• helicobacter pylori
• helicobacter pylori treatment
• immune thrombocytopenia
• immunosuppressants
• upper gastrointestinal endoscopy
• itp
• endoscopie du tractus gastro-intestinal supérieur
• traitement de h. pylori
• immunosuppresseurs

• Humans
• Helicobacter Infections/diagnosis
• Helicobacter Infections/drug therapy
• Helicobacter Infections/complications
• Helicobacter pylori/isolation & purification
• Purpura, Thrombocytopenic, Idiopathic/diagnosis
• Purpura, Thrombocytopenic, Idiopathic/therapy
• Anti-Bacterial Agents/therapeutic use
• Treatment Outcome

• Endoscopic mucosal resection
• Helicobacter pylori
• Polyps
• Recurrence

• Humans
• Helicobacter pylori
• Retrospective Studies
• Endoscopy
• Adenomatous Polyps/surgery
• Helicobacter Infections/complications
• Helicobacter Infections/diagnosis
• Helicobacter Infections/drug therapy
• Stomach Neoplasms/pathology

• clarithromycin resistance
• concomitant therapy
• eradication rate
• helicobacter pylori
• polymerase chain reaction
• tailored therapy

• Amoxicillin/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Clarithromycin/therapeutic use
• Drug Therapy, Combination
• Helicobacter Infections/diagnosis
• Helicobacter Infections/drug therapy
• Helicobacter pylori/genetics
• Humans
• Metronidazole/therapeutic use
• Point Mutation
• Proton Pump Inhibitors/therapeutic use
• RNA, Ribosomal, 23S/genetics
• Rabeprazole/therapeutic use

Approximately half of the world’s population is infected with Helicobacter pylori, which causes gastric disease. Recent systematic reviews and meta-analyses have reported that H. pylori may also have extragastric manifestations such as hematologic diseases, including chronic immune thrombocytopenia (cITP). However, the molecular mechanisms by which H. pylori induces cITP remain unclear, and may involve the host immune response, bacterial strain diversity, and delivery of bacterial molecules to the host blood vessels. This review discusses the important pathophysiological mechanisms by which H. pylori potentially contributes to the development of cITP in infected patients.

• clarithromycin
• helicobacter pylori
• polymerase chain reaction
• triple therapy

• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/adverse effects
• Anti-Bacterial Agents/economics
• Cost-Benefit Analysis
• Drug Administration Schedule
• Drug Resistance, Bacterial
• Drug Therapy, Combination
• Helicobacter Infections/drug therapy
• Helicobacter Infections/microbiology
• Helicobacter pylori/genetics
• Humans
• Microbial Sensitivity Tests
• Point Mutation
• RNA, Ribosomal, 23S/genetics
• Republic of Korea

• Helicobacter infection
• Helicobacter pylori
• clarithromycin
• microbial drug resistance
• microbial sensitivity tests

Antibiotic resistance is the major reason for Helicobacter pylori treatment failure, and the increasing frequency of antibiotic resistance is a challenge for clinicians. Resistance to clarithromycin and metronidazole is a particular problem. The standard triple therapy (proton pump inhibitor, amoxicillin, and clarithromycin) is no longer appropriate as the first-line treatment in most areas. Recent guidelines for the treatment of H. pylori infection recommend a quadruple regimen (bismuth or non-bismuth) as the first-line therapy. This treatment strategy is effective for areas with high resistance to clarithromycin or metronidazole, but the resistance rate inevitably increases as a result of prolonged therapy with multiple antibiotics. Novel potassium-competitive acid blocker-based therapy may be effective, but the data are limited. Tailored therapy based on antimicrobial susceptibility test results is ideal. This review discussed the current important regimens for H. pylori treatment and the optimum H. pylori eradication strategy.

• Helicobacter pylori
• antibiotic resistance
• eradication

Background: The increasing prevalence of antimicrobial resistance, together with the lack of novel treatment options, negatively affects successful eradication of Helicobacter pylori. The aim of this study was to investigate genetic mutations in the 23S rRNA genes, which is associated with clarithromycin resistance, and to determine the clinical impact of genotype on phenotypic antimicrobial resistance. Methods: A total of 46 H. pylori strains were obtained from 13 patients, before and after unsuccessful eradication with clarithromycin-based triple therapy. The phenotypic resistance of each H. pylori strain was determined by minimum inhibitory concentration against clarithromycin using the serial two-fold agar dilution method. The genomic sequences of 23S rRNA genes were identified through next-generation sequencing, and nucleotide variants were determined based on comparison with genome sequences of the reference strain H. pylori 26695. Results: Clarithromycin resistance was found in 9 of 13 subjects before treatment and all subjects after unsuccessful eradication. Whole-genome sequencing of the 23S rRNA genes detected 42 mutations on 40 nonidentical loci, including 2147A>G (formerly 2143A>G) and 2146A>G (formerly 2142A>G). All strains with clarithromycin-resistant phenotype had either 2147A>G or 2146A>G mutation. When comparing genotype and phenotype for clarithromycin resistance, there was a significant association between 2147A>G mutation and clarithromycin-resistant phenotype. Conclusions: All clarithromycin-resistant strains had either 2146A>G or 2147A>G mutation, suggesting that tests targeting these two mutations may be enough for the prediction of clarithromycin resistance in this population.

• Helicobacter pylori
• antibiotic resistance
• whole-genome sequencing

Helicobacter pylori (H. pylori) infection is on the rise as a cause of immune thrombocytopenia (ITP). It has been suggested that platelet recovery can be achieved following successful microbial eradication, although, the exact pathophysiology has yet to be fully elucidated. This study evaluated the long-term effects of H. pylori eradication monotherapy on platelet count recovery in patients with ITP. H. pylori eradication was analysed in 61 ITP patients. Patients who maintained a complete response (CR) for more than six months were classified as sustained responders (SR). The prevalence of H. pylori infection was 54.3% (75/138), and the success rate of eradication with first-line therapy was 71.4% (35/49). Patients who had achieved a CR at 2 months maintained a higher platelet count thereafter. At 1 year following eradication, platelet counts had increased 2.78 times in the eradicated group, 1.36 times in the sustained infection group, and 1.33 times in the no infection group compared with the baseline (P = 0.016).

• 16S rRNA genes sequencing
• Microbiota dysbiosis
• Platelet activation
• Primary immune thrombocytopenia

• Drug Resistance
• Helicobacter pylori
• Proton Pump Inhibitors
• Stomach Neoplasms
• Treatment Outcome

• Adult
• Aged
• Amoxicillin/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Bismuth/therapeutic use
• Breath Tests
• Clarithromycin/therapeutic use
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Helicobacter Infections/drug therapy
• Helicobacter pylori/drug effects
• Humans
• Male
• Middle Aged
• Proton Pump Inhibitors/therapeutic use

• Korean College of Helicobacter and Upper Gastrointestinal Research fund

The Hellenic Society of Gastroenterology recently organized the “Hellenic consensus on Helicobacter pylori (H. pylori) infection”. The aim of this publication is to report the guidelines in order to aid the national gastroenterology community in the management of H. pylori infection. Forty-one delegates from all Greek regions, including gastroenterologists, pathologists, clinical microbiologists, epidemiologists and basic scientists, were invited to this meeting. The participants were allocated to 1 of the 4 main topics of the meeting: i.e., H. pylori diagnosis and association with diseases; H. pylori and gastric cancer; H. pylori and extragastric associated disorders; and H. pylori treatment. The results of each subgroup were submitted to a final consensus vote that included all participants. Relevant data based on international and Greek publications were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. The cutoff level of 70% was considered as acceptance for the final statement. It is hoped that the recommendations and conclusions of this report will guide Greek doctors in their daily practice concerning the management of H. pylori infection.

• Helicobacter pylori
• Hellenic Society of Gastroenterology
• consensus
• diagnosis
• extragastric associations
• gastric cancer
• treatment

Increasing levels of antibiotic resistance have reduced the Helicobacter pylori (H. pylori) eradication rates afforded by the standard triple therapy. Thus, 2-wk first-line four-drug regimens must be considered.

To analyze the eradication rates of modified bismuth-containing quadruple therapy (mBCQT) and concomitant therapy (CT), the associated adverse events, and compliance.

Patients infected with H. pylori were prospectively randomized to receive mBCQT or CT for 2 wk. mBCQT featured a proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline, taken twice daily. CT included a PPI, clarithromycin, metronidazole, and amoxicillin, taken twice daily. The ¹³C-urea breath test was performed no earlier than 4 wk after therapy concluded to confirm eradication. If either the histological or rapid urease test was positive, H. pylori infection was diagnosed.

The demographic characteristics of 68 patients who received mBCQT and 68 who received CT did not differ significantly. On intention-to-treat analysis, the eradication rate was 88.2% (60/68) in the mBCQT group and 79.4% (54/68) in the CT group (P = 0.162). By per-protocol analysis, the respective eradication rates were 98.4% (60/61) and 93.1% (54/58) (P = 0.199). More CT than mBCQT patients experienced adverse events [33.8% (23/68) mBCQT vs 51.5% (35/58) CT patients, respectively, P = 0.037]. All patients showed good compliance [85.3% (58/68) mBCQT vs 82.4% (56/68) CT patients, P = 0.641].

The H. pylori eradication rates of the 2-wk mBCQT and CT regimens are high. Most patients show good compliance, and more CT than mBCQT patients experience adverse events.

• Helicobacter pylori
• Therapy
• Bismuth-containing quadruple therapy
• Concomitant therapy

• Aged
• Antacids/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Bismuth/therapeutic use
• Drug Therapy, Combination/adverse effects
• Female
• Helicobacter Infections/drug therapy
• Helicobacter pylori
• Humans
• Male
• Medication Adherence
• Metronidazole/therapeutic use
• Middle Aged
• Prospective Studies
• Proton Pump Inhibitors/therapeutic use
• Tetracycline/therapeutic use

• Children
• Guideline
• Helicobacter pylori
• Therapeutics

• fermented milk
• glycyrrhiza glabra
• helicobacter pylori
• lactobacillus paracasei
• probiotics

• Adult
• Aged
• Animals
• Breath Tests
• Double-Blind Method
• Female
• Fermentation
• Glycyrrhiza/physiology
• Helicobacter Infections/drug therapy
• Helicobacter Infections/immunology
• Helicobacter Infections/psychology
• Humans
• Lacticaseibacillus paracasei/physiology
• Male
• Middle Aged
• Milk/microbiology
• Probiotics/administration & dosage
• Probiotics/adverse effects
• Prospective Studies
• Quality of Life/psychology
• Treatment Outcome
• Young Adult

• Helicobacter pylori
• atrophy
• intestinal metaplasia

• Helicobacter pylori
• PPI
• therapy
• treatment
• vonoprazan

• Helicobacter pylori
• diabetes mellitus type 2
• glycated hemoglobin A

• Kangwon National University
• Korean Society of Gastrointestinal Endoscopy

The prevalence of Helicobacter pylori resistance to metronidazole and clarithromycin is high in Indonesia. Moreover, the increasing levofloxacin resistance rates in the absence of bismuth treatment in Indonesia has led to the use of other antibiotics as alternative regimens.

We determined the minimum inhibitory concentrations (MICs) of five alternative antibiotics for H. pylori (rifaximin, rifabutin, furazolidone, garenoxacin, and sitafloxacin) using the agar dilution method and assessed mutations associated with antibiotic resistance using next-generation sequencing.

Analysis of 106 strains isolated from 1039 adult dyspeptic patients revealed that none of the strains were furazolidone-resistant. All strains were also sensitive to rifabutin and sitafloxacin. In contrast, the rates of resistance to rifaximin and garenoxacin were high (38.9% and 6.7%, respectively). The strains isolated from patients on Java Island had the highest resistance rates to garenoxacin and rifaximin. In addition, the resistance was distributed evenly among the ethnic groups, ranging between 25.0% and 69.2%. Except for rifaximin, for which the resistance rate was 38.9%, the other four antibiotics could be successfully employed to eradicate levofloxacin- and metronidazole-resistant H. pylori infections in vitro. Interestingly, garenoxacin-sensitive strains were found in regions with high clarithromycin resistance rates such as Bali and Papua Islands. In contrast, rifaximin might not be considered as an alternative antibiotic in regions with high clarithromycin resistance. There was an inconsistent association between gyrA and gyrB mutations and garenoxacin resistance. We confirmed that the I837V (replacement of isoleucine at position 837 with valine), A2414T/V, Q2079K and K2068R were the predominant rpoB point mutations. There was an association between vacA genotypes of H. pylori and rifaximin resistance (P = 0.048).

furazolidone-, rifabutin-, and sitafloxacin-based therapies might be considered as alternative regimens to eradicate H. pylori in Indonesia, including regions with high metronidazole and clarithromycin resistance rates. Moreover, sitafloxacin but not garenoxacin should be considered for eradication of levofloxacin-resistant strains.

• Helicobacter pylori
• Indonesia
• antibiotics
• drug resistance

• Gastric cancer
• Gene polymorphism
• Helicobacter pylori
• Inflammation
• SNP

• Antiretroviral therapy
• Cancer screening
• Endoscopy
• Gastric cancer
• Human immunodeficiency virus

• Gastritis
• Lymphocyte
• Lymphoid tissue

• Concomitant therapy
• Helicobacter pylori
• Meta-analysis
• Sequential therapy

• Guideline
• Helicobacter pylori
• Korea
• Therapeutics

• Child
• Diagnosis
• Guideline
• Helicobacter pylori

• Disease eradication
• Helicobacter pylori
• Korea

• Bismuth
• Helicobacter pylori
• Therapy

• Ecabet sodium
• Helicobacter pylori
• Rebamipide
• Therapeutics

Most international guidelines recommend triple-therapy regimens consisting of a proton pump inhibitor, clarithromycin, and amoxicillin/metronidazole for at least 7 days for the eradication of Helicobacter pylori. However, the efficacy of 7-day clarithromycin-based standard triple therapy for H. pylori infection is currently unacceptable in Korea. In this study, we will compare the efficacy and safety of 7-day standard triple therapy, 10-day sequential therapy, and 10-day concomitant therapy for the first-line treatment of H. pylori infection in Korea.

In this multicenter, investigator-blinded, randomized trial we are recruiting adult patients with H. pylori infection from 15 hospitals in Korea to determine whether sequential or concomitant treatment is superior to standard triple therapy. Patients are randomly assigned to receive either standard triple therapy (lansoprazole, amoxicillin, and clarithromycin) for 7 days, or sequential treatment (lansoprazole and amoxicillin for the first 5 days, followed by lansoprazole, clarithromycin, and metronidazole for another 5 days) for 10 days, or concomitant therapy (lansoprazole, amoxicillin, clarithromycin, and metronidazole) for 10 days. The primary outcome is the rate of H. pylori eradication in the intention-to-treat population.

The results of this study will be crucial for determining the optimal regimen for the primary treatment of H. pylori infection in Korea. This study will produce vital evidence that will lead to revisions to guidelines concerning first-line treatment regimens for H. pylori infection.

Clinical Research Information Service (CRIS), Republic of Korea, KCT0001980. Registered on 25 July 2016.

The online version of this article (doi:10.1186/s13063-017-2281-0) contains supplementary material, which is available to authorized users.

• Concomitant therapy
• Helicobacter pylori
• Sequential therapy
• Triple therapy

• Cohort study
• Helicobacter pylori
• Incidence
• Nonalcoholic fatty liver disease

• Helicobacter pylori
• Hybrid
• Moxifloxacin
• Therapy

Eradication of Helicobacter pylori infection with standard triple therapy (TT) has declined primarily because of increased antibiotic resistance. Sequential therapy (ST) has been suggested as an alternative to TT for the first-line treatment of H. pylori. The purpose of this study was to compare the efficacy of ST with TT.

This was a multicenter, randomized open-label trial performed at nine centers in Korea. Patients with H. pylori infection were randomly assigned to receive either 7 day TT or 10 day ST. Eradication rates, drug compliance, and adverse events were compared among the two regimens.

A total of 601 patients were enrolled between March 2011 and September 2014. The intention-to-treat eradication rates were 70.8% for TT and 82.4% for ST (p=0.001). The corresponding per protocol eradication rates were 76.9% and 88.8% for TT and ST, respectively (p=0.000). There were no statistically significant differences between the two regimens with respect to drug compliance and adverse events.

ST achieved better eradication rates than TT as a first-line therapy for H. pylori eradication in Korea.

• Disease eradication
• Drug resistance
• Helicobacter pylori

• Endoscopic Submucosal Dissection
• Gastric Cancer
• Metachronous Recurrence

• Age Factors
• Aged
• Aged, 80 and over
• Endoscopic Mucosal Resection
• Female
• Gastric Mucosa/pathology
• Helicobacter Infections/complications
• Humans
• Kaplan-Meier Estimate
• Male
• Neoplasm Recurrence, Local
• Neoplasms, Second Primary/epidemiology
• Neoplasms, Second Primary/pathology
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms/complications
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology

• Epidemiology
• Helicobacter pylori
• Peptic ulcer
• Prevalence
• Therapy

The eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70–85%. The aim of this study is to compare 7-day triple therapy versus 10-day sequential therapy as the first line treatment.

Data of 1240 H. pylori positive patients treated with triple therapy or sequential therapy from January 2013 to December 2015 were analyzed retrospectively. The patients who had undertaken previous H. pylori eradication therapy or gastric surgery were excluded.

There were 872 (74.3%) patients in the triple therapy group, and 302 (25.7%) patients in the sequential therapy group. There was no significant difference between the two groups regarding age, residence, comorbidities or drug compliance, but several differences were noted in endoscopic characteristics and indication for the treatment. The eradication rate of H. pylori by intention to treat analysis was 64.3% in the triple therapy group, and 81.9% in the sequential therapy group (P = 0.001). In per protocol analysis, H. pylori eradication rate in the triple therapy and sequential therapy group was 81.9 and 90.3%, respectively (P = 0.002). There was no significant difference in overall adverse events between the two groups (P = 0.706). For the rescue therapy, bismuth-containing quadruple therapy showed comparable treatment efficacy after sequential therapy, as following triple therapy.

The eradication rate of triple therapy was below the recommended threshold. Sequential therapy could be effective and tolerable candidate for the first-line H. pylori eradication therapy.

• Anti-bacterial agents
• First-line triple therapy
• Helicobacter pylori
• Sequential therapy

• Anti-bacterial agents
• Eradication
• Helicobacter pylori