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Xie J, Peng J, Wu S, Yang K, Liu D, Shen L, Gong X, Liu D, Xie Y. Efficacy and safety of tetracycline vs. amoxicillin in furazolidone-based rescue therapy for Helicobacter pylori: a real-world analysis. Ann Med 2025; 57:2464938. [PMID: 39950212 PMCID: PMC11834778 DOI: 10.1080/07853890.2025.2464938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 01/23/2025] [Accepted: 01/25/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND AND AIM Despite the increasing rates of antibiotic resistance, furazolidone-based regimens have demonstrated promise in Helicobacter pylori eradication. Therefore, this study aims to evaluate the comparative efficacy and safety of tetracycline versus amoxicillin in furazolidone-based quadruple therapy [bismuth quadruple therapy with furazolidone and tetracycline (BQFT) vs. bismuth quadruple therapy with furazolidone and amoxicillin (BQFA)] in rescue treatments. METHODS Patients who received BQFT or BQFA as rescue treatment were enrolled in this study. H. pylori status was determined using the 13C/14C urea breath test or histological examination. Eradication rates, adherence and side effects were carefully recorded. RESULTS A total of 342 participants were included. BQFT showed significantly higher eradication rates (modified intention-to-treat: 96.2% vs. 76%; per-protocol: 97.1% vs. 77.8%, P < 0.001), suggesting superior efficacy for patients with prior treatment failures. However, BQFA demonstrated fewer overall adverse effects (11.6% vs. 20.7%, P = 0.046), highlighting a tolerability advantage. Both groups showed similar symptom improvements and compliance rates. CONCLUSION BQFT exhibits superior efficacy with acceptable tolerability, making it a promising option for patients with refractory H. pylori infections. Clinicians should consider its benefits in cases of multiple prior eradication failures.
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Affiliation(s)
- Jinliang Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Jianxiang Peng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Shuang Wu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Gastroenterology, The Second People’s Hospital of Jingdezhen, Jingdezhen, China
| | - Kaijie Yang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Gastroenterology, People’s Hospital of Ganzhou, Ganzhou, China
| | - Dingwei Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Liting Shen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Xiaomin Gong
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Dongsheng Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
| | - Yong Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Provincial Key Laboratory of Digestive Diseases, Nanchang, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, China
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Yang HJ, Kim JS, Ahn JY, Lee OJ, Kim GH, Bang CS, Park MI, Park JY, Kim SM, Hong SJ, Cho JH, Kim SH, Song HJ, Cho JW, Jee SR, Lim H, Kwon YH, Lee JY, Jeon SW, Park SY, Choe Y, Joo MK, Kim DH, Park JM, Kim BJ, Lee JY, Oh TH, Kim JG, Korean College of Helicobacter and Upper Gastrointestinal Research. Korean Registry on the Current Management of Helicobacter pylori (K-Hp-Reg): Interim Analysis of Adherence to the Revised Evidence-Based Guidelines for First-Line Treatment. Gut Liver 2025; 19:364-375. [PMID: 40289740 PMCID: PMC12070206 DOI: 10.5009/gnl240489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/19/2025] [Accepted: 02/04/2025] [Indexed: 04/30/2025] Open
Abstract
Background/Aims The Korean guidelines for Helicobacter pylori treatment were revised in 2020, however, the extent of adherence to these guidelines in clinical practice remains unclear. Herein, we initiated a prospective, nationwide, multicenter registry study in 2021 to evaluate the current management of H. pylori infection in Korea. Methods This interim report describes the adherence to the revised guidelines and their impact on first-line eradication rates. Data on patient demographics, diagnoses, treatments, and eradication outcomes were collected using a web-based electronic case report form. Results A total of 7,261 patients from 66 hospitals who received first-line treatment were analyzed. The modified intention-to-treat eradication rate for first-line treatment was 81.0%, with 80.4% of the prescriptions adhering to the revised guidelines. The most commonly prescribed regimen was the 14-day clarithromycin-based triple therapy (CTT; 42.0%), followed by tailored therapy (TT; 21.2%), 7-day CTT (14.1%), and 10-day concomitant therapy (CT; 10.1%). Time-trend analysis demonstrated significant increases in guideline adherence and the use of 10-day CT and TT, along with a decrease in the use of 7-day CTT (all p<0.001). Multivariate logistic regression analysis revealed that guideline adherence was significantly associated with first-line eradication success (odds ratio, 2.03; 95% confidence interval, 1.61 to 2.56; p<0.001). Conclusions The revised guidelines for the treatment of H. pylori infection have been increasingly adopted in routine clinical practice in Korea, which may have contributed to improved first-line eradication rates. Notably, the 14-day CTT, 10-day CT, and TT regimens are emerging as the preferred first-line treatment options among Korean physicians.
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Affiliation(s)
- Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Sung Kim
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ok-Jae Lee
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Institute of Medical Science, Gyeongsang National University, Jinju, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Yong Park
- Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Joon Hyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Shin Hee Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ju Yup Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Younghee Choe
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Kyung Joo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hyun Kim
- Ulsan Comfort Gastroenterology Clinic, Ulsan, Korea
| | - Jae Myung Park
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Beom Jin Kim
- Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Tae Hoon Oh
- Department of Internal Medicine, Vievis Namuh Hospital, Seoul, Korea
| | - Jae Gyu Kim
- Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Sun M, Liu E, Yang L, Cao H, Han M. A scoping review of worldwide guidelines for diagnosis and treatment of Helicobacter pylori infection. Syst Rev 2025; 14:107. [PMID: 40346683 PMCID: PMC12063324 DOI: 10.1186/s13643-025-02816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 03/12/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND This study comprehensively analyzes the diagnostic criteria, eradication indications, treatment, and other information in the latest guidelines published by various countries around the world, so that researchers can have a systematic understanding of Helicobacter pylori and further provide a basis for clinical H. pylori diagnosis and treatment. METHODS Nine online databases were searched to find the latest version of guidelines for H. pylori worldwide. Two researchers read the included guidelines independently and extracted the eradication indications, diagnostic criteria, and treatment in the guidelines, conducting a summary of them. RESULTS A total of 25 guidelines or consensus were included. Among all diagnostic methods for H. pylori infection, the urea breath test is widely recommended as the first choice. A total of 20 guidelines mentioned indications for H. pylori eradication. Among them, the indications with a higher proportion of recommendations were long-term use of non-steroidal anti-inflammatory drugs (including low-dose aspirin) in 90% of patients with peptic ulcer history or active peptic ulcer disease 80%; gastric mucosa-associated lymphoid tissue (MALT) lymphoma 75%. It is worth mentioning that 40% of the guidelines pointed out that, as long as H. pylori infection is confirmed, it should be eradicated. A total of 24 guidelines mentioned treatment for H. pylori. Among them, bismuth quadruple therapy (a combination of a bismuth, two antibiotics, and a proton pump inhibitor (PPI)) was the most recommended first-line therapy. Levofloxacin triple therapy (a combining of a bismuth, an antibiotic, and a PPI) was the most recommended second-line therapy. CONCLUSION Current global Helicobacter pylori management guidelines share foundational consensus, yet exhibit regional variations in diagnostic criteria, eradication indications, and therapeutic regimens due to context-specific epidemiological, socioeconomic, and antimicrobial resistance profiles. Clinical practice should prioritize regionally tailored approaches, integrating local guidelines while maintaining awareness of international recommendations to optimize decision-making. Moreover, health authorities responsible for guideline development must ensure timely updates based on dynamic surveillance of local resistance patterns and socioeconomic realities.
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Affiliation(s)
- Mingyao Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Enyu Liu
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Liwen Yang
- World Federation of Chinese Medicine Societies, Beijing, China
| | - Huijuan Cao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Mei Han
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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Lin M, Hu J, Liu J, Wang J, Han Z, Wang X, Zhai Z, Yu Y, Yuan W, Zhang W, Wang Z, Kong Q, Lin B, Ding Y, Wan M, Zhang W, Duan M, Zeng S, Li Y, Zuo X, Li Y. The interval of rescue treatment does not affect the efficacy and safety of Helicobacter pylori eradication: A prospective multicenter observational study. Chin Med J (Engl) 2025:00029330-990000000-01533. [PMID: 40304303 DOI: 10.1097/cm9.0000000000003534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND The effect of the interval between previous Helicobacter pylori (H. pylori) eradication and rescue treatment on therapeutic outcomes remains unknown. The aim of this study was to investigate the association between eradication rates and treatment interval durations in H. pylori infections. METHODS This prospective observational study was conducted from December 2021 to February 2023 at six tertiary hospitals in Shandong, China. We recruited patients who were positive for H. pylori infection and required rescue treatment. Demographic information, previous times of eradication therapy, last eradication therapy date, and history of antibiotic use data were collected. The patients were divided into four groups based on the rescue treatment interval length: Group A, ≥4 weeks and ≤3 months; Group B, >3 and ≤6 months; Group C, >6 and ≤12 months; and Group D, >12 months. The primary outcome was the eradication rate of H. pylori . Drug compliance and adverse events (AEs) were also assessed. Pearson's χ2 test or Fisher's exact test was used to compare eradication rates between groups. RESULTS A total of 670 patients were enrolled in this study. The intention-to-treat (ITT) eradication rates were 88.3% in Group A, 89.6% in Group B, 89.1% in Group C, and 87.7% in Group D. The per-protocol (PP) eradication rates were 92.9% in Group A, 94.5% in Group B, 94.5% in Group C, and 93.6% in Group D. There was no statistical difference in the eradication rates between groups in either the ITT ( P = 0.949) or PP analysis ( P = 0.921). No significant differences were observed in the incidence of AEs ( P = 0.934) or drug compliance ( P = 0.849) between groups. CONCLUSION The interval duration of rescue treatment had no significant effect on H. pylori eradication rates or the incidence of AEs. REGISTRATION ClinicalTrials.gov , NCT05173493.
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Affiliation(s)
- Minjuan Lin
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Junnan Hu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Jing Liu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Juan Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Zhongxue Han
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Xiaohong Wang
- Department of Gastroenterology, The Affiliated Taian City Centeral Hospital of Qingdao University, Taian, Shandong 271000, China
| | - Zhenzhen Zhai
- Department of Gastroenterology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong 253000, China
| | - Yanan Yu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Wenjie Yuan
- Department of Gastroenterology, The Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong 261031, China
| | - Wen Zhang
- Department of Gastroenterology, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, China
| | - Zhi Wang
- Department of Internal Medicine, Maternity and Child Care Center of Dezhou, Dezhou, Shandong 253011, China
| | - Qingzhou Kong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Boshen Lin
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Yuming Ding
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Meng Wan
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Wenlin Zhang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Miao Duan
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Shuyan Zeng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Yueyue Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
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Aneiros-Fernández J, Montero Pavón P, García Gómez N, Palo Prian RM, Sánchez García I, Romero Ortiz AI, López Castro R, Casado-Sánchez C, Sánchez Turrión V, Luna A, Berbís MÁ. Rapid and Efficient Screening of Helicobacter pylori in Gastric Samples Stained with Warthin-Starry Using Deep Learning. Diagnostics (Basel) 2025; 15:1085. [PMID: 40361903 PMCID: PMC12071636 DOI: 10.3390/diagnostics15091085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 04/05/2025] [Accepted: 04/16/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Helicobacter pylori is a major risk factor for gastric cancer. The incidence and prevalence of the pathogen are increasing worldwide, urging novel approaches to reduce detection turnaround times. H. pylori diagnosis relies on histological examination of gastric biopsies, but interobserver variability considerably impacts its identification. We present an algorithm combining a feature pyramid network and a ResNet architecture for automatic and rapid H. pylori detection in digitized Warthin-Starry-stained gastric biopsies. Methods: Whole-slide images were segmented into manually annotated smaller patches and segments containing stomach tissue were analyzed for the presence of Gram-negative bacteria. Patches classified as positive were examined to confirm the presence/absence of bacteria in contact with the gastric epithelial surface (H. pylori). Results: The algorithm exhibited 0.923 average precision and 0.982 average recall. The conducted efficiency study demonstrated that algorithm utilization significantly decreased (p < 0.001) diagnostic turnaround times for all participants (two pathologists, a pathology resident, a pathology technician, and a biotechnologist), observing an 88.13-91.76% time reduction. Implementation of the algorithm also improved diagnostic accuracy for the resident, technician, and biotechnologist, indicating that the tool remarkably supports less experienced personnel. Conclusions: We believe that the incorporation of our algorithm into pathology workflows will help standardize diagnostic protocols and drastically reduce H. pylori diagnostic turnaround times.
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Affiliation(s)
- José Aneiros-Fernández
- Department of Pathology, University Hospital Complex of Granada, 18014 Granada, Spain; (J.A.F.)
| | - Pedro Montero Pavón
- Department of Anatomical Pathology, Hospital San Juan de la Cruz, 23400 Úbeda, Jaén, Spain; (P.M.P)
- Cells IA Technologies, 28006 Madrid, Spain; (I.S.G.)
| | - Natalia García Gómez
- Department of Histology, Faculty of Medicine, University of Cádiz, 11003 Cádiz, Spain; (N.G.G.)
| | - Rosa María Palo Prian
- Pathology Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (R.M.P.P.); (A.I.R.O.)
| | - Ismael Sánchez García
- Cells IA Technologies, 28006 Madrid, Spain; (I.S.G.)
- Department of R&D, HT Médica, San Juan de Dios Hospital,14960 Córdoba, Spain
| | - Ana Isabel Romero Ortiz
- Pathology Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (R.M.P.P.); (A.I.R.O.)
| | - Rodrigo López Castro
- Pathology Department, San Cecilio University Clinic Hospital, 18016 Granada, Spain; (R.L.C.)
| | - César Casado-Sánchez
- Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain; (C.C.S.); (V.S.T.)
- Department of Plastic and Reconstructive Surgery, La Paz University Hospital, 28046 Madrid, Spain
| | - Víctor Sánchez Turrión
- Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain; (C.C.S.); (V.S.T.)
- Department of General Surgery and Digestive Tract, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain
| | - Antonio Luna
- Department of Integrated Diagnostics, HT Médica, Clínica Las Nieves, 23007 Jaén, Spain; (A.L.)
| | - Manuel Álvaro Berbís
- Cells IA Technologies, 28006 Madrid, Spain; (I.S.G.)
- Department of R&D, HT Médica, San Juan de Dios Hospital,14960 Córdoba, Spain
- Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain; (C.C.S.); (V.S.T.)
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Hamze H, Payne M, Stefanovic A, Lowe CF, Romney MG, Matic N. Helicobacter pylori culture positivity and antimicrobial susceptibility profiles (Vancouver, Canada). J Antimicrob Chemother 2025:dkaf114. [PMID: 40202867 DOI: 10.1093/jac/dkaf114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 03/20/2025] [Indexed: 04/11/2025] Open
Abstract
INTRODUCTION Helicobacter pylori is associated with gastrointestinal diseases including gastritis and peptic ulcers. Despite its significance, there is a scarcity of antimicrobial susceptibility testing (AST) data available for this organism in North America. OBJECTIVES The aim of this study was to assess the AST profile and identify factors associated with H. pylori culture positivity in a cohort of patients with refractory H. pylori undergoing gastric biopsies. METHODS We retrospectively reviewed gastric biopsy specimens received for culture between July 2009 and February 2023. We analyzed specimen transport time, Gram smear results, direct urease test findings, culture positivity and AST profiles. Using gradient strip methodology and European Committee on Antimicrobial Susceptibility Testing breakpoints, AST was conducted for amoxicillin, clarithromycin, metronidazole, levofloxacin and tetracycline. RESULTS Of 579 biopsy samples received for H. pylori culture, 228 (39.4%) tested positive. Samples transported within <1 h had significantly higher odds (1.81 times, P < 0.015) of being culture positive compared to those with longer transport times. Smear-positive samples had substantially higher odds (18.8 times, P < 0.001) of culture positivity compared to smear-negative. Urease-positive samples demonstrated notably higher odds (7.7 times, P < 0.001) of culture positivity compared to urease-negative samples. The collection of isolates from gastric biopsies showed susceptibility rates of 97.3% to amoxicillin, 99.1% to tetracycline, 50.4% to levofloxacin, 25.9% to metronidazole and 12.9% to clarithromycin. CONCLUSIONS Short sample transport time was associated with improved H. pylori recovery rates. In this cohort of refractory H. pylori cases, susceptibility rates were high for amoxicillin and tetracycline and low for clarithromycin, metronidazole and levofloxacin. Susceptibility rates remained stable over time.
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Affiliation(s)
- Hasan Hamze
- Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, Bc V6T 1Z7, Canada
| | - Michael Payne
- Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, Bc V6T 1Z7, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Providence Health Care, 1081 Burrard St., Vancouver, Bc V6Z 1Y6, Canada
| | - Aleksandra Stefanovic
- Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, Bc V6T 1Z7, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Providence Health Care, 1081 Burrard St., Vancouver, Bc V6Z 1Y6, Canada
| | - Christopher F Lowe
- Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, Bc V6T 1Z7, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Providence Health Care, 1081 Burrard St., Vancouver, Bc V6Z 1Y6, Canada
| | - Marc G Romney
- Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, Bc V6T 1Z7, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Providence Health Care, 1081 Burrard St., Vancouver, Bc V6Z 1Y6, Canada
| | - Nancy Matic
- Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, Bc V6T 1Z7, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Providence Health Care, 1081 Burrard St., Vancouver, Bc V6Z 1Y6, Canada
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7
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Yan T, Wang J, Zhu R, Ma D, Gao J, Wang J, Chen Y, Sun K, Gu Q, Li L. Vonoprazan improves the efficacy of bismuth quadruple therapy containing doxycycline and metronidazole as first-line Helicobacter pylori treatment in penicillin-allergic patients: a randomized controlled trial. J Antimicrob Chemother 2025; 80:927-934. [PMID: 40048654 DOI: 10.1093/jac/dkae467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 12/10/2024] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Helicobacter pylori eradication in penicillin-allergic patients presents challenges. Options of effective regimens are lacking in areas where tetracycline is unavailable. OBJECTIVES To evaluate the efficacy of replacing the proton pump inhibitor (PPI) with a potassium-competitive acid blocker (P-CAB, vonoprazan) in standard bismuth quadruple therapy containing doxycycline and metronidazole as a first-line treatment for H. pylori. METHODS This prospective randomized clinical trial enrolled 332 naive patients with H. pylori infection and penicillin allergy. Participants were randomly assigned in a 1:1 ratio to either the 14 day P-CAB/BDM group (vonoprazan 20 mg twice daily, colloidal bismuth 200 mg twice daily, doxycycline 100 mg twice daily and metronidazole 400 mg three times daily) or the 14 day PPI/BDM group (rabeprazole 10 mg twice daily, and the same dose of the three other drugs as in the 14 day P-CAB/BDM group). RESULTS Eradication rates in the P-CAB/BDM and PPI/BDM groups were 90.4% and 71.1% (P value for superiority was 0.013), respectively, by ITT analysis. The efficacy of P-CAB/BDM remained non-inferior and even superior to PPI/BDM therapy in all ITT, modified ITT and PP analyses. The overall frequency of adverse events (39.8% and 40.4%; P = 0.911) and compliance (88.0% and 91.0%; P = 0.372) were similar between P-CAB and PPI regimens. Patients with higher body surface area were significantly associated with eradication failure in both groups (P < 0.05). CONCLUSIONS The 14 day P-CAB/BDM therapy provided a satisfactory eradication rate of >90% (ITT analysis) and had a good safety profile as first-line H. pylori therapy, providing an alternative option for penicillin-allergic patients.
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Affiliation(s)
- Tianlian Yan
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jinghua Wang
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Renke Zhu
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dan Ma
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jianguo Gao
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jiewei Wang
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ye Chen
- Department of Mathematics and Statistics, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Kefang Sun
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, NY 14621, USA
| | - Qing Gu
- Department of Endoscopy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lan Li
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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8
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Jearth V, Yadav AI, Shah J, Singh AK, Sundaram S, Sharma V, Dutta U, Makharia G, Panigrahi MK. A survey of practice patterns and adherence to national and international guidelines on the management of Helicobacter pylori infection among gastroenterologists and gastroenterology fellows in India. Indian J Gastroenterol 2025; 44:208-219. [PMID: 39419950 DOI: 10.1007/s12664-024-01694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/17/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Patients and primary care providers alike benefit greatly from the expertise of gastroenterologists when it comes to managing Helicobacter pylori (H. pylori) infection. However, information on gastroenterologists' practices in the management of H. pylori infection is scarce in this part of the world. This study aimed at evaluating the practice patterns of gastroenterologists and gastroenterology fellows in India. METHOD This was a cross-sectional questionnaire-based survey of gastroenterologists and gastroenterology fellows working in India. RESULTS Total 207 gastroenterologists and 53 fellows filled out the questionnaire. Responses were received from all around India. Approximately 70% of respondents perceive H. pylori to be a gastric pathogen, while 20% regard it as a commensal bacterium. While the proportion of respondents who chose a test and treat method (34.6%) for uninvestigated dyspepsia without alarm symptoms was comparable to empirical proton pump inhibitor (PPI) therapy (38.8%), about one-fifth chose a scope and treat strategy in this setting. Even in the absence of alarm signs, more than half of respondents (61.5%) preferred endoscopic biopsy to detect H. pylori. While rapid urease testing (RUT) was the preferred modality (80%) for detecting H. pylori, about one-third preferred single-site RUT (from the antrum). Only 40% followed the Updated Sydney protocol, while performing biopsies and a majority (78.8%) are unable to discontinue PPIs before testing for H. pylori. PPI-clarithromycin-based triple treatment was the preferred regimen (67%) for first-line eradication, while nearly a quarter of respondents did not utilize bismuth due to concerns about adverse effects. CONCLUSION The survey reveals a lack of adherence to the current H. pylori guidelines for diagnosis, testing and treatment among gastroenterologists and gastroenterology fellows in India. It is vital that scientific societies simplify guidelines, investigate challenges to their effective implementation and execute targeted interventions to increase adherence.
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Affiliation(s)
- Vaneet Jearth
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ashutosh Ishan Yadav
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Jimil Shah
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Sridhar Sundaram
- Department of Digestive Disease and Clinical Nutrition, Tata Memorial Hospital, Mumbai, 400 012, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India.
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9
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Zhao Y, He L, Sun L, Liu W, Wang H, Zhang J, Gong Y, Wang X. RdxA-independent mechanism of Helicobacter pylori metronidazole metabolism. Front Microbiol 2025; 16:1553734. [PMID: 40207148 PMCID: PMC11979234 DOI: 10.3389/fmicb.2025.1553734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 03/13/2025] [Indexed: 04/11/2025] Open
Abstract
Introduction Metronidazole (MNZ) is widely used to treat Helicobacter pylori infection worldwide. However, due to excessive and repeated use, resistance rates have exceeded 90% in some regions. The mechanisms of MNZ resistance have been extensively studied, and RdxA has been identified as the primary enzyme responsible for MNZ activation. Mutations in RdxA, particularly termination mutations, can lead to high-level MNZ resistance. Methods We identified a strain, ICDC15003s, which harbored RdxA termination mutation but remained highly susceptible to MNZ. To explore this phenomenon, we conducted comparative genomic and transcriptomic analyses to define RdxA-independent mechanisms of MNZ metabolism. Results and discussion We found missense mutations in genes such as yfkO, acxB, alr1, glk, and cobB. Additionally, the expression of multiple genes, including TonB-dependent receptor and mod, significantly changed in resistant strains. Notably, the sequences and expression levels of known nitroreductases like FrxA and FdxB remained unchanged after induction of MNZ resistance, suggesting they were not responsible for MNZ sensitivity in ICDC15003s. Instead, transcriptional alterations were observed in genes encoding NADH-quinone oxidoreductase subunit (M, J, H and K), suggesting a potential compensatory mechanism for the loss of RdxA activity. We proposed that NADH-quinone oxidoreductase might serve as an RdxA-independent mechanism for MNZ metabolism and resistance through regulation of its expression levels. This discovery could provide new strategies to address MNZ resistance and aid in developing nitroimidazole antibiotics.
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Affiliation(s)
- Yakun Zhao
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Health Statistics, China Medical University, Shenyang, China
| | - Lihua He
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lu Sun
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wentao Liu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hairui Wang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianzhong Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanan Gong
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaohui Wang
- Department of Gastroenterology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
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10
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Shih CA, Wu DC, Shie CB, Hsu PI. Dual Therapies Containing an Antibiotic Plus a Proton Pump Inhibitor or Vonoprazan for Helicobacter pylori Infection: A Systematic Review. Microorganisms 2025; 13:715. [PMID: 40284552 PMCID: PMC12029877 DOI: 10.3390/microorganisms13040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 03/14/2025] [Accepted: 03/19/2025] [Indexed: 04/29/2025] Open
Abstract
Due to the increasing prevalence of antimicrobial resistance, the efficacy of standard triple therapy for Helicobacter pylori (H. pylori) infection has declined, with eradication rates now falling below 80% in most countries. Although bismuth quadruple therapy and concomitant therapy are advised in regions with high clarithromycin resistance, these treatments commonly cause frequent adverse events and require the use of two or three antibiotics. This review article evaluates the effectiveness of 14-day mono-antibiotic therapies for H. pylori infection through randomized controlled trials conducted from 1 October 2014 to 1 October 2024. The pooled eradication rates for 14-day high-dose amoxicillin/proton pump inhibitor (PPI) dual therapies were 86.1% (3335/3875; 95% confidence interval (CI): 85.1-87.2%) by intention-to-treat (ITT) analysis and 87.3% (3232/3702; 95% CI: 86.2-88.4%) by per-protocol (PP) analysis. For 14-day high-dose amoxicillin/vonoprazan dual therapies, the rates were 87.4% (1085/1241; 95% CI: 85.5-89.2%) by ITT and 93.0% (1044/1124; 95% CI: 91.5-94.5%) by PP. In the penicillin-allergic population, 14-day tetracycline/vonoprazan dual therapy showed eradication rates of 92.0% (138/150) by ITT and 95.1% (135/142) by PP. In conclusion, 14-day tetracycline/vonoprazan dual therapy presents an effective option for eradicating H. pylori in patients allergic to penicillin. For those without a penicillin allergy, first-line treatments can include 14-day mono-antibiotic regimens, such as high-dose amoxicillin/PPI dual, high-dose amoxicillin/vonoprazan dual, and tetracycline/vonoprazan dual therapies.
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Affiliation(s)
- Chih-An Shih
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Pingtung County 928004, Taiwan;
- Department of Nursing, Meiho University, Pingtung County 912009, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807377, Taiwan;
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan
| | - Chang-Bih Shie
- Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan City 709204, Taiwan
| | - Ping-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan City 709204, Taiwan
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11
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Rocha GR, Lemos FFB, Silva LGDO, Luz MS, Correa Santos GL, Rocha Pinheiro SL, Calmon MS, de Melo FF. Overcoming antibiotic-resistant Helicobacter pylori infection: Current challenges and emerging approaches. World J Gastroenterol 2025; 31:102289. [PMID: 40093672 PMCID: PMC11886534 DOI: 10.3748/wjg.v31.i10.102289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/28/2024] [Accepted: 01/17/2025] [Indexed: 02/26/2025] Open
Abstract
Recent studies have shown a noticeable increase in global Helicobacter pylori (H. pylori) resistance, with clarithromycin resistance surpassing 15% in various areas. However, inadequate epidemiological monitoring, especially in developing countries, and the absence of uniform testing methods lead to discrepancies between regions and a possible underestimation of resistance levels. The complexity of treating H. pylori is driven by its highly dynamic genome, which is prone to frequent mutations contributing to phenotypical resistance. The usual course of action in empirical treatment involves using a combination of various drugs simultaneously, leading to significant resistance selection pressure and potential side effects. The emergence of H. pylori strains resistant to multiple drugs is closely tied to failures in first-line treatment, highlighting the need to prevent further resistance by using optimal initial empirical therapy or regimens guided by antibiotic susceptibility testing, requiring a collection of mixed samples and multiple isolates for accurate assessment. The emergence of new treatments like potassium-competitive acid blockers offers a hopeful approach to decrease antimicrobial usage while still ensuring effectiveness in comparison to traditional therapies with proton pump inhibitors. Additionally, the use of probiotics is under investigation to identify specific strains and formulations that may mitigate therapy-associated adverse effects.
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Affiliation(s)
- Gabriel Reis Rocha
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabian Fellipe Bueno Lemos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Gabriel Lima Correa Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Samuel Luca Rocha Pinheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Mariana Santos Calmon
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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12
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Umar Z, Tang JW, Marshall BJ, Tay ACY, Wang L. Rapid diagnosis and precision treatment of Helicobacter pylori infection in clinical settings. Crit Rev Microbiol 2025; 51:369-398. [PMID: 38910506 DOI: 10.1080/1040841x.2024.2364194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/08/2024] [Accepted: 05/25/2024] [Indexed: 06/25/2024]
Abstract
Helicobacter pylori is a gram-negative bacterium that colonizes the stomach of approximately half of the worldwide population, with higher prevalence in densely populated areas like Asia, the Caribbean, Latin America, and Africa. H. pylori infections range from asymptomatic cases to potentially fatal diseases, including peptic ulcers, chronic gastritis, and stomach adenocarcinoma. The management of these conditions has become more difficult due to the rising prevalence of drug-resistant H. pylori infections, which ultimately lead to gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. In 1994, the International Agency for Research on Cancer (IARC) categorized H. pylori as a Group I carcinogen, contributing to approximately 780,000 cancer cases annually. Antibiotic resistance against drugs used to treat H. pylori infections ranges between 15% and 50% worldwide, with Asian countries having exceptionally high rates. This review systematically examines the impacts of H. pylori infection, the increasing prevalence of antibiotic resistance, and the urgent need for accurate diagnosis and precision treatment. The present status of precision treatment strategies and prospective approaches for eradicating infections caused by antibiotic-resistant H. pylori will also be evaluated.
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Affiliation(s)
- Zeeshan Umar
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jia-Wei Tang
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
| | - Barry J Marshall
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
- Marshall International Digestive Diseases Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Alfred Chin Yen Tay
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
- Marshall International Digestive Diseases Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liang Wang
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- Division of Microbiology and Immunology, School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia, China
- Center for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, China
- School of Agriculture and Food Sustainability, University of Queensland, Brisbane, Queensland, Australia
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13
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Cho JH, Jin SY. Efficacy and Safety of Modified Bismuth Quadruple Therapy for First-Line Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Microorganisms 2025; 13:519. [PMID: 40142411 PMCID: PMC11944862 DOI: 10.3390/microorganisms13030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 02/21/2025] [Accepted: 02/24/2025] [Indexed: 03/28/2025] Open
Abstract
This study aimed to evaluate the efficacy of adding bismuth to conventional triple therapy (modified bismuth quadruple therapy [mBQT]) for Helicobacter pylori treatment-naïve patients in an era of increasing eradication failure. We performed a comprehensive literature search up to December 2024 using PubMed, Embase, and the Cochrane Library to investigate mBQT's benefits. The comparative treatments were as follows: (1) triple therapy without bismuth (TT), (2) non-BQTs (sequential and concomitant), and (3) classic BQT (cBQT) containing metronidazole and tetracycline. Randomized controlled trials (RCTs) were analyzed to compare eradication rates, adverse drug events, and patient compliance between the mBQT and comparison groups. In total, 9162 and 8449 patients from 43 trials in 35 RCTs were included in the intention-to-treat and per-protocol analyses, respectively. The mBQT group had a superior pooled eradication rate compared to the TT group (84.8% vs. 74.1%, p < 0.00001, and odds ratio [OR] = 2.02 [1.61-2.55]). The mBQT showed a similar eradication rate to the non-BQT and cBQT groups (80.8% vs. 80.2%, p = 0.55, and OR = 1.09 [0.83-1.43] in the non-BQT group; 81.5% vs. 83.0%, p = 0.36, and OR = 0.84 [0.59-1.21] in the cBQT group). Regarding adverse drug events, there was no significant difference between the mBQT and comparison groups (25.4% vs. 27.5%, p = 0.53, and OR = 0.95 [0.80-1.12]). The subgroup analysis showed that patient adherence to mBQT was significantly higher than to cBQT (96.4% vs. 93.3%, p = 0.004, and OR = 1.83 [1.21-2.77]). Our meta-analysis showed that mBQT was an effective and tolerable first-line therapy for H. pylori eradication.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea;
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14
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Wei J, Zheng Z, Wang X, Jia B, Sun M, Wang J, Wan Q, Han M, Qiu Y. Guideline-based bismuth quadruple therapy for helicobacter pylori infection in China: A systematic review and network meta-analysis. PLoS One 2025; 20:e0318937. [PMID: 39977453 PMCID: PMC11841909 DOI: 10.1371/journal.pone.0318937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 01/24/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Currently, quadruple therapy is unanimously recommended as the current first-line treatment option for Helicobacter pylori (H. Pylori) eradication. However, the drug composition of quadruple therapy is very complex, and the efficacy and safety between them is not clear. AIMS To compare the efficacy and safety of H. Pylori eradication regimens, which were recommended by the Fifth Consensus of China, by network meta-analysis. METHODS Literature databases were used to retrieve clinical randomized controlled trials of H. Pylori eradication. Network meta-analysis was performed using BUGSnet and meta package of R software, using OR values as effect size, and SUCRA was used to rank the efficacy of interventions under each outcome. RESULTS A total of 55 studies and 130 arms were included. The NMA analysis found that the top regimen in term of eradication rate outcome was: Rabeprazole + Bismuth + Furazolidone + Tetracycline (SUCRA, 97.5). In terms of safety outcomes: Lansoprazole + Bismuth + Amoxycillin + Clarithromycin (SUCRA, 91.97). CONCLUSIONS The bismuth quadruple therapies recommended by the guidelines for the treatment of H. Pylori have good performance in terms of four-week eradication rate and safety outcome indicators, and due to the different resistance of antibiotics in different regional populations, rational use of drugs should be combined with local conditions.
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Affiliation(s)
- Jiali Wei
- Beijing University of Chinese Medicine, Beijing, China
| | - Zehao Zheng
- Beijing University of Chinese Medicine, Beijing, China
| | - Xin Wang
- Wang Jing Hospital of CACMS, Beijing, China
| | - Boyi Jia
- Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Mingyao Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Jiayi Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Qin Wan
- Beijing University of Chinese Medicine, Beijing, China
| | - Mei Han
- Center for Evidence-Based Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Qiu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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15
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Song Z, Du Q, Zhang G, Zhang Z, Liu F, Lu N, Gu L, Kuroda S, Zhou L. Vonoprazan-based quadruple therapy is non-inferior to esomeprazole-based quadruple therapy for Helicobacter pylori eradication: A multicenter, double-blind, randomized, phase 3 study. Chin Med J (Engl) 2025:00029330-990000000-01427. [PMID: 39965795 DOI: 10.1097/cm9.0000000000003437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Owing to the high prevalence of antibiotic resistance in Helicobacter pylori (H. pylori) in China, bismuth-containing quadruple therapies have been recommended for H. pylori eradication. This study compared the efficacy and safety of quadruple regimens containing vonoprazan vs. esomeprazole for H. pylori eradication in a patient population in China. METHODS This was a phase 3, multicenter, randomized, double-blind study. Patients with confirmed H. pylori infection were randomized 1:1 to receive quadruple therapy for 14 days: amoxicillin 1000 mg and clarithromycin 500 mg after meals, bismuth potassium citrate 600 mg before meals, plus either vonoprazan 20 mg or esomeprazole 20 mg before meals, all twice daily. The primary outcome was the eradication rate of H. pylori, evaluated using a 13C urea breath test at 4 weeks after treatment. The non-inferiority margin was at 10%. RESULTS The study included 510 patients, 506 of whom completed the follow-up assessment. The primary analysis revealed eradication rates of 86.8% (210/242) and 86.7% (208/240) for vonoprazan and esomeprazole therapy, respectively (treatment difference: 0.1%; 95% confidence interval [CI]: -5.95, 6.17; non-inferiority P = 0.0009). Per-protocol analysis showed eradication rates of 87.4% for vonoprazan and 86.3% for esomeprazole (treatment difference: 1.2%; 95% CI: -5.03, 7.36; non-inferiority P = 0.0004). Vonoprazan and esomeprazole were well tolerated, with similar safety profiles. CONCLUSION Vonoprazan was found to be well-tolerated and non-inferior to esomeprazole for eradicating H. pylori in patients from China. TRIAL REGISTRATION ClinicalTrials.gov, NCT04198363.
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Affiliation(s)
- Zhiqiang Song
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Qin Du
- Department of Gastroenterology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Zhenyu Zhang
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Fei Liu
- Department of Gastroenterology, Shanghai East Hospital Affiliated Tongji University, Shanghai 200000, China
| | - Nonghua Lu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330000, China
| | - Liqun Gu
- Takeda Development Center Asia, Shanghai 200000, China
| | - Shingo Kuroda
- Takeda Pharmaceutical Company Limited, Osaka 034-0041, Japan
| | - Liya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
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16
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Li H, Li J, Lai M. Efficacy analysis of folic acid in chronic atrophic gastritis with Helicobacter pylori infection: a systematic review and meta-analysis. BMC Gastroenterol 2025; 25:69. [PMID: 39920638 PMCID: PMC11806780 DOI: 10.1186/s12876-025-03644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 01/23/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Current data indicate that supplements such as folic acid play a significant role in treating chronic atrophic gastritis (CAG). However, no meta-analysis article evaluates its efficacy comprehensively. Therefore, we conducted a meta-analysis to compare the effectiveness and safety of folic acid in the treatment of CAG with Helicobacter pylori (H. pylori) infection. METHODS Using a systematic review method, consider randomized controlled trials (RCT), including clinical trial reports, unpublished clinical trial data, and conference papers. A comprehensive search of the literature was conducted from all years up to June 2024. We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Vip, and Wanfang databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan5.4 and STAT15.1. Efficacy and safety outcomes were evaluated using risk ratio (RR) and 95% confidence intervals (CI). RESULTS 16 randomized controlled trials with 1364 patients were included. Compared with conventional therapy, folic acid therapy had a higher total effective rate (95.09% vs.79.06%, pooled RR = 1.19, 95% CI: 1.12-1.26, p < 0.00001) and lower incidence of adverse events (11.64% vs. 14.04%, RR = 0.86, 95% CI: 0.46-1.60, p = 0.64). Moreover, folic acid can better improve gastric function and repair gastric mucosa (MD = 27.20, 95%CI:23.84-30.56, p < 0.00001). CONCLUSIONS For HP-related CAG, anti-HP treatment and folic acid supplementation should be started as early as possible. Gastric mucosal protective agents can improve the curative effect and can be selected according to the condition of patients with obvious adverse reactions. Our study provided evidence for their potential clinical use in the management of CAG. However, CAG-related studies in other countries and regions need to be further studied. REGISTRATION The logn number of our Meta-analysis on PROSPERO is 42,024,571,785.
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Affiliation(s)
- Hui Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530000, People's Republic of China
| | - Jincheng Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530000, People's Republic of China
| | - Mingyu Lai
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530000, People's Republic of China.
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17
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Abdulqader AKA, Alamri TA, Alhamad MA, Shehab El‐Deen S, Essa A, Alfayez RA, Albaqshi BM, Almajed AS, Alhassan MY, Essa A, Albadrani AA, Alomair O, Al Jalal BA, Almulhim MY, Alotaibi A, Darwish E. First-Line Levofloxacin-Based Triple Therapy Versus Standard Bismuth-Based Quadruple Therapy for Helicobacter pylori Eradication in Saudi Arabia: A Retrospective Single-Center Study. Health Sci Rep 2025; 8:e70432. [PMID: 39917596 PMCID: PMC11798733 DOI: 10.1002/hsr2.70432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 12/12/2024] [Accepted: 01/23/2025] [Indexed: 02/09/2025] Open
Abstract
Background and Aims Antibiotic resistance in Saudi Arabia has led to decreased efficacy of conventional triple therapy for Helicobacter pylori (H. pylori) eradication, prompting the development of alternative treatments like levofloxacin-based triple and bismuth-based quadruple therapies. However, comparative data regarding its efficacy are lacking. Therefore, this study's goal was to compare the efficacy of levofloxacin-based triple therapy with that of standard bismuth-based quadruple therapy as first-line regimens. Methods This retrospective analysis included 197 treatment-naïve adults with H. pylori infection who received levofloxacin-based triple (levofloxacin + amoxicillin + PPI) therapy (n = 81) or standard bismuth-based quadruple (bismuth + tetracycline + metronidazole + PPI) therapy (n = 116). H. pylori eradication was evaluated 4-8 weeks after medication administration using the 13C-urea breath test, and variables that could affect the rate of success were examined. Results There were no differences between groups in terms of age, sex, nationality, or type of proton pump inhibitor (PPI) used. The bismuth-based quadruple therapy group exhibited a markedly superior success rate compared to the levofloxacin-based triple therapy group when the latter was administered for 7 or 10 days (81.03% vs. 6.66%, p < 0.001, and 81.03% vs. 36.1%, p < 0.001, respectively). However, when the levofloxacin-based triple therapy was extended to 14 days, its H. pylori eradication rate became comparable to that of the 10-day bismuth-based quadruple therapy (81.03% vs. 80%, p = 0.898). Eradication rates for both regimens were similar for patients aged ≥ 60, non-Saudi, when using omeprazole and those treated with levofloxacin-based triple therapy for 14 days. Conclusion Quadruple treatment based on bismuth is superior to triple therapy based on levofloxacin for eradicating H. pylori in Saudi Arabia and should be used as a first-line treatment. However, the 14-day levofloxacin-based triple treatment had an H. pylori eradication rate comparable to that of the 10-day bismuth-based quadruple therapy.
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Affiliation(s)
| | - Turki Abdullah Alamri
- Internal Medicine Department, Gastroenterology UnitKing Fahad University HospitalAl KhobarKingdom of Saudi Arabia
- Imam Abdulrahman Bin Faisal UniversityDammamKingdom of Saudi Arabia
| | | | - Somaia Shehab El‐Deen
- Internal Medicine DepartmentCollege of Medicine, King Faisal UniversityAl‐AhsaKingdom of Saudi Arabia
- Tropical Medicine Department, Faculty of MedicineMenoufia UniversityShebin El‐KomEgypt
| | - Abdallah Essa
- Internal Medicine DepartmentCollege of Medicine, King Faisal UniversityAl‐AhsaKingdom of Saudi Arabia
- Tropical Medicine Department, Faculty of MedicineMenoufia UniversityShebin El‐KomEgypt
| | | | | | | | | | - Ali Essa
- Faculty of Medicine, Menoufia UniversityShebin El‐KomEgypt
| | - Ahmed Abdullah Albadrani
- Internal Medicine DepartmentCollege of Medicine, Prince Sattam Bin Abdulaziz UniversityAl‐KharjKingdom of Saudi Arabia
| | - Omar Alomair
- Internal Medicine DepartmentCollege of Medicine, King Faisal UniversityAl‐AhsaKingdom of Saudi Arabia
| | - Bashaeer Abdullh Al Jalal
- Internal Medicine DepartmentCollege of Medicine, King Faisal UniversityAl‐AhsaKingdom of Saudi Arabia
| | - Mohammed Yousef Almulhim
- Internal Medicine DepartmentCollege of Medicine, King Faisal UniversityAl‐AhsaKingdom of Saudi Arabia
| | - Abdullah Alotaibi
- Internal Medicine Department, Gastroenterology UnitKing Fahad University HospitalAl KhobarKingdom of Saudi Arabia
- Imam Abdulrahman Bin Faisal UniversityDammamKingdom of Saudi Arabia
| | - Ehab Darwish
- Internal Medicine DepartmentCollege of Medicine, King Faisal UniversityAl‐AhsaKingdom of Saudi Arabia
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of MedicineZagazig UniversityZagazigEgypt
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18
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Jin T, Wu W, Zhang L, Xuan H, Zhang H, Zhong L. The efficacy and safety of Vonoprazan and Tegoprazan in Helicobacter pylori eradication: a comprehensive systematic review and meta-analysis of randomized controlled trials. Therap Adv Gastroenterol 2025; 18:17562848251314801. [PMID: 39898357 PMCID: PMC11783504 DOI: 10.1177/17562848251314801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 01/03/2025] [Indexed: 02/04/2025] Open
Abstract
Background Potassium-competitive acid blocker (P-CAB)-based therapies are emerging as promising alternatives for eradicating Helicobacter pylori infection. However, the comparative efficacy of P-CAB-based therapy versus proton-pump inhibitor (PPI)-based therapy in treating H. pylori infection remains uncertain. Objectives This meta-analysis evaluated the efficacy and safety of P-CAB-based therapies, including Vonoprazan (VPZ) and Tegoprazan (TPZ), compared to PPI-based therapies for H. pylori infection. Subgroup analysis assessed the influence of drug history, experimental drug, treatment duration, combination therapies, and geographic regions on treatment outcomes. Design Meta-analysis. Data sources and methods Comprehensive searches were conducted in major databases, including PubMed, Embase, the Cochrane Library, and Web of Science, up to January 1, 2024. The primary outcome was the eradication rate, analyzed by intention-to-treat (ITT). Secondary outcomes included adverse events. Heterogeneity among studies was assessed using the χ2 test and the I 2 test. I 2 > 50% or p < 0.05 indicated significant heterogeneity. Results The analysis totally included 28 randomized controlled trials (RCTs) comprising 37 studies and 8818 patients diagnosed with H. pylori infection. Of these, 14 RCTs, including 20 studies and 4286 patients, compared P-CAB-based therapy with 14-day bismuth-based quadruple therapy (BQT). P-CAB-based therapy exhibited superior eradication rates compared to both 14-day BQT and PPI-based therapy (ITT analysis: 87.0% vs 79.8%, risk ratio (RR) = 1.08, 95% CI: 1.04-1.12, p < 0.0001; and 85.6% vs 77.8%, RR = 1.09, 95% CI: 1.05-1.12, p < 0.00001, respectively). This enhanced efficacy was particularly pronounced in patients with clarithromycin-resistant infections (73.7% vs 41.5%, RR = 1.53, 95% CI: 1.07-2.20, p = 0.02). Subgroup analysis demonstrated higher eradication rates with P-CAB-based therapy in treatment-naïve participants, VPZ recipients, and those receiving 7- or 14-day regimens (dual, triple, or quadruple therapy). However, no significant differences were observed in treatment-experienced subgroups, TPZ recipients, or those on 10-day regimens. In addition, P-CAB-based therapy showed a lower incidence of adverse events than PPI-based treatments (RR = 0.73, 95% CI: 0.63-0.86, p < 0.0001). Conclusion P-CAB-based therapies are more effective than traditional PPI-based treatments for eradicating H. pylori infection, with a reduced incidence of adverse events. PROSPERO registration CRD42024503665.
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Affiliation(s)
- Ting Jin
- Gastroenterology Department, The First People’s Hospital of Xiaoshan District, Hangzhou, China
| | - Wei Wu
- Gastroenterology Department, The First People’s Hospital of Xiaoshan District, Hangzhou, China
| | - Lei Zhang
- Gastroenterology Department, The First People’s Hospital of Xiaoshan District, Hangzhou, China
| | - Han Xuan
- Gastroenterology Department, The First People’s Hospital of Xiaoshan District, Hangzhou, China
| | - Haixiang Zhang
- Gastroenterology Department, The First People’s Hospital of Xiaoshan District, Hangzhou, China
| | - Li Zhong
- Gastroenterology Department, The First People’s Hospital of Xiaoshan District, 199 Shixin South Road, Xiaoshan District, Hangzhou, Zhejiang 311200, China
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19
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Dilaghi E, Mosciatti L, Dottori L, Ligato I, Esposito G, Pilozzi E, Annibale B, Lahner E. Therapeutic regimens against Helicobacter pylori infection without proton pump inhibitors in patients with corpus atrophic gastritis: a real-life single-centre longitudinal observational study. Therap Adv Gastroenterol 2025; 18:17562848241308035. [PMID: 39816929 PMCID: PMC11733876 DOI: 10.1177/17562848241308035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 12/03/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Efficacy of eradication regimens in Helicobacter pylori (Hp) infection is commonly reported with proton pump inhibitors (PPIs). In patients with corpus atrophic gastritis, characterized by impaired acid secretion, PPI treatment is questionable. OBJECTIVES The current study aimed to assess in clinical practice the tolerability and eradication rate of modified eradication regimens without PPI as first-line treatment in patients with histologically Hp-positive corpus atrophic gastritis. DESIGN Real-life longitudinal observational study. METHODS Overall, 76 patients (77.6% females, age 58.5 (26-88) years) with histologically Hp-positive corpus atrophic gastritis were consecutively diagnosed (2001-2022). First-line eradication treatment was prescribed without PPIs: concomitant or sequential amoxicillin-based therapy (ABT) until 2016 (n = 30), then single-pill bismuth treatment (SPBT; n = 46). Treatment adherence and adverse events were clinically evaluated and treatment efficacy was assessed by histopathology (updated Sydney system) at 6 ± 3 months after treatment. RESULTS Only mild adverse events not requiring medical treatment were observed in four patients treated with SPBT without PPIs (vomiting, self-limiting diarrhoea, nausea, abdominal discomfort) and in two treated with ABT without PPIs (vomiting and abdominal discomfort). Overall, 71/76 (93.4%) corpus atrophic gastritis patients completed the treatment: 43/46 (93.5%) SPBT without PPIs and 28/30 (93.3%) ABT without PPIs. Successful cure of Hp was observed in 64/71 patients: overall eradication rate 90.1%, 95%CI 69.4%-115.1%. 42/43 corpus atrophic gastritis patients treated with SPBT without PPIs were successfully cured against 22/28 of those treated with ABT without PPIs. The eradication rate was higher for SPBT than ABT: 97.7%, 95%CI 70.4%-132.0% vs 78.6%, 95%CI 49.2%-118.9%, p = 0.013. CONCLUSION In clinical practice, Hp cure can be achieved without PPIs as first-line treatment in about 90% of patients with corpus atrophic gastritis.
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Affiliation(s)
- Emanuele Dilaghi
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Mosciatti
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Ludovica Dottori
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Irene Ligato
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Esposito
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Emanuela Pilozzi
- Digestive Disease Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Bruno Annibale
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Edith Lahner
- Digestive Disease Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, via di Grottarossa 1035, Rome 00189, Italy
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Mori H, Nishizawa T, Morioka K, Kato M, Kanai T. Should Metronidazole Be Included in Second-Line Treatment After Standard Triple Therapy for Helicobacter pylori?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Helicobacter 2025; 30:e70010. [PMID: 39868753 PMCID: PMC11771550 DOI: 10.1111/hel.70010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 01/06/2025] [Accepted: 01/11/2025] [Indexed: 01/28/2025]
Abstract
BACKGROUND AND AIM Although standard triple therapy remains the first-line eradication treatment for H. pylori worldwide, it is unclear whether metronidazole should be included empirically in second-line eradication treatments. The aim of this study was to compare the efficacy of metronidazole-containing regimens with that of metronidazole-free regimens after failure of first-line eradication using standard triple therapy. METHODS PubMed, the Cochrane Library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in this systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Thirteen eligible RCTs were included, with a total of 2039 patients assigned to metronidazole-containing (975 patients) or metronidazole-free (1064 patients) regimens. Metronidazole-containing regimens had significantly lower eradication failure rates than regimens without metronidazole (OR 0.55; 95% CI, 0.39-0.78). Subgroup analysis based on the regional risk of metronidazole resistance demonstrated that metronidazole-containing regimens had lower eradication failure rates not only in low-risk regions but also in high-risk regions (OR, 0.29; 95% CI, 0.11-0.74 and OR, 0.66; 95% CI, 0.49-0.91, respectively). CONCLUSION After failure of standard triple therapy, secondary eradication treatment regimens containing metronidazole demonstrate higher eradication rates than those without metronidazole.
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Affiliation(s)
- Hideki Mori
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and HepatologyInternational University of Health and Welfare, Narita HospitalNaritaJapan
| | - Kohei Morioka
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
- Center for Diagnostic and Therapeutic EndoscopyKeio University School of MedicineTokyoJapan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic EndoscopyKeio University School of MedicineTokyoJapan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
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21
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Riaz M, Chan C, Andrews C, Herzlinger M, Liu E, Bonilla S. Factors associated with Helicobacter pylori antimicrobial resistance in a US pediatric cohort. J Pediatr Gastroenterol Nutr 2025; 80:87-99. [PMID: 39584245 DOI: 10.1002/jpn3.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 10/24/2024] [Accepted: 10/28/2024] [Indexed: 11/26/2024]
Abstract
OBJECTIVES The rising rates of Helicobacter pylori antimicrobial resistance highlight the importance of better understanding its epidemiology in the pediatric population. We aim to study the epidemiological factors associated with antimicrobial resistance in a cohort of US children with H. pylori infection. METHODS A retrospective cohort study of patients in the New England region of the United States between January 15, 2015 and October 15, 2022, with a first-time diagnosis of H. pylori on gastric biopsy and who had antimicrobial resistance data available. Descriptive statistics and logistic regression models were used to determine associations between the patient's demographics, clinical factors, endoscopic findings, and antimicrobial resistance. RESULTS Out of 273 patients (46% male, median 12.8 years), 118 (43.2%) were resistant to at least one antimicrobial. Clarithromycin resistance (24.5%) was the highest, followed by metronidazole (21.6%), fluoroquinolones (9.9%), rifabutin (3.3%), and amoxicillin (2.6%). Clarithromycin resistance was higher in Asians compared to White individuals (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [2.01-10.89], p < 0.001), and lower in Black compared to White individuals (OR: 0.23, 95% CI: [0.08-0.69], p = 0.01). Antimicrobial resistance to clarithromycin and metronidazole were similar among Hispanics. Asian individuals were more likely to demonstrate one or more antimicrobial resistances compared to White (OR: 3.66, 95% CI: [1.50-8.89], p < 0.001). Compared to individuals from higher household incomes (>$100,000), those from less than $30,000 household incomes had a higher risk of metronidazole resistance (OR: 7.94, 95% CI: [1.83-34.36], p = 0.01). CONCLUSION Our study provides novel information concerning the association of H. pylori antimicrobial resistance to race, socioeconomic status, and age in the pediatric population.
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Affiliation(s)
- Muhammad Riaz
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Christina Chan
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine Andrews
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Michael Herzlinger
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Warren Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Silvana Bonilla
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
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22
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Salahi-Niri A, Nabavi-Rad A, Monaghan TM, Rokkas T, Doulberis M, Sadeghi A, Zali MR, Yamaoka Y, Tacconelli E, Yadegar A. Global prevalence of Helicobacter pylori antibiotic resistance among children in the world health organization regions between 2000 and 2023: a systematic review and meta-analysis. BMC Med 2024; 22:598. [PMID: 39710669 DOI: 10.1186/s12916-024-03816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 12/11/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND Helicobacter pylori infection causes gastritis, peptic ulcers, and gastric cancer. The infection is typically acquired in childhood and persists throughout life. The major impediment to successful therapy is antibiotic resistance. This systematic review and meta-analysis aimed to comprehensively assess the global prevalence of antibiotic resistance in pediatric H. pylori infection. METHODS We performed a systematic search of publication databases that assessed H. pylori resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, and tetracycline in children. The WHO region classification was used to group pooled primary and secondary resistance estimates along with 95% confidence interval (CI). H. pylori antibiotic resistance rates were retrieved and combined with odds ratios (95% CI) to investigate the global prevalence and temporal trends. Subgroup analysis of the prevalence of antibiotic resistance was conducted by country, age groups, and susceptibility testing methods. RESULTS Among 1417 records obtained initially, 152 studies were selected for eligibility assessment after applying exclusion criteria in multiple steps. Ultimately, 63 studies involving 15,953 individuals were included comprising data from 28 countries in 5 WHO regions. The primary resistance rates were metronidazole 35.3% (5482/15,529, 95% CI: 28.7-42.6), clarithromycin 32.6% (5071/15,555, 95% CI: 27.7-37.9), tetracycline 2.1% (148/7033, 95% CI: 1.3-3.6), levofloxacin 13.2% (1091/8271, 95% CI: 9.3-18.4), and amoxicillin 4.8% (495/10305, 95% CI: 2.5-8.8). Raising antibiotic resistance was detected in most WHO regions. CONCLUSIONS The escalating trend of H. pylori antibiotic resistance in children warrants urgent attention globally. National and regional surveillance networks are required for antibiotic stewardship in children infected with H. pylori.
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Affiliation(s)
- Aryan Salahi-Niri
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Nabavi-Rad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tanya Marie Monaghan
- National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
- Medical School, European University of Cyprus, Nicosia, Cyprus
| | - Michael Doulberis
- Gastroklinik, Private Gastroenterological Practice, Horgen, 8810, Switzerland
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, Aarau, 5001, Switzerland
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
- Research Center for Global and Local Infectious Diseases, Oita University, Oita, Japan
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Schauer C, Teng A, Signal V, Stanley J, Mules TC, Koea J, Inns SJ. Translating evidence into action: overcoming barriers to gastric cancer prevention in Aotearoa. J R Soc N Z 2024:1-19. [DOI: 10.1080/03036758.2024.2427818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 11/06/2024] [Indexed: 01/06/2025]
Affiliation(s)
- Cameron Schauer
- Department of Gastroenterology, Health New Zealand Te Whatu Ora, Waitematā, University of Auckland, Auckland, New Zealand
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Virgina Signal
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Thomas C Mules
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Jonathan Koea
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Stephen J. Inns
- Wellington, Health New Zealand Te Whatu Ora, Capital Coast and Hutt Valley, University of Otago, Dunedin, New Zealand
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24
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Artin MG, Soddano J, Rustgi SD, Aziz Z, Lim F, Yang JY, Ingram MA, Nathanson JT, Kao JY, Hur C. Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis. GASTRO HEP ADVANCES 2024; 4:100602. [PMID: 39996244 PMCID: PMC11849076 DOI: 10.1016/j.gastha.2024.100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 12/11/2024] [Indexed: 02/26/2025]
Abstract
Background and Aims Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and upper gastrointestinal bleeding. Testing for and eradication of H. pylori reduces the risk of future PUD-related complications including readmission for gastrointestinal bleeding. Our aim was to determine the most cost-effective testing strategy for H. pylori in patients hospitalized with bleeding peptic ulcers. Methods We developed a Markov cohort model to compare the following 6 H. pylori testing strategies: no testing, histology, rapid urease test, stool antigen test, urea breath test (UBT), and serology. Histology and rapid urease test require biopsies, while stool antigen test, UBT, and serology do not. We assumed a 17% H. pylori prevalence in patients admitted with bleeding ulcers. Model outcomes included hospitalizations for rebleeds, number needed to treat to avoid another hospitalization, life expectancy, total cost, quality-adjusted life years, and incremental cost-effectiveness ratios. Results Compared to no testing, UBT resulted in a gain of 0.02 quality-adjusted life years, total cost savings of $2140 per patient, and 1675 hospitalizations avoided per 10,000 patients per year. Additionally, the number needed to treat to avoid an additional hospitalization over 35 years was 167. UBT was the preferred strategy as it was both less costly and more effective than no testing. Conclusion Our findings suggest that UBT is the cost-effective strategy to identify H. pylori in patients admitted with PUD. Noninvasive H. pylori testing at the point of care or during inpatient admission should be considered, as it presents limited risk to patients and offers potential clinical benefits.
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Affiliation(s)
- Michael G. Artin
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Josephine Soddano
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sheila D. Rustgi
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Zainab Aziz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jeong Yun Yang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Myles A. Ingram
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - John T. Nathanson
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - John Y. Kao
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Bayir H, Tacer S, Yurdgulu EE, Albayrak A, Toktay E, Bayir Y. Investigation of the effects of rainbow trout (Oncorhynchus mykiss) skin mucus against indomethacin-induced gastric damage in rats. J Mol Histol 2024; 56:41. [PMID: 39673571 DOI: 10.1007/s10735-024-10320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 11/22/2024] [Indexed: 12/16/2024]
Abstract
A peptic ulcer is a stomach lesion. It is generally caused by malnutrition, the use of anti-inflammatory medications, and an imbalance between mucosal defense systems. In fishes, the lubricous substance that called mucus secreted from the skin, prevents the entry of microorganisms that can enter the body through the skin. That mucus contains immune components such as antimicrobial peptides, lysozymes, lectins, proteases, and mucin. This study investigated the antiulcer activity of Rainbow Trout skin Mucus (RTM) in indomethacin induced ulcer model of rats and compared with famotidine as standard antiulcer drug. We administered 50, 100 and 200 mg/kg RTM dose on indomethacin-induced gastric ulcer model in rats and evaluated the numerical density of ulcer areas, histopathologic parameters and oxidative stress parameters (SOD, GSH, MDA) in the rat stomach. RTM was able to inhibit indomethacin-induced ulcer formation and exhibited a similar effect to 40 mg/kg dose of standard drug famotidine. 200 mg/kg dose of RTM had positive effects on oxidative stress biomarkers and histopathological results in the stomach tissue of rats. This is the first time we have fully demonstrated the gastroprotective effects of RTM as a waste product in rats. Analyses have shown that mucin, which has a positive regulatory effect on oxidative stress parameters, may be responsible for the gastroprotective effect.
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Affiliation(s)
- Hilal Bayir
- Faculty of Fisheries, Department of Aquaculture, Ataturk University, Erzurum, 25240, Turkey
- Kocaali District Agriculture Directorate, Sakarya, 54800, Turkey
| | - Seyda Tacer
- Faculty of Fisheries, Department of Aquaculture, Ataturk University, Erzurum, 25240, Turkey
| | - Emir Enis Yurdgulu
- Faculty of Pharmacy, Department of Biochemistry, Ataturk University, Erzurum, 25240, Turkey
| | - Abdulmecit Albayrak
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, 25240, Turkey
| | - Erdem Toktay
- Faculty of Medicine, Department of Histology & Embryology, Kafkas University, Kars, 36000, Turkey
| | - Yasin Bayir
- Faculty of Pharmacy, Department of Biochemistry, Ataturk University, Erzurum, 25240, Turkey.
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26
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Olmedo L, Calvet X, Gené E, Bordin DS, Voynovan I, Castro-Fernandez M, Pabón-Carrasco M, Keco-Huerga A, Perez-Aisa Á, Lucendo AJ, Rodrigo L, Sarsenbaeva AS, Khlinov IB, Fadieienko G, Zaytsev O, Lanas Á, Martínez-Domínguez SJ, Alfaro E, Jonaitis L, Núñez Ó, Pellicano R, Hernández L, Gridnyev O, Kupcinskas J, Gasbarrini A, Boltin D, Niv Y, Babayeva G, Marcos-Pinto R, Tepes B, Venerito M, Papp V, Lerang F, Leja M, Phull PS, Marlicz W, Doulberis M, Smith SM, Milivojevic V, Kunovsky L, Mestrovic A, Matysiak-Budnik T, Simsek H, Cano-Català A, Puig I, Moreira L, Parra P, Nyssen OP, Megraud F, O'Morain C, Gisbert JP. Evolution of the use, effectiveness and safety of bismuth-containing quadruple therapy for Helicobacter pylori infection between 2013 and 2021: results from the European registry on H. pylori management (Hp-EuReg). Gut 2024; 74:15-25. [PMID: 39461739 PMCID: PMC11671959 DOI: 10.1136/gutjnl-2024-332804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 09/04/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance. OBJECTIVE To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg). DESIGN Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success. RESULTS Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT-containing bismuth, metronidazole and tetracycline-plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness. CONCLUSION The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness. TRIAL REGISTRATION NUMBER NCT02328131.
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Affiliation(s)
- Llum Olmedo
- Medicina, Programa de Doctorado en Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
- ABS Manresa 3, Althaia Xarxa Assistencial Universitària de Manresa. Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Barcelona, Spain
- Gastrointestinal Oncology Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa. Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Barcelona, Spain
| | - Xavier Calvet
- Servei d’Aparell Digestiu, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Emili Gené
- Medicina, Programa de Doctorado en Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Servei d'Urgències, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
- Department of Propaedeutic of Internal Diseases and Gastroenterology, Russian University of Medicine, Moscow, Russian Federation
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russian Federation
| | - Irina Voynovan
- Department of Gastroenterology, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - M Castro-Fernandez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario de Valme, Sevilla, Spain
| | | | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital Universitario de Valme, Sevilla, Spain
| | - Ángeles Perez-Aisa
- Department of Gastroenterology, Hospital Universitario Costa del Sol, Marbella, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Department of Gastroenterology, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain
| | - Luís Rodrigo
- Department of Gastroenterology, University of Oviedo, Oviedo, Spain
| | - Aiman S Sarsenbaeva
- Department of Gastroenterology, Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russian Federation
| | - Igor B Khlinov
- Department of faculty therapy and geriatrics, Ural State Medical University, Ekaterinburg, Russian Federation
| | - Galyna Fadieienko
- Departments the Division for the Study of the Digestive diseases and its Comorbidity with Noncommunicable Diseases, Government Institution L.T. Malaya Therapy National Institute of NAMS, Kharkiv, Ukraine
| | - Oleg Zaytsev
- First Clinical Medical Centre, Kovrov, Russian Federation
| | - Ángel Lanas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Samuel J Martínez-Domínguez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Enrique Alfaro
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Óscar Núñez
- Department of Gastroenterology, Hospital Universitario La Moraleja, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Rinaldo Pellicano
- Department of Gastroenterology, Molinette-SGAS Hospital, Turin, Italy
| | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Spain
| | - Oleksiy Gridnyev
- Departments the Division for the Study of the Digestive diseases and its Comorbidity with Noncommunicable Diseases, Government Institution L.T. Malaya Therapy National Institute of NAMS, Kharkiv, Ukraine
| | - Juozas Kupcinskas
- Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Doron Boltin
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Yaron Niv
- Dr. Miriam and Sheldon G. Adelson School of Medicine, Ariel University, Ari'el, Israel
| | - Gülüstan Babayeva
- Department of Therapy, Azerbaijan State Advanced Training Institute for Doctors named by A. Aliyev, Baku, Azerbaijan
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto, Porto, Portugal
- Instituto De Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal
| | - Bojan Tepes
- Department of Gastroenterology, DC Rogaska, Rogaska Slatina, Slovenia
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany
| | - Veronika Papp
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre, Riga, Latvia
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
- The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Michael Doulberis
- Department of Gastroenterology, Kantonsspital Aarau, Aarau, Switzerland
| | - Sinead M Smith
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Vladimir Milivojevic
- Department of Gastroenterology and Hepatology, University Clinical Centre of Serbia, Belgrade University, Belgrade, Serbia
| | - Lumir Kunovsky
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Antonio Mestrovic
- Department of Gastroenterology, University Hospital of Split, Split, Croatia
| | - Tamara Matysiak-Budnik
- Department of Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Nantes, France
| | - Halis Simsek
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey
- Department of Gastroenterology, HC International Clinic, Ankara, Turkey
| | - Anna Cano-Català
- Gastrointestinal Oncology Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa. Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Barcelona, Spain
| | - Ignasi Puig
- Gastrointestinal Oncology Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa. Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Barcelona, Spain
- Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
| | - Leticia Moreira
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Pablo Parra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Olga P Nyssen
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
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27
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Li J, Xu X, Yang S, Liu K, Wu M, Xie M, Xiong T. Helicobacter pylori Inhibition, Gastritis Attenuation, and Gut Microbiota Protection in C57BL/6 Mice by Ligilactobacillus salivarius NCUH062003. Microorganisms 2024; 12:2521. [PMID: 39770724 PMCID: PMC11678540 DOI: 10.3390/microorganisms12122521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 11/28/2024] [Accepted: 12/05/2024] [Indexed: 01/11/2025] Open
Abstract
Helicobacter pylori (H. pylori), one of the most prevalent pathogenic bacteria worldwide, is the leading cause of gastritis, gastric intestinal metaplasia, and gastric cancer. Antibiotics, the conventional treatment for eliminating H. pylori, often lead to severe bacterial resistance, gut dysbiosis, and hepatic insufficiency and fail to address the inflammatory response or gastric mucosal damage caused by H. pylori infection. In this study, based on 10-week animal experiments, two models of L. salivarius NCUH062003 for the prophylaxis and therapy of H. pylori infection in C57BL/6 mice were established; a comprehensive comparative analysis was performed to investigate the anti-H. pylori effect of probiotics, the reduction in inflammation, and repair of gastric mucosal damage. ELISA, immunohistochemistry, and pathology analyses showed that NCUH062003 decreased the expression of pro-inflammatory cytokine interleukins (IL-1β, IL-6) and myeloperoxidase (MPO) and reduced neutrophil infiltration in the gastric mucosa lamina propria. Immunofluorescence and biochemical analysis showed that NCUH062003 resisted gastric epithelial cell apoptosis, increased the level of superoxide dismutase (SOD) in gastric mucosa, and promoted the expression of tight junction protein ZO1 and Occludin. In addition, through high-throughput sequencing, in the probiotic therapy and prophylactic mode, the diversity and composition of the gut microbiota of HP-infected mice were clarified, the potential functions of the gut microbiota were analyzed, the levels of short-chain fatty acids (SCFAs) were measured, and the effects of L. salivarius NCUH062003 on the gut microbiota and its metabolites in HP-infected mice treated with amoxicillin/metronidazole were revealed. This study provides functional strain resources for the development and application of microbial agents seeking to antagonize H. pylori beyond antibiotics.
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Affiliation(s)
- Junyi Li
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
| | - Xiaoyan Xu
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
| | - Shiyu Yang
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
| | - Kui Liu
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
| | - Min Wu
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
| | - Mingyong Xie
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
| | - Tao Xiong
- State Key Laboratory of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China; (J.L.)
- School of Food Science & Technology, Nanchang University, No. 235 Nanjing East Road, Nanchang 330047, China
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28
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Pan J, Wang J, Zhao Y, Han B, Shu G, Ma M, Wang X, Wei X, Hou W, Sun SK. Real-time detection of gastrointestinal leaks via bismuth chelate-enhanced X-ray gastroenterography. Biomaterials 2024; 311:122646. [PMID: 38852553 DOI: 10.1016/j.biomaterials.2024.122646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
Anastomotic leaks are among the most dreaded complications following gastrointestinal (GI) surgery, and contrast-enhanced X-ray gastroenterography is considered the preferred initial diagnostic method for GI leaks. However, from fundamental research to clinical practice, the only oral iodinated contrast agents currently available for GI leaks detection are facing several challenges, including low sensitivity, iodine allergy, and contraindications in patients with thyroid diseases. Herein, we propose a cinematic contrast-enhanced X-ray gastroenterography for the real-time detection of GI leaks with an iodine-free bismuth chelate (Bi-DTPA) for the first time. The Bi-DTPA, synthesized through a straightforward one-pot method, offers distinct advantages such as no need for purification, a nearly 100 % yield, large-scale production capability, and good biocompatibility. The remarkable X-ray attenuation properties of Bi-DTPA enable real-time dynamic visualization of whole GI tract under both X-ray gastroenterography and computed tomography (CT) imaging. More importantly, the leaky site and severity can be both clearly displayed during Bi-DTPA-enhanced gastroenterography in a rat model with esophageal leakage. The proposed movie-like Bi-DTPA-enhanced X-ray imaging approach presents a promising alternative to traditional GI radiography based on iodinated molecules. It demonstrates significant potential in addressing concerns related to iodine-associated adverse effects and offers an alternative method for visually detecting gastrointestinal leaks.
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Affiliation(s)
- Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jiaojiao Wang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yujie Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Bing Han
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Gang Shu
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Min Ma
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xu Wang
- Tianjin Key Laboratory of Technologies Enabling Development on Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin, 300070, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Key Laboratory of Digestive Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Wenjing Hou
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Key Laboratory of Digestive Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China.
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Azad H, Hotrmati A, Sarkeshikian SS, Mohammadbeigi A, Razavinia F, Eshaghi Far M, Pezeshgi Modarres M. Efficacy of Pyloshot in combination with standard four-drug antimicrobial treatment for Helicobacter pylori eradication: A randomized clinical trial. JGH Open 2024; 8:e70046. [PMID: 39655241 PMCID: PMC11625933 DOI: 10.1002/jgh3.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/01/2024] [Accepted: 10/14/2024] [Indexed: 12/12/2024]
Abstract
Background and Aim The treatment for Helicobacter pylori is considered to be a combination of several strict regimens, with patients' dissatisfaction and poor compliance. Probiotics are effective in patients' antibiotic regimens. This study investigated the efficacy of the Pyloshot probiotic in combination with standard four-drug therapy in patients with H. pylori infection. Methods This is an interventional study. The study population consisted of patients with H. pylori infection who were selected using the convenience sampling method and were randomly divided into two groups: (i) A or standard four-drug therapy (amoxicillin-clarithromycin-bismuth-pantoprazole) plus two placebo capsules (80 cases). (ii) B or Pyloshot group (standard four-drug therapy plus 2 Pyloshot probiotic capsules) (90 cases). Patients were followed up for 1 month after treatment completion. Eradication of H. pylori was also assessed using the stool antigen test. Data were analyzed using SPSS (v.26) statistical software. Results Based on the results from the present study, the number of negative stool antigen tests in group A was less than that in group B, and no statistically significant relationship was found between H. pylori eradication (based on stool antigen test) and the studied groups (P = 0.20). There was a statistically significant relationship between vomiting (P = 0.03), diarrhea (P = 0.04), constipation (P = 0.01), and headache (P = 0.04); vomiting and constipation were most frequent in the control group. Conclusion Based on the results of the present study, there was no significant difference between the effectiveness of treatment with Pyloshot probiotic and the standard four-drug therapy in patients with H. pylori infection. However, the incidence of side effects was lower in the group treated with Pyloshot.
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Affiliation(s)
- Hossein Azad
- Clinical Research of Development Unit, Shahid Beheshti HospitalQom University of Medical SciencesQomIran
| | - Ahmad Hotrmati
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Department of Internal Medicine, School of MedicineTehran University of Medical SciencesTehranIran
| | - Seyed S Sarkeshikian
- Gastroenterology and Hepatology Diseases Research CenterQom University of Medical SciencesQomIran
| | - Abolfazl Mohammadbeigi
- Department of Biostatistics and Epidemiology, School of Health Research Center for Environmental PollutantsQom University of Medical SciencesQomIran
| | | | | | - Mehdi Pezeshgi Modarres
- Gastroenterology and Hepatology Diseases Research CenterQom University of Medical SciencesQomIran
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Skokowski J, Vashist Y, Girnyi S, Cwalinski T, Mocarski P, Antropoli C, Brillantino A, Boccardi V, Goyal A, Ciarleglio FA, Almohaimeed MA, De Luca R, Abou-Mrad A, Marano L, Oviedo RJ, Januszko-Giergielewicz B. The Aging Stomach: Clinical Implications of H. pylori Infection in Older Adults-Challenges and Strategies for Improved Management. Int J Mol Sci 2024; 25:12826. [PMID: 39684537 PMCID: PMC11641014 DOI: 10.3390/ijms252312826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 10/25/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024] Open
Abstract
Aging is a multifactorial biological process characterized by a decline in physiological function and increasing susceptibility to various diseases, including malignancies and gastrointestinal disorders. Helicobacter pylori (H. pylori) infection is highly prevalent among older adults, particularly those in institutionalized settings, contributing to conditions such as atrophic gastritis, peptic ulcer disease, and gastric carcinoma. This review examines the intricate interplay between aging, gastrointestinal changes, and H. pylori pathogenesis. The age-associated decline in immune function, known as immunosenescence, exacerbates the challenges of managing H. pylori infection. Comorbidities and polypharmacy further increase the risk of adverse outcomes in older adults. Current clinical guidelines inadequately address the specific needs of the geriatric population, who are disproportionately affected by antibiotic resistance, heightened side effects, and diagnostic complexities. This review focuses on recent advancements in understanding H. pylori infection among older adults, including epidemiology, diagnostics, therapeutic strategies, and age-related gastric changes. Diagnostic approaches must consider the physiological changes that accompany aging, and treatment regimens need to be carefully tailored to balance efficacy and tolerability. Emerging strategies, such as novel eradication regimens and adjunctive probiotic therapies, show promise for improving treatment outcomes. However, significant knowledge gaps persist regarding the impact of aging on H. pylori pathogenesis and treatment efficacy. A multidisciplinary approach involving gastroenterologists, geriatricians, and other specialists is crucial to providing comprehensive care for this vulnerable population. Future research should focus on refining diagnostic and therapeutic protocols to bridge these gaps, ultimately enhancing clinical outcomes and reducing the burden of H. pylori-associated diseases in the aging population.
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Affiliation(s)
- Jaroslaw Skokowski
- Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych, 82-330 Elbląg, Poland;
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (S.G.); (T.C.); (P.M.)
| | - Yogesh Vashist
- Organ Transplant Center for Excellence, Center for Liver Diseases and Oncology, King Faisal Specialist Hospital and Research Center, 12211 Riyadh, Saudi Arabia; (Y.V.); (M.A.A.)
| | - Sergii Girnyi
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (S.G.); (T.C.); (P.M.)
| | - Tomasz Cwalinski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (S.G.); (T.C.); (P.M.)
| | - Piotr Mocarski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (S.G.); (T.C.); (P.M.)
| | - Carmine Antropoli
- Department of Surgery, Antonio Cardarelli Hospital, 80100 Naples, Italy; (C.A.); (A.B.)
| | - Antonio Brillantino
- Department of Surgery, Antonio Cardarelli Hospital, 80100 Naples, Italy; (C.A.); (A.B.)
| | - Virginia Boccardi
- Division of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy;
| | - Aman Goyal
- Adesh Institute of Medical Sciences and Research, 151001 Bathinda, Punjab, India;
| | - Francesco A. Ciarleglio
- Department of General Surgery and Hepato-Pancreato-Biliary (HPB) Unit-APSS, 38121Trento, Italy;
| | - Muhannad Abdullah Almohaimeed
- Organ Transplant Center for Excellence, Center for Liver Diseases and Oncology, King Faisal Specialist Hospital and Research Center, 12211 Riyadh, Saudi Arabia; (Y.V.); (M.A.A.)
| | - Raffaele De Luca
- Department of Surgical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, 70100 Bari, Italy;
| | - Adel Abou-Mrad
- Department of Surgery, Centre Hospitalier Universitaire d’Orléans, 45100 Orléans, France;
| | - Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych, 82-330 Elbląg, Poland;
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (S.G.); (T.C.); (P.M.)
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Rodolfo J. Oviedo
- Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX 75965, USA;
- Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX 75961, USA
- Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77301, USA
| | - Beata Januszko-Giergielewicz
- Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych, 82-330 Elbląg, Poland;
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Kuhn EMA, Sominsky LA, Chittò M, Schwarz EM, Moriarty TF. Antibacterial Mechanisms and Clinical Impact of Sitafloxacin. Pharmaceuticals (Basel) 2024; 17:1537. [PMID: 39598446 PMCID: PMC11597390 DOI: 10.3390/ph17111537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 11/09/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024] Open
Abstract
Sitafloxacin is a 4th generation fluoroquinolone antibiotic with broad activity against a wide range of Gram-negative and Gram-positive bacteria. It is approved in Japan and used to treat pneumonia and urinary tract infections (UTIs) as well as other upper and lower respiratory infections, genitourinary infections, oral infections and otitis media. Compared to other fluoroquinolones, sitafloxacin displays a low minimal inhibitory concentration (MIC) for many bacterial species but also activity against anaerobes, intracellular bacteria, and persisters. Furthermore, it has also shown strong activity against biofilms of P. aeruginosa and S. aureus in vitro, which was recently validated in vivo with murine models of S. aureus implant-associated bone infection. Although limited in scale at present, the published literature supports the further evaluation of sitafloxacin in implant-related infections and other biofilm-related infections. The aim of this review is to summarize the chemical-positioning-based mechanisms, activity, resistance profile, and future clinical potential of sitafloxacin.
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Affiliation(s)
- Elian M. A. Kuhn
- AO Research Institute Davos, 7270 Davos, Switzerland; (E.M.A.K.); (M.C.)
- Infection Biology, Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Levy A. Sominsky
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY 14642, USA (E.M.S.)
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
- Medical Scientist Training Program, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Marco Chittò
- AO Research Institute Davos, 7270 Davos, Switzerland; (E.M.A.K.); (M.C.)
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY 14642, USA (E.M.S.)
| | - T. Fintan Moriarty
- AO Research Institute Davos, 7270 Davos, Switzerland; (E.M.A.K.); (M.C.)
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Rajan C, Chiou FK, Ho CWW. Prevalence, Management, and Outcomes of Non-Invasive Helicobacter pylori Testing in Children at a Tertiary Paediatric Hospital in Singapore. Pediatr Gastroenterol Hepatol Nutr 2024; 27:336-344. [PMID: 39563839 PMCID: PMC11570354 DOI: 10.5223/pghn.2024.27.6.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/02/2024] [Accepted: 07/12/2024] [Indexed: 11/21/2024] Open
Abstract
Purpose Helicobacter pylori infections differ between children and adults. The Pediatric society practice guidelines recommend against a test-and-treat approach, characterized by the use of non-invasive tests for diagnosis (e.g. urea breath test [UBT] or stool antigen test). However, significant variations exist in clinical practice. This study examined the use of non-invasive testing for the screening and diagnosis of H. pylori infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes. Methods A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for H. pylori infection using either a stool antigen test or UBT between January 2018 and June 2020. Results Among the 1,397 children tested, 117 (8.4%) had a positive stool H. pylori antigen result, and 5 out of 85 tested (5.9%) had a positive UBT. Abdominal pain was the predominant symptom (n=98; 80.3%). Only 7 treatment-naïve children had biopsy-proven disease. Tissue biopsies for H. pylori culture were sent to 2 children, with 1 negative result. A total of 111 children (91.0%) received treatment, wherein proton pump inhibitor, amoxicillin, and clarithromycin for 14 days was the most common therapeutic regimen. Symptom resolution was observed in 62 children (50.8%). Conclusion A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of H. pylori infections in children at our center and significant false-positive rates.
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Affiliation(s)
- Charanya Rajan
- Division of Gastroenterology, Hepatology and Nutrition Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Fang Kuan Chiou
- Division of Gastroenterology, Hepatology and Nutrition Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christopher Wen Wei Ho
- Division of Gastroenterology, Hepatology and Nutrition Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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Ouyang M, Zou S, Cheng Q, Shi X, Sun M. Comparative Efficacy and Safety of Potassium-Competitive Acid Blockers and Proton Pump Inhibitors for First-Line Helicobacter pylori Eradication Therapy: A Systematic Review and Network Meta-Analysis. Helicobacter 2024; 29:e13150. [PMID: 39508303 DOI: 10.1111/hel.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/16/2024] [Accepted: 10/22/2024] [Indexed: 11/15/2024]
Abstract
BACKGROUND Given the increasing antibiotic resistance and the inadequate acid-suppressing effects of proton pump inhibitors (PPIs), it is crucial to continuously optimize existing Helicobacter pylori (H. pylori) treatment regimens. This study aimed to evaluate the clinical efficacy and safety of novel potassium-competitive acid blocker (P-CAB)-based eradication regimens compared with traditional PPI-based regimens for the initial treatment of H. pylori. MATERIALS AND METHODS We conducted a systematic review and network meta-analysis, searching seven electronic databases for randomized controlled trials (RCTs) evaluating initial P-CAB-based H. pylori eradication therapy. The primary outcome was the H. pylori eradication rate. Secondary outcomes included adverse events and patient compliance. We synthesized the effect sizes of the trials using odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS A total of 54 RCTs involving 15,320 patients (74.9% male, mean age 30.2 years) were included in this study. In the intention-to-treat (ITT) analysis, VPZ-HD-dual, VPZ-triple, and VPZ-quadruple regimens demonstrated significantly higher eradication rates than PPI-triple, PPI-quadruple, and VPZ-dual regimens. Similar trends were observed in the per-protocol (PP) analysis. Subgroup analysis indicated that poor patient compliance significantly reduced eradication rates. Resistance to clarithromycin and metronidazole significantly weakened the eradication effects of PPI-triple, TPZ-triple, and VPZ-triple regimens. Additionally, the eradication rates for 7-day regimens were significantly lower than those for 14-day or 10-day regimens, but there was no significant difference between the eradication rates of 10-day and 14-day regimens. Notably, the risk of adverse events with VPZ-HD-dual was significantly lower than with VPZ-quadruple. CONCLUSION Vonoprazan combined with high-dose amoxicillin dual therapy not only provides satisfactory eradication rates but also exhibits lower adverse event rates and good patient compliance, indicating its potential as a promising regimen for further promotion.
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Affiliation(s)
- Mengling Ouyang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shupeng Zou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Cheng
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuan Shi
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghui Sun
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Jiang G, Luo M, Zheng P, Cong Y, Feng Y, Zhou F. Eradication rate and safety of vonoprazan-amoxicillin dual therapy for helicobacter pylori eradication: a randomized controlled trial. Scand J Gastroenterol 2024; 59:1229-1233. [PMID: 39306707 DOI: 10.1080/00365521.2024.2407898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/14/2024] [Accepted: 09/18/2024] [Indexed: 11/01/2024]
Abstract
BACKGROUND Helicobacter pylori (H. pylori), prevalent in developing regions, is a key factor in gastrointestinal diseases. Despite the common use of bismuth-based quadruple therapy, its drawbacks have prompted the search for alternatives. Recently, vonoprazan, a novel acid suppressant, has shown promise in combination with antibiotics as a dual therapy for H. pylori eradication. This study aimed to assess the therapeutic outcomes and adverse events of vonoprazan-amoxicillin dual therapy compared to quadruple therapy. METHODS A randomized controlled trial (RCT) enrolled H. pylori-infected patients at Zhejiang Hospital. Participants were randomly assigned to dual and quadruple therapy groups. The primary endpoints were H. pylori eradication and adverse events. RESULTS Of the 400 patients studied from April 2022 to June 2023, In the intention-to-treat (ITT) analysis, the eradication rates of H. pylori in vonoprazan-amoxicillin dual therapy group and quadruple therapy group were 94.0% and 87.0%, respectively, p = 0.017. In the per-protocol (PP) analysis were 97.9% and 93.0%, p = 0.022. Additionally, the dual therapy group had a significantly lower incidence of adverse events (19%) compared to the quadruple therapy group (53%) (p < 0.001). CONCLUSION Vonoprazan-amoxicillin dual therapy demonstrates superior eradication efficacy and reduced adverse events compared to quadruple therapy in H. pylori-infected patients, suggesting its potential for clinical application and promotion.
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Affiliation(s)
- Guoping Jiang
- Department of Digestion, Zhejiang Hospital, Hangzhou, China
| | - Mengzhao Luo
- Department of Digestion, Zhejiang Hospital, Hangzhou, China
| | - Peifen Zheng
- Department of Digestion, Zhejiang Hospital, Hangzhou, China
| | - Yanqun Cong
- Department of Digestion, Zhejiang Hospital, Hangzhou, China
| | - Yuliang Feng
- Department of Digestion, Zhejiang Hospital, Hangzhou, China
| | - Feng Zhou
- Department of Digestion, Zhejiang Hospital, Hangzhou, China
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Zeng S, Kong Q, Wu X, Duan M, Nan X, Yang X, Zuo X, Li Y, Li Y. Antibiotic resistance of Helicobacter pylori in Mainland China: A focus on geographic differences through systematic review and meta-analysis. Int J Antimicrob Agents 2024; 64:107325. [PMID: 39245326 DOI: 10.1016/j.ijantimicag.2024.107325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/23/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Empirical treatment needs to be supported by regional data, but knowledge of interregional differences is currently lacking in China. This study aimed to summarize and map the primary and secondary antibiotic resistance of Helicobacter pylori in different regions of mainland China. METHODS PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure and Wanfang databases were systematically reviewed for studies published between 1 January 2000 and 15 July 2023. Data related to primary and secondary H. pylori antibiotic resistance rates were included. Random-effects models were used to synthesize the pooled resistance rates. RESULTS Ultimately, 74 studies were included in the final analysis. A total of 16 provinces reported resistance data. The overall resistance rates of H. pylori in mainland China were 30.72% (95% CI 27.53%-33.99%) to clarithromycin, 70.14% (95% CI 29.53%-37.46%) to metronidazole and 32.98% (95% CI 28.73%-37.37%) to levofloxacin; for amoxicillin, tetracycline, and furazolidone, the rates were 2.41% (95% CI 1.43%-3.60%), 2.53% (95% CI 1.19%-4.28%) and 1.54% (95% CI 0.28%-3.62%), respectively. Spatial and temporal differences were observed. The resistance rates increased after treatment failure; however, secondary resistance to amoxicillin, tetracycline and furazolidone were still low across the vast majority of study regions. CONCLUSION Surveillance of the updated prevalence of antibiotic resistance of H. pylori for different regions is warranted, which should factor into clinical decision making and guideline recommendations.
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Affiliation(s)
- Shuyan Zeng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qingzhou Kong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoqi Wu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Miao Duan
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xueping Nan
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoyun Yang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yueyue Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Liang JW, Xiong S, Jia YG, Xiao D, Tan SY, Cao JW, Sun J, Tian X, Li SY, Chen RH, Ruan GZ, Xiong JG, Wang XM, Xu SP, Qi LP, Liu YH, Zhao YC, Bai SY, Chen W, Cao MD, Peng W, Li YL, Yang YL, Chen SR, Cui HC, Liu LY, Aruna, Zhou Y, Cheng B. Comparison of vonoprazan bismuth-containing triple therapy with quadruple therapy in Helicobacter pylori-infected treatment-naive patients: a prospective multicenter randomized controlled trial. J Gastroenterol Hepatol 2024; 39:2293-2298. [PMID: 39013587 PMCID: PMC11618220 DOI: 10.1111/jgh.16679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/25/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND AIM Helicobacter pylori infection is linked to various gastrointestinal conditions, such as chronic active gastritis, peptic ulcers, and gastric cancer. Traditional treatment options encounter difficulties due to antibiotic resistance and adverse effects. Therefore, the aim of this study was to explore the effectiveness of a new treatment plan that combines vonoprazan (VPZ), amoxicillin, and bismuth for the eradication of H. pylori. METHODS A total of 600 patients infected with H. pylori were recruited for this multicenter randomized controlled trial. Patients treated for H. pylori elimination were randomly assigned at a 1:1 ratio to receive 14 days of vonoprazan-based triple therapy (vonoprazan + amoxicillin + bismuth, group A) or standard quadruple therapy (esomeprazole + clarithromycin + amoxicillin + bismuth, group B). Compliance and adverse effects were tracked through daily medication and side effect records. All patients underwent a 13C/14C-urea breath test 4 weeks after treatment completion. RESULTS Intention-to-treat (ITT) and per-protocol (PP) analyses revealed no substantial differences in H. pylori eradication rates between groups A and B (ITT: 83.7% vs 83.2%; PP: 90.9% vs 89.7%). However, significant differences were observed in the assessment of side effects (13.7% vs 28.6%, P < 0.001). Specifically, group A had significantly fewer "bitter mouths" than group B did (3.7% vs 16.2%, P < 0.001). CONCLUSION Triple therapy comprising vonoprazan (20 mg), amoxicillin (750 mg), and bismuth potassium citrate (220 mg) achieved a PP eradication rate ≥90%, paralleling standard quadruple therapy, and had fewer adverse events and lower costs (¥306.8 vs ¥645.8) for treatment-naive patients.
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Affiliation(s)
- Jing Wen Liang
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Si Xiong
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Ye Gui Jia
- Department of GastroenterologyWuhan City Sixth HospitalWuhanChina
| | - Dan Xiao
- Department of GastroenterologyWuhan City Sixth HospitalWuhanChina
| | - Shi Yun Tan
- Department of GastroenterologyHubei General HospitalWuhanChina
| | - Ji Wang Cao
- Department of GastroenterologyHubei General HospitalWuhanChina
| | - Jun Sun
- Department of GastroenterologyHubei General HospitalWuhanChina
| | - Xia Tian
- Department of GastroenterologyWuhan City Third HospitalWuhanChina
| | - Shu Yu Li
- Department of GastroenterologyZhongshan Hospital of Hubei ProvinceWuhanChina
| | - Rui Hong Chen
- Department of GastroenterologyXiantao First People's Hospital Affiliated to Yangtze UniversityXiantaoChina
| | - Gui Zhen Ruan
- Department of GastroenterologyHongan People's HospitalHuanggangChina
| | - Jian Guang Xiong
- Department of GastroenterologyXianning Center HospitalXianningChina
| | - Xiao Ming Wang
- Department of GastroenterologyPanzhihua Municipal Central HospitalPanzhihuaChina
| | - San Ping Xu
- Department of GastroenterologyWuhan Union Hospital of ChinaWuhanChina
| | - Li Ping Qi
- Department of GastroenterologyWuhan Asia Heart HospitalWuhanChina
| | - Yun Hua Liu
- Department of GastroenterologyThe First People's Hospital of Tianmen CityTianmenChina
| | - Yu Chong Zhao
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shu Ya Bai
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wei Chen
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Meng Die Cao
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wang Peng
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yan Ling Li
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yi Lei Yang
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shi Ru Chen
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hao Chen Cui
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Lu Yao Liu
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Aruna
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yi Zhou
- Department of GastroenterologyHubei Provincial Hospital of Traditional Chinese MedicineWuhanChina
| | - Bin Cheng
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Wang J, Fu D, Tang C, Shu G, Zhang X, Zhang X, Pan J, Sun SK. Bismuth Chelate-Mediated Digital Subtraction Angiography. Adv Healthc Mater 2024; 13:e2401653. [PMID: 38830126 DOI: 10.1002/adhm.202401653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Indexed: 06/05/2024]
Abstract
Digital subtraction angiography (DSA) is considered the "gold standard" for the diagnosis of vascular diseases. However, the contrast agents used in DSA are limited to iodine (I)-based small molecules, which are unsuitable for patients with contraindications. Here, iodine-free DSA utilizing a bismuth (Bi) chelate, Bi-DTPA Dimeglumine, is proposed for vascular visualization for the first time. Bi-DTPA Dimeglumine possesses a simple synthesis process without the need for purification, large-scale production ability (over 200 g in the lab), superior X-ray imaging capability, renal clearance capacity, and good biocompatibility. Bi-DTPA-enhanced DSA can clearly display the arteries of the rabbit's head and lower limbs, with a minimum vascular resolution of 0.5 mm. The displayed integrity of terminal vessels by Bi-DTPA-enhanced DSA is superior to that of iopromide-enhanced DSA. In a rabbit model of thrombotic disease, Bi-DTPA Dimeglumine-enhanced DSA enables the detection of embolism and subsequent reevaluation of vascular conditions after recanalization therapy. This proposed iodine-free DSA provides a promising and universal approach for diagnosing vascular diseases.
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Affiliation(s)
- Jiaojiao Wang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Dianxun Fu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Cong Tang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Gang Shu
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Xuejun Zhang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
| | - Xuening Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
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Wang X, Chan XF, Go Y, Wang Y, Li T, Wang G. Combatting Helicobacter pylori: A Focus on Nanomaterials. Helicobacter 2024; 29:e70004. [PMID: 39725648 DOI: 10.1111/hel.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 11/09/2024] [Accepted: 12/05/2024] [Indexed: 12/28/2024]
Abstract
Developing effective non-antibiotic antimicrobial strategies is essential for combating global antibiotic resistance, including resistance stemming from Helicobacter pylori (H. pylori) treatment. Nanomaterials offer a promising and innovative approach for non-antibiotic anti-H. pylori treatment strategies. This review highlights the progress made in the use of metallic and nonmetallic nanoparticles, as well as nanozymes, to directly inhibit H. pylori growth. Moreover, we summarize advances made in the direct targeting of H. pylori by nanomaterials and the stimuli-responsive release of nanoparticles in the stomach. Additionally, we explore the recent advancements in multifunctional nanoplatforms that integrate physical methods, such as light, heat, ultrasound, and magnetism, with nanomaterials to synergistically treat H. pylori infections. Finally, we briefly address the existing challenges and future directions in this field. In summary, we highlight that with ongoing research, nanomaterials may serve as a promising treatment strategy for H. pylori eradication.
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Affiliation(s)
- Xuanping Wang
- Geriatric Department, Royal Victoria Hospital, Belfast, UK
| | | | - Yuyo Go
- Department of Engineering Science, University of Oxford, Oxford, UK
| | | | - Tingyu Li
- Department of Gastroenterology, National Clinical Research Center for Geriatric Diseases, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Gangshi Wang
- Department of Gastroenterology, National Clinical Research Center for Geriatric Diseases, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
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Scarpignato C, Hunt RH. Potassium-competitive Acid Blockers: Current Clinical Use and Future Developments. Curr Gastroenterol Rep 2024; 26:273-293. [PMID: 39145848 PMCID: PMC11401795 DOI: 10.1007/s11894-024-00939-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE OF THE REVIEW Acid suppression with proton pump inhibitors (PPIs) represents the standard of care in the treatment of acid-related diseases. However, despite their effectiveness, PPIs display some intrinsic limitations, which underlie the unmet clinical needs that have been identified over the past decades. The aims of this review are to summarize the current status and future development of the new class of antisecretory drugs (potassium-competitive acid blockers, P-CABs) that have recently been introduced into medical practice. RECENT FINDINGS Over the past decades, clinical needs unmet by the current acid suppressants have been recognized, especially in the management of patients with GERD, Helicobacter pylori infection and NSAID-related peptic ulcer. The failure to address these needs is mainly due to their inability to achieve a consistent acid suppression in all patients and, particularly, to control nighttime acidity. It was then realized that an extended duration of acid suppression would exert additional benefits. The available data with P-CABs show that they are able to address these unmet clinical needs. Four different P-CABs (vonoprazan, tegoprazan, fexuprazan and keverprazan) are currently available. However, only two of them are approved outside Asia. Vonoprazan is available in North, Central and South America while tegoprazan is marketed only in Latin American countries. Two other compounds (namely linazapran glurate and zestaprazan) are presently under clinical development. While clinical trials on GERD have been performed with all P-CABs, only vonoprazan and tegoprazan have been investigated as components of Helicobacter pylori eradication regimens. The available data show that-in the above two clinical indications-P-CABs provide similar or better efficacy in comparison with PPIs. Their safety in the short-term overlaps that of PPIs, but data from long-term treatment are needed.
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Affiliation(s)
- Carmelo Scarpignato
- Department of Medicine & Surgery, University of Parma, Parma, Italy.
- Department of Health Sciences, United Campus of Malta, Msida, Malta.
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong.
- Faculty of Medicine, University of Nantes, Nantes, France.
| | - Richard H Hunt
- Department of Medicine, Division of Gastroenterology and Farncombe Family Digestive, Health Research Institute, McMaster University, Hamilton, ON, Canada
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Zhao YR, Wang XJ, Zhu MJ, Chen AL, Zhang D, Du Q, Kim JJ, Hu WL. Efficacy and safety of low-dose tetracycline, amoxicillin quadruple therapy in Helicobacter pylori infection: A retrospective single center study. World J Gastroenterol 2024; 30:4295-4304. [PMID: 39492823 PMCID: PMC11525849 DOI: 10.3748/wjg.v30.i39.4295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/09/2024] [Accepted: 09/24/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) eradication rates have declined with the rise of antibiotic-resistant strains in recent years. Although highly effective with a low prevalence of resistance, standard dose tetracycline is associated with frequent adverse events. The efficacy and safety of low-dose tetracycline as part of tetracycline and amoxicillin-containing bismuth quadruple therapy are not well described. AIM To compare the efficacy and safety of low-dose compared to standard dose tetracycline with combined amoxicillin-containing bismuth quadruple therapy in patients with H. pylori infection. METHODS Consecutive patients with H. pylori infection receiving tetracycline, amoxicillin, proton pump inhibitor, and bismuth for 14 days at Sir Run Run Shaw Hospital (1/2022-6/2023) were evaluated. The low-dose tetracycline group received tetracycline 500 mg twice daily (bid) while the standard dose group received 750 mg bid or 500 mg three times daily (tid). Primary endpoints were H. pylori eradication rate and treatment-related adverse events. RESULTS The mean age of the 218 patients was 48.7 ± 14.0 years, 120 (55%) were male, and 118 (54.1%) received treatment as primary therapy. Furthermore, 73 (33%) patients received low-dose tetracycline (500 mg bid) and 145 (67%) received standard dose tetracycline including 500 mg tid in 74 (33%) and 750 mg bid in 71 (33%). On intention-to-treat analysis, H. pylori eradication rates were 89% [95% confidence interval (CI): 82%-96%] in the 500 mg bid group, 82% (95%CI: 74%-91%) in the 500 mg tid group, and 79% (95%CI: 69%-89%) in the 750 mg bid group without a statistically significant difference (P = 0.25). The incidence of adverse events was lower in the low-dose compared to the standard dose group (12.3% vs 31.1% or 23.9%; P = 0.02). CONCLUSION Low-dose tetracycline combined with amoxicillin quadruple therapy for 14 days achieved a high eradication rate and fewer adverse events compared to the standard dose tetracycline regimen in patients with H. pylori infection.
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Affiliation(s)
- Yi-Ru Zhao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Department of Gastroenterology, The First Affiliated Hospital, Medical School, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xin-Jie Wang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Meng-Jia Zhu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ang-Li Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Dian Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Qin Du
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - John J Kim
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9021, United States
| | - Wei-Ling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Bognár B, Spohn R, Lázár V. Drug combinations targeting antibiotic resistance. NPJ ANTIMICROBIALS AND RESISTANCE 2024; 2:29. [PMID: 39843924 PMCID: PMC11721080 DOI: 10.1038/s44259-024-00047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 09/02/2024] [Indexed: 01/24/2025]
Abstract
While the rise of antibiotic resistance poses a global health challenge, the development of new antibiotics has slowed down over the past decades. This turned the attention of researchers towards the rational design of drug combination therapies to combat antibiotic resistance. In this review we discuss how drug combinations can exploit the deleterious pleiotropic effects of antibiotic resistance and conclude that each drug interaction has its prospective therapeutic application.
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Affiliation(s)
- Bence Bognár
- HCEMM-BRC Pharmacodynamic Drug Interaction Research Group, Szeged, Hungary
- Synthetic and Systems Biology Unit, Institute of Biochemistry, HUN-REN Biological Research Centre, Szeged, Hungary
| | - Réka Spohn
- Synthetic and Systems Biology Unit, Institute of Biochemistry, HUN-REN Biological Research Centre, Szeged, Hungary
| | - Viktória Lázár
- HCEMM-BRC Pharmacodynamic Drug Interaction Research Group, Szeged, Hungary.
- Synthetic and Systems Biology Unit, Institute of Biochemistry, HUN-REN Biological Research Centre, Szeged, Hungary.
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Lunagariya Y, Shah M, Lad S, Chauhan S, Rawat V, Bairwa Y, Tailor C, Borkar V, Chopra S, Sasikumar D, Ingle M. Comparing Short-Term Dual vs Standard Quadruple Therapy for Helicobacter pylori Eradication. Am J Gastroenterol 2024; 119:2138. [PMID: 39016395 DOI: 10.14309/ajg.0000000000002882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Yatin Lunagariya
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Mit Shah
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Saiprasad Lad
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | | | - Vikramaditya Rawat
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Yogesh Bairwa
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Chintan Tailor
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Vinay Borkar
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Shivani Chopra
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Deepak Sasikumar
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Meghraj Ingle
- Department of Medical Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Cho JH, Jin SY. Comparison of Amoxicillin Administered Twice versus Four Times a Day in First-Line Helicobacter pylori Eradication Using Tegoprazan, Clarithromycin, and Bismuth: A Propensity Score Matching Analysis. Microorganisms 2024; 12:1952. [PMID: 39458261 PMCID: PMC11509814 DOI: 10.3390/microorganisms12101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/28/2024] Open
Abstract
This study aimed to investigate the effects of different amoxicillin (AMX) dosing schedules on bismuth quadruple therapy in Helicobacter pylori treatment-naïve patients. A total of 139 H. pylori-infected patients received a 2-week eradication regimen consisting of 50 mg tegoprazan, 500 mg clarithromycin, and 300 mg bismuth tripotassium dicitrate twice daily, 1000 mg AMX twice daily (BID group), or 500 mg AMX four times daily (QID group). We performed a urea breath test to evaluate H. pylori eradication eight weeks after treatment and compared the H. pylori eradication rate, patient compliance, and adverse drug events between the BID and QID groups. Based on propensity score matching, 114 and 100 patients were included in intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The H. pylori eradication rate did not differ significantly according to the ITT (82.5% vs. 87.7%, p = 0.429) and PP (95.9% vs. 98.0%, p = 0.536) analyses between the BID and QID groups. No significant differences were found in treatment compliance or adverse drug event rates between the two groups. In conclusion, the eradication rate of first-line H. pylori therapy containing tegoprazan, clarithromycin, and bismuth was not affected by AMX dosing schedules administered twice and four times daily.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Yongsan-gu, Seoul 04401, Republic of Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Yongsan-gu, Seoul 04401, Republic of Korea;
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Qian J, Li Z, Wang J, Lin Y, Yu Y. 6-gingerol and its derivatives inhibit Helicobacter pylori-induced gastric mucosal inflammation and improve gastrin and somatostatin secretion. Front Microbiol 2024; 15:1451563. [PMID: 39234535 PMCID: PMC11371576 DOI: 10.3389/fmicb.2024.1451563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/17/2024] [Indexed: 09/06/2024] Open
Abstract
The resistance of Helicobacter pylori (H. pylori) has increased in recent years, prompting a trend in the research and development of new drugs. In our study, three derivatives (JF-1, JF-2, and JF-3) were synthesized using 6-gingerol as the main component, while JF-4, containing both 6-gingerol and 6-shogaol as the main components, was extracted from dried ginger. The minimum inhibitory concentrations (MICs), determined using the ratio dilution method, were 80 μg/mL for JF-1, 40 μg/mL for JF-2, 30 μg/mL for JF-3, 40 μg/mL for JF-4, 60 μg/mL for 6-gingerol standard (SS), and 0.03 μg/mL for amoxicillin (AMX). After treating H. pylori-infected mice, the inflammation of the gastric mucosa was suppressed. The eradication rate of H. pylori was 16.7% of JF-3 low-dose treatment (LDT), 25.0% of JF-3 high-dose treatment (HDT), 16.7% of JF-4 LDT, 16.7% of JF-4 HDT, 30% of SS LDT, 50% of SS HDT, and 36.4% of the positive control group (PCG). The levels of gastrin, somatostatin (SST), IFN-γ, IL-4, and IL-8 were significantly recovered in the JF-3 and JF-4 administration groups, but the effect was stronger in the high-dose group. These results demonstrate that 6-gingerol and its derivatives have significant anti-Helicobacter pylori effects and are promising potential treatments for H. pylori infection.
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Affiliation(s)
- Jiali Qian
- The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
- Department of Gastroenterology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhennan Li
- The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
- School of Medicine, Shanghai University, Shanghai, China
| | - Jinhui Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuxian Lin
- The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Yingcong Yu
- The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China
- School of Medicine, Shanghai University, Shanghai, China
- The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China
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Li D, Merchant SA, Badalov JM, Corley DA. Time Trends and Demographic Disparities in Helicobacter pylori Burden in a Large, Community-Based Population in the United States. GASTRO HEP ADVANCES 2024; 3:749-760. [PMID: 39280908 PMCID: PMC11401565 DOI: 10.1016/j.gastha.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 09/18/2024]
Abstract
Background and Aims There are minimal recent population-based data on the epidemiology of Helicobacter pylori (H. pylori) in the United States. Methods This retrospective cohort study evaluated H. pylori positivity rates in adult members of a large, community-based US population in 2000-2019. Time trends, demographic disparities, and birth cohort effects on H. pylori test positivity rates were analyzed. Results Among 751,322 individuals tested for H. pylori, the overall nonserological and serological test positivity rates were 18.2% (95% confidence interval [CI], 18.1%-18.4%) and 36.8% (95% CI, 36.6%-36.9%), respectively. Nonserological positivity rate (95% CI) was significantly higher among Asian (23.2% [22.8%-23.6%]), Black (25.1% [24.4%-25.8%]), and Hispanic (28.1% [27.7%-28.5%]) individuals than non-Hispanic White individuals (10.0% [9.8%-10.2%]), and was significantly higher among individuals with a non-English language preference (32.9% [32.3%-33.5%]) than those with English language preference (15.8% [15.6%-15.9%]). Patterns were similar for serological positivity, although with substantially higher rates. Serological positivity rates decreased over 2 decades but nonserological positivity rates initially decreased and then stabilized over the past decade. There was a significant decrease in both nonserological and serological positivity rates from older to younger birth cohorts. Older age, non-White race or Hispanic ethnicity, male sex, and non-English language preference were associated with high odds of H. pylori positivity. Conclusion The burden of H. pylori decreased over 2 decades, although the rates of active infection plateaued over the past decade in a diverse, community-based US population, likely attributable to birth cohort effects and demographic changes. Asian, Black, and Hispanic individuals had 2-3-fold higher rates of active H. pylori infection than non-Hispanic White individuals. These findings should inform targeted screening and eradication of H. pylori in high-risk US populations.
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Affiliation(s)
- Dan Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Gastroenterology, The Permanente Medical Group, Kaiser Permanente Northern California, Santa Clara, California
| | - Sophie A Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jessica M Badalov
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Gastroenterology, The Permanente Medical Group, Kaiser Permanente Northern California, San Francisco, California
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Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic ulcer disease. Lancet 2024; 404:68-81. [PMID: 38885678 DOI: 10.1016/s0140-6736(24)00155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 06/20/2024]
Abstract
Annual prevalence estimates of peptic ulcer disease range between 0·12% and 1·5%. Peptic ulcer disease is usually attributable to Helicobacter pylori infection, intake of some medications (such as aspirin and non-steroidal anti-inflammatory medications), or being critically ill (stress-related), or it can be idiopathic. The clinical presentation is usually uncomplicated, with peptic ulcer disease management based on eradicating H pylori if present, the use of acid-suppressing medications-most often proton pump inhibitors (PPIs)-or addressing complications, such as with early endoscopy and high-dose PPIs for peptic ulcer bleeding. Special considerations apply to patients on antiplatelet and antithrombotic agents. H pylori treatment has evolved, with the choice of regimen dictated by local antibiotic resistance patterns. Indications for primary and secondary prophylaxis vary across societies; most suggest PPIs for patients at highest risk of developing a peptic ulcer, its complications, or its recurrence. Additional research areas include the use of potassium-competitive acid blockers and H pylori vaccination; the optimal approach for patients at risk of stress ulcer bleeding requires more robust determinations of optimal patient selection and treatment selection, if any. Appropriate continuation of PPI use outweighs most possible side-effects if given for approved indications, while de-prescribing should be trialled when a definitive indication is no longer present.
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Affiliation(s)
- Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - Yidan Lu
- Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, Kuwait
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada; Division of Clinical Epidemiology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada.
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Ebrahimi M, Tirgar Fakheri S, Aeeni F, Taghvaei T, Saberi Firoozi M, Fakheri H. An Update on Eradication of Helicobacter Pylori in Iran: A Review. Middle East J Dig Dis 2024; 16:147-154. [PMID: 39386340 PMCID: PMC11459289 DOI: 10.34172/mejdd.2024.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/25/2024] [Indexed: 10/12/2024] Open
Abstract
Background Helicobacter pylori, the most prevalent infection in the world, has great importance due to being related to peptic ulcer disease, gastric metaplasia, dysplasia, and even gastric adenocarcinoma or mucosa-associated lymphoid tissue (MALT) lymphoma. The standard H. pylori eradication regimen is based on antibiotic susceptibility testing. If susceptibility testing is not available, a standard treatment regimen will be recommended based on records of H. pylori resistance rates to antibiotics in a region or locally proven highly effective regimens (equal to or higher than 90% eradication rate). The aim of this review was to define suitable recommendations for local treatment in different cities of Iran. Methods This review article consists of randomized controlled trials related to H. pylori eradication in Iran. Data including the kind of therapy, number of patients and per-protocol H. pylori eradication rates were recorded in data gathering forms. Data search was conducted in PubMed and Google Scholar databases from 2018 to December 2023. Results According to our review of Iranian articles regarding first-line H. pylori eradication regimens, these treatment protocols could be recommended: Bismuth-clarithromycin quadruple therapy in Ardabil, bismuth-clarithromycin quadruple therapy with probiotics in Birjand, standard triple therapy in Ilam, bismuth quadruple therapy or bismuth triple therapy or concomitant regimen in Sari, sequential therapy in Tehran and bismuth quadruple therapy in Yazd. These regimes can be extended to other regions that have a similar situation. According to the reports of Iranian researchers, a quinolone-containing regimen (levofloxacin preferred) is recommended for second-line eradication therapy. Conclusion Various H. pylori eradication regimens can be used as first-line therapy; however, choices for second-line therapy are limited. We recommend the quinolone-containing regimens as the preferred second-line therapy.
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Affiliation(s)
- Mahboobe Ebrahimi
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sepehr Tirgar Fakheri
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Tarang Taghvaei
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Saberi Firoozi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hafez Fakheri
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Hao N, Liu B, Zhao M, Lu M, Chen F, Kang J, Tang X, Zhang Y, Dang C. Real-world evidence of a novel tetravalent immunoglobulin Y effectiveness and safety in patients with the refractory Helicobacter pylori infection. BMC Infect Dis 2024; 24:647. [PMID: 38937679 PMCID: PMC11210110 DOI: 10.1186/s12879-024-09498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Refractory Helicobacter pylori (H. pylori) infection inevitably increase the difficulty of drug selection. Here, we described our experience with the use of a novel tetravalent IgY against H. pylori for the treatment of patients with refractory H. pylori infection. METHODS Patients were randomly assigned to receive the standard quadruple therapy (amoxicillin, clarithromycin, omeprazole and bismuth potassium citrate ) for 2 weeks or 250 mg of avian polyclonal IgY orally twice a day for 4 weeks. The binding efficacy of IgY to H. pylori antigens was detected by western blotting13. C-urea breath test was performed to evaluate the eradication therap's efficacy. The side effects of IgY were evaluated via various routine tests. The questionnaire was used to gather clinical symptoms and adverse reactions. RESULTS Western blot analysis showed that tetravalent IgY simultaneously bind to VacA, HpaA, CagA and UreB of H. pylori. Tetravalent IgY had an eradication rate of 50.74% in patients with refractory H. pylori and an inhibition rate of 50.04% against DOB (delta over baseline) of 13C-urea. The symptom relief rate was 61.76% in thirty-four patients with clinical symptoms, and no adverse reactions were observed during tetravalent IgY treatment period. CONCLUSIONS Polyclonal avian tetravalent IgY reduced H. pylori infection, and showed good efficacy and safety in the treatment of refractory H. pylori infection patients, which represented an effective therapeutic option of choice for patients with refractory H. pylori infection.
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Affiliation(s)
- Nan Hao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bo Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Meng Zhao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mingming Lu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Feiyi Chen
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jialu Kang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaojun Tang
- Key Laboratory of Antibody Technique, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Chengxue Dang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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49
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Wang Y, Zhang Z, Chen Q, Chen T. Simultaneous application of oral and intravaginal probiotics for Helicobacter pylori and its antibiotic-therapy-induced vaginal dysbacteriosis. NPJ Biofilms Microbiomes 2024; 10:49. [PMID: 38902244 PMCID: PMC11190290 DOI: 10.1038/s41522-024-00521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 06/07/2024] [Indexed: 06/22/2024] Open
Abstract
Helicobacter pylori is a prevalent bacterial pathogen globally, implicated in various gastrointestinal disorders. Current recommended antibiotic therapies for H. pylori infection have been proven to be therapeutically insufficient, with low eradication rates and high recurrence rates. Emerging evidence suggests that antibiotic therapy for H. pylori can lead to gastrointestinal and subsequent vaginal dysbiosis, posing challenges for conventional antibiotic approaches. Thus, this article proposes a novel probiotic therapy involving simultaneous oral and intra-vaginal probiotic administration alongside antibiotics for H. pylori treatment, aiming to enhance eradication rates and mitigate dysbiosis. We begin by providing an overview of gastrointestinal and vaginal microbiota and their interconnectedness through the vagina-gut axis. We then review the efficacy of current antibiotic regimens for H. pylori and discuss how antibiotic treatment impacts the vaginal microenvironment. To explore the feasibility of this approach, we evaluate the effectiveness of oral and intra-vaginal probiotics in restoring normal microbiota in the gastrointestinal and vaginal tracts, respectively. Additionally, we analyze the direct mechanisms by which oral and intra-vaginal probiotics act on their respective tracts and discuss potential cross-tract mechanisms. Considering the potential synergistic therapeutic effects of probiotics in both the gastrointestinal and vaginal tracts, dual-channel probiotic therapy holds promise as a more effective approach for H. pylori eradication and dysbiosis mitigation, presenting a novel concept in the collaborative treatment of gastrointestinal and genital disorders.
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Affiliation(s)
- Yufan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, 330031, China
- National Engineering Research Centre for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang, 330031, China
| | - Zhenyu Zhang
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Qi Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China.
| | - Tingtao Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China.
- National Engineering Research Centre for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang, 330031, China.
- School of Pharmacy, Jiangxi Medical College, Nanchang University, Nanchang, 330031, China.
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Matchimabura N, Praparatana R, Issarachot O, Oungbho K, Wiwattanapatapee R. Development of raft-forming liquid formulations loaded with ginger extract-solid dispersion for treatment of gastric ulceration. Heliyon 2024; 10:e31803. [PMID: 38841494 PMCID: PMC11152664 DOI: 10.1016/j.heliyon.2024.e31803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024] Open
Abstract
Raft-forming liquid formulations incorporating ginger extract solid dispersion (GE-SD) were developed to achieve prolonged delivery of 6-gingerol in the stomach and thus increase the effectiveness of gastric ulcer treatment. The solubility of 6-gingerol in 0.1 N HCl (pH 1.2) was maximized (15 mg/mL) by combining ginger extract with PVP K30 at 1:3 w/w ratio to produce a solid dispersion. The nature of GE-SD was confirmed by PXRD and FT-IR analysis. PXRD pattern showed miscibility of GE and PVP K30 in amorphous solid dispersion and the FT-IR spectra confirmed the formation of hydrogen bond between GE and PVP K30. GE-SD-loaded raft-forming liquids were prepared using sodium alginate as a gel former and HPMC as a release-controlling agent. The formulations exhibited rapid floating behavior in 0.1 N HCl (<30 s) and remained afloat on the surface over 8 h. The formed raft structures provided sufficient strength (>7.5 g) and allowed sustained release of more than 70 % of the 6-gingerol content over 8 h in 0.1 N HCl. Raft-forming formulations incorporating ginger extract demonstrated anti-inflammatory activity by inhibiting nitric oxide production in LPS-stimulated RAW 264.7 macrophage cells (IC50 = 5.13 ± 0.07 μg/mL). Exposure to the formulations also had a significant cytotoxic effect on AGS human gastric adenocarcinoma cells with an IC50 of 17.45 ± 0.29 μg/mL. In addition, the raft-forming formulations enhanced the migratory behavior of L929 mouse fibroblasts in the scratch wound model. Taken together, these findings reveal the benefits of gastro-retentive, GE-SD-loaded raft-forming liquid formulations for improving the treatment of gastric ulcers.
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Affiliation(s)
- Nattawipa Matchimabura
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Rachanida Praparatana
- Faculty of Medical Technology, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Ousanee Issarachot
- Department of Pharmacy Technician, Sirindhorn College of Public Health Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Trang, 92110, Thailand
| | - Kwunchit Oungbho
- Medical Science Research and Innovation, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
- Drug Delivery System Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Ruedeekorn Wiwattanapatapee
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
- Phytomedicine and Pharmaceutical Biotechnology Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand
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