Eradication Therapy In Patients Research Articles

Helicobacter pylori Eradication Therapy in Patients with Decreased Renal Function: A Systematic Review

Background: There are concerns that Helicobacter pylori eradication therapy may worsen kidney function in patients with decreased renal function. This study aimed to systematically review the literature regarding Helicobacter pylori eradication in patients with renal impairment. Methods: PubMed, the Cochrane Library, and Igaku Chuo Zasshi were searched for comparative studies on H. pylori eradication in patients with renal impairment. Results: Five articles were included in this systematic review. According to a randomized trial comparing a proton pump inhibitor (PPI) + clarithromycin + metronidazole and PPI + clarithromycin + amoxicillin in patients with decreased renal function, the incidence of acute renal failure was significantly lower in PPI + clarithromycin + metronidazole (2%: 1/44) than in PPI + clarithromycin + amoxicillin (18%: 8/44). The eradication rate in PPI + clarithromycin + metronidazole (92.5%) was significantly better than that in PPI + clarithromycin + amoxicillin (76.3%). According to four reports on eradication treatment using PPI + clarithromycin + amoxicillin in patients with and without decreased renal function, the eradication rates and adverse effects were similar in both groups. Regarding dose adjustment, three reports reduced the dose of antibiotics by half in patients with a creatinine clearance of 30 mL/min or less. Conclusions: The regimen with PPIs, clarithromycin, and metronidazole is recommended for renal impairment. The combination of PPIs, clarithromycin, and amoxicillin, at reduced doses depending on the renal function, is also a potential option.

The significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus and for Helicobacter pylori survival

Aim: This study aims to determine the significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus (T2DM) and Helicobacter pylori (H. pylori)-associated upper gastrointestinal tract pathology as well as for H. pylori survival. Methods: A prospective randomized study with the participation of 180 patients (87 men and 93 women) with H. pylori-associated upper gastrointestinal pathology was carried out. Ninety of these patients were with T2DM and 90 were without diabetes mellitus (DM). The patients were divided into 4 groups of 45 patients: the group 1 included non-diabetic patients treated with the classical triple eradication scheme; the group 2 included patients with T2DM treated with the classical triple eradication scheme; the group 3 included non-diabetic patients treated with bismuth quadro-therapy; the group 4 included patients with T2DM treated with bismuth quadro-therapy. The presence of H. pylori and evaluation of eradication efficacy was carried out using the Helix breath test. Results: The effectiveness of 1st line anti-Helicobacter therapy was higher (88.2%) in patients without diabetes in comparison with the group of patients with concomitant T2DM (74.7%). The efficacy of classical triple eradication therapy in patients with concomitant T2DM was 69.1%, and quadro-therapy was 80.5%. There was significantly lower effectiveness (P < 0.017) of eradication therapy in patients with T2DM and glycated hemoglobin (HbA1c) level ≥ 7.0% as compared with the group of patients in whom the target (≤ 6.5%) level of HbA1c was achieved. Conclusions: Chronic hyperglycemia has a favorable effect on the viability of H. pylori bacteria in patients with T2DM. A hypothesis explaining the reduced efficacy of eradication therapy in patients with hyperglycemia has been proposed.

Effects of Antibiotic Eradication Therapy on H. Pylori-Negative Stage IE Gastric MALT Lymphoma ─ Real World Experience

Background: Helicobacter pylori (H. pylori) infection plays a critical role in the pathogenesis of gastric MALT lymphoma and its eradication can lead to tumor regression with a complete response (CR) rate of 78% in early-stage disease and a 5-year survival rate > 95%. However, 10% of patients have gastric MALT lymphoma with no detectable H. pylori infection (Zullo et al., J Clin Gastroenterol 2010). There is controversy regarding whether H. pylori-negative gastric MALT patients should receive a trial of antibiotic therapy. The NCCN guideline recommends skipping antibiotics and proceeding directly to radiation therapy. On the other hand, the ESMO guideline recommends H. pylori eradication (HPE) as the first-line therapy for every patient with gastric MALT lymphoma irrespective of H. pylori status. This report aimed to evaluate the effectiveness of H. pylori eradication therapy in patients with limited-stage gastric MALT lymphoma. Methods: A retrospective analysis was performed to identify patients diagnosed with stage IE gastric MALT lymphoma between January 2002 and December 2022. H. pylori infection was determined by immunostaining of gastric mucosa, serology, stool antigen, or urea breath test. H. pylori status was considered positive when at least one of those tests showed positive results and negative when all of the performed test results in that patient were negative. The primary outcome was the CR rate defined as no macroscopic findings of lymphoma and negative biopsy resultsfrom the follow-up endoscopy 3-6 months following completion of treatment. Results: A total of 52 patients were identified; the median age was 68 years (range 52-87), and 29 (55.8%) were male. H. pylori infection was detected in 36.5% (19/52) patients by at least one of the methods - 14 cases by immunostaining, 3 cases by serology, and 1 each by stool antigen and urea breath test. The PCR or FISH for t(11;18) was performed in 10 cases (19.2%) and 2 cases of t(11;18) were detected (both were H. pylori-negative). All 19 H. pylori-positive patients were treated for H. pylori eradication (HPE) and 63% (12/19) achieved a CR. Of the 33 H. pylori-negative patients, 8 (24.2%) received HPE as the initial treatment and 1 (12.5%) responded with a CR. The treatment outcomes after HPE therapy showed the CR rate was significantly higher in H. pylori-positive patients than in H. pylori-negative patients (63.2% vs 12.5%, p=0.033) (Table 1). Only 2 of the 12 H. pylori-positive patients achieving CR have relapsed after a median follow-up of 89.7 months (range 2.9-227.8); the one H. pylori-negative patient that received HPE also remains in CR at 9+ months. The other first-line treatments applied for the 25 H. pylori-negative patients were radiation therapy in 18 (54.5%), single-agent rituximab in 3 (9.0%), surgical resections in 2 (6%), oral chlorambucil in 1 (3%), and observation in 1 (3%) The outcomes are shown in Figure 1. Conclusion: In our United States patient population, the incidence of H. pylori-negative gastric MALT lymphoma was 63%, much higher than previously reported (Zullo et al., J Clin Gastroenterol 2010) and similar to that found by other US investigators (Strati et al. 10.1002/ajh.25447). For limited-stage H. pylori-positive gastric MALT lymphoma, HPE is an effective first-line treatment and should be used. For patients who have no detectable H. pylori infection with multiple methods, the CR rate with HPE is very low in our experience. Although there is likely little harm to trying HPE (as ESMO guidelines suggest), this delays definitive radiation therapy. These data will be useful in patient counseling and treatment decision-making.

Role of Helicobacter pylori Eradication Therapy in Patients with Functional Dyspepsia

Role of Helicobacter pylori Eradication Therapy in Patients with Functional Dyspepsia

Evaluation of the dynamics of symptoms of dyspepsia after eradication therapy in patients with Helicobacter pylori-associated gastritis

The treatment of functional dyspepsia remains a complex and incompletely resolved issue of gastroenterology. Subjective sensations of the patient, described as a feeling of fullness in the epigastrium after eating, early satiety, pain in the epigastrium, may be a manifestation of dyspepsia associated with Helicobacter pylori (H. pylori) infection. Aim was evaluation of the effectiveness of standard triple eradication therapy enhanced with bismuth tripotassium dicitrate for the relief of symptoms of dyspepsia in patients with H. pylori-associated chronic gastritis. Materials and Methods. The study involved 38 patients with H. pylori-associated chronic gastritis with symptoms of dyspepsia. The Questionnaire “7 × 7” was used to describe the dynamics of symptoms of dyspepsia. Results. At the initial examination, dyspeptic disorders in most patients corresponded the criteria for mild and moderate severity, respectively - 44.7% and 28.9% of patients. The severity of pain in the stomach area on average corresponded to a moderate pain syndrome, and the burning sensation was of low intensity. A feeling of fullness in the stomach after eating and/or early satiety was experienced by 76.3% of patients, pain disorders were observed in 92.1% of individuals. Two months after successful eradication treatment, complete relief of dyspepsia symptoms was noted in 57.9% of patients, and significant relief of symptoms of the combined form of dyspepsia in 23.7% of individuals. Conclusions: Successful standard triple eradication therapy enhanced with bismuth tripotassium dicitrate is effective for the treatment of dyspeptic symptoms in patients with H. pylori-associated chronic gastritis.

The influence of rosuvastatin on the efficacy of standard triple eradication therapy in patients with gallstone disease and Helicobacter pylori infection

The influence of rosuvastatin on the efficacy of standard triple eradication therapy in patients with gallstone disease and Helicobacter pylori infection

Multicenter Randomized Controlled Trial of Surveillance Versus Endoscopic Therapy for Barrett’s Esophagus With Low-grade Dysplasia: The SURVENT Trial: Study Rationale, Methodology, Innovation, and Implications

Multicenter Randomized Controlled Trial of Surveillance Versus Endoscopic Therapy for Barrett’s Esophagus With Low-grade Dysplasia: The SURVENT Trial: Study Rationale, Methodology, Innovation, and Implications

Clinical outcomes of metachronous recurrence of gastric epithelial neoplasia based on Helicobacter pylori infection status and microsatellite stability

Background/AimsHelicobacter pylori eradication may prevent the recurrence of gastric epithelial neoplasia after endoscopic treatment. However, H. pylori eradication therapy is unlikely to prevent gastric cancer. This study determined the long-term results and clinical outcomes of patients with gastric epithelial neoplasia based on H. pylori infection status and microsatellite stability (MSS).MethodsPatients diagnosed with gastric epithelial neoplasia who underwent an endoscopic mucosal resection or submucosal dissection between 2004 and 2010 were included in this retrospective study. During the follow-up period (range, 4 to 14 years), disease recurrence was monitored, and tissue examinations were conducted for seven sets of microsatellite loci initially linked to the tumour suppressor gene locus. When H. pylori infection was identified, patients underwent eradication therapy.ResultsThe patients (n = 120) were divided into three groups: H. pylori-negative with MSS, H. pylori-positive with MSS, and microsatellite instability (MSI). After H. pylori eradication, the rate of metachronous recurrence was significantly different in the MSI (28.2%) and MSS groups (3.7%, p < 0.01). The mean duration of recurrence was 77 months (range, 24 to 139) in the MSI group. There was no recurrence after eradication therapy in patients who were positive for H. pylori in the MSS group.ConclusionH. pylori eradication could help prevent gastric cancer recurrence in patients with stable microsatellite loci. Careful, long-term monitoring is required in patients with unstable microsatellite loci.

The effectiveness of eradication therapy of the 1st line of Helicobacter pylori infection in patients with type 2 diabetes mellitus

Evaluation of the efficacy and safety of eradication therapy of infection Helicobacter pylori in patients with H. pylori- associated pathology of the upper gastrointestinal tract and concomitant type 2 diabetes mellitus (DM). The prospective randomized study involving 180 patients (87 men and 93 women) with H. pylori- associated pathology of the upper gastrointestinal tract was carried out. The patients were divided into four groups of 45 people: 1 patients without diabetes who received the classic triple eradication therapy; 2 patients with type 2 DM who received the classic triple eradication therapy; 3 patients without DM who underwent quadrotherapy with bismuth preparations; 4 patients with type 2 DM who underwent quadrotherapy with bismuth preparations. Eradication therapy was carried out for 14 days. Evaluation of the effectiveness of eradication using a breath test was carried out 4 weeks after completion of the course of treatment. Eradication success was assessed separately for ITT and PP analyzes. The effectiveness of classical triple eradication therapy in patients with concomitant type 2 DM is 64.4% in the ITT group and 69.05% in the PP: quadrotherapy 73.34 and 80.49%, respectively. The effectiveness of first line eradication therapy is higher in patients without DM compared with groups of patients with concomitant type 2 DM: ITT 83.33%, PP 88.23% and ITT 68.89%, PP 74.70%, respectively. The incidence of side effects in patients with type 2 DM: with the use of classical triple therapy 22.23%, quadrotherapy 31.12%. The data of the study of the efficacy and safety of line I eradication therapy make it possible to recommend the four-component therapy based on bismuth for use in clinical practice, especially in patients with DM.

Эффективность применения природной минеральной воды «Увинская» в комплексной эрадикации Helicobacter pylori у больных хроническим гастритом на фоне сахарного диабета 2 типа

The purpose — to assess the effectiveness of therapeutic use of «Uvinskaya» natural mineral water for Helicobacter Pylori eradication in patients with chronic gastritis and type 2 diabetes mellitus. Material and methods. The study included 120 patients with type 2 diabetes mellitus, who were diagnosed with chronic gastritis associated with Helicobacter Pylori. The average age of patients was 61.6 ± 4.13 years, the duration of diabetes — from 2 to 15 years (on average – 9.9 ± 2.5 years), gender composition — 21 men and 99 women. The patients were divided into two groups by simple randomization. In the first group (n = 60), the first line eradication therapy was carried out according to Maastricht V recommendations, in the second group (n = 60) underwent eradication therapy combined with «Uvinskaya» mineral water. The diagnosis of «chronic gastritis» was histologically verified in all patients. The eradication control was carried out 4 weeks after therapy. Changes in the severity of gastroenterological symptoms in patients were determined by the Gastrointestinal Symptom Rating Scale questionnaire. Statistical processing was carried out with the calculation of average values and standard errors of the average. The differences were considered reliable at p ≤ 0.05. Results. The study shows the positive effect of the «Uvinskaya» mineral water inclusion into the Helicobacter Pylori eradication treatment complex in patients with type 2 diabetes mellitus: the condition of patients improved, inflammatory changes in the stomach mucosa were reduced and the efficiency of eradication therapy increased. Conclusion. The amplification of the positive therapeutic effects of drug treatment and drinking balneotherapy provides a significant increase in the efficiency of eradication, improving the clinical course and forecast of chronic gastritis associated with Helicobacter Pylori in patients with type 2 diabetes mellitus. It enables to recommend the intake of «Uvinskaya» mineral water as part of eradication therapy in patients with type 2 diabetes mellitus.

Влияние инфекции дыхательных путей на стоимость терапии при муковисцидозе

Cystic fibrosis (CF) is a severe progressive disease in which the control of respiratory infection determines the disease prognosis. Objective. To assess the impact of different respiratory tract infections on the costs of antibiotic therapy in children with CF, depending on their age. Patients and methods. Patients were divided into three groups (0–3 years, 4–10 years, and 11–18 years) for the costeffectiveness analysis; mean body weight was calculated for each group. Current regulatory documents were used to evaluate antibacterial therapy. The State Register of Medicines was used to calculate the costs of each drug. Results. We found that the highest costs were associated with inhaled antibiotics used for the eradication therapy in patients with P. aeruginosa and Achromobacter spp. infections (up to 1,152,000 RUB per year), chronic P. aeruginosa and Achromobacter spp. infections (up to 2,304,000 RUB per year), and infections caused by Burkholderia cepacia complex (up to 750,178 RUB per year). In case of intravenous antibiotics, the highest costs were associated with the treatment of infections caused by Burkholderia cepacia complex (up to 790,236 RUB per year). Conclusion. Patients with CF require regular microbiological monitoring to ensure timely detection of pathogenic microorganisms and respiratory tract infections. Early initiation of adequate antibacterial therapy in accordance with clinical guidelines is necessary to prevent chronic infections. Key words: antibacterial drugs, children, cystic fibrosis, therapy cost

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

H. pylori eradication therapy: impact of gastric mucosa atrophy on transport of amoxicillin to H. pylori colonization area

AIM: The aim was to assess systemic transport of amoxicillin, the most common antibiotic in H. pylori eradication regimens to the gastric in atrophic gastritis.&#x0D; MATERIALS AND METHODS: Systemic transport of amoxicillin to the gastric lumen of rats was evaluated in washes from the gastric mucosa in the model of atrophic gastritis after intravenous drug infusion. Transport of amoxicillin from bloodstream to the gastric lumen was also assessed in patients with atrophic and non-atrophic gastritis in aspirated via nasogastric probe gastric juice after oral drug administration. Amoxicillin concentration was measured in samples using liquid chromatography-mass spectrometry.&#x0D; RESULTS: In rats with induced atrophic gastritis, hyperemia and acute erosions of the gastric mucosa, as well as microscopic signs of non-active chronic body gastritis and non-active antral atrophic gastritis were found. Amoxicillin concentration in washes from the gastric mucosa was significantly (p 0.01) higher in rats of experimental group than in control group at all time points (30, 60, 120, 240 min after drug infusion). The lowest mean amoxicillin concentration in gastric juice was observed in patients with antral atrophy (p 0.01). The maximum amoxicillin concentration in gastric secretion was found at the 180th min of aspiration in patients with atrophy of gastric mucosa, while in patients of the group of comparison it was found at 30-120th min of aspiration.&#x0D; CONCLUSIONS: Acute gastric mucosa erosions enhance amoxicillin delivery to gastric lumen in rats. Atrophy of antral mucosa more than in the corpus is characterized by decreased amoxicillin transfer from systemic bloodstream to gastric lumen in patients after oral amoxicillin intake. The gastric mucosa atrophy should be taken into consideration while predicting the efficacy of H. pylori eradication therapy in patients with chronic gastritis.

Прогностические возможности опросника GSRS при эрадикации Helicobacter pylori у пациентов с сахарным диабетом 2-го типа

The study aimed to determine the predictive capabilities of the Gastrointestinal Symptom Rating Scale (GSRS) for assessing the effectiveness of eradication therapy in Helicobacter pylori (HP) infected patients with type 2 diabetes mellitus. The study involved 60 patients of both sexes with a diagnosis of type 2 diabetes mellitus and chronic HP-associated gastritis, the average age of patients was 61.9 years, average duration of type 2 diabetes was 10.1 years. For statistical analysis of the data, we used the method of constructing ROC curves, which allowed us to identify prognostic factors (in this case, gastroenterological syndromes, such as abdominal pain, refl ux, indigestion, diarrhea and constipation) that influence the effectiveness of eradication therapy in patients with type 2 diabetes. It was found that high values of refl ux and indigestion syndromes scales of the GSRS are associated with the probability of low eradication therapy response in patients with type 2 diabetes, i.e. these syndromes can act as complicating factors for the elimination of Helicobacter pylori. The obtained data suggest the need for screening diagnostics of Helicobacter pylori, clinical manifestations of gastrointestinal pathology and subsequent etiological and pathogenetic treatment.

Differentiated approach to eradication therapy in patients with chronic pancreatitis

Purpose of the study. Compare the effectiveness of different eradication therapy regimens in patients with chronic pancreatitis with concomitant gastritis associated with various genetic variants of H. pylori.Materials and methods: 63 patients with chronic pancreatitis and concomitant Helicobacter pylori-associated gastritis were examined. The control group consisted of 45 patients with chronic gastritis. Diagnosis of chronic pancreatitis was based on anamnestic, clinical data, instrumental studies (MSCT). Diagnosis of H. pylori infection was carried out by the morphological method, 13C urease breath test, and immunoblotting. Statistical processing was carried out using application packages SPSS Statistic 17.0.Results. In patients with chronic pancreatitis, CagA-positive H. pylori strains were found 19.3% less often compared with the control group (p &lt;0.05), VacA-positive—21.9% less often (p &lt;0.05). In the study group, H. pylori genes encoding urease A production and genes encoding the synthesis of H. pylori outer membrane proteins (p33, p30, p29, p26, p19, p17) were significantly more frequently met. In the group of patients with chronic pancreatitis, the standard triple therapy of the 1st line with the inclusion of bismuth tripotassium dicitrate was 86.8% more effective (p &lt;0.01) compared to the standard triple therapy of the 1st line, and the maximum increase in efficiency was observed among owners of H. pylori strains, expressing urease A and with the representation on the outer membrane of the proteins p30, p33, p26, p19, p17 (p &lt;0.01).Conclusion. Eradication therapy in patients with chronic pancreatitis in the presence of pathogenicity complex p30, p33, urease A, p26, p19, p17 in H. pylori according to the standard line triple therapy protocol with the inclusion of bismuth tripotassium dicitrate has advantages compared to the standard triple therapy protocol 1 line (p &lt;0.001).

Impact of the timing of Helicobacter pylori eradication on the risk of development of metachronous lesions after treatment of early gastric cancer: a population-based cohort study

Helicobacter pylori eradication can reduce the risk of metachronous lesions after the treatment of early gastric cancer. We aimed to analyze the impact of the timing of H pylori eradication on metachronous recurrence. Data of patients who underwent endoscopic resection or partial gastrectomy for early stage gastric cancer and received H pylori eradication therapy were obtained from the Korean National Health Insurance Service database. Patients were classified into 3 groups according to the timing of the prescription for H pylori eradication: preresection; within 1 year postresection; and >1 year postresection. Among 19,767 patients, 7452 and 12,315 underwent endoscopic resection and surgery, respectively. The 5-year cumulative incidence of metachronous lesions after endoscopic resection was 14.0% in the preresection group, 12.3% in the within 1 year postresection group, and 16.9% in the >1 year postresection group. Surgery was performed in 1.2% of the preresection group, 1.3% of the within 1 year postresection group, and 2.9% of the >1 year postresection group. The within 1 year postresection group had a lower risk of development of metachronous lesions than the >1 year postresection group (hazard ratio [95% confidence interval]: after endoscopic resection, 0.79 [0.65-0.95]; after surgery, 0.39 [0.28-0.53]). The risk of development of metachronous lesions did not differ between the preresection and within 1 year postresection groups. Prescription of H pylori eradication therapy within 1 year after gastric cancer treatment reduces therisk of development of metachronous gastric neoplasms compared with a late prescription of eradication therapy in patients undergoing endoscopic resection and those undergoing surgery.

Helicobacter pylori eradication therapy in patients with immune thrombocytopenic purpura: a single-center experience

Objective: The aim was to determine the frequency of Helicobacter pylori infection in patients with immune thrombocytopenic purpura (ITP) and to detect the effect of its eradication therapy on platelet count response in H. pylori-positive patients. Patients and methods: H. pylori stool antigen enzyme immunoassay test was done for 54 patients with ITP. H. pylori-positive patients received standard triple therapy for 2 weeks. Platelet count response to H. pylori eradication therapy was evaluated 2 and 3 months after the treatment. Results: H. pylori infection was positive in 38 (70.4%) patients with ITP. Eradication of H. pylori was achieved in 30 (78.9%) patients (responder group). There were statistically significant increases in platelet count (among the responder group) after H. pylori eradication therapy at 2 and 3 months (P Conclusion: Eradication of H. pylori infection in patients with ITP is associated with significant increase in platelet counts.

Comparative evaluation of efficacy of 10-day regimens of helicobacter pylori infection eradication (triple and triple with the addition bismuth tripotassium dicitrate)

The article presents the results of a comparative study of the efficacy and tolerability of two 10-day eradication therapy regimens of Helicobacter pylori (HP) infection (triple and triple with the addition of bismuth tripotassium dicitrate (BTD). The study involved 158 patients with HP-associated pathology (dispepsia, erosive and ulcerative lesions of the gastroduodenal mucosa) from 18 to 65 years of age (mean age=44,6±13,5 years): 57 men (36,1 %), 101 women (63,9 %). The diagnostics of HP-infection performed using a rapid urease test (Helpil test St'Petersburg) in the course fibrogastroduodenoscopy (FGDS). The patients were divided randomly into two groups. In the group 1, 75 patients received classical first-line triple therapy: esomeprazole 20 mg twice a day, amoxicillin 1 000 mg twice a day, clarithromycin 500 mg twice a day. In the group 2, 83 patients received treatment using a similar regimen, but with the addition of BTD 240 mg twice a day. The duration of treatment in both groups was 10 days. The effectiveness of the eradication therapy was evaluated after 6-8 weeks of the end of the treatment course by means of qualitative rapid determination of fecal HP antigens using the method of immunochromatography with monoclonal antibodies (Vegal Farmaceutica, Spain). Out of the 75 patients in group 1, 60 (80 %) showed eradication of HP infection was achieved. Out of 83 patients in group 2, the eradication of HP infection was achieved in 76 patients (92,5 %). The difference in the effectiveness of eradication therapy in patients in group 1 and group 2 is statistically significant (p&lt;0,05). Thus, the classical 10-day regimen of triple antihelicobacter therapy is not effective enough and is not recommended for use in clinical practice in Khabarovsk. A 10-day triple therapy with the addition of BTD is highly effective in the Far Eastern region (Khabarovsk) and recommended as a first-line therapy. A significant reduction in the adverse events frequency in the form of bitter taste in the mouth and diarrhea is an additional advantage of the regimen using bismuth tripotassium dicitrate in comparison with the classical regimen of the triple antihelicobacter therapy.

Systematic review and meta‐analysis: Effect of Helicobacter pylori eradication on chronic spontaneous urticaria

Helicobacter pylori (HP) infection is considered to play a role in the pathogenesis of chronic spontaneous urticaria (CSU). However, the efficacy of HP eradication therapy on CSU symptom improvement has not been well established. This meta-analysis was conducted to estimate the association between HP infection and CSU and to evaluate whether HP eradication therapy benefits patients with CSU. In October 2018, we searched databases for studies investigating the efficacy of HP eradication therapy for patients with CSU. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using random effects models. The meta-analysis included 22 studies with a total of 1385 patients with CSU. When comparing the spontaneous remission of urticarial symptom in patients with HP-positive to HP-negative patients, HP-negative patients showed significantly higher spontaneous remission of urticarial symptoms. (risk ratio 0.39; 95% confidence interval: 0.19-0.81). Among HP-positive CSU patients, remission of CSU was more likely shown in HP eradication therapy group compared to untreated group, aside from achieving HP elimination (risk ratio 2.10; 95% confidence interval: 1.20-3.68). However, there was no significant difference in the remission of CSU whether antibiotic therapy was successful in eradication of HP or not (risk ratio 1.00; 95% confidence interval: 0.65-1.54). The results of this meta-analysis show that HP might be associated with the occurrence and persistence of CSU. The effectiveness of HP eradication therapy in suppressing CSU symptoms was significant. Interestingly, we found that resolution of CSU was not associated with successful eradication of HP infection. CSU Patients who were undergone antibiotic therapy for HP eradication showed significant higher CSU remission with or without HP eradication. Further studies are recommended to evaluate the mechanisms associated with relation of HP with CSU.

Probiotics for intestinal decolonization of ESBL-producing Enterobacteriaceae: a randomized, placebo-controlled clinical trial

ObjectivesInfections with extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EPE) are a major healthcare concern. Our goal was to investigate whether a probiotic mixture could be used for eradication therapy in patients with prolonged intestinal EPE carriage. MethodsWe performed a randomized, placebo-controlled, single-blinded clinical superiority trial in the south of Sweden between February 2017 and April 2019. Probiotic Vivomixx®, a mixture of 8 different living bacterial strains or placebo was given to adult outpatients intestinally colonized for at least 3 months with EPE. Patients with suspected active infections at the time of evaluation were excluded, and also those with immunosuppression, severe psychiatric disorder, drug abuse or dementia. Each patient in the probiotic arm was administered 2 sachets (9.0 × 1011 live bacteria) twice daily for 2 months. The primary outcome was intestinal EPE eradication at the end of the 1-year follow-up, as shown by 3 consecutive negative EPE rectal swabs during the follow-up year. The per protocol follow-up for all patients was 1, 3, 6 and 12 months after the initiation of the intervention. ClinicalTrials.gov Identifier: NCT03860415. ResultsIn total, the target size of 80 patients were included. The median age was 68 years in both groups. The number of females in the probiotics group was 23 (58%) and in the placebo group 28 (70%). At the end of the trial, 12.5% (5 out of 40) of the patients in the probiotic group had achieved successful eradication of EPE, as defined by the primary outcome, in the intention to treat analysis. In the placebo group, 5% (2 out of 40) of the patients had achieved successful eradication of EPE (odds ratio 2.71; 95% confidence interval (CI), 0.49–14.9; p 0.24). ConclusionsSuccessful EPE eradication was observed in very few individuals. This trial did not support Vivomixx® as being superior to placebo for intestinal decolonization in adult patients with chronic colonization of EPE, but was limited in power.