End Of Eradication Therapy Research Articles

Butyric Acid Supplementation Reduces Changes in the Taxonomic and Functional Composition of Gut Microbiota Caused by H. pylori Eradication Therapy.

Twenty two H. pylori-positive patients, aged 19 to 64 years, were enrolled in the study and randomized into two treatment groups, as follows: (1) ECAB-14 (n = 11), with esomeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1000 mg, and bismuthate tripotassium dicitrate 240 mg, twice daily, per os, for 14 days, and (2), ECAB-Z-14 (n = 11), with esomeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1000 mg, and bismuthate tripotassium dicitrate 240 mg, twice daily, along with butyric acid+inulin (Zacofalk), two tablets daily, each containing 250 mg of butyric acid, and 250 mg of inulin, per os, for 14 days. Fecal samples were collected from each subject prior to eradication therapy (time point I), after the end of eradication therapy (time point II), and a month after the end of eradication therapy (time point III). The total DNA from the fecal samples was isolated for whole genome sequencing using the Illumina NextSeq 500 platform. Qualitative and quantitative changes in gut microbiota were assessed, including alpha and beta diversity, functional potential and antibiotic resistance gene profiling. Gut microbiota alpha diversity significantly decreased compared with the baseline immediately after eradication therapy in both treatment groups (ECAB-14 and ECAB-Z-14). This diversity reached its baseline in the ECAB-Z-14 treatment group a month after the end of eradication therapy. However, in the ECAB-14 treatment arm, a reduction in the Shannon index was observed up to a month after the end of H. pylori eradication therapy. Fewer alterations in the gut microbiota functional potential were observed in the ECAB-Z-14 treatment group. The abundance of genes responsible for the metabolic pathway associated with butyrate production decreased only in the ECAB-14 treatment group. The prevalence of antibiotic-resistant genes in the gut microbiota increased significantly in both treatment groups by the end of treatment. However, more severe alterations were noted in the ECAB-14 treatment group. H. pylori eradication therapy leads to taxonomic changes, a reduction in the alpha diversity index, and alterations in the functional potential of the gut microbiota and gut resistome. Taking butyric acid+inulin supplements during H. pylori eradication therapy could help maintain the gut microbiota in its initial state and facilitate its recovery after H. pylori eradication.

Initiation of a Helicobacter pylori Screening Program: Enhancing Healthcare at Juntendo University.

We started Helicobacter pylori (H. pylori) screening program of students at Juntendo university in 2020. We report the current status of H. pylori screening program and the outcomes of H. pylori screening program. The students of the School of the Faculty of Health Sciences of Juntendo University enrolling in the spring of 2020-2022 were recruited for this study. The anti-H. pylori antibody test was used for detecting H. pylori infection. An individual with a serum anti-H. pylori antibody titer of less than 3 U/ml was considered to be negative for H. pylori infection. If the antibody titer was 3 U/ml or higher, the subject was considered to be possibly infected and recommended to visit a hospital for further testing. Esophagogastroduodenoscopy and 13C urea breath test were performed for diagnosing H. pylori infection at the hospital. Eradication therapy was performed, and the eradication assessment were performed at least 8 weeks after the end of eradication therapy. Seven hundred twenty-eight students were screened for H. pylori from 2020 to 2022. Fifty-seven students were recommended to visit a hospital based on the anti-H. pylori antibody serum test. Forty-seven students visited Juntendo university hospital. Eleven of the 47 students were positive for H. pylori and all of them students received eradication therapy. H. pylori eradication was successful in nine of the 11 students. The H. pylori screening program for university students at Juntendo university has been successfully initiated with nine successful eradications since its inception in 2020.

Safety and effectiveness of vonoprazan-based rescue therapy for Helicobacter pylori infection

Vonoprazan (VPZ)-based regimens are an effective first-line therapy for Helicobacter pylori (H. pylori) infection. However, their value as a rescue therapy needs to be explored.To assess a VPZ-based regimen as H. pylori rescue therapy.This prospective, single-center, clinical trial was conducted between January and August 2022. Patients with a history of H. pylori treatment failure were administered 20 mg VPZ twice daily, 750 mg amoxicillin 3 times daily, and 250 mg Saccharomyces boulardii (S. boulardii) twice daily for 14 d (14-d VAS regimen). VPZ and S. boulardii were taken before meals, while amoxicillin was taken after meals. Within 3 d after the end of eradication therapy, all patients were asked to fill in a questionnaire to assess any adverse events they may have experienced. At least 4-6 wk after the end of eradication therapy, eradication success was assessed using a 13C-urea breath test, and factors associated with eradication success were explored.Herein, 103 patients were assessed, and 68 patients were finally included. All included patients had 1-3 previous eradication failures. The overall eradication rates calculated using intention-to-treat and per-protocol analyses were 92.6% (63/68) and 92.3% (60/65), respectively. The eradication rate did not differ with the number of treatment failures (P = 0.433). The rates of clarithromycin, metronidazole, and levofloxacin resistance were 91.3% (21/23), 100.0% (23/23), and 60.9% (14/23), respectively. There were no cases of resistance to tetracycline, amoxicillin, or furazolidone. In 60.9% (14/23) patients, the H. pylori isolate was resistant to all 3 antibiotics (clarithromycin, metronidazole, and levofloxacin); however, eradication was achieved in 92.9% (13/14) patients. All patients showed metronidazole resistance, and had an eradication rate of 91.3% (21/23). The eradication rate was higher among patients without anxiety (96.8%) than among patients with anxiety (60.0%, P = 0.025). No severe adverse events occurred; most adverse events were mild and disappeared without intervention. Good compliance was seen in 95.6% (65/68) patients. Serological examination showed no significant changes in liver and kidney function.VAS is a safe and effective rescue therapy, with an acceptable eradication rate (> 90%), regardless of the number of prior treatment failures. Anxiety may be associated with eradication failure.

Анализ клинического течения хронических гастритов при проведении трехкомпонентной схемы эрадикации Helicobacter pylori с включением висмута трикалия дицитрата

Purpose: to evaluate the dynamics of clinical manifestations of the disease in patients with chronic gastritis during the three-component treatment regimen of Helicobacter pylori with the inclusion of bismuthi trikalium dicitrate in the treatment. Material and methods. 38 residents of the Khanty-Mansi Autonomous Okrug-Ugra with chronic gastritis associated with Helicobacter pylori were examined in the Budgetary Establishment «Raduzhninskaya City Hospital». The clinical manifestations of dyspepsia and other manifestations of gastrointestinal dysfunction in patients before and after triple therapy with bismuthi trikalium dicitrate were evaluated. Statistical data processing was carried out using the program Statistica’ 99 Edition (Statsoft). The statistical significance of differences in different treatment periods was assessed using the Pearson – χ2 consent test and the Fisher test. The results. Clinical manifestations of the disease in the examined patients were represented by direct (58-84%) and complementary manifestations of dyspepsia (34-55%), manifestations of intestinal (32%), esophageal dysfunction (42%) in the presence of changes in general well-being (58%). When conducting eradication therapy, regression of direct manifestations of dyspepsia and heartburn is significant by the end of the first week of treatment, complementary criteria of dyspepsia – at the end of treatment. Manifestations of intestinal dysfunction in the form of constipation and discomfort in the mouth regress only 1 week after the end of therapy. Conclusion. The persistence of dyspepsia in 18% of cases after the end of eradication therapy is associated with the absence of eradication of Helicobacter pylori in 5% of cases and the functional origin of dyspepsia in 13% of cases. In patients with functional dyspepsia, the preservation of a low assessment of well-being according to the SAN questionnaire was verified, and in 5% of cases, the preservation of initial diarrhea after eradication therapy of Helicobacter pylori.

Dual Therapy with Vonoprazan and Amoxicillin Is as Effective as Triple Therapy with Vonoprazan, Amoxicillin and Clarithromycin for Eradication of Helicobacter pylori

Backgrounds/Aims: Vonoprazan (VPZ) is the first clinically available potassium competitive acid blocker. This class of agents provides faster and more potent acid inhibition than proton pump inhibitors. Most strains of Helicobacter pylori are sensitive to amoxicillin. We hypothesized that dual therapy with VPZ and amoxicillin would provide the sufficient eradication rate for H. pylori infection. To evaluate this, we compared the eradication rate by the dual VPZ/amoxicillin therapy with that by the standard triple VPZ/amoxicillin/clarithromycin therapy. Methods: Non-inferiority of the eradication rate of H. pylori by the dual therapy with VPZ 20 mg twice daily (bid) and amoxicillin 500 mg 3 times daily (tid) for 1 week to that by the triple therapy with VPZ 20 mg bid, amoxicillin 750 mg bid and clarithromycin 200 mg bid for 1 week was retrospectively studied. Propensity score matching was performed to improve comparability between 2 regimen groups. Successful eradication was diagnosed using the [¹³C]-urea breath test at 1–2 months after the end of eradication therapy. Results: The intention-to-treat analysis demonstrated that the eradication rate by the dual therapy (92.9%; 95% CI 82.7–98.0%, 52/56) was not inferior to that of the triple therapy (91.9%; 95% CI 80.4–97.0%, 51/56; OR 1.275, 95% CI 0.324–5.017%, p = 0.728). There were no statistically significant differences in incidences of adverse events between 2 regimens. Conclusion: VPZ-based dual therapy (VPZ 20 mg bid and amoxicillin 500 mg tid for 1 week) provides an acceptable eradication rate of H. pylori infection without the need for second antimicrobial agents, such as clarithromycin.

The Efficacy of Saccharomyces boulardii CNCM I-745 in Addition to Standard Helicobacter pylori Eradication Treatment in Children.

PurposeThis study aims to investigate Saccharomyces boulardii CNCM I-745 during Helicobacter pylori eradication in children.MethodsOne hundred ninety-four H. pylori positive children were randomized in two groups. Therapy (omeprazole+clarithromycin+amoxicillin or omeprazole+clarithromycin+metronidazole in case of penicillin allergy) was given to both groups during two weeks. In the treatment group (n: 102) S. boulardii was added to the triple therapy, while the control group (n: 92) only received triple therapy. The incidence, onset, duration and severity of diarrhea and compliance to the eradication treatment were compared. A 13C urea breath test was done 4 weeks after the end of eradication therapy in two groups of 21 patients aged 12 years and older to test the H. pylori eradication rate.ResultsIn the treatment group, diarrhea occurred in 12 cases (11.76%), starting after 6.25±1.24 days, lasting 3.17±1.08 days, and compliance to eradication treatment was 100%. In the control group, diarrhea occurred in 26 cases (28.26%), starting after 4.05±1.11 days, lasting 4.02±0.87 days, and in six cases eradication treatment was stopped prematurely (p<0.05). The 13C urea breath test showed successful H. pylori eradication in 71.4% of the patients in the treatment and in 61.9 % in the control group (not significant).ConclusionS. boulardii has a beneficial effect on the prevention and treatment of diarrhea during H. pylori eradication in children. Although S. boulardii did only slightly increase H. pylori eradication rate, compliance to eradication treatment was improved.

Glycosylation of mucins present in gastric juice: the effect of helicobacter pylori eradication treatment

It is suggested that gastric mucins, and in particular some specific glycan structures that can act as carbohydrate receptors, are involved in the interactions with Helicobacter pylori adhesins. The main aim of our study was to evaluate glycosylation pattern of glycoproteins of gastric juice before and at the end of eradication therapy. Gastric juices were taken from 13 clinical patients and subjected to analysis. Pooled fractions of the void volume obtained after gel filtration were subjected to ELISA tests. To assess the relative amounts of carbohydrate structures, lectins and monoclonal antibodies were used. Changes in the level of MUC 1 and MUC 5AC mucins and of carbohydrate structures, which are suggested to be receptors for Helicobacter pylori adhesins, were observed by the end of the eradication treatment. Our results support the idea about the involvement of MUC 5AC and MUC 1 with some specific sugar structures in the mechanism of Helicobacter pylori infection.

Effect of Helicobacter pylori Eradication on Insulin Resistance, Serum Lipids and Low-Grade Inflammation

Many studies have revealed a close relationship between Helicobacter pylori (HP) infection and insulin resistance. The aim of this study was to investigate the effects of HP eradication on insulin resistance, serum lipids and low-grade inflammation. This was a prospective, open-label, single-center study which consisted of 159 patients. The patients with HP infection received a 14-day sequential regimen. A HOMA-IR (homeostasis model assessment of insulin resistance) level was used to assess insulin resistance. Eighty-eight patients with HP infection and seventy-one patients without HP infection were studied. HOMA-IR, total cholesterol (TC), triglyceride (TG), LDL cholesterol (LDL-C) and C reactive protein (CRP) levels were significantly higher and HDL-cholesterol (HDL-C) levels were significantly lower in patients with HP infection compared to the patients without HP infection (P<0.05). The HP eradication rates with a sequential regimen in dyspeptic patients were 53.4%. Six weeks after the end of eradication therapy, the mean fasting insulin, HOMA-IR, TC, TG, LDL-C, and CRP levels in patients with successful eradication were significantly decreased from the pretreatment levels (P<0.05) and HDL-C level was significantly increased from the pretreatment levels (P<0.05). The mean fasting insulin, HOMA-IR, TC, TG, LDL-C, CRP levels and HDL-C levels in patients with unsuccessful eradication were not significantly changed from pretreatment levels (P<0.05). This study showed beneficial effects of HP eradication on insulin resistance, atherogenic lipid abnormalities and low-grade inflammation. The results suggest that HP eradication may prevent coronary artery disease and metabolic syndrome.

MUC 1 mucin content in gastric juice of duodenal ulcer patients: effect of Helicobacter pylori eradication therapy

It has been suggested that Helicobacter pylori can interact via carbohydrate structures with gastric mucins. Particularly, the Lewis b structures of the secretory MUC 5AC mucin are considered to be putative receptors for bacterial adhesins. Also the epithelial MUC 1 mucin is implicated by some authors to have a major role in the mechanism of infection. The main objective of our study was to evaluate MUC 1 mucin levels in human gastric juice before and at the end of eradication therapy. Any possible changes could suggest the participation of MUC 1 in H. pylori infection. We assume that the amount of the soluble form of MUC 1 exfoliated to the juice correlates with MUC 1 expressed on epithelial cells. Gastric juice samples of 14 duodenal ulcer patients infected with H. pylori were assayed before and at the end of eradication. In all samples, DNA content was determined. Mucin fractions were isolated by gel exclusion chromatography. High molecular mass material containing MUC 1 was subjected to 4%-12% polyacrylamide gradient gels, electrotransfer to Immobilon P and immunodetection. In 12 infected patients (86%), the initial low level of MUC 1 mucin in gastric juice increased at the end of eradication. In comparison to the infected patients, neutral carbohydrate and DNA content in gastric juice diminished after treatment. Our results indicate that the bacterium affects the soluble form of MUC 1 mucin, thus suggesting a likely role of this mucin in the course of H. pylori infection.

A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

A standard third-line treatment is lacking, and European guidelines recommend performing culture in these patients. However, the use of this procedure as 'routine practice' is definitively not feasible. To evaluate the eradication rate of a 10-day levofloxacin-based triple therapy in patients who have failed two eradication courses for Helicobacter pylori. A total of 151 patients with persistent Helicobacter pylori infection after two treatments were studied. Patients were considered positive if two of three endoscopic tests were positive. Susceptibility testing was also performed. Patients received a standard dose of proton-pump inhibitors twice daily, levofloxacin 250 mg twice daily and amoxicillin 1 g twice daily, for 10 days. Endoscopic follow-up was carried out 4-6 weeks after the end of eradication therapy. About 76% (95% CI: 68.8-82.3), and 85% (95% CI: 77.5-89.7) of patients were eradicated according to intention-to-treat and per-protocol analysis, respectively. Eradication rates of the strains showed as 92% (95% CI: 83.2-96.7) of those resistant to both metronidazole and clarithromycin but susceptible to levofloxacin. In patients who failed previous regimens, the 10-day levofloxacin-based triple therapy is safe and effective, allowing eradication in almost 80% of the patients.

Increased serum pepsinogen-I level predicts development of new duodenal erosion following eradication teraphy of H.pylori

Aims: Eradication of Helicobacter pylori (Hp) decreases the concentrations of serum gastrin (G) and pepsinogen (PG). However, the changes in serum level of such peptides during or just after eradication therapy have not been well investigated. In this study, we evaluated the changes in serum G and PG levels at the end of eradication therapy, and then investigated the relation to the duodenal erosion following eradication. Methods: We randomly treated 318 patients (104 female and 318 men, mean age 51 years) with abdominal symptom (109 gastric ulcer (GU), 113 duodenal ulcer (DU), 32 gastro-duodenal ulcer (GDU), and 64 atrophic gastritis (AG». Before eradication, endoscopy was performed and patients with duodenal erosion were excluded. One month after eradication, endoscopy was performed to check duodenal erosion, and Hip culture, histology, and urea breath test performed to assess Hip treatment. We determined G and PG level in sera at three time points: before eradication, at the end of eradication, and one month after eradication. Results: In 272 (85.5%) cured patients, 39 (14.3%) patients had new duodenal erosions. In 46 (14.5%) patients with unsuccessful treatment, no duodenal erosion appeared. Duodenal erosion developed in 27.3%, 10.7%, 9.1%, and 0% in the patients with DU, GDU, GU, and AG. The prevalence of duodenal erosion after Hip eradication was significantly higher (p < 0.005) in DU patients than in GU, and AG patients. In cured patients, G, PG-I, II, and IIII level one month after eradication were significantly decreased compared to those measured before eradication (p < 0.005). At the end of eradication, G and PG-I level were significantly higher than before eradication (p < 0.0001). In uncured patients, no changes were seen. In the patients with new duodenal erosions, G, PG-I, II, and IIII levels were similar to non-duodenal erosion patients before eradication and one month after eradication. However, at the end of eradication, only PG-I levels were significantly higher (p < 0.0001) than in the patients with non-duodenal erosion. Conclusions: 1. Successful Hip treatment causes a temporary high G and PG-I response at the end of eradication therapy. 2. Increased PG-I might be a kind of gastric mucosal response to H.p eradication since this temporary high level of serum PG-I is strongly associated with development of new erosions in duodenum. 3. These phenomenon strongly bring about duodenal mucosal damage by excess acid secretion and PG-I following eradication therapy.

Evaluation of the PyloriTek test for detection of Helicobacter pylori infection in cases with and without eradication therapy

Objective: The accuracy of the PyloriTek test (a 1-h rapid urease test) used after eradication therapy of Helicobacter pylori ( H. pylori) has not been well clarified. This study was done to evaluate the accuracy of the PyloriTek test results for cases with and without eradication therapy, using culture and histology as gold standard methods, and to establish the suitable timing of the PyloriTek test after eradication treatment. Methods: One hundred sixty-three patients undergoing upper endoscopy were randomly selected; 100 patients had not received eradication therapy and 63 had. Three biopsy specimens each were obtained from the gastric antrum and the body for examination by PyloriTek, culture, and histology. The absence of H. pylori was established with negative results from both culture and histology. Results: In cases without eradication therapy, PyloriTek, correctly identified 66 of 67 H. pylori-positive cases and 30 of 33 H. pylori-negative cases, yielding 98.5% sensitivity and 90.9% specificity. In cases with eradication therapy, PyloriTek gave correct diagnoses in 10 of 17 H. pylori-positive cases and in 45 of 46 H. pylori-negative cases, for 58.8% sensitivity and 97.8% specificity. However, when PyloriTek was used more than 4 months after the end of eradication therapy, both the sensitivity and the specificity increased to 100%. Conclusion: Considering time and cost, the use of PyloriTek alone may be satisfactory for detecting H. pylori infection in cases without eradication therapy. When patients are examined more than 4 months after intervention, the use of PyloriTek alone may be sufficient for correctly diagnosing H. pylori infections.