678 737 1 PB PDF
678 737 1 PB PDF
Dragon Kho
Fakultas Kedokteran Universitas Tarumanagara, Jakarta
381
Abstract: Helicobacter pylori infection is related to gastritis, gastroduodenal ulcer and gastric
cancer. H. pylori eradication has been shown to have a prophylactic effect against gastric cancer.
There are 2 methods used to establish the diagnosis of H. pylori infection. First, the non-invasive
measures consists of urea breath test (UBT), stool antigen test (SAT) and serology while endoscopy is used to get a specimen of biopsy. According to several international guidelines, there are
three lines of therapy which can be used in H. pylori eradication. The first-line therapy a proton
pump inhibitor (PPI) in combination with any of the antibiotics amoxicilline, clarithromycin or
metronidazole, given for 7-14 days. However, even with these recommended regimens, failure in
H. pylori eradication is still found in 20% of patients. The recommended second-line therapy is a
quadruple regimen composed of PPI, bismuth subsalicylate, tetracycline and metronidazole. For
cases of failure from second line therapy, European guideline recommends culture before start the
third-line treatment and selection should be based on the microbial antibiotic sensitivity. The
alternative candidates for third line therapy are quinolones and rifabutin.
Key words: Helicobacter pylori, first-line, second-line, third-line.
Pendahuluan
Penemuan Helicobacter pylori pada tahun 1982, telah
mengubah tata laksana beberapa penyakit gastroduodenalis.
Hingga saat ini, H. pylori dikenal sebagai faktor patogen
pada gastritis kronis, ulkus peptikum, dan karsinoma gaster.
Eradikasi H. pylori efektif untuk gastric mucosal associated
lymphoid tissue (MALT) lymphoma derajat ringan, ulkus
peptikum dengan H. pylori yang positif serta gejala dispepsia
yang disebabkan olehnya. Eradikasi ini juga berpotensi
mencegah terjadinya karsinoma gaster yang disebabkan oleh
infeksi H. pylori.1
Eradikasi H. pylori yang dianjurkan kini meliputi
penggunaan proton pump inhibitor (PPI) berkombinasi
dengan 2 jenis antibiotik. Hal ini yang dikenal dengan triple
therapy. Akan tetapi,penyalahgunaan (misuse) antibiotik
yang luas akhir-akhir ini telah menimbulkan masalah
resistensi H. pylori terhadap beberapa jenis antibiotik yang
digunakan untuk eradikasi, sehingga diperlukan modalitas
tata laksana yang lebih efektif. Sebelum memulai tata laksana,
seyogianya dipastikan dahulu ada tidaknya infeksi H. pylori.
Diagnosis infeksi H.pylori
Pemeriksaan adanya infeksi H. pylori terdiri dari
pemeriksaan noninvasif (tanpa endoskopik) dan invasif
(dengan endoskopik). Pemeriksaan ini diindikasikan pada
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