Diagnosis Of Helicobacter Pylori Infection Research Articles

Change in Diagnosis of Helicobacter pylori Infection in the Treatment-Failure Era.

Helicobacter pylori (H. pylori) infection is a prevalent global health issue, associated with several gastrointestinal disorders, including gastritis, peptic ulcers, and gastric cancer. The landscape of H. pylori treatment has evolved over the years, with increasing challenges due to antibiotic resistance and treatment failure. Traditional diagnostic methods, such as the urea breath test, stool antigen test, and endoscopy with biopsy, are commonly used in clinical practice. However, the emergence of antibiotic-resistant strains has led to a decline in treatment efficacy, necessitating a re-evaluation of common diagnostic tools. This narrative review aims to explore the possible changes in the diagnostic approach of H. pylori infection in the era of treatment failure. Molecular techniques, including polymerase chain reaction and whole genome sequencing, which have high sensitivity and specificity, allow the detection of genes associated with antibiotic resistance. On the other hand, culture isolation and a phenotypic antibiogram could be used in the diagnostic routine, although H. pylori is a fastidious bacterium. However, new molecular approaches are promising tools for detecting the pathogen and its resistance genes. In this regard, more real-life studies are needed to reveal new diagnostic tools suitable for identifying multidrug-resistant H. pylori strains and for outlining proper treatment.

Helicobacter pylori infection diagnosis and management: current practices of Greek gastroenterologists.

The diagnosis and management of Helicobacter pylori (H. pylori) infection vary significantly, depending on country, area, and specialty. The aim of this study was to record the current practices of Greek gastroenterologists in the screening and treatment of H. pylori infection. An anonymous questionnaire consisting of 19 questions about the management of H. pylori infection was sent with the aid of the Hellenic Society of Gastroenterology to all members of the Society. The questionnaire was completed by 180 gastroenterologists, with a response rate of 31.4%. Diagnostic tests to confirm H. pylori infection are ordered by >90% of the gastroenterologists for patients with current peptic ulcer disease, gastric lymphoma, family history of gastric cancer, and an endoscopic appearance suggestive of gastritis. Most gastroenterologists (55.8%) also tested for H. pylori in patients with gastroesophageal reflux disease (GERD). Histopathology was the most preferred (60.6%) method when testing was decided during endoscopy, while urea breath test was the most preferred method (67.8%) regardless of endoscopy. Most gastroenterologists use quadruple eradication regimens supported by international guidelines (90%), while 65.6% of the physicians answered that they systematically recommend the addition of probiotics to standard therapy. Most physicians (82.8%) answered that they always confirm the eradication of the pathogen. The majority of Greek gastroenterologists conform to the recommendations of international guidelines regarding the diagnosis and management of H. pylori infection, except for the screening of patients with GERD. A considerable number of doctors use probiotics in addition to standard therapy.

Accuracy of gastric nodule combined with rapid urease test prediction in diagnosing Helicobacter pylori infection in children.

The diagnosis of Helicobacter pylori (H. pylori) infection in children remains challenging with the lack of a rapid, cost-effective, and highly accurate diagnostic method. Consequently, this study aimed to investigate the accuracy of the combination of gastric nodule and rapid urease test (RUT) as a diagnostic method for H. pylori infection in children. The study included participants who underwent a thorough examination, including gastroscopy, a 13C breath test, RUT, and pathological methylene blue staining, with the gold standard for diagnosing of H. pylori infection being a positive result from both pathological methylene blue staining and 13C breath test. The sensitivity, specificity, positive and negative predictive values, and accuracy of the diagnostic methods were calculated. The accuracy of the different tests for H. pylori infection was evaluated in 2202 participants. A total of 730 (33.2%) children were diagnosed with H. pylori infection (pathological methylene blue staining and 13C breath test, both positive). Gastric nodule had a sensitivity of 87.1% and a specificity of 93.1%, whereas combining gastric nodule and RUT in parallel had the higher accuracy of 95.4%. The accuracy of gastric nodule diagnosis was higher in younger age groups and increased after excluding patients with a history of anti-H. pylori treatment. The findings of this study suggest that gastric nodules, particularly when combined with RUT, can be a valuable predictor of H. pylori infection in children, offering a simple and feasible alternative to other invasive methods.

ASSESSMENT OF THE ACCURACY OF THE RAPID TEST FOR THE DIAGNOSIS OF HELICOBACTER PYLORI IN PATIENTS THAT DIDN'T UNDERGO PREVIOUS ERADICATION THERAPY AND WHO WENT THROUGH ENDOSCOPY.

Helicobacter pylori infection is widely spread globally and is known to cause potentially serious diseases. Several diagnostic methods exist to identify and treat carriers of this bacterium. Serological tests for the diagnosis of infection are based on the detection of antibodies immunoglobulin G against H. pylori, a non-invasive, inexpensive, and easy-to-perform option. This research aims to ascertain the accuracy of an immunochromatographic serological test to verify the feasibility of using this method in patients who have not undergone previous eradication therapy. Rapid tests and questionnaires were applied to 53 patients that underwent upper digestive endoscopy with research for H. pylori between the period of September and October 2021. The results were compared with histopathology. In the rapid tests, seven positive and 46 negative results were obtained. When compared with the gold stan-dard, the following values were described: sensitivity 54.5%, specificity 97.6%, positive predictive value 85.7%, and negative predictive value 89.1%. In the present study, the immunochromatographic serological tests had an accuracy close to the values found in other similar studies. Therefore, it may be concluded that the rapid serological test remains a reasonable choice for screening large populations due to its low cost and ease of application, especially in those individuals who have not undergone previous treatment. • Helicobacter pylori infection can cause potentially serious diseases. • Serological tests are based on the detection of antibodies immunoglobulin G against Helicobacter pylori. • Serological tests for the diagnosis of Helicobacter pylori infection are low cost tools and have easy application. • Rapid serological test is a reasonable choice for screening large populations.

Diagnostic usefulness of deep learning methods for Helicobacter pylori infection using esophagogastroduodenoscopy images.

We aimed to assess the diagnostic potential of deep convolutional neural networks (DCNNs) for detecting Helicobacter pylori infection in patients who underwent esophagogastroduodenoscopy and Campylobacter-like organism tests. We categorized a total of 13,071 images of various gastric sub-areas and employed five pretrained DCNN architectures: ResNet-101, Xception, Inception-v3, InceptionResnet-v2, and DenseNet-201. Additionally, we created an ensemble model by combining the output probabilities of the best models. We used images of different sub-areas of the stomach for training and evaluated the performance of our models. The diagnostic metrics assessed included area under the curve (AUC), specificity, accuracy, positive predictive value, and negative predictive value. When training included images from all sub-areas of the stomach, our ensemble model demonstrated the highest AUC (0.867), with specificity at 78.44%, accuracy at 80.28%, positive predictive value at 82.66%, and negative predictive value at 77.37%. Significant differences were observed in AUC between the ensemble model and the individual DCNN models. When training utilized images from each sub-area separately, the AUC values for the antrum, cardia and fundus, lower body greater curvature and lesser curvature, and upper body greater curvature and lesser curvature regions were 0.842, 0.826, 0.718, and 0.858, respectively, when the ensemble model was used. Our study demonstrates that the DCNN model, designed for automated image analysis, holds promise for the evaluation and diagnosis of Helicobacter pylori infection.

Room-Temperature NH3 Gas Surface Acoustic Wave (SAW) Sensors Based on Graphene/PPy Composite Films Decorated by Au Nanoparticles with ppb Detection Ability.

Exhaled human breath analysis has great potential for the diagnosis of diseases in non-invasive way. The 13C-Urea breath test for the diagnosis of Helicobacter pylori infection indicates the ammonia concentration of 50-400 ppb in the breath. This work successfully developed a surface acoustic wave (SAW) resonator based on graphene/polypyrrole composite films decorated by gold nanoparticles (AuNPs-G/PPy) with sensitivity and selectivity to detect ammonia in parts-per-billion concentrations, which is promising for the accurate diagnosis of H. pylori infection. XRD, EDS, and SEM characterized the AuNPs-G/PPy nanocomposites, providing comprehensive insights into their structural, compositional, and morphological properties. The gas-sensing capabilities of the fabricated SAW sensors were extensively investigated, focusing on their response to NH3 gas at ambient temperature. The concentration of ammonia gas was effectively quantified by monitoring the frequency shift of the SAW device. Notably, our developed SAW sensor demonstrated outstanding sensitivity, selectivity, repeatability, and reproducibility for 50-1000 ppb NH3 in dry air. The excellent sensing performance of the AuNPs-G/PPy hybrid composite film can be attributed to the synergistic effects of graphene's superior conductivity, the catalytic properties of gold nanoparticles, and the conductivity sensitization facilitated by electron-hole recombination on the polypyrrole surface.

Endoscopic Features of Undifferentiated-Type Early Gastric Cancer in Patients with Helicobacter pylori-Uninfected or -Eradicated Stomachs: A Comprehensive Review.

Since the indications for endoscopic submucosal dissection have been expanded to include undifferentiated-type early gastric cancers, improvements in preoperative diagnostic ability have been an area of research. There are also concerns about the impact on the diagnosis of Helicobacter pylori infection. Based on our previous studies, in undifferentiated-type early gastric cancers, magnifying endoscopy with narrow-band imaging is useful for delineating the demarcation regardless of the tumor size. Additionally, inflammatory cell infiltration appears to be a cause of misdiagnosis, suggesting that the resolution of inflammation could contribute to the accurate diagnosis of demarcations. As such, the accuracy of demarcation in eradicated and uninfected cases is higher than that in non-eradicated cases. The common features of the endoscopic findings were discoloration under white-light imaging and a predominance of sites in the lower and middle regions. The uninfected group was characterized by smaller tumor size, flat type, more extended intervening parts in magnifying endoscopy with narrow-band imaging, and pure signet ring cell carcinoma. In contrast, the eradication and non-eradication groups were characterized by larger tumor size, depressed type, and wavy microvessels in magnifying endoscopy with narrow-band imaging. In this comprehensive review, as described above, we discuss the diagnosis of demarcation of undifferentiated-type early gastric cancers, undifferentiated-type early gastric cancers that developed following H. pylori eradication, and H. pylori-uninfected undifferentiated-type early gastric cancers, with a focus on studies with self-examination and endoscopic findings and describe the future direction.

Endoscopic Features of Undifferentiated-Type Early Gastric Cancer in Patients with Helicobacter pylori-Uninfected or -Eradicated Stomachs: A Comprehensive Review.

Since the indications for endoscopic submucosal dissection have been expanded to include undifferentiated-type early gastric cancers, improvements in preoperative diagnostic ability have been an area of research. There are also concerns about the impact on the diagnosis of Helicobacter pylori infection. Based on our previous studies, in undifferentiated-type early gastric cancers, magnifying endoscopy with narrow-band imaging is useful for delineating the demarcation regardless of the tumor size. Additionally, inflammatory cell infiltration appears to be a cause of misdiagnosis, suggesting that the resolution of inflammation could contribute to the accurate diagnosis of demarcations. As such, the accuracy of demarcation in eradicated and uninfected cases is higher than that in non-eradicated cases. The common features of the endoscopic findings were discoloration under white-light imaging and a predominance of sites in the lower and middle regions. The uninfected group was characterized by smaller tumor size, flat type, more extended intervening parts in magnifying endoscopy with narrow-band imaging, and pure signet ring cell carcinoma. In contrast, the eradication and non-eradication groups were characterized by larger tumor size, depressed type, and wavy microvessels in magnifying endoscopy with narrow-band imaging. In this comprehensive review, as described above, we discuss the diagnosis of demarcation of undifferentiated-type early gastric cancers, undifferentiated-type early gastric cancers that developed following H. pylori eradication, and H. pylori-uninfected undifferentiated-type early gastric cancers, with a focus on studies with self-examination and endoscopic findings and describe the future direction.

Graded diagnosis of Helicobacter pylori infection using hyperspectral images of gastric juice.

Helicobacter pylori is a potential underlying cause of many diseases. Although the Carbon 13 breath test is considered the gold standard for detection, it is high cost and low public accessibility in certain areas limit its widespread use. In this study, we sought to use machine learning and deep learning algorithm models to classify and diagnose H. pylori infection status. We used hyperspectral imaging system to gather gastric juice images and then retrieved spectral feature information between 400 and 1000 nm. Two different data processing methods were employed, resulting in the establishment of one-dimensional (1D) and two-dimensional (2D) datasets. In the binary classification task, the random forest model achieved a prediction accuracy of 83.27% when learning features from 1D data, with a specificity of 84.56% and a sensitivity of 92.31%. In the ternary classification task, the ResNet model learned from 2D data and achieved a classification accuracy of 91.48%.

Accuracy of Stool Antigen Test in the Diagnosis of Helicobacter pylori Infection in the Dominican Republic.

This study proposes to define the diagnostic accuracy of the stool antigen test for H. pyloriinfection in the Dominican Republic. An observational, retrospective, and cross-sectional study was conducted. The results of the stool antigen test for H. pylori infection were compared with the results of the gastric biopsy, as a gold standard test. Patients over 18 years of age with an indication for endoscopy due to suspicion of H. pylori infection, who attended the gastroenterology clinic in 2021, were included in the study. It was shown that the stool antigen test for H. pylori infection has a 61.54% sensitivity and 59.65% specificity. According to the study population, the positive predictive value (PPV) was 67.60% and the negative predictive value (NPV) was 53.13%. Low numbers of both sensitivity and specificity were determined, which is why it is pertinent to study alternative non-invasive methods. However, it is important to assess the antibiotic exposure of the study population, since the diagnostic accuracy of the stool test can be influenced by this factor.

Quantitative Polymerase Chain Reaction (qPCR)-Based Rapid Diagnosis of Helicobacter pylori Infection and Antibiotic Resistance.

Helicobacter pylori is a major human pathogen thatinfects approximately half of the global population and is becoming a serious health threat due to its increasing antibiotic resistance. It is the causative agent of chronic active gastritis, peptic ulcer disease, and gastric cancer and has been classified as a Group I Carcinogen by the International Agency for Research on Cancer. Therefore, the rapid and accurate diagnosis of H. pylori and the determination of its antibiotic resistance are important for the efficient eradication of this bacterial pathogen. Currently, H. pylori diagnosis methods mainly include the urea breath test (UBT), the antigen test, the serum antibody test, gastroscopy, the rapid urease test (RUT), and bacterial culture. Among them, the first three detection methods are noninvasive, meaning they are easy tests to conduct. However, bacteria cannot be retrieved through these techniques; thus, drug resistance testing cannot be performed. The last three are invasive examinations, but they are costly, require high skills, and have the potential to cause damage to patients. Therefore, a noninvasive, rapid, and simultaneous method for H. pylori detection and drug resistance testing is very important for efficiently eradicating H. pylori in clinical practice. This protocol aims to present a specific procedure involving the string test in combination with quantitative polymerase chain reaction (qPCR) for the rapid detection of H. pylori infection and antibiotic resistance. Unlike bacterial cultures, this method allows for easy, rapid, noninvasive diagnosis of H. pylori infection status and drug resistance. Specifically, we used qPCR to detect rea for H. pylori infection and mutations in the 23S rRNA and gyrA genes, which encode resistance against clarithromycin and levofloxacin, respectively. Compared to routinely used culturing techniques, this protocol provides a noninvasive, low-cost, and time-saving technique to detect H. pylori infection and determine its antibiotic resistance using qPCR.

Clinical value of serum pepsinogen in the diagnosis and treatment of gastric diseases.

Pepsinogen, secreted from the gastric mucosa, is the precursor of pepsin. It is categorized as pepsinogen 1 and pepsinogen 2 based on its immunogenicity. The pepsinogen content that can enter the blood circulation through the capillaries of the gastric mucosa is approximately 1% and remains stable all the time. The pepsinogen content in serum will change with the pathological changes of gastric mucosa. Therefore, the level of pepsinogen in serum can play a role in serologic biopsy to reflect the function and morphology of different regions of gastric mucosa and serve as an indicator of gastric disease. This study conducts relevant research on serum pepsinogen 1, pepsinogen 2, and the ratio of pepsinogen 1 to pepsinogen 2, and reviews their important value in clinical diagnosis of Helicobacter pylori infection, gastric ulcer, and even gastric carcinoma, providing ideas for other researchers.

Infection with Helicobacter Pylori and the Risk of Iron Deficiency Anaemia

Objective: The objective of this research is to determine the frequency of a condition known as iron deficiency anaemia (IDA) among people who have been infected with Helicobacter pylori. Study Design: Cross-sectional/ Prospective study Place and Duration: Hayatabad Medical Complex Peshawar in the duration from November, 2022 to April, 2023. Methods: There were a total of 116 patients with Helicobacter pylori infections, whose ages ranged from 20 to 70. After collecting demographic information from each participant (including age, sex, BMI, education level, and residence), each patient gave written informed consent. Subjects' blood was tested for iron, transferrin saturation, ferritin, which and total iron-binding capacity. Histopathology, stool antigen testing, a fast urease test, and a urea breath test can all diagnose Helicobacter pylori infection. All statistical analyses were performed in SPSS 25.0. Results: There were 74 (63.8%) females and 42 (36.2%) males in our study. Patients mean age was 28.13±14.68 years and had mean BMI 23.6±11.26 kg/m2. The mean Hemoglobin level of the patients was 11.9±1.8 (g/dl), the iron level was 47.11±6.49 (ug/dl) and mean ferritin level was 119.6±32.68 (ng per ml). Among 116 cases, 42 (36.2%) patients had Iron Deficiency Anemia (IDA). Conclusion: An increased incidence of iron deficiency anaemia was seen among individuals with Helicobacter pylori infections; the majority of these patients were adult females. Keywords: H.pylori infection, Prevalence, Iron Deficiency Anemia (IDA),

Evaluation of two commercially available rapid stool antigen tests for the diagnosis of Helicobacter pylori infection.

Helicobacter pylori (H. pylori) is one of the most prevalent infections, which can cause chronic gastritis, peptic ulcers and even gastric cancer. Prompt diagnosis and subsequent eradication are essential. Many commercially available H. pylori stool antigen diagnostic kits are used. However, the diagnostic performance of these tests has not yet been evaluated. This study aimed to evaluate two commercial rapid H. pylori Stool Antigen-Lateral Flow Immunochromatography Assay kits (HpSA-LFIA). A total of 88 adult patients with dyspeptic symptoms were included in the study. Full case history was obtained, and fresh stool samples were tested for HpSA by two different kits: RightSign® (BiotesT, Hangzhou, China) and OnSite® (CTK biotech, Poway, USA) and HpSA-enzyme-linked immunosorbent assay (ELISA) as a reference standard. Of the 88 patients, H. pylori infection was positive in 32 (36.4%), negative in 53 (60.2%), and indeterminate in 3 (3.4%) by ELISA. The sensitivity, specificity, positive predictive value, and negative predictive value were as follows: 96.6%, 66.1%, 62%, and 97.4%, respectively for RightSign® test and 96.9%, 50%, 52.5%, and 96.6%, respectively for OnSite® test. HpSA-LFIA, RightSign® and OnSite®, are good negative tests, however they cannot be used as a sole test for diagnosis and needs other confirmatory tests in case of positive results.

Diagnosis of helicobacter pylori infection in low out-outcome country: Rapid urease test, serological test, versus direct microbiological examination with gram staining

Introduction: Helicobacter pylori is a Gram-negative bacillus, responsible for numerous gastroduodenal pathologies and this infection constitutes a public health problem. The prevalence of infection with this bacterium remains high in countries with limited resources

Prevalence, Clinical and Demographic Characteristics of Helicobacter pylori in Patients Undergoing Esophagogastroduodenoscopy in Specialized Health Centers in Two Departments of the Colombian Coffee Growing Axis

Helicobacter pylori is a Gram-negative, microaerophilic bacterium with the ability to survive in extreme acid environments, with pH below 4.0. It is estimated that more than half of the world’s population is infected with this bacterium. Objective: To determine the prevalence, clinical and demographic characteristics of Helicobacter pylori infection in patients undergoing esophagogastroduodenoscopy in two specialized centers of the Coffee Growing Axis in Pereira and Manizales from February to October 2018. Method: Cross-sectional descriptive observational study in which the proportion of positivity to Helicobacter pylori in a period of time was determined. Results: The study included 94 patients; the prevalence of positivity to Helicobacter pylori was 86.1% (81/94), 56 (59.5%) of which were diagnosed by culture and 52 (55.3%) by histology. In the histological study, of the 24 (25.5%) subjects who presented precursor lesions of malignancy, 9 (9.5%) were positive for Helicobacter pylori, while in the 70 subjects (74.5%) without precursor lesions of malignancy, 43 (45.7%) were positive. The significant variables for Helicobacter pylori infection were: Histological response for precursor lesions of malignancy: OR of 0.3808 (95% CI: 0.1408-0.9907) p=0.04 and epigastric pain: OR 0.09489 (95% CI: 0.01928-0.3637) p=0.001. Conclusion: The frequency of Helicobacter pylori infection in the Departments of Risaralda and Caldas is high, and does not discriminate against gender, age, race or origin of the study subjects; Epigastric pain continues to be the most relevant symptom in the diagnosis of Helicobacter pylori infection and the combination of diagnostic tests improves the diagnosis of Helicobacter pylori infection.

Performance evaluation of a novel 14C-urea breath test (solid scintillation) for the diagnosis of helicobacter pylori infection.

14C-urea breath tests (UBTs) can be used to diagnose helicobacter pylori (H. pylori) infection. This study aimed to evaluate the accuracy of a solid scintillation 14C-UBT in diagnosing H pylori infection. This open-label, prospective multicenter study enrolled patients who underwent H pylori screening from January 7, 2020, to October 28, 2020, in 3 centers in China. All participants underwent solid scintillation UBT first and then gastroscopy. The rapid urease test and histological examination results were the gold standards (H pylori-positive was defined as the 2 tests being positive; H pylori-negative was defined as both tests being negative). The solid scintillation 14C-UBT involves a scintillation sampling bottle and a 14C-urea capsule. The sampling bottle contains a stack of carbon dioxide-absorbing and scintillation sheets. The test is read using a photomultiplier. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for H pylori infection were evaluated. This study enrolled 239 participants. There were 98 males and 141 females, aged 45.8 ± 11.9 (range: 21-66) years. Thirty-four participants were excluded due to a discrepancy between the rapid urease test and immunohistochemistry examination. Finally, 205 participants were included in the analysis. According to the gold standard, 87 out of 205 (42.4%) participants were H pylori-positive. Compared with the gold standard, the sensitivity, specificity, accuracy, and positive and negative predictive values of the solid scintillation 14C-UBT were 95.4%, 97.5%, 96.6%, 96.5%, and 96.6% for the solid scintillation UBT, respectively. One participant experienced 1 adverse event (AE) (exacerbation of chronic cholecystitis), and the AE eventually improved by itself. The investigators determined that the AE was unrelated to the study device. The noninvasive solid scintillation 14C-UBT has a high diagnostic value for H pylori infection, comparable to the diagnostic value of the gold standard.

Artificial Intelligence—The Rising Star in the Field of Gastroenterology and Hepatology

Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In this field, AI has several applications, such as detecting and classifying polyps, detecting the malignancy in polyps, diagnosing Helicobacter pylori infection, gastritis, inflammatory bowel disease, gastric cancer, esophageal neoplasia, and pancreatic and hepatic lesions. The aim of this mini-review is to analyze the currently available studies regarding AI in the field of gastroenterology and hepatology and to discuss its main applications as well as its main limitations.

Seven-day vonoprazan-based triple therapy as first-lineHelicobacter pylori treatment in comparison with extended sequential therapy.

Vonoprazan as a new acid blocker has more potency and longer lasting acid suppression than proton pump inhibitors. Whether the efficacy of vonoprazan-based triple therapy is comparable with or even better than that of currently recommended first-line therapies is still unknown. Our study aims to compare the eradication rate and major adverse effects between 7-day vonoprazan-based triple therapy with high-dose amoxicillin and 14-day extended sequential therapy. We performed a retrospective analysis from the database of 13C-urea breath test at Fu Jen Catholic University Hospital. All patients with a definite diagnosis of Helicobacter pylori infection by rapid urease test, urea breath test, stool antigen test, or pathology report were recruited. Patients receiving first-line regimens with vonoprazan-based triple therapy or extended sequential therapy were included. The respective eradication rate determined by 13C-urea breath test and major adverse effects were demonstrated. Totally, 106 patients were recruited in the vonoprazan-based triple therapy group and 357 in the extended sequential therapy group. There was no significant difference in eradication rate between vonoprazan-based triple therapy with high-dose amoxicillin and extended sequential therapy (83.0 vs 88.8%, P= 0.12). Major adverse effects occurred in 13 of the extended sequential therapy group but none in the other group (0% vs 3.6%, P= 0.046). Seven-day vonoprazan-based triple therapy with high-dose amoxicillin is a potential first-line anti-Helicobacter pylori regimen alternative to current standard treatment, with the advantages of simplicity, short treatment duration, low pill burden, and fewer major adverse effects.

Helicobacter pylori infection diagnosis and management: current practices of Greek gastroenterologists

Helicobacter pylori infection diagnosis and management: current practices of Greek gastroenterologists