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STUDY THE EFFICACY OF 14 DAYS HYBRID THERAPY (EA-EACT) ON PATIENTS WITH POSITIVE HELICOBACTER PYLORI DUODENAL ULCERANH PHU PHAM THANG TRONG HOANG, Hue University of Medicine and Pharmacy, Đak Lak province Hospital INTRODUCTION SUBJECT S AND METHOD CONTENTS RESULTS AND DISCUSSION CONCLUSION INTRODUCTION - Gastric duodenum ulcer: encounter anywhere in the world, 35% of gastricenterologic disease Duodenum ulcer/ peptic ulcer = 4/1 - Complications: bleeding, ulcer perforation, pylorus stenosis Those influence patients’ life and work ability - Helicobacter pylori (H.pylori) has been confirmed as an important cause H.pylori eradication accelerates duodenal ulcer healing and prevents ulcer recurrence Fan H, Wang J et al Exp Ther Med, (2013), p912-916   INTRODUCTION ĐẶT VẤN ĐỀ Standard therapy used to be popupar, but its efficacy was  To find out HP eradication decreased due to antibiotic resistance of H.Pylori therapies, resistant especially HP really antibiotic need a synchronous strategy for medicine Wu et al (2012): Metronidazole resistance: 37,1% (Asia), 43,9% and community (Africa) and 44,1% (America) Clarithromycin and Amoxicillin resistance in Africa are 92,4% and 65,6% (*) Zhang M World J Gastroenterol (2015), p13432-13437 (*)Wu W., Yang Y Gastroenterol Res Pract( 2012), 723183 INTRODUCTION  Many new therapies have been figured out from this reality Among them, hybrid  Hsu (2015): studies with 1207 patients therapy is a regimen which Amoxicillin was maintained theand treatment of treated by hybridduring therapy, the H.pylory sequential therapy and then made a non eradication was 93,3% (PP) In Vietnam, a Bismuth quadruple therapy such sequential -concomittant therapy.at Cho Ray study of Thanh Van Nguyen showed result 88.% Hsu P I., Lin P C World J Gastroenterol, (2015), 12954- INTRODUCTION Thus, the study aimed to: To survey the success rate of H.pylori eradication of 14 days hybrid therapy with EA-EACT in patients with positive H.pylori duodenal ulcer Evaluate the side effects of the hybrid therapy (EA-EACT) in those patients SUBJECT S AND METHOD SUBJECT - 73 Patients - Site of study: Hue central hospital - Standard for subjects: Diagnosed duodenal ulcer with Helicobacter pylori positive by endoscopy and Clotest - Treated with 14 days hybrid therapy (EA-EACT) SUBJECT S AND METHOD METHOD  Study Design: prospective study and evaluating by ITT (intention-to-treat) and PP(per-protocol)  Study method: Collect based on protocol METHOD Standard for evaluating H.pylori infection CLO-test postive: Change of color in jelly pool to red purple within minutes or dark red in 30 CLO-test negative: Change of jelly color to pink after 30 or no change (yellow orange) after 60min CLO-test negative  CLO-test postive METHOD TREATMENT REGIMEN The first seven days : Esomeprazol, Amoxicillin -> weeks after finished treatment:endoscopy, Clo The next days: Esomeprazol, Amoxicillin, test and estimate result Clarithromycin, Tinidazol Nexium: Tablet 20 mg, x tablets/day, before meal 30 minutes Ospamox® : Tablet 500 mg, tablets x tablets/day, after breakfast Clamisel® : Tablet 500 mg, x tablets/day, after breakfast and dinner and dinner Tzide-50: Tablet 500 mg, x tablets/day, after breakfast and dinner METHOD Evaluate thearpy efficacy Successful H.pylori eradication when CLO test was negative Evaluate side effect fatigue, diarrhea, bitter taste, nausea, headache, allergy Result evaluatio n Statistic analyse: SPSS 16.0 and Word 2013 RESULTS AND DISCUSSION CHARACTERISTICS OF STUDY GROUP Characteristis of 73 cohorts were: Avarage of age: 46,42 ± 15,569 Male: 56,2%, Female: 43,8%  Be Mainly agriculturers Countryside > urban RESULTS AND DISCUSSION  73 patients with H.pylori positive duodenum ulcer were treated by14 days EA-EACT : 63 patients completed, and returned for endoscopy, and 10 patients no returned  Rate of successful eradication was up to ITT (Intention-to-treat) and PP (protocol) RESULTS AND DISCUSSION ERADICATION EFFICACY OF HYBRID EA- EACT RESULTS AND DISCUSSION ERADICATION EFFICACY OF HYBRID EA- EACT Hsu et al • Eso 40mg + Amox 1g ( bid) x first 7d 117 patients (1) • Clari 0,5g và Metro 0,5g ( 2bid) next 7d • Rate of HP eradication was 97,4% (ITT), 99,1%(PP) • Sadarian cs Sequential therapy with 210 patients (PA 5d_PCT 5d) • regimens (2) hybrid therapy in 210 patients: PA 7d_PACT7d • HP eardication rate (PP) of sequential therapy: 79,9%, hybrid therapy : 92,9% (1) Hsu P I., Wu D C Helicobacter, (2011), 139-145 (2) Sardarian H Helicobacter(2013), 18(2), 129-134 RESULTS AND DISCUSSION ERADICATION EFFICACY OF HYBRID EA- EACT (1) Cuadrado-Lavin A J Antimicrob Chemother(2015), 70(8), 2376-2381 (2) Wu J Y Helicobacter(2014), 19(3), 207-213 RESULTS AND DISCUSSION ERADICATION EFFICACY OF HYBRID EA- EACT Hybrid 86,6% 92,7% Sequential 84,3%, 86,4% He L Review 10 studies ITT,PP (3501 bn) Concomitant 86,7% 89,8% He L et al Intern Med(2015), 54(7), 703-710 RESULTS AND DISCUSSION ERADICATION EFFICACY OF HYBRID EA- EACT cause of efficacy Amox affected bacteria cells, interfered development and destroyed anti Clari channels, then weakened bacteria, and prevent secondary clary resistance (*) Second week: antibiotics because there was no use when we used such PpI and antibiotics with low efficacy and cannot get the treatment goal (*) Vaira D., Zullo A et al Therap Adv Gastroenterol(2009), 2(6), RESULTS AND DISCUSSION SIDE EFFECT OF THERAPY 47,9% RESULTS AND DISCUSSION SIDE EFFECT OF THERAPY  Cuadrado-Lavin: Side effect was 68,6%, obedient was 98,5%  Molina-Infante: 334 patients with hybrid and concomittant therapy:side effect was 51,5% in 172 patients with hybrid:47%, concomittant 56%  He L reviewed randomized studies with 3501 patients There were no significant difference between sequential, concomittant and hybrid therapy in side effect (*) (*) He L., Deng T Intern Med (2015), 54(7), 703-710 ... was 97,4% (ITT), 99,1%(PP) • Sadarian cs Sequential therapy with 210 patients (PA 5d_PCT 5d) • regimens (2) hybrid therapy in 210 patients: PA 7d_PACT7d • HP eardication rate (PP) of sequential... Vietnam, a Bismuth quadruple therapy such sequential -concomittant therapy.at Cho Ray study of Thanh Van Nguyen showed result 88.% Hsu P I., Lin P C World J Gastroenterol, (2015), 12954- INTRODUCTION... Cuadrado-Lavin A J Antimicrob Chemother(2015), 70(8), 2376-2381 (2) Wu J Y Helicobacter(2014), 19(3), 207 -213 RESULTS AND DISCUSSION ERADICATION EFFICACY OF HYBRID EA- EACT Hybrid 86,6% 92,7% Sequential