Helicobacter pylori Eradication According to Sequencing-Based 23S Ribosomal RNA Point Mutation Associated with Clarithromycin Resistance.

Seung In Seo,Byoung Joo Do,Hyoung Su Kim,Jin Gu Kang,Woon Geon Shin,Hak Yang Kim,Myoung Kuk Jang

doi:10.3390/jcm9010054

Seung In Seo, Byoung Joo Do + Show 5 more

Open Access

https://doi.org/10.3390/jcm9010054

Copy DOI

Abstract

Background/Aims: Clarithromycin resistance in Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene. We investigated the point mutations in the 23S rRNA genes of patients with clarithromycin-resistant H. pylori and compared the H. pylori eradication rates based on the point mutations. Methods: A total of 431 adult patients with H. pylori infection were recruited in Kangdong Sacred Heart Hospital in 2017 and 2018. Patients who did not have point mutations related to clarithromycin resistance and/or had clinically insignificant point mutations were treated with PAC (proton pump inhibitor, amoxicillin, clarithromycin) for seven days, while patients with clinically significant point mutations were treated with PAM (proton pump inhibitor, amoxicillin, metronidazole) for seven days. H. pylori eradication rates were compared. Results: Sequencing-based detection of point mutations identified four mutations that were considered clinically significant (A2142G, A2142C, A2143G, A2143C). The clarithromycin resistance rate was 21.3% in the overall group of patients. A2143G was the most clinically significant point mutation (84/431, 19.5%), while T2182C was the most clinically insignificant point mutation (283/431, 65.7%). The overall H. pylori eradication rate was 83.7%, and the seven-day PAM-treated clarithromycin-resistance group showed a significantly lower eradication rate than the seven-day PAC-treated nonresistance group (ITT; 55.4% (51/92) vs. 74.3% (252/339), p = 0.001, PP; 66.2% (51/77) vs. 88.4% (252/285), p = 0.0001). Conclusions: There were significantly lower eradication rates in the patients with clarithromycin-resistant H. pylori when treated with PAM for seven days. A future study comparing treatment regimens in clarithromycin-resistant H. pylori-infected patients may be necessary.

Highlights

Helicobacter pylori is a gram-negative bacterium that causes gastritis, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma [1]
This study aimed to investigate point mutations in patients infected with clarithromycin-resistant H. pylori and to compare the H. pylori eradication rates based on the clinically significant point mutations identified by 23S ribosomal RNA (rRNA) gene sequencing
Mucosal biopsies taken from the antrum and body were used to detect clarithromycin resistance (CAMR)-related point mutations in patients who were positive in the rapid urease test

Summary

Introduction

Helicobacter pylori is a gram-negative bacterium that causes gastritis, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma [1]. H. pylori gastritis is considered an infectious disease [1,2], and recent meta-analyses have proven that H. pylori eradication can significantly improve gastric atrophy [3,4]. Increasing evidence has shown that H. pylori eradication might prevent the development of gastric cancer [5,6,7]. First line therapy for H. pylori eradication in Korea involves a regimen of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin for 7–14 days [8]. There has been an increase in the rate of antibiotic resistance in the past two decades, leading to decreased H. pylori eradication.

Objectives

Methods

Results

Conclusion