Management of patients with chronic gastritis after H. pylori eradication
Authors: Dorofeev A. E. , Tkach S. M. , Dyadik O. O. , Chichula Y. V. , Kugler T. E. , Gurkalo Y. Z. 
Published: May 2023

Objective — to study the prevalence of H. pylori infection in patients with organic and functional dyspepsia in the central region of Ukraine and to perform clinical and morphological evaluation of the efficacy of “Gialera” preparation in the complex treatment of patients with chronic gastritis after H. pylori eradication.
Materials and methods. To assess H. pylori prevalence, an analysis of endoscopic data and the frequency of contamination of the gastric mucosa with H. pylori was carried out in 5903 gastroenterological patients aged 18 to 94 years. The study was multicenter, multiplicative cross‑sectional and lasted from the year 2016 to 2022. The average age of patients was 50.5±15.6 years, there were 3188 (54.0%) women and 2715 (46.0%) men. The presence of H. pylori infection was assessed using a 13C‑urease breath test, performed according to the standard method before the start of the treatment. Sixty patients with chronic gastritis, who, after successful eradication of H. pylori, confirmed by a repeated 13C‑urease breath test, had dyspeptic symptoms after 1 month, were transferred to the second stage of the study. A multicenter, randomized, blinded, comparative study was conducted to evaluate the efficacy and safety of Giallera in the complex treatment of dyspepsia in patients with chronic gastritis after H. pylori eradication. The patients were divided into 2 groups: the first group — 30 patients received a proton pump inhibitor (PPI) in a dose of 40 mg/day and Gialera, the second group — 30 patients received only PPI in the same dose. In addition, in the presence of heaviness in the epigastrium, patients in both groups could take a prokinetic. All patients before and after treatment, in addition to clinical examination and assessment of the intensity of abdominal pain, underwent endoscopic examination of the esophagus, stomach and duodenum with a biopsy of the gastric mucosa. The biopsy was stained with hematoxylin and eosin, and PAS reaction and immunohistochemical study with tight junction sealing proteins claudins 1 and 7 were carried out.
Results. Patients with functional dyspepsia predominate (51.1%) in the population of Ukrainian patients with lesions of the upper gastrointestinal tract, while patients with organic dyspepsia account for 46.1%, of which 52.8% have chronic gastritis with high H. pylori infection, which is the majority cases, eradication anti‑Helicobacter therapy is required. After eradication, some patients still have dyspeptic complaints in the presence of a morphological picture of chronic gastritis without signs of pronounced activity, with elements of gland atrophy with preserved mucus secretion, weak inflammatory cell infiltration and increased epithelial permeability with a decrease in the expression of sealing claudins.
Conclusions. The use of combined therapy with Gialera resulted in a more rapid decrease in the intensity of abdominal pain and its stable absence after the end of treatment. Positive clinical symptoms in such patients are combined with improvement in morphological changes in the gastric mucosa (GM): minimization of histological signs of inflammation, improvement in mucosal formation and a tendency to stabilize the epithelial permeability of the GM, normalization of the expression of claudins 1 and 7.