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Abstract(s)
Introdução: A Helicobacter pylori (H. pylori) é uma bactéria gram-negativa que coloniza a
mucosa do estômago. É considerada o principal patógeno humano, com uma prevalência
estimada de 50% na população mundial, sendo responsável por doenças gástricas clinicamente
graves, como a úlcera péptica, linfoma MALT e carcinoma gástrico, que diminuem a qualidade
de vida dos indivíduos. Genericamente, o tratamento da erradicação consiste na
administração de uma terapêutica tripla composta por um IBP e dois antibióticos,
Claritromicina e Amoxicilina ou Metronidazole, por um período de 7-14 dias, de acordo com as
guidelines do “Maastrich Consensus in Europe and the American Gastroenterological
Association in the United States”. (1, 2)
É sabido que os tratamentos para a erradicação da H. pylori se têm revelado um verdadeiro
desafio. Os regimes atualmente utilizados têm perdido eficácia, sendo a principal causa
atribuída à resistência da bactéria aos antibióticos; contudo, a importância patológica que
representa torna necessária a sua erradicação. (3)
A presente dissertação centra-se em novos esquemas ou alterações aos regimes atuais para
aumentar a eficácia do tratamento. Pretende-se uma revisão sistemática para avaliar os
benefícios da erradicação da H. pylori com a utilização de probióticos, prebióticos e
simbióticos.
Métodos: Foram pesquisadas publicações indexadas na base eletrónica científica, Pubmed,
referentes aos últimos dez anos; selecionando-se quarenta e sete publicações para análise.
Resultados: Dos estudos analisados, vinte em probióticos, dois em simbióticos e apenas um
em prebióticos, demonstram uma redução estatisticamente significativa nas taxas de
erradicação do H. pylori.
Conclusão: Os efeitos gastrointestinais adversos associados à terapêutica antibiótica podem
representar sérias desvantagens na terapia anti-H. pylori. Nesse sentido, a suplementação
com probióticos, prebióticos e simbióticos, para além de parecer ser eficaz na redução de
alguns efeitos adversos e melhorar a adesão do paciente ao tratamento convencional,
apresenta uma maior taxa de erradicação, pela diminuição das contagens da bactéria após a
utilização destes adjuvantes. Torna-se necessário procurar outras combinações de probióticos
e prebióticos, com dosagens diferentes e em períodos de tempo de tratamento específicos,
para os introduzir como terapia padrão de primeira linha, atingindo de uma forma mais
consistente uma erradicação custo-efetiva.
Introduction: The Helicobacter pylori is a gram-negative bacteria which colonizes gastric mucosa. It is considered the main human pathogen, with an estimated incidence of 50% on world´s population, being the main responsible for serious gastric diseases, as gastric ulcer, MALT lymphoma and gastric carcinoma, which reduce individuals´ quality of life. Generally, the eradication treatment consists on the administration of a triple combination therapy composed of one Proton Pump Inhibitor (PPI) and two antibiotics, Clarithromycin and Amoxicillin or Metronidazole, for a period of 7-14 days, according to the guidelines presented on “Maastrich Consensus in Europe and the American Gastroenterological Association in the United States”. (1, 2) It is known that eradication treatments of H.pylori are proving to be a challenge. The techniques currently used have lost efficacy, mainly due to the bacteria´s resistance to the antibiotic; however, its pathological importance makes eradication crucial in some cases. (3) This study focuses on new schemes or alterations to current techniques in order to increase the treatment´s efficacy. This paper aims to do a systematically review in order to evaluate the benefits of H.pylori eradication through the use of probiotics, prebiotics and symbiotics. Methods: publications on the scientific database Pubmed concerning the last ten years were analyzed. Forty-seven publications have been selected to this study. Results: The analyzed studies, twenty on probiotics, two on symbiotics and only one on prebiotics, show a significant reduction on eradication rates of H.pylori. Conclusions: Gastrointestinal effects associated to the antibiotic treatment may represent serious disadvantages on anti-H.pylori therapy. Therefore, supplementation with probiotics, prebiotics and symbiotics, besides seeming effective on the reduction of side effects, and consequently improve patient´s adherence to the conventional treatment, presents a higher eradication rate, through the reduction in bacterial counts after using these adjuncts. Therefore, it becomes necessary searching other combinations of probiotics and prebiotics, with different dosages and with specific periods of time in order to achieve a more costeffective eradication and introduce it as a first line standard therapy.
Introduction: The Helicobacter pylori is a gram-negative bacteria which colonizes gastric mucosa. It is considered the main human pathogen, with an estimated incidence of 50% on world´s population, being the main responsible for serious gastric diseases, as gastric ulcer, MALT lymphoma and gastric carcinoma, which reduce individuals´ quality of life. Generally, the eradication treatment consists on the administration of a triple combination therapy composed of one Proton Pump Inhibitor (PPI) and two antibiotics, Clarithromycin and Amoxicillin or Metronidazole, for a period of 7-14 days, according to the guidelines presented on “Maastrich Consensus in Europe and the American Gastroenterological Association in the United States”. (1, 2) It is known that eradication treatments of H.pylori are proving to be a challenge. The techniques currently used have lost efficacy, mainly due to the bacteria´s resistance to the antibiotic; however, its pathological importance makes eradication crucial in some cases. (3) This study focuses on new schemes or alterations to current techniques in order to increase the treatment´s efficacy. This paper aims to do a systematically review in order to evaluate the benefits of H.pylori eradication through the use of probiotics, prebiotics and symbiotics. Methods: publications on the scientific database Pubmed concerning the last ten years were analyzed. Forty-seven publications have been selected to this study. Results: The analyzed studies, twenty on probiotics, two on symbiotics and only one on prebiotics, show a significant reduction on eradication rates of H.pylori. Conclusions: Gastrointestinal effects associated to the antibiotic treatment may represent serious disadvantages on anti-H.pylori therapy. Therefore, supplementation with probiotics, prebiotics and symbiotics, besides seeming effective on the reduction of side effects, and consequently improve patient´s adherence to the conventional treatment, presents a higher eradication rate, through the reduction in bacterial counts after using these adjuncts. Therefore, it becomes necessary searching other combinations of probiotics and prebiotics, with different dosages and with specific periods of time in order to achieve a more costeffective eradication and introduce it as a first line standard therapy.
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Keywords
Bifidobacterium Erradicação Helicobacter Pylori Lactobacillus Prebióticos Probióticos Simbióticos