Eradication Of Helicobacter Pylori Infection Research Articles

Bismuth-Based Quadruple Therapy as First-Line Treatment for Clarithromycin-resistant Helicobacter pylori Infection: A Prospective Randomized Comparison of 7- and 14-Day Treatment Regimens.

: Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant Helicobacter pylori (HP) infection. The aim of this study was to compare the efficacy of 7-day BQT with that of 14-day BQT as first-line treatment for clarithromycin-resistant HP infection. : A total of 162 treatment-naïve patients with peptic ulcer disease and clarithromycin-resistant HP infection confirmed by real-time polymerase chain reaction (RT-PCR) were enrolled. The enrolled patients were prospectively randomized to receive BQT for either 7 or 14 days of treatment. Eradication of HP infection was assessed using a 13C-urea breath test. Eradication and adverse event rates of the two groups were assessed. : The overall eradication rates in the intention-to-treat (ITT) and per-protocol (PP) analyses were 83.0% (95% confidence interval [CI], 77.2% to 88.9%; 132/159) and 89.8% (95% CI, 84.9% to 94.7%; 132/147), respectively. The eradication rates in the ITT analysis were 79.0% (64/81) in the 7-day group and 87.2% (68/78) in the 14-day group (p=0.170). The eradication rates in the PP analysis were 86.5% (64/74) in the 7-day group and 93.2% (68/73) in the 14-day group (p=0.182). Clinically significant adverse events occurred in 18.2% of patients. There was no statistically significant difference in the rates of individual or all adverse events between the two groups. : Both 7-day and 14-day BQT were effective and safe as first-line therapy for HP infections identified as resistant to clarithromycin by RT-PCR. For clarithromycin-resistant HP infections, 7-day BQT may be sufficient as first-line therapy.

Application of furazolidone in Helicobacter pylori infection eradication.

Increasing antibiotic resistance is the primary reason for treatment failure of Helicobacter pylori (H. pylori) infection. To enhance the eradication rate, minimize the development of secondary resistance, and alleviate the socioeconomic burden, it is crucial to select H. pylori-sensitive antibiotics carefully. Furazolidone has been used for H. pylori eradication in developing countries for decades due to its affordability and low resistance rate. Numerous studies have demonstrated that furazolidone-containing regimens are more efficacious than those containing other antibiotics, as both first- and second-line therapies, and are also well tolerated. However, utility of furazolidone is restricted or not optimal in certain countries due to its infrequent but potentially severe adverse effects. The decision to discontinue usage of furazolidone because of concerns regarding adverse effects may be misguided. Here we comprehensively reviewed the studies on furazolidone at different dosages and treatment durations for H. pylori eradication. Further research on the mechanisms of action and clinical trials of furazolidone are of great practical importance.

High-dose dual therapy versus bismuth-containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta-analysis.

To update evidence-based data comparing the efficacy and safety of high-dose dual therapy (HDDT) and bismuth-containing quadruple therapy (BQT) in eradicating Helicobacter pylori infection through meta-analysis. Multiple databases were systematically searched for randomized controlled trials (RCTs) published upto May 18, 2023. Dichotomous data were evaluated using risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis, sensitivity analysis, risk of bias assessment, and quality of evidence evaluation were performed. Twenty RCTs containing 7891 subjects were included in the analysis. There was no statistically significant difference in H. pylori eradication ratebetween HDDT and BQT in the intention-to-treat (ITT) analysis (86.31% vs 84.88%; RR 1.02, 95% CI 1.00-1.04, P = 0.12). In the per-protocol (PP) analysis, the eradication rates for HDDT and BQT were 90.27% and 89.94%, respectively (RR 1.01, 95% CI 0.99-1.03, P = 0.44). Adverse events were significantly lower with HDDT than with BQT (RR 0.44, 95% CI 0.38-0.51, P < 0.00001). Patient adherence was significantly different between the two groups (RR 1.01, 95% CI 1.00-1.03, P = 0.02). Subgroup analysis based on antibiotic combinations within the BQT group showed a significantly higher eradication rate for HDDT than for BQT only when BQT used amoxicillin combined with clarithromycin (P = 0.0009). HDDT showed comparable efficacy with BQT for H. pylori eradication, with fewer adverse effects and higher compliance. Due to regional differences, antibiotic resistance rates, and combined BQT antibiotics, more studies are needed for further validation and optimization of HDDT.

Obliteration of H. pylori infection through the development of a novel thyme oil laden nanoporous gastric floating microsponge

Thyme oil (TO) is a valuable essential oil believed to possess a variety of bioactivities, including antibacterial, anticancer, and antioxidant properties. These attributes grant TO the excellent capability to treat a wide range of diseases, particularly the effective eradication of Helicobacter pylori infection in the stomach. However, its practical use is limited by its low stability under atmospheric conditions. Our current research aims to encapsulate TO in eudragit (EGT) microsponges to enhance its stability and improve its effectiveness against H. pylori. The TO microsponges were prepared using EGT as a polymer, polysorbate 80 as a stabilizer, and dichloromethane (DCM) as a solvent via the quasi-emulsion solvent evaporation method. The product yield, particle size, surface morphology, entrapment efficiency, drug-polymer interaction, in-vitro floating, and in-vitro drug release of the microsponges were evaluated. The most promising microsponge was tested against H. pylori ATCC 43504 strains. The results showed that the microsponges exhibited a high product yield (ranging from 41 % ± 0.75–81.27 % ± 1.13), excellent entrapment efficiency (ranging from 63.01 % ± 0.79–88.64 % ± 0.98), prolonged in-vitro floating time (more than 12 h) and sustained in-vitro drug release for 18 h (81.53 %). Scanning electron microscopy results indicated that the microsponges were spherical in shape with a spongy surface. The average particle size of the selected microsponges was determined to be 49.79 ± 1.4 μm, and their average pore size was measured to be 0.81 ± 0.14 μm. DSC study results revealed that TO was physically entrapped in the microsponges. In-vitro anti-H. pylori activity studies demonstrated that TO in microsponge was more effective against H. pylori than pure TO. In conclusion, the developed microsponges containing thyme oil provide a promising alternative for the efficient targeting and eradication of H. Pylori infection.

Barriers to Community-Based Eradication of Helicobacter pylori Infection

Helicobacter pylori (HP) is a causative agent in gastric cancer (GC).1 In the United States, HP is more prevalent in racial and ethnic minorities, including African Americans, Asian Americans, Latinos, and immigrants, the same groups that are more likely to develop and die from GC.2 Although screening for HP is not presently performed in the United States, there are plausible benefits to doing so, because HP is considered a group 1 carcinogen by the World Health Organization, and its link to GC parallels that of human papilloma virus and cervical cancer.1 HP eradication as a means of preventing GC also fulfils the Wilson and Jungner criteria for a successful screening program, and literature has consistently demonstrated that HP eradication reduces GC risk and death from GC.3 In fact, in countries with a high burden of GC, HP eradication is considered primary prevention for GC. As such, targeted HP testing in the United States may reduce GC burden in high-risk groups.4 We evaluate the results of community-based HP testing in an at-risk, underserved population.

Dual acid-pump blocking as novel therapeutic approach to treatment of acid-related diseases

Proton-pump inhibitors are highly efficient in the treatment of acid-related disease; however, their efficacy in treating reflux symptoms, healing esophageal erosions and peptic ulcers and eradicating Helicobacter pylori is sometimes suboptimal. Potassium-competitive acid blockers have a different mechanism of action, resulting in higher and longer-lasting increases in intragastric pH, which is neither non-inferior or superior to those of proton-pump inhibitors. The pharmacology, metabolism and mechanism of action of these drugs are different, therefore, it is hypothesised, that their combined use might be of clinical benefit through increased intragastric pH. This hypothesis is supported by pharmacological, physiological and microbiological data. The combined administration of proton-pump inhibitors and potassium-competitive acid blockers should be investigated in short-term therapy (4–8 weeks); if their complementary or additive effect is proven, dual acid pump blocking can be of further benefit in managing gastroesophageal reflux disease, peptic ulcers and eradicating Helicobacter pylori infection, in cases refractory to current therapies. For safety reasons, long-term administration of this combination as maintenance treatment should be avoided.

10-Day versus 14-day bismuth quadruple therapy for first-line eradication of Helicobacter pylori infection: a randomised, open-label, non-inferiority trial

Bismuth quadruple therapy is currently consensus recommendation for first-line Helicobacter pylori (H. pylori) treatment; however, the optimal duration is unknown. We compared the efficacy of 10-day bismuth quadruple therapy with that of 14-day bismuth quadruple therapy for first-line eradication. For our multicentre, parallel randomised, open-label, and non-inferiority study, we recruited H.pylori treatment-naïve patients from one medical centre and one teaching hospital in Taiwan. Patients were randomly assigned (1:1) to receive 10-day (PBMT-10) or 14-day (PBMT-14) bismuth quadruple therapy. The primary outcome was the eradication rate as determined by intention-to-treat (ITT) and per-protocol (PP) analyses. The eradication rates between the two groups were compared using a one-sided α value of 0.025 and a non-inferiority margin of 7%. The secondary outcomes were the rate of adverse effects. The trial is registered with ClincialTrials.gov (NCT04527055). From August 3, 2020 to April 28, 2023, 313H.pylori treatment-naïve patients (PBMT-10=157; PBMT-14=156) were enrolled. 35 patients were excluded from PP analyses. The eradication rates (95% CI) for PBMT-10 and PBMT-14 were respectively 92.4% (88.2%-96.5%) and 92.9% (88.9%-97.0%) by ITT analyses, and 97.9% (95.5%-100.0%) and 99.3% (97.8%-100.0%) by PP analyses. The eradication rates for PBMT-10 were non-inferior to those for PBMT-14 (absolute difference [lower boundary of the one-sided 97.5% CI]-0.6% [-6.7%], PNI=0.020 in ITT analyses,-1.4% [-5.8%], PNI=0.007 in PP analyses). The rates of overall adverse effects (54.1% versus 57.1%, P=0.604) were similar between the two groups; nevertheless, the rates of dizziness (18.5% versus 34.0%, P=0.003) and vomiting (4.5% versus 12.8%, P=0.008) were lower in PBMT-10 than in PBMT-14. The 10-day bismuth quadruple therapy was non-inferior to the 14-day therapy as a first-line treatment for eradicating H.pylori infection and had no different rates of overall adverse effects, but less serious adverse events in terms of dizziness and vomiting. The National Science and Technology Council and Ministry of Health and Welfare, Taiwan.

Vonoprazan: A Review in Helicobacter pylori Infection.

Treatment for the eradication of Helicobacter pylori infection, a leading cause of peptic ulcer disease and an important risk factor for gastric cancer and mucosa-associated lymphoid tissue lymphoma, is indicated whenever infection is identified. However, treatment success rates with current guideline-recommended proton-pump inhibitor (PPI)-based regimens remain suboptimal, with one potential factor associated with treatment failure being inadequate acid suppression. Vonoprazan (Voquezna®) is a first-in-class potassium-competitive acid blocker with the potential to provide potent and sustained acid suppression. Following clinical trials conducted mainly in Asia (supported by post-marketing experience from Asia) and the phaseIII PHALCON-HP trial conducted in the USA and Europe, vonoprazan is now approved in the USA for use in combination with amoxicillin (dual therapy) or amoxicillin and clarithromycin (triple therapy) for the treatment of H.pylori infection in adults. The vonoprazan-based dual and triple therapy regimens were generally well tolerated in PHALCON-HP. In addition, vonoprazan has advantages including a rapid onset of action and no food effect, making vonoprazan-based dual and triple therapy regimens valuable alternatives to standard PPI-based triple therapy in the treatment of H.pylori infection.

Fermented milk product “Narineh” with Lactobacillus acidophilus in sequential and classical therapy for Helicobacter pylori-associated peptic ulcers

Background: In recent years, there has been a growing dissatisfaction with the classical schemes of the eradication of Helicobacter pylori in ulcerative disease among physicians due to frequent failures in eradication therapy, mostly due to antibiotic resistance. It is a known fact that the Lactobacillus acidophilus inhibits the growth of Helicobacter pylori.  Objective: Our main goal was to investigate the ability of the fermented milk product "Narineh,” as a functional food, containing Lactobacillus acidophilus to evaluate the efficiency and incidence of adverse effects in addition to the standard triple scheme of eradication therapy with colloidal bismuth substrate.  Methods: The patients with peptic ulcer were divided into 2 groups: control (42 patients) received traditional treatment regimens, including 7 days proton pump inhibitor (PPI) + amoxicillin (A) and clarithromycin (C) in the standard doses and subsequent 14 day De-nol (colloidal bismuth subcitrate); experimental (44 patients) received in addition to this standard  conventional scheme "Narineh" - 200g, containing 2x109 Lactobacillus acidophilus one time a day starting from the 8-th day for 4 weeks. The results of the eradication in patients were evaluated after 4 -5 weeks, 6 months, and 12 months after completion of treatment using the C13 respiratory urea test (RUT). Repeated endoscopy with histological biopsies was carried out together with RUT in 4-5 weeks after the completion of treatment, and later (6-12 months) for the identification of recurrent ulcer.  Results: The treatment with “Narineh” added to the standard regimen significantly reduces the percentage of reinfection and relapse of the disease with a statistical difference (P&lt;0,05). The combination of fermentation milk product “Narineh”, containing Lactobacillus acidophilus with bismuth subcitrate, doesn’t cause a violation of biocenosis of the large intestine, in contrast to the PPI and antibiotics with a statistical difference (P&lt;0,05). In addition, it provides the normalization of gut biocenosis and reduces the frequency of antibiotic-associated diarrhea and other side effects.   Conclusion: The treatment with “Narineh” added to the standard scheme is more effective for eradication of Helicobacter pylori infection and significantly reduces the percentage of reinfection and relapse of the disease and lessens the side effects of medications.   Keywords: peptic ulcer, eradication Helicobacter pylori, side effects reinfection, fermented milk product “Narineh”, Lactobacillus acidophilus, functional foods

Comparison of the Efficacy of Two-Week Vonoprazan Versus Lansoprazole-Based Quadruple Sequential Antibiotic Therapy in Eradicating Helicobacter pylori Infection: A Non-randomized Clinical Trial.

The prevalence of Helicobacter pylori is escalating in developing countries, exacerbated by unjustified antibiotic usage, which leads to increased resistance. This trend has been notably amplified since the COVID-19 pandemic. Consequently, the effectiveness of existing eradication regimens has been compromised. This study aimed to compare the efficacy of two weeks of vonoprazan-based quadruple sequential therapy and lansoprazole-based quadruple sequential therapy in treating H. pylori infection. Methods: A non-randomized clinical trial was conducted over 18 months at the Department of Gastroenterology, Lahore General Hospital, Lahore, Pakistan. It included patients presenting with dyspepsia, as defined by the Rome IV criteria, and who tested positive on the urea breath test. Patients were divided into two groups, i.e., Group A and Group B. Group A patients received lansoprazole 30 mg + amoxicillin + tinidazole + tab. colloidal bismuth subcitrate for the first seven days, followed by lansoprazole + levofloxacin + azithromycin + colloidal bismuth subcitrate. Group B patients received vonoprazan + amoxicillin + tinidazole + colloidal bismuth subcitrate for the first seven days, followed by vonoprazan + levofloxacin + azithromycin + colloidal bismuth subcitrate. Both regimes continued for 14 days. Four weeks after 14 days of the treatment, an early morning urea breath test was conducted to evaluate the efficacy of the treatment. Patients were scheduled for follow-up visits at seven and 14 days post-treatment initiation to record adverse events and assess compliance with the treatment regimen. Patients who lost the follow-up and remained non-compliant to the medications were excluded from the final data analysis as per standard protocols of the per-protocol analysis. Results: A total of 252 patients were included. In Group A and Group B, 6/126 (4.76%) and 8/126 (6.35%) of the patients were lost to follow-up, respectively. The non-compliance rate in Group A was 5/126 (3.97%), compared to Group B with 3/126 (2.38%). Finally, the per-protocol analysis of the resultsincluded 115 patients in each group. Baseline characteristics, including demographics, lifestyle, and clinical factors, were comparable between groups with p-values of 0.138 for age, 0.356 for gender, 0.126 for BMI, 0.495 for residence, 0.500 for water source, 0.866 for meal habit, 0.863 for smoking, 0.188 for nonsteroidal anti-inflammatory drug(NSAID) use, 0.145 for proton pump inhibitor(PPI) use, 0.213 for antibiotics, and 0.456 for treatment history. Both treatments effectively eradicated H. pylori, as determined by a negative urea breath test at four weeks post-treatment, with Group B showing a higher eradication rate of 96.5% compared to 92.2% in Group A, although the difference was not statistically significant (p = 0.153).There was no difference in adverse effects in both treatment groups (p-value > 0.05). Conclusion: The study found that while the vonoprazan-based regime exhibited a slightly higher eradication rate of H. pylori compared to lansoprazole, the difference was not statistically significant. It was concluded that both regimens demonstrated comparable efficacy and similar profiles of adverse effects in treating H. pylori infection.

Assessing the Efficacy of a Modified Triple Drug Regimen Supplemented with Mastic Gum in the Eradication of Helicobacter pylori Infection

Abstract Introduction/Objective Helicobacter pylori (H. pylori) is a bacterium that infects the stomach and small intestine. It is known to be the main cause of gastritis and peptic ulcers. The infection is common worldwide, with a prevalence rate of 50% in many countries. Eradication of H. pylori infection is crucial, as failure to do so can lead to serious complications such as gastric cancer. Treatment for H. pylori infection involves a combination of antibiotics, proton pump inhibitors (PPIs), and bismuth compounds. However, due to the emergence of antibiotic resistance, there is a need for alternative treatments. Methods/Case Report This study had been a randomized controlled trial involving 180 patients with H. pylori infection. The patients had been divided into two groups: Group A received the standard triple-drug regimen (clarithromycin, amoxicillin, and omeprazole), while Group B received the triple-drug regimen along with mastic gum. The treatment duration was 14 days for both groups. Baseline demographics and clinical characteristics had been collected for all patients. The presence of H. pylori infection had been confirmed by a urea breath test and fecal antigen test. Results (if a Case Study enter NA) This study has investigated the effects of mastic gum on H. pylori infection. In a randomized controlled trial of 180 H. pylori-positive patients, mastic gum was found to be effective in eradicating the bacteria in 83 of 90 patients (92.2%) who received the supplementation Group B received the triple-drug regimen along with mastic gum, compared to only 57 of 90 patients (63.3%) in the group A (p &amp;lt; 0.001). Thus, a randomized controlled trial of 90 patients with H. pylori infection found that combination therapy of mastic gum and a triple-drug regimen resulted in a significantly higher eradication rate (92.2%) compared to a triple-drug regimen only (63.3%). Conclusion The current study investigated the adding mastic gum to the standard triple-drug regimen can improve the eradication rate of H. pylori infection. This could potentially offer an alternative treatment option for patients with H. pylori infection, especially those with antibiotic resistance. Applying the mastic gum has approved its effectiveness, and it could reduce the reliance on antibiotics and minimize the risk of resistance development.

Dysbiosis by Eradication of Helicobacter pylori Infection Associated with Follicular Gastropathy and Pangastropathy.

Dysbiosis plays an important role in the development of bacterial infections in the gastric mucosa, particularly Helicobacter pylori. The international guidelines for the treatment of H. pylori infections suggest standard triple therapy (STT). Nevertheless, because of the increasing resistance rates to clarithromycin, metronidazole has been widely considered in several countries. Unfortunately, the non-justified administration of antibiotics induces dysbiosis in the target organ. We characterized the gastric microbiota of patients diagnosed with follicular gastropathy and pangastropathy attributed to H. pylori infection, before and after the administration of STT with metronidazole. Dominant relative abundances of Cutibacterium were observed in pre-treatment patients, whereas H. pylori was observed at <11%, suggesting the multifactor property of the disease. The correlation of Cutibacterium acnes and H. pylori with gastric infectious diseases was also evaluated using quantitative real-time polymerase chain reaction. The dominance of C. acnes over H. pylori was observed in gastritis, gastropathies, and non-significant histological alterations. None of the microorganisms were detected in the intestinal metaplasia. Post-treatment alterations revealed an increase in the relative abundances of Staphylococcus, Pseudomonas, and Klebsiella. Non-H. pylori gastrointestinal bacteria can be associated with the initiation and development of gastric diseases, such as pathobiont C. acnes.

Navigating the complexities of developing a classification of esophagogastric junction tumors suitable for preoperative setting.

Despite the worldwide decrease in the incidence of gastric cancer, the proportion of occurrence of carcinomas of the esophagogastric junction and proximal third of stomach is on the rise. The cause of this development is believed to lie in an increasing incidence of reflux esophagitis with Barrett´s metaplasiaand successful eradication ofHelicobacter pyloriinfection. The aim of this work is to present various views on the definition of the esophagogastric junction itself and to give an overview of tumor classification schemes being used (Fig. 2, Ref. 54). Keywords: gastric cancer, esophagogastric junction, definition, classification.

[Current use of proton pump inhibitors and when to limit, stop or not start treatment].

Proton pump inhibitors (PPIs) are potent inhibitors of gastric acid secretion that have changed treatment practice for gastric acid-related disorders. The major adequate indications for their use are treatment of gastro-esophageal reflux disease, peptic ulcers, eradication of Helicobacter pylori infection in combination with antibiotics and prophylaxis for patients on non-steroidal anti-inflammatory or antiplatelet drugs. Since their introduction, clinical success has been accompanied by widespread use of PPIs, which has steadily increased over the last decades without concomitant increase in the incidence of acid-related disorders. PPIs are now among the most widely prescribed class of medications worldwide and around 10% of Icelanders are current PPI users. This increase has been linked to PPI prescription without an indication, or continued use for longer duration than recommended. In recent years, concerns have been raised about PPI overuse and the associated increased risk of harm, not only in terms of increased costs but also the potential risk of physical dependence and long-term side effects of PPIs. The article is based on search in PubMed, the authors' own clinical experience and research, and is intended to provide practice advice on the use of PPIs with focus on appropriate prescription and deprescription of PPIs.

Eradication of Helicobacter pylori Infection Using 7-day PCR-based Tailored Therapy

Background/Aims: Standard triple therapy (STT; proton pump inhibitor [PPI]+clarithromycin+amoxicillin) used for Helicobacter pylori (H. pylori) eradication has shown low treatment success rates in recent years, which is most likely attributable to increased clarithromycin resistance. In this study, we compared treatment success rates of tailored therapy (TT) using real-time polymerase chain reaction (RT-PCR) and empirical STT.Methods: This retrospective study included 650 patients with H. pylori infection, who visited Eunpyeong St. Mary’s Hospital in Korea; 343 patients received TT based on RT-PCR assays, and 307 patients received STT. Eradication success was defined as a negative &lt;sup&gt;13&lt;/sup&gt;C-urea breath test result 4~8 weeks after treatment completion. Patients who failed first-line therapy and those with clarithromycin resistance received bismuth-containing quadruple therapy (BQT; PPI+bismuth+metronidazole+tetracycline).Results: Intention-to-treat analysis showed that H. pylori eradication rates were higher in patients who received RT-PCR–based TT than in those who were treated using empirical STT (80.5% [190/236] vs. 70.4% [216/307], P=0.069). Per-protocol (PP) analysis showed similar results (84.4% [190/225] vs. 74.7% [216/289], P=0.007). PP analysis showed that 7-day TT treatment was associated with a higher eradication rate than that observed with 10- to 14-day STT (85.2% [178/209] vs. 73.8% [59/80], P=0.029). The clarithromycin resistance rate was 27.9% (87/312). The eradication success rate was 89.2% (74/83) in patients with clarithromycin resistance, who received BQT as first-line therapy.Conclusions: The treatment success rate was higher in patients who received 7-day RT-PCR–based TT than in those who were administered 10- to 14-day empirical treatment.

The role of eradication of Helicobacter pylori infection in the prevention of gastric cancer (based on the Maastricht-VI consensus report)

The article discusses the statements of the section of the consensus meeting “Maastricht-VI” (2021), dedicated to the role of H.pylori infection eradication in prevention of the development of gastric cancer. Experts have confi rmed that this infection is currently the main etiological factor of gastric cancer. Its eradication leads to regression of atrophic changes in the gastric mucosa and reduces the risk of development of gastric cancer. This makes it necessary to implement the population program “test and treat” for the purpose of cancer prevention and to include it among the priorities of healthcare. 

Newer, Older, and Alternative Agents for the Eradication of Helicobacter pylori Infection: A Narrative Review.

Although discovered 40 years ago, Helicobacter pylori infection is still raising diagnostic and therapeutic problems today. The infection is currently managed based on statements in several guidelines, but implementing them in practice is a long process. Increasing antibiotic resistance and weak compliance of the patients limit the efficacy of eradication regimens, leaving much room for improvement. Third-generation proton pump inhibitors have added little to the results of the first two generations. Potassium-competitive acid blockers have a stronger and longer inhibitory action of acid secretion, increasing the intragastric pH. They obtained superior results in eradication when compared to proton pump inhibitors. Instead of innovative antibiotics, derivatives of existing antimicrobials were developed; some new fluoroquinolones and nitazoxanide seem promising in practice, but they are not recommended by the guidelines. Carbonic anhydrase inhibitors have both anti-secretory and bactericidal effects, and some researchers are expecting their revival in the treatment of infection. Capsules containing components of the eradication regimens have obtained excellent results, but are of limited availability. Probiotics, if containing bacteria with anti-Helicobacter pylori activity, may be useful, increasing the rates of eradication and lowering the prevalence and severity of the side effects.

Comparison of the efficacies of triple, quadruple and sequential antibiotic therapy in eradicating Helicobacter pylori infection: A randomized controlled trial.

There is regional variation in the eradication rates of Helicobacter pylori (H. pylori) regimens depending on the local antibiotic resistance patterns. The aim of this study was to compare the efficacies of triple, quadruple and sequential antibiotic therapy in eradicating H. pylori infection. A total of 296 H. pylori-positive patients were randomized to receive one of the three regimens (triple, quadruple or sequential antibiotic therapy) and eradication rate was assessed by H. pylori stool antigen test. The eradication rates of standard triple therapy, sequential therapy and quadruple therapy were 93%, 92.9% and 96.4%, respectively (p = 0.57). Fourteen days of standard triple therapy, 14 days of bismuth-based quadruple therapy and 10 days of sequential therapy are equally efficacious in eradicating H. pylori and all regimens have optimum H. pylori eradication rates. ClinicalTrials.gov Identifier: CTRI/2020/04/024929.

A translational pharmacokinetic/pharmacodynamic approach supports optimal vonoprazan dosing for erosive oesophagitis and Helicobacter pylori infection.

Treatment of acid-related disorders relies on gastric acid suppression. The percentage of time intragastric pH is >4 (pH >4 holding time ratio [HTR]) is important for healing erosive oesophagitis; and the pH >6 HTR is critical for eradication of Helicobacter pylori infection, as bacterial replication is active and antibiotic effectiveness is optimised. Vonoprazan, a potassium-competitive acid blocker approved in the USA and other countries, suppresses gastric acid secretion in a predictable, rapid and consistent manner, extended over prolonged periods. To explore the relationship between vonoprazan exposure and pH HTR through a pharmacokinetic/pharmacodynamic (PK/PD) model. We pooled data from Phase 1 studies with intragastric pH measurements. Pharmacokinetic profiles were predicted for study participants using an existing population pharmacokinetic model. Pharmacokinetic and pharmacodynamic data were merged, and three direct-link PK/PD models were derived and used to simulate pH HTRs with between-participant variability for pH >4, >5 and >6, for vonoprazan doses of 20 mg once and twice daily. We used data from five Phase 1 studies to derive the PK/PD model. These included 245 participants (95.1% male, 50.6% Japanese and 49.4% non-Asian). Pre-dose, the mean pH >4 HTR was 6.4%, pH >5 3.2% and pH >6 1.2%. After 7 days of dosing, simulations predicted pH >4 HTRs of 89.7% and 98.1%, and pH >6 HTRs of 53.1% and 75.3%, for vonoprazan 20 mg once and twice daily, respectively. Vonoprazan 20 mg once- and twice-daily dosing demonstrated high, dose-dependent, 24-hour intragastric acid control in this PK/PD model, supporting clinical efficacy data in patients with acid-related disorders.

Comparing high-dose dual therapy with bismuth-containing quadruple therapy for the initial eradication of Helicobacter pylori infection on Hainan Island: A randomized, multicenter clinical trial

BackgroundTraditional bismuth-containing quadruple therapy, as a first-line eradication treatment for Helicobacter pylori (H. pylori), has several disadvantages, including drug side effects, low medication adherence, and high costs. Trials of high-dose dual treatment have demonstrated its advantages, which include good safety and adherence profiles. In this study, we investigated the efficacy, safety, and compliance of a high-dose dual therapy when compared with bismuth-based quadruple treatment for the initial eradication of H. pylori infection on Hainan Island, China. MethodsWe randomized 846 H. pylori-infected patients into two groups. A bismuth-containing quadruple therapy group was administered the following: esomeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily, and colloidal bismuth pectin in suspension 150 mg three times/day for 2 weeks. A high-dose dual therapy group was administered the following: esomeprazole 20 mg four times/day and amoxicillin 1000 mg three times/day for 2 weeks. Patients were given a 13C urea breath test at 4 weeks at treatment end. Adverse effects and compliance were evaluated at follow-up visits. ResultsEradication rates in the high-dose dual therapy group were: 90.3% (381/422, 95% confidence interval [CI]: 87.1%–92.9%) in intention-to-treat (ITT) and 93.6% (381/407, 95% CI: 90.8%–95.8%) in per-protocol (PP) analyses. Eradication rates were 87.3% in ITT (370/424, 95% CI: 83.7%–90.3%) and 91.8% in PP analyses (370/403, 95% CI: 88.7%–94.3%) for quadruple therapy, with no statistical differences (P = 0.164 in ITT and P = 0.324 in PP analyses). Adverse effects were 13.5% (55/407) in the dual group and 17.4% (70/403) in the quadruple group (P = 0.129). Compliance was 92.4% (376/407) in the dual group and 86.6% (349/403) in the quadruple group (P = 0.007). ConclusionsHigh-dose dual therapy had high eradication rates comparable with bismuth-based quadruple treatment, with no differences in adverse effects, however higher adherence rates were recorded.