Abstract
Background and aimsPatients that have failed therapy for Helicobacter pylori (H. pylori) infection are incompletely characterized. The aim of this study was to characterize a H. pylori treatment resistant cohort compared to the cohorts of newly diagnosed, earlier eradicated and non-infected.Material and methodsPatients were selected from routine referrals to the Endoscopy units at three different Norwegian hospitals. In all four cohorts, gastric biopsies were scored according to the Sydney classification, and symptoms according to the Gastrointestinal Symptom Rating Scale score, including sub-scores for upper gastrointestinal symptoms and functional bowel symptoms. Patients in the H. pylori resistant group were treated with a triple therapy regimen that consisted of levofloxacin, amoxicillin and a proton pump inhibitor.ResultsWe included 185 patients, 42 H. pylori treatment resistant, 50 newly diagnosed, 61 previously H. pylori eradicated and 32 never infected. The treatment-resistant cohort had higher scores for upper gastrointestinal symptoms and functional bowel symptoms compared to the other groups except for the group being never H. pylori infected. The H. pylori resistant patients had lower Sydney scores than patients with newly diagnosed H. pylori infection. The triple combination showed a high efficacy of 91% to eradicate H. pylori.ConclusionsPatients with treatment-resistant H. pylori infection had more gastrointestinal symptoms, but a lower Sydney score than patients with newly diagnosed infection. A treatment regimen including levofloxacin showed a high efficacy in eradicating H. pylori in patients that previously had failed eradication treatment.
Highlights
Helicobacter pylori (H. pylori) has been identified as the main pathogenic factor for gastric and duodenal peptic ulcer.[1,2] Treatment of H. pylori infection cures most of the patients with ulcer, and the disease is no longer a chronically recurrent and disabling condition in Western world
Gastric biopsies were scored according to the Sydney classification, and symptoms according to the Gastrointestinal Symptom Rating Scale score, including sub-scores for upper gastrointestinal symptoms and functional bowel symptoms
Patients in the H. pylori resistant group were treated with a triple therapy regimen that consisted of levofloxacin, amoxicillin and a proton pump inhibitor
Summary
Helicobacter pylori (H. pylori) has been identified as the main pathogenic factor for gastric and duodenal peptic ulcer.[1,2] Treatment of H. pylori infection cures most of the patients with ulcer, and the disease is no longer a chronically recurrent and disabling condition in Western world. The most effective eradication regimes gave an efficacy >90%.[5] during the 30 years of treatment one has observed a growing antimicrobial resistance of H. pylori[6], including resistance to clarithromycin and metronidazole, proposed to be a consequence of increased antibiotic use in the general population. Metronidazole resistance is highly prevalent but is possible to overcome to some extent.[7] an increasing prevalence of resistance has been observed.[8,9] In areas with high occurrence of both clarithromycin and metronidazole resistance, a bismuth-containing quadruple therapy is recommended.[10] Despite this, a cohort of patients with treatment-resistant H. pylori has accumulated even in areas with low prevalence of antibiotic resistance, like Norway.[9] These patients will have a persistent gastric inflammation and a risk of recurrent ulcer disease and gastric cancer. The aim of this study was to characterize a H. pylori treatment resistant cohort compared to the cohorts of newly diagnosed, earlier eradicated and non-infected
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