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Die rol van Helicobacter pylori by peptiese ulkusse : 'n literatuurstudie

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dc.contributor.author Liddell J en
dc.date.accessioned 2016-09-22T07:17:28Z
dc.date.available 2016-09-22T07:17:28Z
dc.date.created 1997 en
dc.date.submitted 1998 en
dc.identifier.uri http://hdl.handle.net/20.500.11892/11392
dc.description.abstract Peptic ulcers is an important disease in our society and 10 percent of society will suffer from this in its lifetime. It is also important to know that up to 40 percent of people in a western society will suffer from a functional gastro-enterological disease like dyspepsia or spastic colon. It is possible that we are currently over-emphasising the importance of Helicobacter pyloris association with peptic ulcers. Helicobacter pylori is however associated with up to 95 percent of all duodenal ulcers and up to 66 percent of patients with gastric ulcers. Patients in the non-associated group are: Zollinger-Ellison syndrome-patients, heavy smokers and users of NSAIDs. The aim of the study is to provide evidence from the literature that: up to 95 percent of duodenal ulcers and up to 66 percent of gastric ulcers are associated with Helicobacter pylori; diagnostic tests and eradication therapy are available that can heal peptic ulcers and reduce relapses and also that eradication therapy is cost effective. The aim is also to develop guidelines to enable the pharmacist to fulfill his/her role regarding patients suffering from peptic ulcers and dyspepsia in a professional manner. A literature study was performed, lectures and discussions attended and a therapeutic guideline developed. The subject matter include both testing and treatment. It is important to test for Helicobacter pylori before treatment is started. There are two types of tests: Invasive and non-invasive. Diagnostic tests for the organism are in general invasive and require endoscopy. Non-invasive tests are used mainly for screening and follow-up after therapy. It would be justifiable to give eradication therapy to all patients that test positive for Helicobacter pylori with confirmed duodenal ulceration and gastric ulcers. Because of the risk of carcinoma, gastric ulcers all require close follow-up to ensure cure. Eradication therapy is not justified for patients with dyspepsia who have not undergone endoscopy or barium studies. There is currently no routine indication to treat Helicobacter pylori infection in patients with dyspepsia who do not have ulceration, so-called non-ulcer dyspeptics. Triple therapy that includes a proton pump inhibitor (PPI) with two antibiotics are as effective and better tolerated than bismuth-based triple therapy. The cost is high for eradication therapy, but justifiable, given the cost of maintenance therapy of a Histamine-2 blocker for 10 years. Eradication rates with a PPI and a single antibiotic are too low. The MACH 1 study produced results of 96 percent with 20 mg omeprazole twice daily, 1000 mg amoxycillin twice daily and 500 mg clanithromycin twice daily. An eradication rate of 95 percent was obtained with 20 mg omeprazole twice daily, 400 mg metronidazole twice daily and 250 mg clanithromycin twice daily. Both regimens were taken for seven days. Metronidazole resistance is 25 percent in South Africa, which is much higher than in developed countries. The relapse rates with metronidazole regimens are therefore also higher in South Africa. Guidelines on the pharmacists role regarding and interaction with patients with suspected peptic ulceration have been developed. These include aspects of the assessment of the typical medicines utilisation profile and counselling regarding diagnosis and treatment. en
dc.language Afrikaans en
dc.subject Medical sciences: Pharmacology and therapeutics en
dc.subject Practical pharmacy en
dc.title Die rol van Helicobacter pylori by peptiese ulkusse : 'n literatuurstudie en
dc.type Masters degree en
dc.description.degree MPharm en

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