. In order for it to be more beautiful than that, and the new Maastricht-IV is coming out of the weather, let’s just briefly, more closely guessed the main position ahead of the Maastricht-III consensus.

Consensus "Maastricht-III", the first for everything, having established the main indications for carrying out radiation therapy. All of you know well: the sinus disease, the malt-lymphoma of the slunker, the atrophic gastritis, the process of the resection of the slunker with the drive early cancer, Tse the most relatives of the ailments for cancer of the shlunk and the bazhannya of the patient himself in quiet vipadki, as in the case of a new one for a proof.

Consensus "Maastricht-III" having looked at three disputable nutrition, there is a need for a combination of pyloric gelcobacter and such diseases as functional dyspepsia, gastropathy, associated with the intake of non-steroidal ulcerative diseases.

If there is a functional dyspepsia, then carrying out a long time meta-analysis of a great number of robots has shown that the effectiveness of the treatment of dyspepsia is not apparent. Indicator NNT before 17: 17 patients are needed for us to get rid of, one sick person got scarg. Protest, those, about what Tetyana Lvivna spoke about - about the significance of the pyloric helikobacter in the development of the shlunk cancer, and also about those, that the pyloric helicobacter is the main factor in the development of the pyloric swirling ailments in lands with high contamination - and, unfortunately, we are put to such lands - in case of functional dyspepsia, the diagnosis of pyloric gelcobacter is indicated, and in case of positive results of the treatment.

It was established that the development of NPZP-gastropathy in H. Pilori-positive people with ailments, but in H. pick it up. Before the harvest at the oil refinery plant, it was thoroughly confirmed that there was an evidence of infection and that it should be carried out in case of confirmation. A little more important is the remark - that only the eradication of the pyloric Helicobacter is not enough for the prevention of the diagnosis of NVPV-gastropathy. To the one that the sick person has a dodatkovo factor for the risk of NVPV-gastropathy - abduction vik, Evidence in anamnesis of fever ailments, one-hour intake of corticosteroids or anticoagulants - then the corticosteroids are likely to be indicative of a preoccupation with the proton pump.

Yakscho take a broad colo negastroenterologіcheskіh zahvoryuvan, the phone reception of іnfektsієyu pyloric gelіkobaktera postavlenі tіlki Dvi nozologіchnі Form: tse іmunna trombotsitopenіya - here Je perehreschennya antitіl to pіlorichnomu gelіkobakter i antitіl to trombotsitіv - i zalіzodefіtsitna anemіya, Ale in quiet vipadkah, Yakscho not obstezhennya have revealed some of the causes of hypertension anemia, sputum, bleeding.

Who are the ones who are sick, in the first place ischemic ailments heart, then in the Danish hour of overconflicting proofs for the connection of the cich illnesses with the infection of the pyloric Helicobacter nemaє.

Consensus "Maastricht-III" based on the basic provisions in the diagnosis of infection of the pilorrhea Helicobacter. If the ailment does not undergo esophagogastroduodenoscopy, then for the diagnosis of the infection, it is important to diagnose the urease dichal test, which is assigned to the antigen of the pyloric gel in the case of a serological method. Most often, the presence of a piloric Helicobacter at the time of the gastroduodenoscopy is evident: say, a sick person has a twist or erosion. Here, for diagnostics, call up a quick urease test.

To control eradication, it is better to use a dichny urease test. In case of unpleasantness of the second conduct - see the antigen of the pyloric gelcobacter in the feces. Even more importantly, in-line antisecretory therapy reduces the incidence of pyloric Helicobacter antigen in feces and the frequency of positive results in the dichy test.

And it is important that the identification of pyloric Helicobacter strains - zokrem, cagA-strains, vacA-strains and others - is not of little significance in the virgin food for the treatment of ailments. If there is a strain of a pyloric Helicobacter, if the ailment comes in before an indication for the redevelopment is carried out, it will be carried out.

As for the liking, the consensus "Maastricht-III" is based on the scheme of the first, other line and reserve scheme of therapy.

The scheme of the first line - a standard use of therapy, already mentioned by Tetyana Lvivna - includes a proton pump blocker in a lower dose. Tse Rabeprazole, ale before we wrote Pariet, to that we didn’t have any drugs. Aunty Lvivna said that at the same time we already had rabeprazole analogs, and Zokrem, Ontaym - in combination with clarithromycin and amoxicilin. The scheme is indicated, as the resistance to clarithromycin in this region does not outweigh 20%.

If you adhere to the scheme of another line, then the blockers of the proton pump in a sub-dose - Tetracycline, Metronidazole and preparations for bismuth - become stagnant. Bulo okremo is suspended, so the scheme is effective if it is resistant to metronidazole.

Also, the consensus "Maastricht-III" was established, but the efficiency for the 14-day rate of radiation is approximately 10% in the middle, below the seven-day rate.

I, nareshty, as the schemes of the first and other lines appear to be ineffective, in the order of the car there are a lot of possibilities of the given game. The price of an additional dose of Amoxicilin up to three grams for a supplement in a combination of two times more - there is not 4 times for a supplement, but for a dose - say, if the same Rabeprazole, the price is not 40 mg, but 80 mg for extra

Bulo proponents substitute Metronidazole in Furazolidone quadrotherapy schemes, in combination with proton pump blockers and amoxicillin antibiotics rifabutin or Levofloxacin. A short version of the backup scheme is a set of individual antibiotics for the purpose of sensitization of the microorganisms.

What is the role of the proton pump in the proton pumping schemes? First for everything, it smells like a self-contained antiheliobacterial activity: reducing the amount of slunk secretion, the stench increases the concentration of antibiotics in the slurry juice, and, smut, creates an optimal pH for children.

Tetyana Lvivna also spoke about rabeprazole. According to the recommendations of the Russian Gastroenterological Association in 2000, Rabeprazole was known to be the most suitable for the treatment of ailments on the malignant ailment. For what it is, it’s not because of the cytochrome P450 system in operation, but it’s obvious that we know all the possible side effects of the proton pump. The effect of rabeprazole grows more quickly and turns out more. Rabeprazole is more effective, less proton pump inhibitors, induces pyloric gelcobacter pyloric growth. First, it is shown at every hour that the seven-day course of treatment with rabeprazole appears to be more effective, less than the ten-day course of treatment with omeprazole.

It is shown that in rabeprazole in all schemes of treatment with metronidazole, amoxicilin, clarithromycin, the lowest concentration of inflammation is indicated, so that it is the most active in the anti-pyloric hyperthermic

It is shown here that the concentration of rabeprazole is 64 times lower than that of omeprazole. In addition, Rabeprazole is used to release mucin and mucin, preventing the mucus membrane. The first axis of that slide, which was shown by Tetiana Lvivna: Ontaym is a price form, a new version, a new analogue of rabeprazole is guilty of its pharmacodynamic and pharmacogenetic powers, which will increase the analogy of Pariet.

Why did it change for the fate that passed in the moment of accepting the consensus "Maastricht-III"? In the first place, there were expanded two new schemes of radiation: the last therapy and the so-called concomitant. Who has the sense of the scheme? The head is zavdannya - podolati quickly grows stiffness to clarithromycin. The last scheme of transferring two five-day courses: on the ear of a combination of proton pump and Amoxicillin, other five days - the combination of proton pump with clarithromycinol and metron.

A collection of the results of the whole scheme will be taken away with the help of gastroenterologists, I would like to say that all robots have gone from Italy, that would not have been confirmed. Until 2011, analogous results were thrown away and in the European regions, in the United States of America, that in Denmark the scheme is very effective.

To admit the supplementary scheme of eradication, the same scheme of quadrotherapy with an additional antibacterial drug. Tsequadrotherapy without drugs in bismuth. The price is a standard consumer therapy, before which one more antibacterial drug can be supplied. Most often Metronidazole. You should see that the effectiveness of the supportive therapy is also the tempo and the reach is 90%.

There is widespread use of levofloxacin regimens. On the cob, a dose of 500 milligrams was added, and in a given hour - 1000 milligrams. Levofloxacin has become a substitute for Clarithromycin in standard and post-treatment regimens. True, there and then appeared a serious problem of shvidkozrostayucha the stiffness to levofloxacin.

From the same time, to what time did the Maastricht IV consensus come to be? Check it out: 45 experts from 26 countries discussed the situation - showing up to radiation, diagnostics and treatment, prophylaxis and screening of cancer. The decision was respected by the accepted, as more than 70% of those present voted for a new one, and you should have three meals, which were negotiated.

Otzhe, there is a problem of functional dyspepsia. In the zagaly, one hundred percent shown by nothing, melodiously, new in the context of "Maastricht-III" is not positioned. In the regions with a high widening of the infection of the pyloric Helicobacter, we are sick with the functional dyspepsia, it is shown that the disease has been carried out. Here I write in the arches the diagnosis "chronic gastritis s key symptoms"That is why in our country and earlier there are a lot of drugs, especially outside practice, to this day they are treated with the clinical diagnosis of" chronic gastritis ".

It has been confirmed that the treatment of pyloric helicobacter is not the cause of the coat of arms, it is not the sharpening of the coat of arms, it is not infused into the efficiency of the treatment. However, it is obvious that the correlation between infectious pyloric gelcobacter, GERD, Barrett's strain and the development of adenocarcinoma of the strain is negative.

If there is a non-gastroenterological illness, then the radicalization, as it was said, is carried out in the case of ailments with an autoimmune idiopathic thrombocytopenia and idiopathic hypertensive anemia. Eradication may be effective in B12 deficiency anemia, however, the level of evidence of abandonment is low.

Yak and consensus "Maastricht-III", "Maastricht-IV" having installed, pyloric helicobacter advances the development of NPZP-gastropathy, we have a problem, as it takes a trivial hour to get rid of the drug, it is shown eradication. Eradication can change the turn of atrophy in the fundal form of the slunk, but it is even more important in terms of cancer prevention, rather than infusing it into the turn of the intestinal metaplasia.

If we talk about diagnostics, then the two main tests are the urease test and the value of the antigen in the calories - equivalent for its accuracy. But if the serological method is used, then the whole method, the results of which are not infused with the difficulty of pyloric gelcobacter (I may be on your feet), the manifestation of atrophy of mucous, taking antisecretory drugs and antibiotics. Ale bulo is specially fitted, so that for rejection of accurate results, it is necessary to start an antibody to the class of immunoglobulin G.

If the ailment will be removed from the proton pump, then it will need to be pinned two times before the test. If it is not possible to skasuvati the proton pump, then it is necessary to use the serological method. If the microbiological method is used, then the culture of microorganisms needs to be eliminated from the sick for ineffective treatment for individual preparation of drugs.

New, which has been introduced into diagnostics by the Maastricht-IV plant, is introduced into the clinical practice of molecular methods. For example, the development of lantsyugov reaction in real-time mode is used to develop resistance to clarithromycin.

Consensus "Maastricht-IV" hastened the number of anti-drug schemes, which in this day may be stalled. Is it superfluous? The price is a standard consumer scheme (7 or more days), a final scheme (10 days), a quadrotherapy scheme with Bismuth drugs (also 10 days), a normal scheme, they talked about (10 days) and Edina backup scheme (with levofloxacin) may be trivial for at least 10 days).

Yak zastosovuvati ci schemes? The stagnation of visa regimens is an indicator of the stability to clarithromycin in the given region. If the strength does not change 10%, then it is possible to recognize in the first line a standard consumer therapy without prior testing. If the indicators of resistance to clarithromycin range from 10 to 50%, then it is necessary to carry out an earlier test for sensitivity to the whole antibiotic.

How mi bachimo on the edges of Western Europe? However, the sensitiveness in Austria and the Ugorsk region shows how the two lands were prone to the same land. Ale at the same hour, mi bachimo duzhe low indicators stikosti, say in Ireland and in Nimechchin.

If you feel good about our country, then you should know: the recent years spent in St. Petersburg, Smolensk, Nizhny Novgorod and Novosibirsk showed that the resistance to clarithromycin in our country is less than 10%. This means that it is recommended for regions with low resistance to clarithromycin. In such a fallacy, the scheme of the first line is a standard use of therapy. Maybe the last therapy or quadrotherapy with bismuth drugs is stagnated. Yak schemes of another line - a scheme of quadrotherapy with preparations of bismuth, or the use of therapy with levofloxacin. The first scheme of the third line is to be guided on an individualized basis of sensitivity to antibiotics.

I know it has been confirmed that the adjustment of the dose of the proton pump in two times allows the adjustment and the efficiency of approximately 5%. For the first time, it was officially announced that antibiotics can be added to the antibiotics in the treatment regimens as an adjuvant therapy can increase the effectiveness. We and earlier widely used probiotics, enterol zokrema, albeit mainly for the reduction of risik side effects, Intestines Ale viyavilosya, it is possible with such a rank of promotion and efficiency of radiation.

Efficiency control, even earlier, it is necessary to carry out after 4 months of radiation, a vicious test for a complete urease test, whether it is for antigen in feces.

Tetyana Lvivna spoke about pyloric gelcobacter and shlunk cancer in a lecture about how he was going to get rid of shlunk cancer and its relapse due to operative treatment. A little more results are achievable, if the radiation is carried out before the atrophy and intestinal metaplasia.

Tetyana Lvivna also spoke about the recommendations of the Russian gastroenterological association, based on the "Maastricht-IV" with regard to the specifics of our land. I will look at the fact that the resistance to clarithromycin in Russia does not exceed 10%, the scheme of the first line is used as a standard consumer therapy. Є Come in, if you allow the adjustment and efficiency: the increase in the dose of the proton pump, the increase in the triviality of the drink and the addition of the preparation in the smoke, the winterization of the Tricycle of the drug.

As a variant of the radical scheme of the first line, Vikoristan can be used as a classic choice of the component therapy. This scheme can also be used in the other line of therapy for the ineffectiveness of standard consumer therapy. The first useful therapy with levofloxacin may be indicated by a fairly short test of the treatment with the scheme of standard consumer therapy and quadrotherapy with the help of Tricali ditrate.

Otzhe, slit times pіdsumovuyuchi scho scheme pershoї lіnії in nashіy kraїnі - tse standard potrіyna terapіya i kvadroterapіya of drugs vіsmutu Scheme Druha lіnії - kvadroterapіya of drugs vіsmutu that potrіyna terapіya of levofloxacin, i circuit tretoї lіnії pіdbiraєtsya іndivіdualno of urahuvannyam rezultatіv viznachennya antibіotikorezistentnostі.

With such a rank, as if pidsumovuvati, it is possible to say that the main show before the anti-infectious disease of the pyloric Helicobacter becomes overwhelming. Vibir of the scheme of antibiotics is based on the level of resistance of strains of pyloric Helicobacter to clarithromycin. The main schemes of radiation in this hour are the standard consumer scheme, the scheme of quadrotherapy with the help of Tricalii dicitrate. It’s worthwhile to admit the last and second therapy - we remembered it, it’s not recommended for us in our Russian recommendations, it’s not enough for the effectiveness of the scheme in our country. If we accept the first results, then we will negotiate a few schemes.

March 3, 2016 in the framework of the 42nd scientific session of the Central Scientific Research Institute "Principles of Evidence-Based Medicine in Clinical Practice"

Che is one of the first, as well as not the first public whistup in Russia with information about the weather and news conference on the diagnosis and diagnosis of Helicobacter pylori infection - Maastricht V, which was held in June 2015 on the occasion of Florence (Italy). The materials of the conference have not yet been published, so be it information about the accepted solution.

The previous weather-juvenile conference "Diagnostics and treatment of Helicobacter pylori infection: Maastricht IV" was also held in Florence in the fall of 2010, and the text was published in 2012 for the same reason.

Marcis Leja took part as an expert in both conferences.

Dopovіd bulo crushed with Russian language. The text of the slides of the views is below in the frame.

Yak meaning Marcis Leja, a number of Maastricht V positions are overburdened with the Chinese Global Consensus on Helicobacter pylori-associated gastritis.

Marcis Leja rozpov_v, a new European association has been launched Cancer Control Joint Action (CanCon) - Sleeping diy for cancer control, www .cancercontrol.eu.

The Russian organisation did not come to the end of the association.

On May 28, 2015, Rizi hosted the CanCon - Gastric cancer screening working group meeting. Vid Russia in the Naradia took on the fate of D.S. Borin. We discussed the possibility of monitoring the cancer of the shlunk and riziki, mated with the mass radiation of H. pylori.

Marcis Leja said that following the results of the Rizky Narada, it was decided not to carry out mass monitoring of the slunk cancer and the mass radiation of H. pylori in Latvia. The price of the decision is not in accordance with the European recommendations, but Latvia is still not ready to follow the recommendations.

Participants of the weatherconferences on diagnostics and diseases of Helicobacter pylori infection - "Maastricht V "(Florence, 2015)

The statute of the oglyadic type is assigned to one of the provincial problems of gastroenterology - the choice of the proton pump (IPP) engine in addition to the improvement of the effectiveness of the Helicobacter pylori therapy. For the analysis of the results of the experimental and clinical studies, the study of the fact that rabeprazole is low in rice in the middle of the IPP, should start a high degree of therapy of the first choice for the success. Among them - the maximum effect even if the first reception; the dose of rabeprazole is lower in proportion to the doses of the first IPP (pharmacological activity); rabeprazole is superior to the secretion of hydrochloric acid, so that it does not accumulate in the liver because of the manifestation of polymorphisms in the cytP450 gene, and the effect of rabeprazole in transmission; rabeprazole is safe for patients who take the drug in one hour; rabeprazole has low pleiotropic effects. Quite an argument for the corny nature of generic drugs, and the mensha mensha in the original drug, they do not seem to be of proper biological, pharmaceutical and therapeutic equivalence. In a given hour, drug users and patients will be taught about the changes in the company "Dr. Reddy" from "Razo®" - a generic rabeprazole, which will be one of the most important efficiency of the original drug, the availability of pharmaceuticals in the "Orange Kniz" in the AB category.

Key words: H. pylori eradication, proton pump infection, rabeprazole, generic, Razo®.

For a quote: Kazyulin A.N., Goncharenko O.Yu. Vibir of the proton pump inhibitor during the Helicobacter pylori therapy. Maastricht V // RMZ. 2017. No. 10. S. 712-717

The choice of proton pump inhibitor in the eradication therapy of Helicobacter pylori infection. Maastricht V
Kazyulin A.N., Goncharenko A.Yu.

Moscow State Medical Stomatological University named after A.I. Evdokimov

The review is devoted to one of the main problems in gastroenterology - the choice of proton pump inhibitor (PPI) in order to increase the effectiveness of eradication therapy of Helicobacter pylori. Based on the analysis of the results of experimental and clinical studies, it has been concluded that rabeprazole has a number of distinctive features among the other PPIs that determine the high feasibility of its choice for successful eradication therapy. Among them - the maximum effect after the first intake; the dose of rabeprazole is lower in comparison with the doses of other PPIs (the highest pharmacological activity); rabeprazole reliably suppresses the secretion of hydrochloric acid, because its destruction in the liver does not depend on the presence of polymorphisms of the cytP450 gene, and the effects of rabeprazole are predictable; rabeprazole is safe for patients taking several drugs at the same time; rabeprazole has a number of pleiotropic effects. The lower cost of generics compared to the cost of the original drug has always been an important reason for their appointment, but they do not always have the proper biological, pharmaceutical and therapeutic equivalence to the original drug. At present, doctors and their patients are offered the Razo® generic rabeprazole produced by Dr Reddy's®, which combines the high clinical efficacy of the original drug, safety of use, economic accessibility and high production culture in accordance with GMP criteria, registered FDA in the "Orange Book" in the AB category.

Key words: H. pylori eradication, proton pump inhibitors, rabeprazole, generic, Razo®.
For citation: Kazyulin A.N., Goncharenko A.Yu. The choice of proton pump inhibitor in the eradication therapy of Helicobacter pylori infection. Maastricht V // RMJ. 2017. No. 10. P. 712-717.

The article is assigned to the problem of the vibration of the proton pump engine

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