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Альманах клинической медицины. 2019; 47: 535-547

H. pylori как фактор риска рака желудка: доказательная база и стратегия первичной профилактики

Войнован И. Н., Эмбутниекс Ю. В., Мареева Д. В., Колбасников С. В., Бордин Д. С.

https://doi.org/10.18786/2072-0505-2019-47-052

Аннотация

Россия относится к странам с высокой распространенностью инфекции Helicobacter pylori (HP), высокой заболеваемостью раком желудка и поздней его диагностикой. Ведущим устранимым фактором риска рака желудка признана инфекция HP, что определяет необходимость использования точных диагностических тестов для выявления и контроля эффективности эрадикации HP и применения эффективных схем лечения. В этой связи нашей целью был анализ последних согласительных документов, систематических обзоров и данных метаанализов, в которых отражена роль HP как фактора риска развития рака желудка, меры по снижению этого риска. В статье подробно рассмотрены возможности методов диагностики инфекции HP, приведены данные по их использованию в Российской Федерации и проанализирована эффективность схем эрадикации. Отмечено, что HP у всех инфицированных вызывает хроническое воспаление в слизистой оболочке желудка и запускает каскад предраковых изменений (каскад Корреа). По мере развития атрофии, кишечной метаплазии и дисплазии повышается риск развития рака желудка. Наиболее эффективна первичная профилактика рака желудка при проведении эрадикации до развития атрофического гастрита. В консенсусах подчеркивается важность выявления инфекции HP на этой стадии хронического гастрита с использованием точных методов диагностики. В России для первичной диагностики HР применяются гистологический метод (37,7%), быстрый уреазный (29,2%) и серологический тесты (29,7%), для контроля эрадикации наиболее часто используют выявление антигена в стуле (31,3%), 13С-уреазный дыхательный тест (23,4%) и гистологический метод (23,3%). В качестве схемы первой линии в России рекомендована тройная терапия продолжительностью 14 дней, усиленная добавлением  препаратов висмута.

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Almanac of Clinical Medicine. 2019; 47: 535-547

Helicobacter pylori as a risk factor for gastric cancer: the evidence and primary prevention strategy

Voynovan I. N., Embutnieks Yu. V., Mareeva D. V., Kolbasnikov S. V., Bordin D. S.

https://doi.org/10.18786/2072-0505-2019-47-052

Abstract

Russia is a country with a high prevalence of Helicobacter pylori (HP) infection, a high incidence of gastric cancer, and its late diagnosis. HР infection has been recognized as the leading manageable risk factor for gastric cancer. Accurate diagnostic tests must be used to identify and control the effectiveness of HP eradication, and effective schemes must be implemented for HP eradication. The aim of this article was to analyze the latest consensus documents, systematic reviews and meta-analyzes that reflected the role of HP as a risk factor for the development of gastric cancer, as well as measures for the risk reduction. We describe in detail the diagnostic methods for HP infection, provide data on their use in the Russian Federation, and analyze the efficacy of eradication regimens. In all HPinfected individuals, HP leads to chronic inflammation in the gastric mucosa and launches a precancerous cascade (Correa's cascade). The risk of gastric cancer increases with severe atrophy, intestinal metaplasia and dysplasia. Primary prevention of gastric cancer is most effective if the eradication is performed before atrophic gastritis develops. The available consensus documents underline the importance of HP infection identification by accurate diagnostics at this stage of chronic gastritis. In Russia, the primary HP diagnosis is based on histology (37.7%), rapid urease test (29.2%), and serology (29.7%). HP stool antigen test (31.3%), 13C-urea breath test (23.4%) and the histological method (23.3%) are most often used to control eradication. Currently, the first line of eradication therapy is recommended as triple therapy with clarithromycin prescribed for 14 days. It is recommended to use double dose of proton pump inhibitors and bismuth to increase the effectiveness of this scheme. A 14-days triple regimen enhanced by bismuth has been recommended as the first-line therapy in the Russian Federation.

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