13C-urea Breath Test Research Articles

Lifestyle and dietary factors associated with serologically detected gastric atrophy in a Caucasian population in the GISTAR study.

To identify dietary and lifestyle factors associated with decreased pepsinogen levels indicative of gastric atrophy. Participants aged 40 to 64 from the "Multicentric randomized study of H. pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (GISTAR study)" in Latvia tested for serum pepsinogen, as well as for Helicobacter pylori infection by 13 C-urea breath test or serology were included. Data on sex, age, education, employment, diet, smoking, alcohol and proton pump inhibitor use were obtained by survey and compared for participants with and without serologically detected gastric atrophy defined as pepsinogen I/pepsinogen II ≤ 2 and pepsinogen I ≤ 30 ng/mL. Of 3001 participants (median age 53, interquartile range, 11.0, 36.9% male) 52.8% had H. pylori and 7.7% had serologically detected gastric atrophy. In multivariate analysis, increasing age, consumption of alcohol, coffee, and onions were positively, while H. pylori , former smoking, pickled product and proton pump inhibitor use were inversely associated with gastric atrophy. Pepsinogen values were higher in smokers and those with H. pylori . Pepsinogen ratio was lower in those with H. pylori . When stratifying by H. pylori presence, significantly higher pepsinogen levels remained for smokers without H. pylori . Several dietary factors and smoking were associated with serologically detected gastric atrophy. Pepsinogen levels differed by smoking and H. pylori status, which may affect the serologic detection of gastric atrophy. There seems to be a complicated interaction between multiple factors. A prospective study including atrophy determined by both serology and histology is necessary.

Gastric Fermentation in Functional Dyspepsia

Background: The role of the gastric fermentation in functional dyspepsia has been investigated. Methods: Lactulose Hydrogen Breath test, H. pylori 13C Urea Breath Test. 47 patients with functional dyspepsia (FD) has been investigated. Results: Positives for lactulose hydrogen breath test 23, negatives 24. H. pylori and hydrogen breath test positives 12.

Association of Helicobacter pylori Infection With Carotid Atherosclerosis in a Northern Chinese Population: A Cross-Sectional Study.

Numerous studies have shown that Helicobacter pylori (HP) infection may be involved in the development of carotid atherosclerosis (CAS), but this conclusion is still controversial. The aim of this study was to explore whether there is a positive association between HP infection and CAS occurrence. We collected data on demographic characteristics, lifestyle, and disease history of the participants by questionnaire. We obtained clinical anthropometric data and blood samples of the participants from clinical examinations and laboratory work. The 13C urea breath test (13C-UBT) was performed to assess the HP infection status, and carotid ultrasonography was used to diagnose the CAS and plaque types. Univariate analysis and multivariate logistic regression were used to identify the relationship between HP infection and CAS. A total of 1,424 participants were recruited for this study. A total of 740 HP-positive individuals and 684 HP-negative individuals were identified, and 345 participants were diagnosed with CAS. The prevalence of CAS was higher in the HP-positive group (26.4%) than in the HP-negative group (21.7%) (P < 0.05). A significantly higher prevalence of carotid intima-media thickening, carotid plaque, and carotid stenosis was identified in the HP-positive group than in the HP-negative group (P < 0.05). There was no significant difference in the detection rate of unstable plaques between the HP-positive and HP-negative groups (P > 0.05). In multivariate models adjusted for covariates, HP infection showed a positive association with CAS, independent of other risk factors (ORs range: 1.283–1.333, P < 0.05). HP infection independently accounted for approximately 5% of the CAS risk in the absence of other cardiovascular risk factors. A positive association between HP infection and CAS was demonstrated in this study. HP infection might be an independent risk factor for CAS. Although the effect of HP infection on CAS observed in our study was less than that of traditional risk factors, we believe that this is an indispensable advance in the etiological study of CAS. These results imply that the microbial population might play an essential role in CAS, which provides a new perspective for the primary prevention of CAS.

Helicobacter pylori Infection Acts as an Independent Risk Factor for Intracranial Atherosclerosis in Women Less Than 60 Years Old.

Background: Studies show inconsistent results regarding the relationship between Helicobacter pylori (H. pylori) infection and stroke. The present study assessed a potential association between H. pylori infection and an important risk factor for stroke, intracranial atherosclerosis.Methods: In total, 15,798 subjects with transcranial Doppler (TCD) and 13C-urea breath test (13C-UBT) were enrolled from March 2012 to March 2017. Intracranial atherosclerosis was further measured using intracranial carotid artery calcification (ICAC) on past or recent head CT, and 14,084 subjects were ultimately included in the study. Baseline demographics, atherosclerosis risk factors, and laboratory results were investigated. Since endothelial dysfunction is critical to the development of atherosclerosis, the role of H. pylori in migration, tube formation, and proliferation of human brain microvascular endothelial cells (HBMECs) was assessed in vitro.Results: The intracranial atherosclerosis group had a higher proportion of women and a greater rate of H. pylori infection than those without intracranial atherosclerosis. H. pylori infection was significantly more common in women with intracranial atherosclerosis than males. In addition, the incidence of intracranial atherosclerosis was significantly higher in women with H. pylori infection than uninfected women (53.8 vs. 46.4%, p < 0.001). In an adjusted model, H. pylori was shown to be an independent risk factor for intracranial atherosclerosis in women ≤ 60 years of age [odds ratio (OR) = 2.261, 95% CI = 1.839–2.780, p < 0.001]. Serum exosomes from patients with H. pylori infection had significantly reduced brain endothelial cell migration, tube formation, and proliferation in vitro.Conclusion: Helicobacter pylori infection may be an important independent risk factor for intracranial atherosclerosis in women ≤ 60 years of age.

Zinc carnosine-based modified bismuth quadruple therapy vs standard triple therapy for Helicobacter pylori eradication: A randomized controlled study.

BACKGROUND Helicobacter pylori (H. pylori) infection is a worldwide problem with increasing burden on the health sector due to its increasing rate of resistance. The conventional triple therapy (TT) is becoming obsolete with a high failure rate of eradication, necessitating the need for better alternatives or regimens.AIMTo investigate H. pylori eradication rate of TT vs modified bismuth quadruple therapy.METHODSNinety-two patients with dyspepsia symptoms and positive 13C-urea breath test were randomly assigned to two groups. The first group (control group) was treated for 14 d using standard TT protocol: Esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). On the other hand, the second group was prescribed a 10-d course of modified bismuth quadruple therapy fortified with zinc carnosine: TT in addition to bismuth subcitrate (240 mg twice daily) and zinc carnosine (75 mg twice daily). A repeated 13C-urea breath test was done 4 wk after the completion of the eradication therapy.RESULTSAmong the 92 subjects, 67.4% were males and 32.6% were females. There were no differences in demographic characteristics (age, body mass index, smoking history, previous antibiotics use and ethnicity) between the modified bismuth quadruple therapy group and TT group. The eradication rate was higher [93.5% (43/46)] in the modified bismuth quadruple therapy group compared to 69.6% (32/46) in the standard TT group (P = 0.003). Of the tested predictor variables, only nationality, smoking and therapy type were statistically significant. Besides dizziness, which was recorded in modified bismuth quadruple therapy group, there were no significant differences in side effects between the two groups.CONCLUSIONTen days of modified bismuth quadruple therapy fortified with zinc carnosine is superior to 14 d of conventional TT in eradicating H. pylori infection, with no additional significant adverse events.

Effects of inflammatory cytokines on eradication and recurrence of Helicobacter pylori infection in children.

Objectives:To study the correlation of eradication and recurrence with IL-1 β, IL-6 and TNF-α levels in children with Helicobacter pylori (Hp) infection.Methods:Children confirmed with Hp infection (n = 153) in our hospital from January to June 2019 and successfully followed up for one year were selected as the study subjects, and 73 healthy children of the same period were selected as the control group. The levels of IL-1 β, IL-6 and TNF-α in children confirmed with Hp infection and healthy children were detected, respectively.Results:Results of triple therapy: 113 cases (73.9%) reexamined with negative 13C-urea breath test were included in Group-A; and 40 cases (26.1%) reexamined with positive 13C-urea breath test were included in Group-B. Follow up results: 23 cases (20.4%) positive in 13C-urea breath test in one year follow-up were included in Group-C; and 90 cases (79.6%) negative in 13C-urea breath test in one year follow-up were included in Group-D. Group-B showed significantly higher levels of IL-1β, IL-6 and TNF-α when compared with the Group-A and the control group, respectively (P < 0.05). Obviously higher levels of IL-1β, IL-6 and TNF-α were observed in Group-C and Group-D in comparison with the control group (P < 0.05). There was no significant difference in IL-1 β level between Group-C and Group-D (P > 0.05). IL-6 and TNF-α levels in Group-C were remarkably higher than those in Group-D (P < 0.05).Conclusions:Higher levels of IL-1β, IL-6 and TNF-α may affect the eradication effect of triple therapy in Children with Hp infection, and increased levels of IL-6 and TNF-α may affect the recurrence rate of Hp infection in children.

Association between Helicobacter pylori infection and the risk of type 2 diabetes mellitus based on a middle-aged and elderly Chinese population.

Evidence about the relationship between Helicobacter pylori (Hp) infection and type 2 diabetes mellitus (T2DM) is inconsistent and contradictory. This study attempted to investigate this association in the middle-aged and elderly Chinese population and analyze the joint effects of Hp infection and some risk factors on T2DM. Following a cross-sectional design, participants were recruited from the First Affiliated Hospital of Anhui Medical University in Hefei City, China. Hp status was measured using a 14C urea breath test. A total of 1,288 participants, including 90 diabetic patients and 1,198 nondiabetic subjects, were recruited in the current study. The participants with T2DM had a greater prevalence of Hp infection than participants without T2DM (26.67% versus 18.11%, p = 0.045). Furthermore, we found that Hp infection was closely associated with an incremental risk of T2DM [odds ratio (OR) = 1.77, 95% confidence intervals (CI): 1.04-3.00] after adjustment for potential confounders. In addition, we observed that the participants who were Hp-positive and ≥60 years old (OR = 9.16, 95% CI: 3.29-25.52), Hp-positive and obese (OR = 3.35, 95% CI: 1.57-7.14) or Hp-positive and hypertensive (OR = 6.10, 95% CI: 3.10-12.01) had a significantly higher risk for T2DM than those who were Hp-negative and ≤50 years old, Hp-negative and nonobese or Hp-negative and nonhypertensive. These findings imply that Hp infection is associated with an increased risk of T2DM in the middle-aged and elderly Chinese population. The association could be further elevated by the combination of Hp infection and some traditional risk factors.

Application of minocycline in patients with Helicobacter pylori infection allergic to penicillin

To observe the eradication rate, safety and compliance of bismuth quadruple therapies based on minocycline in the newly diagnosed patients with Helicobacter pylori (Hp) infection. We selected 150 penicillin allergic patients for the initial treatment of Hp infection treated in Beijing Jishuitan hospital from January 2018 to February 2019. Subsequently, the patients were randomly selected into the minocycline and metronidazole-containing group (RMMB) and minocycline and levofloxacin-containing group (RMLB). The total course of treatment is 14 days. Follow-up clinical manifestations 3 to 5 days after treatment. The 13C urea breath test was performed 4 to 12 weeks to confirm the eradication of Hp. There were no significant differences in baseline data between the two groups (p>0.05). According to ITT analysis, the eradication rates of RMMB group and RMLB group were 80.3% (61/76) and 89.2% (66/74), respectively (χ2=2.301, p=0.129). According to PP analysis, the eradication rates of the RMMB group and the RMLB group were 83.6% (61/73) and 90.4% (66/73), respectively (χ2=1.513, p=0.21). The overall incidences of adverse events were 47.4% and 38.8% in the RMMB and RMLB groups, respectively (p=0.924). In patients with penicillin allergy, the eradication rate of minocycline-based bismuth quadruple therapies is ideal and the side effects are few. It is recommended for the eradication treatment of Hp-infected patients with penicillin allergy.

The necessity and appropriate range of the diagnostic "gray zone" of 13C-urea breath test.

The 13C-urea breath test (13C-UBT) is preferred for non-invasive detection of Helicobacter pylori (H. pylori); however, its accuracy drops when results fall between 2‰ and 6‰ (called the gray zone). This study aimed to evaluate the accuracy of 13C-UBT (cut-off point 4‰) between 2‰ and 6‰, find a more appropriate gray zone, and identify the factors influencing 13C-UBT. Patients with 13C-UBT results 2‰-6‰, over an eight-year period, were studied. H. pylori infection was diagnosed if patients were positive for either Warthin-Starry staining or quantitative real-time polymerase chain reaction (real-time PCR), and excluded if both were negative. Accuracy of 13C-UBT under different cut-off points was calculated, and the factors affecting 13C-UBT were analyzed. A total of 208 patients were included, of whom 129 were H. pylori-positive. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 13C-UBT were 71.32%, 83.54%, 64.08%, and 87.62%, respectively. When the cut-off point was changed to 2.15‰, the NPV of 13C-UBT reached a maximum (76.47%); when the cut-off point was changed to 4.95‰, PPV reached its maximum (93.22%). Therefore, the original gray zone (2‰-6‰) was adjusted to 2‰-4.95‰. Gastric antral intestinal metaplasia (OR = 3.055, 95% CI: 1.003-9.309) was an independent risk factor for false-negative 13C-UBT. Accuracy of 13C-UBT over 2‰-6‰ was poor, and the gray zone was changed to 2‰-4.95‰. 13C-UBT results over 2‰-4.95‰ should be interpreted with caution during mass screening of H. pylori, especially for patients with gastric antral intestinal metaplasia.

Correlation between helicobacter pylori infection and iron deficiency in children.

Objectives:To investigate the correlation between Helicobacter pylori (Hp) infection and Iron deficiency (ID) in children.Methods:This cross-sectional study was conducted at Baoding Children’s Hospital from January 2018 to December 2019. A total of one thousand children who came to our hospital for physical examination and met the inclusion criteria were continuously included in this study. All the children were given questionnaires (personal and family social and economic status), a stool Hp antigen test and/or a 13C-urea breath test, as well as measurements of hemoglobin (Hb), mean red blood cell volume (MCV), red blood cell distribution width (RDW), mean corpuscular hemoglobin concentration (MCHC), serum ferritin (SF), serum iron (SI), and total iron binding capacity (TIBC). Children who tested positive for Hp were divided into the Hp group and children who tested negative for Hp were divided into the control group. ID or IDA was diagnosed based on the child’s blood test results.Results:A total of 902 children met the inclusion criteria, including 194 (21.5%) in the Hp group and 708 (78.5%) in the control group. The incidence of ID and IDA in Hp group was higher than that in control group (2=9.112, 2=4.478; All P < 0.05); The levels of MCV, SI, SF and Hb in Hp group were lower than those in control group (t=5.288; T = 3.864; T = 6.751; T =11.841, all P < 0.05), TIBC level was higher than that of control group (T =7.630, P < 0.05); The levels of MCHC and RDW in THE Hp group were not statistically significant compared with the control group. Logistic regression showed that Hp infection was not a combined risk factor for ID. Older age, higher educational background of the mother, living in the city, and higher family income were the combined protective factors to prevent the occurrence of ID in children.Conclusion:Hp infection is not a combined risk factor for the development of ID in children. The influence of family social and economic factors should be taken into consideration when analyzing the correlation between Hp infection and ID.

Efficacy and safety of bismuth quadruple regimens containing tetracycline or furazolidone for initial eradication of Helicobacter pylori.

Helicobacter pylori (H pylori) infection can cause chronic gastritis, peptic ulcer, and even gastric cancer, so effective eradication is critical.This study compared the efficacy and safety of bismuth quadruple regimens including either tetracycline or furazolidone for initial eradication.Patients newly diagnosed with H pylori infection from January 2020 to January 2021 were randomly assigned to receive either the tetracycline-containing regimen (n = 116) or furazolidone-containing regimen (n = 168). Both regimens included 1 proton pump inhibitor (rabeprazole 20 mg, or esomeprazole 20 mg, or eprazole 5 mg), colloidal pectin bismuth 300 mg, and amoxicillin 1000 mg in addition to tetracycline 1.0 g or furazolidone 0.1 g. All drugs were administered twice daily for 12 consecutive days. The 14C urea breath test was used for diagnosis, and re-test negativity at one-month follow-up was considered successful eradication. Adverse events were recorded during follow-up by telephone interview.In total, 109 patients in the tetracycline group and 157 in the furazolidone group were re-examined at 1 month. In the tetracycline group, 101 patients tested negative at follow-up, yielding an eradication rate of 92.7% according to per-protocol analysis and 87.1% by intention-to-treat analysis. In the furazolidone group, 141 patients tested negative, yielding eradication rates of 89.8% by PP and 83.9% by ITT. Eradication rates did not differ significantly between regimens (per-protocol: χ2 = 0.637, P = .517; intention-to-treat: χ2 = 0.537, P = .501). However, total adverse events incidence was significantly lower in the tetracycline group (20.2% vs 37.6%; χ2 = 9.193, P = .003).Both bismuth quadruple regimens produce high initial eradication, but the tetracycline regimen appears safer.

Randomised clinical trial: comparison of efficacy and adverse effects of a standard triple clarithromycin-containing regimen with high-dose amoxicillin and bismuth therapy in Helicobacter pylori eradication

The clarithromycin-based triple therapy is the most prescribed Helicobacter pylori eradication regimen in Europe; it causes adverse effects in a significant proportion of subjects, leading to discontinuation. Alternative therapies are required because of increasing clarithromycin resistance or to decrease the adverse effects. We compared the efficacy and spectrum of adverse effects of clarithromycin-based triple therapy with the high-dose amoxicillin/bismuth regimen. A randomised clinical trial enrolled healthy individuals aged 40-64 years. H. pylori was assessed with a 13C-urea breath test. In total 579 H. pylori-positive subjects were randomly allocated in two groups: group 1: clarithromycin 500 mg, amoxicillin 1000 mg, esomeprazole 40 mg, all twice daily; group 2: bismuth subcitrate 240 mg twice daily, amoxicillin 1000 mg three times daily, esomeprazole 40 mg twice daily. Regimens were administered for 14 days.Information on treatment completion and adverse effects were collected via a telephone interview at 21-28 days after medication delivery. The efficacy was assessed by UBT 6 months after the treatment. We analysed 483 subjects for adverse effects (248 vs. 235 respectively). Furthermore, 316 subjects were analysed for efficacy. In per-protocol analysis, a higher efficacy was seen in group 1 (88.4 vs. 77.0%; P < 0.001); no difference was observed in compliance (90.3 and 91.2%). Therapy-related adverse effects were more common in group 1 (56.9 vs. 40.0%; P < 0.01). In intention-to-treat analysis no statistical difference in efficacy was revealed. Bismuth-based high-dose amoxicillin therapy showed a lower efficacy but was less frequently associated with adverse effects. Further research is required to examine the high-dose amoxicillin and bismuth-containing regimens in various populations to maximise eradication efficacy.

Serum gastrin-17 concentration for prediction of upper gastrointestinal tract bleeding risk among peptic ulcer patients.

BACKGROUNDSerum gastrin-17 (G-17), pepsinogen I (PGI), and pepsinogen II (PGII) concentrations regulate gastric acid secretion, and hypersecretion of gastric acid increases the risks of peptic ulcer and upper gastrointestinal bleeding. These associations suggest that serum G-17, PGI, and (or) PGII may predict gastrointestinal bleeding risk among peptic ulcer patients. AIMTo evaluate the efficacies of serum G-17, PGI, PGII, and PGI/PGII ratio (PGR) for predicting upper gastrointestinal bleeding among peptic ulcer patients.METHODSA total of 199 patients diagnosed with peptic ulcer confirmed by gastroscopy and positivity for Helicobacter pylori by the 14C-urea breath test were recruited, including 107 patients with simple peptic ulcer and 92 cases complicated by upper gastrointestinal bleeding. Serum PGI, PGII, G-17, and PGR were measured by immune methods and compared between bleeding and non-bleeding groups by univariate analysis. The specificity and sensitivity of PGs and G-17 for evaluating upper gastrointestinal bleeding risk were then assessed by constructing receiver operating characteristic (ROC) curves.RESULTSSerum G-17 was significantly higher among peptic ulcer patients with upper gastrointestinal bleeding compared to simple peptic ulcer patients (25.34 ± 14.29 vs 8.84 ± 8.03 pmol/L, t = 9.822, P < 0.01), whereas serum PGI, PGII, and PGR did not differ significantly between bleeding and non-bleeding groups (all P > 0.05). The risk of bleeding was significantly higher among peptic ulcer patients with elevated serum G-17 (> 15 pmol/L) compared to patients with normal or low serum G-17 (73.2% vs 27.4%, χ2 = 40.72, P < 0.01). The area under the ROC curve for serum G-17 was 0.866 ± 0.024, and a cut-off of 9.86 pmol/L yielded 90.2% sensitivity and 68.2% specificity for distinguishing peptic ulcer with and without upper gastrointestinal bleeding.CONCLUSIONSerum G-17 is significantly upregulated in peptic ulcer patients and higher levels are predictive of upper gastrointestinal bleeding. Conversely, serum PGI, PGII, and PGR have no predictive value. Further prospective studies are warranted to examine if high G-17 can be used to assess risk of bleeding prior to onset.

Lack of Association Between Helicobacter pylori Infection and the Risk of Thyroid Nodule Types: A Multicenter Case-Control Study in China.

The prevalence of Helicobacter pylori infection is high worldwide, while numerous research has focused on unraveling the relationship between H. pylori infection and extragastric diseases. Although H. pylori infection has been associated with thyroid diseases, including thyroid nodule (TN), the relationship has mainly focused on potential physiological mechanisms and has not been validated by large population epidemiological investigations. Therefore, we thus designed a case-control study comprising participants who received regular health examination between 2017 and 2019. The cases and controls were diagnosed via ultrasound, while TN types were classified according to the guidelines of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Moreover, H. pylori infection was determined by C14 urea breath test, while its relationship with TN type risk and severity was analyzed using binary and ordinal logistic regression analyses. A total of 43,411 participants, including 13,036 TN patients and 30,375 controls, were finally recruited in the study. The crude odds ratio (OR) was 1.07 in Model 1 (95% CI = 1.03–1.14) without adjustment compared to the H. pylori non-infection group. However, it was negative in Model 2 (OR = 1.02, 95% CI = 0.97–1.06) after being adjusted for gender, age, body mass index (BMI), and blood pressure and in Model 3 (OR = 1.01, 95% CI = 0.97–1.06) after being adjusted for total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein on the basis of Model 2. Control variables, including gender, age, BMI, and diastolic pressure, were significantly correlated with the risk of TN types. Additionally, ordinal logistic regression results revealed that H. pylori infection was positively correlated with malignant differentiation of TN (Model 1: OR = 1.06, 95% CI = 1.02–1.11), while Model 2 and Model 3 showed negative results (Model 2: OR = 1.01, 95% CI = 0.96–1.06; Model 3: OR = 1.01, 95% CI = 0.96–1.05). In conclusion, H. pylori infection was not significantly associated with both TN type risk and severity of its malignant differentiation. These findings provide relevant insights for correcting possible misconceptions regarding TN type pathogenesis and will help guide optimization of therapeutic strategies for thyroid diseases.

Efficacy of Lactobacillus reuteri Supplementation in Eradication of H. pylori: A Comparison Study with Triple Drug Therapy

Helicobacter pylori (H. pylori) infections affect roughly one-half of the world’s population. Although many standard regimens, including triple-drug therapy, eradicate H. pylori, the success rate and efficacy have been declining due to associated side effects and symptom severity. The addition of probiotics to a standard regimen can considerably increase eradication rates. The objective is to find the efficacy of a probiotic Lactobacillus reuteri (L. reuteri) in eradicating human H. pylori infection and effect on symptoms regression and side effects associated with triple therapy. This prospective interventional study was conducted in 90 H. pylori-positive patients. 45 patients received standard triple treatment (group-I) for 14 days. Another 45 patients received a combination of standard triple therapy and L. reuteri (group-II) for 14 days. After the completion of treatment, H. pylori status was evaluated using a 13-C Urea-Breath Test (UBT). Each subject is interviewed with a validated Gastrointestinal Symptoms Rating Scale (GSRS) questionnaire to record symptoms and symptom severity before and after the therapy. Group-II patients showed a significantly higher eradication rate (86.67%) than group-I patients (66.67%). The absolute values of 13C-UBT (group-I: 14.02± 5.4, group-II: 11.9±3.73) revealed that a more substantial reduction in H. Pylori load was observed in group II. Statistical analysis proved that group II patients had a significant reduction in GSRS mean scores (baseline score: 15.39±4.52 to end score: 5.33±2.34) compared to group-I patients (baseline score: 14.47±3.67 to end score: 9.86±4.78). Addition of L. reuteri has reduced side effects associated with triple drug therapy except bloating. In conclusion, supplementation of L. reuteri to standard triple drug therapy significantly improved the eradication rate of H. pylori, reduced intensity of gastrointestinal symptoms and also treatment related side effects.

Antibiotic resistances and eradication rates in Helicobacter pylori infection

IntroductionThe resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. Patients and methodsAn observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing — EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6–8 weeks after finalising the treatment. ResultsThe study included 80 patients (63.8% females), with a mean age of 11.9 years (SD ± 2.7 DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P = 0.04). ConclusionsThe high rate of H. pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.

Association between Helicobacter pylori infection and food-specific immunoglobulin G in Southwest China.

BACKGROUND Helicobacter pylori (H. pylori) has been found to be associated with extragastrointestinal diseases, possibly including adverse food reactions (such as food allergy or intolerance). However, there are few studies on H. pylori and food allergy or intolerance, and the results are inconsistent. Food-specific immunoglobulin (Ig) G has been revealed to be associated with food allergy or intolerance and can be used as a marker to explore the correlation between H. pylori infection and food allergy or intolerance.AIMTo explore the relationship between H. pylori infection and food-specific IgGMETHODSWe retrospectively analyzed the physical examination data of 21822 subjects from February 2014 to December 2018 in this study. H. pylori infection was detected using the 13C urea breath test. Food-specific IgG of eggs, milk and wheat in serum was assessed. Subjects were grouped according to H. pylori positivity, and the positive rates of three kinds of food-specific IgG were compared between the two groups. Multivariable logistic regression analysis was performed to elucidate the association between H. pylori infection and food-specific IgG.RESULTSThe total infection rate of H. pylori was 39.3%, and the total food-specific IgG-positive rates of eggs, milk and wheat were 25.2%, 9.0% and 4.9%, respectively. The infection rate of H. pylori was higher in males than in females, while the positive rates of food-specific IgG were lower in males than in females. The positive rates of food-specific IgG decreased with age in both males and females. In the H. pylori-positive groups, the positive rates of food-specific IgG of eggs, milk and wheat were all lower than those in the H. pylori-negative groups. Multivariate logistic regression analysis revealed that H. pylori infection was negatively correlated with the food-specific IgG-positive rates of eggs, milk and wheat (odds ratio value of eggs 0.844-0.873, milk 0.741-0.751 and wheat 0.755-0.788, in different models).CONCLUSION H. pylori infection was found to be negatively associated with the food-specific IgG of eggs, milk and wheat in Southwest China.

The efficacy of Lactobacillus acidophilus and rhamnosus in the reduction of bacterial load of Helicobacter pylori and modification of gut microbiota-a double-blind, placebo-controlled, randomized trial.

Probiotics may alter the gut microbiota and may reduce antibiotic-related dysbiosis after H.pylori eradication. However, whether probiotics are effective in reducing the bacterial load of H.pylori and modifying the gut microbiota remains unknown. We aimed to assess the efficacy of Lactobacillus acidophilus and Lactobacillus rhamnosus in reducing the bacterial load of H.pylori and modifying the gut microbiota. In this double-blind, randomized, placebo-controlled trial, we recruited 40 adult subjects with moderate to high bacterial loads of H.pylori, defined as a mean delta over baseline (DOB) value of the 13 C-urea breath test (13 C-UBT) of 10 or greater every 4days 6 times. Eligible subjects were randomized in a 1:1 ratio to receive either probiotics containing Lactobacillus acidophilus and Lactobacillus rhamnosus or placebo twice daily for 4weeks. 13 C-UBT was measured weekly from the beginning of treatment to 2weeks after treatment. Amplification of the V3 and V4 hypervariable regions of the 16S rRNA was performed for fecal microbiota. A total of 40subjects were randomized to receive probiotics or placebo. The DOB value was significantly lower in the probiotic group than in the placebo group after 4weeks of treatment (26.0 vs. 18.5, p=.045). The DOB value was significantly reduced compared to that at baseline in the probiotic group (18.5 vs. 26.7, p=.001) but not in the placebo group (26.0 vs. 25.0, p=.648). However, the eradication rate for H.pylori was 0% in both groups. There was no significant difference in the DOB values between the two groups 1 and 2weeks after discontinuation of the probiotics. There were also no significant changes observed in the α-diversity and β-diversity at week 4 compared to baseline in the probiotic group (p=.77 and 0.91) and the placebo group (p=.26 and 0.67). Although the use of Lactobacillus acidophilus and Lactobacillus rhamnosus may reduce the bacterial load of H.pylori, there were no significant changes in the composition of gut microbiota. This trial is registered with ClinicalTrials.gov, NCT02725138.

S1382 Vonoprazan Dual and Triple Therapy for Helicobacter pylori Eradication

Introduction: Eradication rates with standard PPI-based triple therapy (TT) for Helicobacter pylori infection are falling, primarily due to increasing antimicrobial resistance. Here, we present the efficacy and safety results of a Phase 3 trial (PHALCON-HP; NCT04167670) in US and European patients with H pylori, investigating novel TT and dual therapy (DT) regimens containing vonoprazan, an investigational potassium-competitive acid blocker, vs PPI TT. Methods: Patients (N=1046) aged ≥18 years with a positive 13C-urea breath test (13C-UBT) indication of H pylori infection were randomized to 14-day DT with open-label vonoprazan (20 mg two times a day [BID]) and amoxicillin (A; 1 g three times a day [TID]), or double-blind TT with either vonoprazan (20 mg BID) or lansoprazole (L; 30 mg BID), plus A (1 g BID) and clarithromycin (C; 500 mg BID). Eradication was determined by 13C-UBT 4 weeks after treatment. The primary endpoint was the eradication rate in patients without strains resistant to A or C; key secondary endpoints were eradication rates in all patients and in patients with C-resistant strains. The primary endpoint was assessed for non-inferiority (10% margin) of vonoprazan regimens vs LTT; secondary endpoints were assessed for superiority. Safety was also assessed. Results: For the primary endpoint, eradication rates with vonoprazan TT and DT proved non-inferior to LTT in patients with H pylori not resistant to A or C (Table 1): vonoprazan TT 84.7% (P< 0.0001) and vonoprazan DT 78.5% (P=0.0037) vs LTT (78.8%). In all patients, vonoprazan TT and DT were superior to LTT: vonoprazan TT 80.8% (P=0.0001) and vonoprazan DT 77.2% (P=0.0063) vs LTT (68.5%). In patients with C-resistant strains, vonoprazan TT and DT were superior to LTT. Treatment-emergent adverse events (TEAEs) occurred in 32.8% of patients overall; serious TEAEs in 1.3% of patients overall (Table 1). Fifteen patients discontinued treatment due to TEAEs: vonoprazan TT n=8 (2.3%); vonoprazan DT n=3 (0.9%); and LTT n=4 (1.2%). Conclusion: In this large US and European trial, vonoprazan TT and DT were non-inferior to LTT in patients with H pylori strains that were not resistant to C or A. In all patients, and in patients with C-resistant strains, vonoprazan TT and DT were superior to LTT. These data support vonoprazan TT and DT as potential new treatment alternatives to PPI-based TT for H pylori eradication.Table 1.: Key results.

Clinical audit of current Helicobacter pylori treatment outcomes in Singapore.

H. pylori eradication reduces the risk of gastric malignancies and peptic ulcer disease. First-line therapies include 14-day PAC (proton pump inhibitor [PPI], amoxicillin, clarithromycin) and PBMT (PPI, bismuth, metronidazole, tetracycline). Second-line therapies include 14-day PBMT and PAL (PPI, amoxicillin, levofloxacin). This clinical audit examined current treatment outcomes in Singapore. Clinical data of H. pylori-positive patientswho underwent empirical first- and second-line eradication therapies from 1 January 2017 to 31 December 2018 were reviewed. Treatment success was determined by 13C urea breath test performed at least 4 weeks after treatment and 2 weeks off PPI. A total of 963 patients (862 PAC, 36 PMC [PPI, metronidazole, clarithromycin], 18 PBMT, 13 PBAC [PAC with bismuth], 34 others) and 98 patients (62 PMBT, 15 PAL, 21 others) received first-and second-line therapies respectively. A 14-day treatment duration was appropriately prescribed for first- and second-line therapies in 65.2% and 82.7% of patients, respectively. First-line treatment success rates were noted for PAC (seven-day: 76.9%, ten-day: 88.3%, 14-day: 92.0%), PMC (seven-day: 0, ten-day: 75.0%, 14-day: 69.8%), PBMT (ten-day: 100%, 14-day: 87.5%) and PBAC (14-day: 100%). 14-day treatment was superior to seven-day treatment (90.8% vs. 71.4%; P = 0.028). PAC was superior to PMC (P < 0.001) but similar to PBMT (P = 0.518) and PBAC (P = 0.288) in 14-day therapies. 14-day second-line PAL and PBMT had similar efficacy (90.9% vs. 82.4%; P = 0.674). First-line empirical treatment using PAC, PBMT and PBAC for 14 days had similar efficacy. Success rates for second-line PBMT and PAL were similar.