{"id":4064,"date":"2022-12-28T06:30:00","date_gmt":"2022-12-28T09:30:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=4064"},"modified":"2022-12-20T21:11:57","modified_gmt":"2022-12-21T00:11:57","slug":"como-tratar-helicobacter-pylori","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/estomago\/como-tratar-helicobacter-pylori\/","title":{"rendered":"<strong>Como tratar o <em>Helicobacter pylori<\/em>? Entendendo como escolher o esquema de primeira linha<\/strong>"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/4064?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/4064?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<p>O <em>Helicobacter pylori<\/em> (<em>H. pylori<\/em>) \u00e9 a infec\u00e7\u00e3o bacteriana cr\u00f4nica mais prevalente do mundo, acometendo mais de metade da popula\u00e7\u00e3o. Associa-se com gastrite cr\u00f4nica, que pode progredir para complica\u00e7\u00f5es graves, como \u00falcera p\u00e9ptica, adenocarcinoma e linfoma MALT.&nbsp;<\/p>\n\n\n\n<p>Pelas evid\u00eancias atuais, a sua erradica\u00e7\u00e3o tem sido recomendada de forma mais ampla, mesmo na aus\u00eancia de sintomas em muitas situa\u00e7\u00f5es. As principais refer\u00eancias que norteiam a conduta do <em>H. pylori<\/em> em nosso pa\u00eds s\u00e3o:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>IV Consenso Brasileiro (2018)<\/li>\n\n\n\n<li>Consenso Maastricht VI \/ Florence (2022)<\/li>\n<\/ul>\n\n\n\n<p>Uma das mais importantes causas de falha \u00e0 erradica\u00e7\u00e3o do <em>H. pylori<\/em> \u00e9 o aumento da resist\u00eancia \u00e0 claritromicina e levofloxacino. A resist\u00eancia aos nitroimidaz\u00f3icos tamb\u00e9m \u00e9 comum. Por outro lado, a resist\u00eancia \u00e0 amoxicilina e \u00e0 tetraciclina \u00e9 baixa e est\u00e1vel. Esses conceitos s\u00e3o importantes tanto quando pensamos em esquemas de primeira linha como em esquema de retratamento.<\/p>\n\n\n\n<p>A escolha do esquema inicial de tratamento para o <em>H pylori<\/em> considera dois principais aspectos:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Taxa local de resist\u00eancia \u00e0 claritromicina<\/li>\n\n\n\n<li>Hist\u00f3rico de alergia medicamentosa<\/li>\n<\/ul>\n\n\n\n<p class=\"has-background has-normal-font-size\" style=\"background:linear-gradient(135deg,rgb(238,238,238) 0%,rgb(152,126,209) 74%,rgb(169,184,195) 100%)\"><strong>Seria interessante a realiza\u00e7\u00e3o de teste de susceptibilidade (molecular ou cultura) antes da prescri\u00e7\u00e3o de antibi\u00f3ticos, mas sabemos que estes m\u00e9todos ainda s\u00e3o extremamente escassos (ou mesmo quase inexistentes) na nossa pr\u00e1tica di\u00e1ria brasileira.<\/strong><\/p>\n\n\n\n<p>Em \u00e1reas em que h\u00e1 baixa resist\u00eancia \u00e0 claritromicina (&lt; 15%), o tratamento emp\u00edrico de primeira linha deve ser a terapia tripla com claritromicina ou a qu\u00e1drupla com bismuto. Alguns poucos estudos avaliaram o perfil de resist\u00eancia do <em>H. pylori<\/em> no Brasil, identificando resist\u00eancia de 2.5 a 16.9% \u00e0 claritromicina, 5 a 23% \u00e0s fluoroquinolonas, aproximadamente 50% ao metronidazol e duplas resist\u00eancia \u00e0 claritromicina e metronidazol de 7.5 a 10%. Diante disso, a tend\u00eancia do Consenso Brasileiro ainda \u00e9 considerar o <strong>Brasil<\/strong> como uma <strong>\u00e1rea de baixa resist\u00eancia \u00e0 claritromicina<\/strong>.<\/p>\n\n\n\n<p>Desde o Maastricht V (2017) e o IV Consenso Brasileiro (2018), uma importante mudan\u00e7a nas recomenda\u00e7\u00f5es de tratamento para o <em>H. pylori<\/em> foi o <strong>aumento da dura\u00e7\u00e3o de 7 para 14 dias<\/strong> na tentativa de aumentar a taxa de erradica\u00e7\u00e3o diante da crescente eleva\u00e7\u00e3o de resist\u00eancia bacteriana.<\/p>\n\n\n\n<p>Os esquemas de primeira linha propostos em nosso pa\u00eds, portanto, s\u00e3o os seguintes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Esquema recomendado: OAC &#8211; Terapia tripla padr\u00e3o com claritromicina<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1.png\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-1024x576.png\" alt=\"\" class=\"wp-image-4075\" width=\"512\" height=\"288\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-1024x576.png 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-300x169.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-768x432.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-1536x864.png 1536w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-2048x1152.png 2048w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-1920x1080.png 1920w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-1170x658.png 1170w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-1-585x329.png 585w\" sizes=\"(max-width: 512px) 100vw, 512px\" \/><\/a><\/figure>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li>Esquema alternativo: BOTM &#8211; Terapia qu\u00e1drupla com bismuto<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-1024x576.png\" alt=\"\" class=\"wp-image-4083\" width=\"512\" height=\"288\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-1024x576.png 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-300x169.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-768x432.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-1536x864.png 1536w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-2048x1152.png 2048w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-1920x1080.png 1920w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-1170x658.png 1170w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/bismuto-585x329.png 585w\" sizes=\"(max-width: 512px) 100vw, 512px\" \/><\/a><\/figure>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li>Outro esquema alternativo: OACM &#8211; Terapia qu\u00e1drupla concomitante sem bismuto. \u00c9 uma op\u00e7\u00e3o em \u00e1reas de maior resist\u00eancia comprovada \u00e0 claritromicina quando o bismuto n\u00e3o for dispon\u00edvel.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-1024x576.png\" alt=\"\" class=\"wp-image-4077\" width=\"512\" height=\"288\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-1024x576.png 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-300x169.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-768x432.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-1536x864.png 1536w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-2048x1152.png 2048w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-1920x1080.png 1920w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-1170x658.png 1170w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-3-585x329.png 585w\" sizes=\"(max-width: 512px) 100vw, 512px\" \/><\/a><\/figure>\n<\/div>\n\n\n<p class=\"has-background\" style=\"background:linear-gradient(140deg,rgb(238,238,238) 0%,rgb(183,155,202) 56%,rgb(160,124,207) 72%,rgb(169,184,195) 100%)\"><strong>Por falar em disponibilidade de subcitrato de bismuto coloidal, essa medica\u00e7\u00e3o tem sido bem pouco dispon\u00edvel em nosso pa\u00eds. Atualmente, \u00e9 poss\u00edvel conseguir apenas por meio de manipula\u00e7\u00e3o (e mesmo assim com certa dificuldade). Isso nos faz lembrar da furazolidona, que j\u00e1 foi muito utilizada em esquemas para tratamento de <em>H. pylori<\/em>, mas que n\u00e3o \u00e9 comercializada h\u00e1 anos em nosso pa\u00eds.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Alergia \u00e0 penicilina<\/strong> <\/h2>\n\n\n\n<p>A erradica\u00e7\u00e3o do <em>H. pylori<\/em> em pacientes com alergia \u00e0 penicilina (relatada em at\u00e9 3 a 10% das pessoas) \u00e9 um desafio. O ideal seria realmente comprovar que essa alergia \u00e9 verdadeira para ter \u00e0 disposi\u00e7\u00e3o os esquemas com amoxicilina.<\/p>\n\n\n\n<p>Pelo Consenso Brasileiro, s\u00e3o dois os esquemas principais:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Terapia tripla com levofloxacino em substitui\u00e7\u00e3o \u00e0 amoxicilina (OCL)<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-1024x576.png\" alt=\"\" class=\"wp-image-4076\" width=\"512\" height=\"288\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-1024x576.png 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-300x169.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-768x432.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-1536x864.png 1536w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-2048x1152.png 2048w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-1920x1080.png 1920w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-1170x658.png 1170w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2022\/12\/imagem-2-585x329.png 585w\" sizes=\"(max-width: 512px) 100vw, 512px\" \/><\/figure>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li>Terapia qu\u00e1drupla com bismuto (BOTM), conforme j\u00e1 citada previamente<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Efeitos adversos<\/strong><\/h2>\n\n\n\n<p>Infelizmente, at\u00e9 50% dos pacientes apresentam efeitos colaterais com o tratamento do <em>H. pylori<\/em>. Em menos de 10%, esses efeitos s\u00e3o limitantes e levam \u00e0 interrup\u00e7\u00e3o da terapia. \u00c9 importante, portanto, sempre orientar bem os pacientes dos efeitos adversos mais comuns para aumentar a ades\u00e3o:<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Amoxicilina: Diarreia, rash cut\u00e2neo<\/li>\n\n\n\n<li>Claritromicina: n\u00e1useas, v\u00f4mitos, dor abdominal, gosto met\u00e1lico, raramente prolongamento QT<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Usar probi\u00f3ticos ajuda?<\/strong><\/h2>\n\n\n\n<p>Os probi\u00f3ticos (como <em>Lactobacilli<\/em> e <em>Saccharomyces boulardii<\/em>) reduzem os efeitos adversos associados \u00e0 terapia de erradica\u00e7\u00e3o e, com isso, podem aumentar a ades\u00e3o. H\u00e1 estudos sobre efeitos diretos sobre o <em>H. pylori<\/em>, mas ainda s\u00e3o necess\u00e1rios mais dados.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Preciso fazer controle de cura? Quando?<\/strong><\/h2>\n\n\n\n<p>Sim. Deve ser realizado pelo menos 4 semanas ap\u00f3s o tratamento. O ideal \u00e9 preferir m\u00e9todo n\u00e3o invasivos, reservando-se a endoscopia apenas se indicada por outra raz\u00e3o (ex: controle de cura de \u00falcera g\u00e1strica).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Conclus\u00e3o<\/strong><\/h2>\n\n\n\n<p class=\"has-white-color has-text-color has-background has-medium-font-size\" style=\"background:linear-gradient(135deg,rgb(0,42,81) 0%,rgb(4,82,155) 100%)\">O <em>H. pylori<\/em> \u00e9 extremamente comum e sua erradica\u00e7\u00e3o pode ser muitas vezes um desafio. A terapia tripla padr\u00e3o (OAC) no Brasil fornece taxas de cura acima de 80% e ainda \u00e9 a mais utilizada. Devemos, contudo, estar atentos aos crescentes n\u00edveis de resist\u00eancia bacteriana para atualizarmos constantemente nossas recomenda\u00e7\u00f5es.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-background\" style=\"background-color:#abb7c287\">Lages RB. Como tratar o <em>Helicobacter pylori<\/em>? Entendendo como escolher o esquema de primeira linha. Gastropedia 2022. Dispon\u00edvel em <a href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/estomago\/strongcomo-tratar-o-emhelicobacter-pylori-em-entendendo-como-escolher-o-esquema-de-primeira-linha-strong\/  \">https:\/\/gastropedia.pub\/pt\/gastroenterologia\/estomago\/como-tratar-helicobacter-pylori<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<p>[1] Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI\/Florence consensus report. Gut 2022;71:1724\u201362. doi:10.1136\/gutjnl-2022-327745.<br>[2] Coelho LGV, Marinho JR, Genta R, Ribeiro LT, Passos M CF, Zaterka S, et al. IVth Brazilian Consensus Conference on Helicobacter pylori infection. Arq Gastroenterol 2018;55:97\u2013121. doi:10.1590\/s0004-2803.201800000-20.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>O Helicobacter pylori (H. pylori) \u00e9 a infec\u00e7\u00e3o bacteriana cr\u00f4nica mais prevalente do mundo, acometendo mais de metade da popula\u00e7\u00e3o. Associa-se com gastrite cr\u00f4nica, que pode progredir para complica\u00e7\u00f5es graves,&hellip;<\/p>\n","protected":false},"author":4165,"featured_media":1743,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[20,18],"tags":[],"ano":[43],"tipo":[121],"volume":[44],"class_list":["post-4064","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-estomago","category-gastroenterologia","ano-43","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Como tratar o Helicobacter pylori? 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