#1
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Ïîêàçàíèÿ ê ýðàäèêàöèè H.Pylori ó äåòåé
Óâàæàåìûå êîëëåãè! Îáðàùàþñü çà ñîâåòîì.
Ñóùåñòâóþò ëè ó äåòåé ïîêàçàíèÿ ê ýðàäèêàöèè õåëèêîáàêòåð ïèëîðè, êàêèå åñòü ó âçðîñëûõ (îïðåäåëåíû Ìààñòðèõò-3)? Íàäî ëè ïðîâîäèòü ëå÷åíèå, à îíî äîâîëüíî àãðåññèâíîå, âñåì ïîäðÿä ñ âûÿâëåííûì õåëèêîáàêòåðîì? Ïðèìåð: ðåáåíîê 7 ëåò, ðåöèäèâèðóþùèå áîëè â æèâîòå, ïðè ÔÃÄÑ - ïîâåðõíîñòíûé ãàñòðèò, H.pylori+++ Îáùàÿñü ñ êîëëåãàìè ñëûøó ïðîòèâîïîëîæíûå ìíåíèÿ. Áóäó ïðèçíàòåëüíà çà ëþáûå ññûëêè. Ñïàñèáî. |
#2
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À ãäå â Ìààñòðèõòñêèõ ñîãëàøåíèÿõ ìîæíî ïðî÷åñòü ÷òî ýðàäèêàöèÿ ïðîâîäèòñÿ "âñåì ïîäðÿä", ÷òî ïîêàçàíèåì ê íåé ÿâëÿåòñÿ ôàêò íàëè÷èÿ õåëèêîáàêòåðà?
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ðóêó êú ñåìó ïðèëîæèëú Àëåêñàíäðú |
#3
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 òîì òî è äåëî, ÷òî íå íàïèñàíî. Ýòî ÿ è õîòåëà óñëûøàòü. Ïðîñòî ó íåêîòîðûõ âðà÷åé åñòü ìíåíèå, ÷òî âûÿâëåíèå õåëèêîáàêòåðà â ëþáîì ñëó÷àå ÿâëÿåòñÿ ïîêàçàíèåì ê ýðàäèêàöèè. Îøèáî÷íî ëè ýòî ìíåíèå? È êîãî âñå òàêè ñòîèò ëå÷èòü?
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#4
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All current recommendations for managing cases with children indicate that evidence of H pylori infection in a child with peptic ulcer disease is a definite indication for instituting eradication therapy. In addition, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition also recommends eradication therapy for the very small subset of H pylori–infected children with either MALT lymphoma or atrophic gastritis accompanied by intestinal metaplasia.
Eradication of H pylori could be considered an option for therapy for children with chronic ITP, especially for those who are refractory to conventional therapies and those who have frequent episodes of disease recurrence. Eradicating H pylori could be considered in cases refractory to iron supplementation and in the setting of frequent relapses, assuming that screening serology for celiac disease has been taken and the test results are negative. --- Arch Pediatr Adolesc Med. 2005 May;159(5):415-21. What is new related to Helicobacter pylori infection in children and teenagers? [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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Ñïàñèáî! Ïîäâîæó èòîã, ïðàâèëüíî ëè ÿ ïîíèìàþ - ýðàäèêàöèþ ïðîâîäèì òîëüêî: ÿçâåííàÿ áîëåçíü, ñåìåéíûé àíàìíåç, íåîáúÿñìíèìàÿ àíåìèÿ,àòðîôè÷åñêèé ãàñòðèò, ÌÀËÒ ëèìôîìà.
À ýòî Íåëüñîí: HELICOBACTER PYLORI GASTRITIS. If H. pylori is identified, even in a child with no symptoms, eradication therapy should be offered ( Table 332-1 and Table 332-2 ). Ðàçâåéòå ìîè ñîìíåíèÿ!!!!!!! |
#6
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Öèòàòà:
Íàøëà, ïðàâäà, âîò ÷òî. UPDATE Date Added: 30 December 2008 Abstract: Helicobacter pylori antigen in stool is associated with SIDS and sudden infant deaths due to infectious diseases --------- The relative risk of gastric carcinoma is 2.3-8.7 times greater in infected adults as compared to uninfected subjects. |
#7
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Íàøåë âîò àáçàö èç Íåëüñîí öåëèêîì:
The diagnosis of H. pylori infection is made histologically by demonstrating the organism in the biopsy specimens ( Fig. 332-1 ). Although serologic assays using validated immunoglobulin G (IgG) antibody detection may be helpful for screening children for the presence of H. pylori, they do not help predict active infection or assess the success of antimicrobial eradication therapy. 13C-urea breath tests and stool antigen tests are also available noninvasive methods of detecting H. pylori infection. Nonetheless, for children suspected of having H. pylori infection, an initial upper endoscopy is recommended to evaluate and confirm H. pylori disease. The range of endoscopic findings in children with H. pylori infection varies from being grossly normal to the presence of nonspecific gastritis with prominent rugal folds, nodularity ( Fig. 332-2 ), or ulcers. Because the antral mucosa appears to be endoscopically normal in a significant number of children with primary H. pylori gastritis, gastric biopsies should always be obtained from the body and antrum of the stomach regardless of the endoscopic appearance. If H. pylori is identified, even in a child with no symptoms, eradication therapy should be offered ( Table 332-1 and Table 332-2 ).  êîíòåêñòå çâó÷èò, ÷òî íå ñàì ôàêò íàëè÷èÿ ïèëîðîáàêòåðèé, à âñå òàêè íàëè÷èå ñóáêëèíè÷åñêîãî çàáîëåâàíèÿ ïðè÷èíà íàçíà÷åíèÿ ýðàäèêàöèîííîé òåðàïèè. (Íàäî êîíòåêñò ó÷èòûâàòü). |
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#8
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Ëîãè÷íî. Ïîòîìó êàê âðÿä ëè êòî-òî áóäåò äåëàòü ãàñòðîñêîïèþ ñ áèîïñèåé ðåáåíêó áåç æàëîá è êëèíèêè.
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#9
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Ñïàñèáî âñåì, êòî îòêëèêíóëñÿ!
Óâàæàåìûé Nachmed, à ÷òî òàêîå ñóáêëèíè÷åñêîå çàáîëåâàíèå? Êîíêðåòíûé âîïðîñ - õåëèêîáàêòåð+++ ïðè îòñóòñòâèè àòðîôè÷åñêîãî ãàñòðèòà, ÿçâåííîé áîëåçíè ëå÷èòü? ß ñ÷èòàþ, ÷òî ëå÷èòü íå íàäî. ß ïðàâà? È åùå îäíà âûäåðæêà: Gastritis, Chronic Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center Coauthor(s): Antonia R Sepulveda, MD, PhD, Associate Professor of Pathology, University of Pennsylvania School of Medicine; Director of Surgical Pathology, Director of Surgical Pathology Fellowship, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; Maria P Dore, MD, Associate Professor, Department of Medicine, Institute of Internal Medicine, University of Sassari, Italy; Franco Bazzoli, MD, Professor, Department of Internal Medicine and Gastroenterology, University of Bologna, Italy Contributor Information and Disclosures Updated: Aug 24, 2009 Treatment of H pylori infection in children: The optimal treatment for H pylori in childhood is not well established. Treatment has not been studied extensively, and no consensus exists for the optimum regimen. However, the benefits of treating the infection in patients with duodenal ulcer are obvious, whereas treating children who are asymptomatic is controversial. Although the literature is replete with contrary recommendations, many authorities now recommend treating all people, adults and children, in whom H pylori infection is demonstrated. Isolated studies have shown eradication efficiencies with triple therapies, ranging from 56% to 87% of the cases. In children, clarithromycin and metronidazole H pylori resistance is a problem in several countries, resulting in less efficient eradication regimens. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Èìååòñÿ ââèäó ëå÷åíèå Í.pylori ïðè íàëè÷èè ÿçâ èëè ó âñåõ? |
#10
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Ñóáêëèíè÷åñêèå (ëàòåíòíûå, áåññèìïòîìíûå) ïðîÿâëåíèÿ ýòî: íå ÿâíî âûðàæåííûå, â äàííîì êîíòåêñòå: ïîâåðõíîñòíûé ãàñòðèò ñ íåÿñíûìè æàëîáàìè èëè îòñóòñòâèåì òàêîâûõ (â êà÷åñòâå ïðèìåðà).
ß äóìàþ, ÷òî âû ëóêàâèòå çàäàâàÿ ýòî âîïðîñ! Èëè ïðàâäà íå çíàåòå ñëîâî ñóáêëèíè÷åñêèé? |
#11
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ß êîíå÷íî çíàþ, ÷òî òàêîå ñóáêëèíè÷åñêèé. Íî õîòåëà óñëûøàòü, ÷òî Âû èìååòå ââèäó ïðè êîíêðåòíî ãàñòðîïàòîëîãèè. ß, íàïðèìåð, íå ñ÷èòàþ, ÷òî ðåáåíêà ñ ðåöèäèâèðóþùèìè áîëÿìè â æèâîòå, H.pylori+++, ïðè îòñóòñòâèè ýðîçèâíî-ÿçâåííûõ èçìåíåíèé íàäî ëå÷èòü 3 ïðåïàðàòàìè (ÈÏÏ+2à/á). Òåì áîëåå, ÷òî âñå ÈÏÏ èìåþò îãðàíè÷åíèÿ ê èñïîëüçîâàíèþ â äåòñêîì âîçðàñòå (ïî èíñòðóêöèè). Èëè âñå òàêè ÿ íå ïðàâà? Êîìó æå öåëåñîîáðàçíî ïðîâîäèòü ýðàäèêàöèþ?
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#12
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Âû æå ñàìè ïðèâîäèòå èñòî÷íèêè ñ ðàçëè÷íûìè âçãëÿäàìè íà ýòó ïðîáëåìó. Ìíå êàæåòñÿ öåëåñîîáðàçíûì " ÷òî ðåáåíêà ñ ðåöèäèâèðóþùèìè áîëÿìè â æèâîòå, H.pylori+++, ïðè îòñóòñòâèè ýðîçèâíî-ÿçâåííûõ èçìåíåíèé íàäî ëå÷èòü 3 ïðåïàðàòàìè (ÈÏÏ+2à/á)." Âñå òàêè ëå÷èòü öåëåñîîáðàçíî. Òåì áîëåå ýòî óæå íå ñóáêëèíè÷åñêèé, à ÿâíî êëèíè÷åñêèé ñëó÷àé. Âðåäà áóäåò ìåíüøå ÷åì ïîëüçû ïðè íå ëå÷åíèè îïèñûâàåìîãî ñîñòîÿíèÿ.
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#13
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À êàê ÷àñòî ìîæíî ïðîâîäèòü ýðàäèêàöèþ? Åñëè ðåáåíîê îáñëåäóåòñÿ åæåãîäíî, åæåãîäíî âûÿâëÿåòñÿ H.p. Êàæäûé ðàç ëå÷èòü?
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#14
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Öèòàòà:
È çà÷åì, ñêàæèòå íà ìèëîñòü, êàæäûé ãîä ðåáåíêà îáñëåäîâàòü íà õåëèêîáàêòåð? Ñïîðòèâíûé èíòåðåñ? |
#15
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Åñòü ñëó÷àè. Ðåáåíîê æàëóåòñÿ íà áîëè â æèâîòå, îáñëåäóþò, íàõîäÿò õåëèêîáàêòåð, ëå÷àò. ×åðåç ãîä èëè ÷åðåç 2 îí ïðèõîäèò ñíîâà, æàëóåòñÿ íà áîëè â æèâîòå. Îáñëåäóþò, íàõîäÿò, íàïðèìåð ïîâåðõíîñòíûé ãàñòðèò, õåëèêîáàêòåð+. Ëå÷èòü? Íåóæåëè íèêòî ñ òàêèìè ñëó÷àÿìè íå ñòàëêèâàåòñÿ?
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