Eradication Therapy Research Articles

In Vitro Susceptibility and Synergistic Effect of Bismuth Against Helicobacter pylori

Background/objectives: Bismuth is commonly used in Helicobacter pylori (H. pylori) eradication therapy. However, few studies have examined the in vitro susceptibility of H. pylori to bismuth. Moreover, the exact mechanism of action of bismuth on H. pylori remains unclear. The aim of this study was to identify the anti-bacterial effect of bismuth as well as to evaluate potential synergistic effects between bismuth and various antibiotics. Methods: The minimum inhibitory concentrations (MICs) of three bismuth preparations, bismuth subsalicylate, bismuth potassium citrate, and colloidal bismuth subcitrate (CBS, De-Nol) were determined for H. pylori strains using the agar dilution technique. Agar plates of varying pH values from 5.0 to 8.0 were used to investigate whether acidity influences the anti-bacterial effect of bismuth. A checkerboard assay was performed to assess the synergism between CBS and antibiotics (amoxicillin, clarithromycin, and metronidazole). Results: Twelve H. pylori strains, including three reference strains (H. pylori 26695, J99, and ATCC 43504), and nine clinically isolated strains were tested. The MICs for bismuth subsalicylate, bismuth potassium citrate, and CBS ranged from 4 to 32 μg/mL, 2 to 16 μg/mL, and 1 to 8 μg/mL, respectively. The bismuth MICs for the reference strains were similar at pH 5–8. In the checkerboard assay, no interactions between CBS and any of the antibiotics were observed in the reference H. pylori strains. Conclusions: Bismuth showed in vitro susceptibility against H. pylori. The enhanced eradication efficacy of bismuth-containing regimens appears to be due to mechanisms other than direct synergy with antibiotics.

Association between Helicobacter pylori infection and gastric adenocarcinoma: a retrospective and comparative analysis

The Helicobacter pylori infection increases the risk of development gastric neoplasia. This is the most important risk factor for causing intestinal adenocarcinoma, which is the most prevalent gastric cancer, and is also strongly associated with mucosa-associated lymphoid tissue lymphoma - MALT. A retrospective and comparative analysis was carried out at Hospital de Amor de Barretos, a reference oncology service, in the years 2017 and 2021, in order to determine whether there is an association between the existence of the infection and gastric adenocarcinoma, and whether there was any change over 05 years. In total, 369 medical records of patients diagnosed with gastric cancer were analyzed, 218 and 151, respectively. In 2017, 45.1% of patients were investigated for Helicobacter pylori and 54% in 2021 (p=0.104). Infection was detected in 42.3 and 33.3% (p=0.232) respectively, and eradication therapy in 19.5 and 24%. Although the present study was carried out in a referral oncology hospital, it was not possible to objectively determine the relationship between Helicobacter pylori infection and the development of gastric adenocarcinoma.

Antibiotic Susceptibility-Guided Concomitant Therapy Regimen with Vonoprazan, High-Dose Amoxicillin, Clarithromycin, and Metronidazole for Helicobacter pylori Eradication as Fourth-Line Regimen: An Interventional Study.

Twenty patients who underwent three rounds of eradication therapies (first- or second-line 7-day triple therapy consisting of amoxicillin and clarithromycin, or metronidazole- and sitafloxacin-based third-line therapy) and had failed eradication based on a urea breath test or fecal antigen test were recruited. All patients underwent endoscopic examination and culture tests before starting eradication therapy. The intervention was concomitant therapy consisting of vonoprazan 20 mg bid, amoxicillin 500 mg qid, clarithromycin 400 mg bid, and metronidazole 250 mg bid for 14 days, which were modified based on the susceptibility test, and the resistant drugs were removed from the regimen. Patients with negative culture results were treated with quadruple therapy. The primary outcome was the eradication rate (UMIN000025765, jRCTs 031180208). The eradication rate of susceptibility-testing-based fourth-line eradication therapy was 63.2% (95%CI: 38.4-83.7%) in intent-to-treat analysis and 70.6% (95%CI: 44.0-89.7%) in per-protocol analysis. Thirteen patients received quadruple therapy, with eradication rates of 61.5% and 75.0%, respectively. No serious adverse events were reported. This vonoprazan-based concomitant therapy modified by the susceptibility test is a potential option as fourth-line eradication after first-line clarithromycin-based 7-day triple, second-line metronidazole-based 7-day triple, and third-line sitafloxacin-based 7-day triple therapy failure.

Effect of Helicobacter pylori Eradication on Serum Level of Valproic Acid in Children with Idiopathic Generalized Epilepsy.

The purpose of this study was to determine the influence of H. pylori eradication on the serum level of the orally administered valproic acid (VPA) in children with idiopathic generalized epilepsy; Methods: This prospective cohort observational study included 100 children with idiopathic generalized epilepsy, recruited from a neurology clinic from May 2021 to December 2021. The patients were divided into two groups, each containing 50 children. The first group had a positive H. pylori stool antigen and H. pylori-related symptoms, while the second group had a negative antigen. H. pylori Eradication therapy was given to the positive H. pylori group. The serum level of VPA was obtained at baseline and 4 weeks after eradication therapy. Despite there being no significant difference between the H. pylori-positive and H. pylori-negative groups regarding the baseline VPA serum level (79.9 ± 13.9 and 77.9 ± 13.1 mcg/mL), respectively, the serum VPA level had significantly increased after H. pylori eradication therapy (99.4 ± 11 mcg/mL) (p value = 0.000), as opposed to the H. pylori-negative group (85.3 ± 10.9 mcg/mL) (p value = 0.142). Furthermore, there was a statistically significant association with a negative correlation between the VPA serum level after eradication and the number of epileptic attacks per month (p value = 0.033, R value = -0.301) and the dose of VPA (p value = 0.046, R value = -0.284). The eradication of H. pylori resulted in a highly significant improvement in the serum level of the orally given VPA in children with idiopathic generalized epilepsy, as well as an indirect decrease in the frequency of epileptic events per month, allowing for dose reduction. Eradication therapy may have anticonvulsant properties and might indirectly aid in the management of epileptic activity. H. pylori screening for children with idiopathic generalized epilepsy can optimize serum VPA levels, potentially leading to better seizure control. To our knowledge, this is the first study in the literature to describe the effect of H. pylori eradication on the serum level of the orally administered VPA in children with idiopathic generalized epilepsy.

Efficacy and safety of vonoprazan-based bismuth quadruple therapy for first-line Helicobacter pylori eradication: A large-scale, real-world study.

Vonoprazan (VPZ) has been shown to have superior acid-inhibitory effects compared to proton pump inhibitors (PPIs). However, there is a paucity of research examining the efficacy of vonoprazan-based bismuth quadruple therapy (VBQT) in the eradication of primary Helicobacter pylori infection. This study aimed to evaluate the effectiveness and safety of VBQT as a first-line treatment for H pylori eradication. This retrospective, real-world, single-arm study included consecutive treatment-naive patients who received VBQT (VPZ 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, bismuth potassium citrate 220 mg, all administered twice daily for 14 days) for H pylori eradication between March 1, 2021, and May 30, 2023. The study included both outpatients and inpatients. Eradication rates were assessed using 13C-urea breath tests or 14C-urea breath tests performed 4 to 6 weeks after treatment. The primary outcomes included eradication rates, adverse events, and treatment compliance. A total of 612 H pylori-infected patients were included in the study. The intention-to-treat (ITT), modified ITT (MITT), and per-protocol analyses showed H pylori eradication rates of 84.3% (95% CI: 812% to 87.1%), 95.9% (95% CI: 93.9% to 97.4%), and 96.4% (95% CI: 94.4% to 97.8%), respectively. In the ITT analysis, the adverse event rate was 12.7%, and the treatment compliance rate was 96.9%. In real-world practice, the VBQT regimen demonstrates excellent efficacy and favorable tolerability as a first-line therapy for H pylori eradication.

Modern approaches to the eradication of <i>Helicobacter pylori</i>: a spectrum of perspectives

Helicobacter pylori is one of the most widespread infections, affecting approximately 50% of the global population, with the Russian Federation ranking among the regions with a relatively high prevalence. Eradication therapy remains the primary strategy, not only for the treatment and prevention of gastrointestinal diseases but also for reducing the risk of stomach cancer, highlighting the medical and social impact of this infection. A key factor contributing to the reduced effectiveness of eradication therapy is the microorganism’s primary or secondary resistance to antibacterial drugs, a problem recognized worldwide. It is widely acknowledged that national treatment regimens for Helicobacter pylori infection must be adapted based on systematic antimicrobial sensitivity testing to curb the rise of global antibiotic resistance. Despite decades of research and clinical practice, identifying the most effective, safe, and straightforward therapy remains a significant challenge for clinicians. This review provides a comparative analysis of current treatment recommendations for Helicobacter pylori infection, as presented by various national and regional gastroenterological societies, including those relevant in the Russian Federation.

Newer Therapies for Refractory Helicobacter pylori Infection in Adults: A Systematic Review.

Helicobacter pylori (H. pylori) infection is a global health concern, affecting approximately two-thirds of the world's population. Standard first-line treatment regimens often fail, necessitating alternative rescue therapies. This review aims to evaluate the efficacy and safety of newer treatment regimens in patients who have failed initial H. pylori eradication therapy. A comprehensive literature search was conducted in PubMed, the Cochrane Library, and Embase. Inclusion criteria were randomized controlled trials (RCTs) published after 2010, involving patients with previous H. pylori treatment failure and interventions with vonoprazan-based therapy, high-dose PPI-amoxicillin dual therapy (HDDT), or rifabutin-containing triple therapy. 10 RCTs were included. HDDT demonstrated high eradication rates (81.3% to 89.2%), particularly when combined with metronidazole (92.6%), although at an increased frequency of adverse events. Vonoprazan-based regimens achieved comparable or higher eradication rates (83.3% to 89.5%) compared to PPI-based therapies, with similar adverse events. Rifabutin-containing triple therapy showed high efficacy (80.7% to 100%), particularly in patients with a history of multiple treatment failures, and it was associated with lower adverse events compared to bismuth-containing regimens. HDDT, vonoprazan-based therapy, and rifabutin-based therapy have proven to be effective and safe rescue regimens for treating H. pylori infection. Additional large-scale randomized studies are needed to determine the optimal doses and durations of these regimens to achieve the highest eradication rate with the lowest incidence of adverse events among patients with refractory H. pylori infections globally.

PCR-based RFLP and ERIC-PCR patterns of Helicobacter pylori strains linked to multidrug resistance in Egypt.

H. pylori infects approximately 50% of the world's population that causes chronic gastritis, and may lead to peptic ulcer disease (PUD). H. pylori-induced chronic infections are associated with gastric adenocarcinoma and low-grade gastric lymphoma. In Egypt, H. pylori strains are widespread and became resistant to antimicrobial agents, thus advanced typing methods are needed to differentiate infectious strains that are resistant to antibiotics, and therefore earlier prognosis and infection control. The main objectives were (i) to determine susceptibility of infectious H. pylori strains to some antimicrobial agents that are currently used in eradication therapy in Egypt; (ii) to identify diverse strains commonly detected in the gastrointestinal (GIT) endoscopy units in Egypt through phenotypic and genotypic analyses. In this observational study we isolated 167 isolates from 232 gastric biopsies (antrum and corpus) of patients who were admitted to the upper GIT endoscopy units in five governmental Egyptian hospitals. Antimicrobial susceptibility patterns were investigated using Kirby Bauer disc diffusion and agar dilution Minimum Inhibitory Concentrations (MICs) methods. Phenotypic characterization was based on biotyping and antibiogram typing techniques. Genotypic characterization was carried out using PCR-based Restriction Fragment Length Polymorphism (RFLP) and Enterobacterial Repetitive Intergenic Consensus (ERIC)-PCR analyses. H. pylori isolates were highly resistant to diverse antimicrobial agents including Metronidazole, Fluoroquinolones, Macrolides, Amoxycillin, Tetracycline and Gentamicin. Two factors contributed to the increased resistance of H. pylori to the conventional therapy seen in Egypt: (i) Metronidazole and Amoxycillin are inexpensive and available drugs being abused by patients; (ii) the regional prescribing practice of Macrolids commonly used to treat upper respiratory and urinary tract infections. Five different biotypes were identified depending on the ability of the isolates to synthesize different enzymes. Nine antibiogram types were identified. PCR-RFLP analysis revealed fifteen different fingerprints while ERIC-PCR revealed 22 fingerprints. Biotyping alone or in combination with antibiogram typing are highly useful molecular tools in the prognosis of strain relatedness. PCR-RFLP and ERIC-PCR acquired good discriminatory power for identifying H. pylori infectious sub-types.

Beyond Conventional Treatments: Exploring CAR-T Cell Therapy for Cancer Stem Cell Eradication

Abstract Background For decades cancer remained the center of attention in the scientific community as its survival rates are low. Researchers from all around the world wanted to know the core of the problem as to what initiates cancer in a patient and helps with its progression. Many postulations came to light, but Cancer Stem Cells (CSC) was the most appealing and convincing. Main Body In this review, we shed light on a potential solution to the problem by reviewing CAR-T cells (Chimeric antigen receptor T cells). These specialized T cells are designed to detect specific antigens on cancer cells. We analyse the steps of their formation from the collection of T cells from the patient’s bloodstream and modifying it to exhibit specific CAR structures on their surfaces, to reinjecting them back and evaluating their efficacy. We thoroughly investigate the structure of the CAR design with improvements across different generations. The focus extends to the unique properties of CSCs as in how targeting specific markers on them can enhance the precision of cancer therapy. Conclusion Despite the successes, the review discusses the existing limitations and toxicities associated with CAR-derived therapies, highlighting the ongoing need for research and refinement. Looking ahead, we explore proposed strategies aimed at optimizing CAR-T cell therapy to mitigate adverse effects for improved cancer treatments. Graphical Abstract

Eradication rate and safety of vonoprazan-amoxicillin dual therapy for helicobacter pylori eradication: a randomized controlled trial

Background Helicobacter pylori (H. pylori), prevalent in developing regions, is a key factor in gastrointestinal diseases. Despite the common use of bismuth-based quadruple therapy, its drawbacks have prompted the search for alternatives. Recently, vonoprazan, a novel acid suppressant, has shown promise in combination with antibiotics as a dual therapy for H. pylori eradication. This study aimed to assess the therapeutic outcomes and adverse events of vonoprazan-amoxicillin dual therapy compared to quadruple therapy. Methods A randomized controlled trial (RCT) enrolled H. pylori-infected patients at Zhejiang Hospital. Participants were randomly assigned to dual and quadruple therapy groups. The primary endpoints were H. pylori eradication and adverse events. Results Of the 400 patients studied from April 2022 to June 2023, In the intention-to-treat (ITT) analysis, the eradication rates of H. pylori in vonoprazan-amoxicillin dual therapy group and quadruple therapy group were 94.0% and 87.0%, respectively, p = 0.017. In the per-protocol (PP) analysis were 97.9% and 93.0%, p = 0.022. Additionally, the dual therapy group had a significantly lower incidence of adverse events (19%) compared to the quadruple therapy group (53%) (p < 0.001). Conclusion Vonoprazan-amoxicillin dual therapy demonstrates superior eradication efficacy and reduced adverse events compared to quadruple therapy in H. pylori-infected patients, suggesting its potential for clinical application and promotion.

Evaluation of the Efficacy of Helicobacter pylori Eradication Regimens

Background: Several studies have been carried out to assess the effectiveness of current combination therapies for H. pylori infection. Usually, a PPI is combined with two antibiotics (triple therapy) or bismuth salts are added to these three medication agents (quadruple therapy). Antibiotic selection ought to be region-specific, taking into account local H. pylori resistance to those drugs. Aim of the Study: The objective is to evaluate and compare the efficacy of treatment regimens for H. pylori infection. Methods: A retrospective cohort study will be conducted at the Gastroenterology department at King Hussein Medical Centre in The Royal Medical Services, Amman, Jordan. Electronic health records (Hakeem) will be accessed for data extraction. Inclusion criteria will be patients who were diagnosed with H. pylori infection and received one of the two prescribed eradication regimens. Regimen A consists of two doses of 1 g amoxicillin capsules and 40 mg esomeprazole capsules twice a day for 14 days, in addition to a 500 mg levofloxacin tablet once a day while regimen B consists of 500 mg clarithromycin tablets, 500 mg metronidazole tablets, and 40 mg esomeprazole capsules taken twice daily. Exclusion Criteria include patients with incomplete medical records or those with contraindications to standard eradication therapies. Version 24 of the Statistical Package for the Social Sciences (SPSS) will be used to code and analyse the data. Results: We enrolled 62 patients in the levofloxacin-based regimen and in the clarithromycin-based therapy distributed equally among the two study groups. The former was successful in 27 patients (43.5%) and the latter in 20 patients (32.3%), using chi-square test (P &lt; .05). Regimen A had greater eradication rates than regimen B in the current investigation, with 87% and 64.5% eradication rates, respectively. Conclusion: A levofloxacin–amoxycillin-based triple therapy has been proved to be acceptably effective as second- or even ..........

Melioidosis in Patients with Cancer, A Cloaked Menace: A Case Series

Melioidosis is an infection caused by the gram-negative bacteria Burkholderia pseudomallei. The infection is endemic in South Asia and Australia, and several risk factors have been described for acquiring the infection, the most prominent among them being diabetes. Active malignancy is not a recognized common predisposing condition for this infection, but there have been several case reports of patients with underlying malignancies who have been diagnosed with concomitant melioidosis. But the increasing use of corticosteroids along with chemotherapy-induced immunosuppression could be factors that could lead to a possible rise of the infection in this patient population. The recognition of the infection is challenging due to nonspecific clinical features, but arriving at the diagnosis is crucial in view of the protracted course of antibiotics needed to treat the acute infection, while also giving eradication therapy to prevent recurrences. The authors describe a series of three cases of melioidosis in patients with active malignancy, each highlighting a different aspect of treatment of the infection.

The efficacy of keverprazan-based quadruple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind, multicentre trial

IntroductionKeverprazan is a novel potassium-competitive acid blocker. The advantages of keverprazan as a potent acid suppressor in Helicobacter pylori eradication have not yet been demonstrated. The aim of this study was to evaluate the efficacy of keverprazan as a component of bismuth quadruple therapy in H. pylori treatment. MethodsAdult patients with H. pylori infection were enrolled and randomised to take keverprazan (KEV group)- or esomeprazole (ESO group)-quadruple therapy. The regimens contained keverprazan 20 mg or esomeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1000 mg and bismuth potassium citrate 240 mg and were administered twice daily for 14 days. The primary endpoint was the H. pylori eradication rate at 4 weeks after treatment. ResultsThe full analysis set showed that the H. pylori eradication rates were 87.8% (252/287) and 82.52% (236/286) for the KEV and ESO groups, respectively (difference: 5.29%; 95% confidence interval [CI]: -0.55–11.18). Keverprazan was superior to esomeprazole in terms of eradication rate in the per protocol set (P=0.0382). The eradication rates for patients resistant or non-resistant to clarithromycin were both numerically higher in the KEV group than the ESO group (83.45% vs. 76.98% for clarithromycin-resistance; 92.31% vs. 88.16% for clarithromycin-non-resistance). The incidence of adverse events was similar in the KEV and ESO groups (76.31% vs. 77.62%), with most adverse events (>90%) being mild in severity. No TEAEs led to death in either group. ConclusionsKeverprazan 20 mg twice daily, used as a component of bismuth quadruple therapy, provided effective H. pylori eradication and was non-inferior to an esomeprazole-based regimen.

Prevention of Gastric Cancer: Helicobacter pylori Treatment

&lt;i&gt;Helicobacter pylori&lt;/i&gt; infection has been associated with various gastric diseases, including ulcers, adenomas, and adenocarcinomas. Over 40 years since the discovery of &lt;i&gt;H. pylori&lt;/i&gt;, numerous studies have shown that &lt;i&gt;H. pylori&lt;/i&gt; eradication therapy can help prevent gastric cancer not only in healthy individuals but also in patients who have already been treated for early gastric cancer. Moreover, some studies have shown that eradication therapy can improve gastric mucosal inflammatory diseases, such as atrophic changes and intestinal metaplasia. This article reviews the epidemiology of &lt;i&gt;H. pylori&lt;/i&gt; infections and gastric cancer, mechanisms of &lt;i&gt;H. pylori&lt;/i&gt;-associated gastric cancer development, and current evidence supporting the benefits of &lt;i&gt;H. pylori&lt;/i&gt; eradication for reducing or preventing gastric cancer.

Prevalence, Predictors, and Treatment Outcomes of Anemia in Vietnamese School-Age Children With Helicobacter pylori Infection.

Background A growing number of studies suggest that anemia caused by Helicobacter pylori (H. pylori) infection is prevalent in developing countries. A combination of H. pylori eradication and iron supplementation may be effective intreating iron deficiency anemia (IDA) caused by H. pylori infection. The aim of this study is to assess the prevalence, risk factors, and treatment outcomes of anemia in Vietnamese school-age children infected with H. pylori Methods A cross-sectional study was conducted from April 2023 to April 2024 involving 112 dyspeptic children from 5 to 16 years old who were admitted to Can Tho Children's Hospital, Vietnam. H. pylori infection was diagnosed with a positive histopathology combined with a rapid urease test. A bivariate and multivariate logistic regression model was used to identify independent variables associated with anemia in H. pylori-infected children. Results The prevalence of anemia and IDA (iron deficiency anemia) amongH . pylori-infected children were 28.6% and 53.1%, respectively. The risk factor for anemia was age group from 11 to 16 years of age (OR: 3.24; CI 95%:1.21- 8.70). Iron supplementation (OR: 0.14; CI 95%:0.03 - 0.66) and periodic deworming (OR: 0.29; CI 95%: 0.10-0.89) were protective factors against anemia. After H. pyroli eradication and iron supplementation, all hematological parameters were increased among 32 anemic patients. Hemoglobin increased from 9.9 ±2.1 to 11.9±2.1 g/dL (p<0.001), mean corpuscular hemoglobin increased from 25.1 ± 4.1 to 28.0 ± 3.3 pg (P=0.003), and ferritin (IQR) increased from 16.7 (9.5-45.2) to 27.0 (15.1-47.0) µg/L (p<0.001). Conclusion Anemia in Vietnamese school-age children infected with H. pylori is prevalent. Taking iron supplements and periodic deworming reduces the risk of anemia. H. pylori eradication therapy plus oral iron supplementation will improve iron status in H. pylori-infected children.

Clinicopathologic Features of Early Gastric Cancer after Heli-cobacter pylori Eradication in Japanese Patients: Comparative Study between Early (10 Years) Onset.

Eradication therapy for Helicobacter pylori gastritis was approved for insurance coverage by the Japanese government in 2013. Since then, the incidence of gastric cancer discovered after eradication (GCAE) has increased. However, there are only a few reports of GCAE diagnosed more than 10 years after eradication. We investigated the clinicopathological characteristics of early-stage GCAE, including histological types and the interval from eradication to diagnosis. Overall, 379 patients with a total of 448 GCAE lesions treated with endoscopic resection or surgery at our hospital between January 2015 and December 2021 were assessed, and 315 patients with a known interval from eradication to diagnosis of GCAE with a total of 354 lesions were included. We classified the cases into two groups: differentiated-type GCAE (D-GCAE; 279 patients, 318 lesions) and undifferentiated-type GCAE (UD-GCAE; 36 patients, 36 lesions). Smoking and a mild-to-moderate degree of atrophy were risk factors associated with differentiated-type gastric cancer occurring more than 10 years after H. pylori eradication. Additionally, the rate of a mixture of histological types with relatively high malignant potential was significantly higher in UD-GCAE presenting more than 10 years after eradication group than those presenting within 10 years after eradication.

Sex differences in Helicobacter pylori infection and recurrence rate among 81,754 Chinese adults: a cross-sectional study

ObjectiveTo compare the sex differences of Helicobacter pylori (HP) infection rate and 1-year recurrence rate.MethodsA cross-sectional study was conducted on the prevalence of HP infection in 81,754 people who underwent physical examination in physical examination centers and outpatient clinics of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine, the Second People’s Hospital of Zhangye City, Tianshui City Hospital of Integrated Chinese and Western Medicine, the First and Second Department of The First Hospital of Lanzhou University Physical Examination Center, from March 2010 to December 2019. Among them, 53,771 (65.77%) were males (18–91 years old) and 27,983 (34.23%) were females (18–94 years old). According to age, they were divided into young group, middle-aged group and old group. 1448 asymptomatic infected patients were selected and treated with bismuth-containing quadruple drug eradication therapy for 2 weeks. The eradication rate and recurrence rate after 1 year were compared between males and females.ResultsThe overall infection rate was 49.59%, including 49.74% in males and 49.3% in females. The risk of infection in young women was lower than that in men (OR = 0.908, 95%CI: 0.868–0.95, P < 0.01), the risk of infection in older women was higher than that in men (OR = 1.137, 95%CI: 1.041–1.243, P < 0.01). The female infection rate was positively correlated with age from 18 to 60, and Spearman’s correlation coefficient was 0.825 (P < 0.01). The overall eradication rate was 84.67% in intention-to-treat analysis (ITT) and 88.46% in protocol analysis (PP). The eradication rates of ITT and PP in the older group were 78.38% and 82.27%, respectively, which were lower than 87.25% and 89.39% in the male group (P < 0.05). The 1-year overall recurrence rate was 3.86%, including 2.82% in males and 5.44% in females (P < 0.05), female was a risk factor for recurrence after eradication after controlling for age (OR = 2.177, 95%CI 1.166–4.066, P < 0.05). There were no obvious adverse reactions during the treatment.ConclusionThere is a positive linear correlation between HP infection rate and age increase in women. Older women have the characteristics of high HP infection rate, low eradication rate and high recurrence rate.

Validity of self-reported Helicobacter pylori eradication treatment from questionnaire and interview surveys of the JPHC-NEXT study: comparison with prescription history from insurance claims data.

We aimed to evaluate the validity of self-administered questionnaire surveys and face-to-face interview surveys for the detection of Helicobacter pylori eradication therapy. Participants were a cohort, aged 40-74 years, living in three different locations of Japan, who took part in the baseline survey (2011-2012) of the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT). Five years after the baseline survey, a questionnaire and interview survey were independently conducted to determine the history of Helicobacter pylori eradication treatment over the 5-year period. Prescription of Helicobacter pylori eradication medications in national insurance claims data from the baseline survey to the 5-year survey was used as a reference standard. In total, 15,760 questionnaire surveys and 8,006 interview surveys were included in the analysis. There were 3,471 respondents to the questionnaire and 2,398 respondents to the interview who reported having received Helicobacter pylori eradication treatment within the past five years. Comparison of the questionnaire survey to national insurance claims data showed a sensitivity of 95.1% (2213/2328), specificity of 90.6% (12174/13432), positive predictive value of 63.8% (2213/3471), negative predictive value of 99.1% (12174/12289), and Cohen's Kappa value of 0.71. Respective values of the interview survey were 94.4% (1694/1795), 88.7% (5507/6211), 70.6% (1694/2398), 98.2% (5507/5608), and 0.74. Both the questionnaire and the interview showed high sensitivity, high specificity, and good agreement with the insurance claim prescriptions data. Some participants may have received eradication treatment without going through the public insurance claim database, resulting in a low positive predictive value.

Efficacy and Safety of Standard Triple Therapy for Helicobacter pylori Eradication in Latin America: A Systematic Review and Meta-Analysis.

To evaluate the efficacy and safety of standard triple therapy (STT) in Latin America. Helicobacter pylori infection affects more than 50% of the Latin Americans and leads to gastric mucosa damage. Scarce data on effective therapeutic approaches in the region underscores the need for comprehensive information. The analysis included Randomized Controlled Trials published up to the year 2020, comparing STT with other treatments. Cumulative relative risks (RR) were estimated, with 95% CI, according to intention-to-treat (ITT) and per protocol (PP) analysis. Eleven studies (clinical trials conducted between 1995 and 2013), revealed cumulative eradication rates of 78.31-90.63% (ITT) and 76.71-93.55% (PP). The eradication with the STT was superior to sequential therapy (ITT-RR: 10.6, 95% CI: 1.01 to 1.12) (PP-RR: 10.6, 95% CI: 1.02-1.11) and dual therapy (ITT-RR: 1.61, 95% CI: 1.13-2.30) (PP-RR: 1.72, 95% CI: 1.25-2.37), but is less effective than other triple therapies (PP-RR: 0.85, 95% CI: 0.78-092). Regarding adverse effects, diarrhea, metallic taste, nausea, vomiting, and headache were the most common symptoms across treatments. Abdominal pain was associated with STT (ITT-RR: 1.75, 95% CI: 1.07-2.86). STT was a safe regimen but with acceptable efficacy (most eradication rates <90%). Due to rising clarithromycin resistance, the study suggests avoiding STT as a first-line treatment. These results must be considered with caution due to the low representativeness of several Latin American countries and the lack of recent high-quality randomized studies.

Efficacy and Safety of Postbiotic Contained Inactivated Lactobacillus reuteri ( Limosilactobacillus reuteri ) DSM 17648 as Adjuvant Therapy in the Eradication of Helicobacter pylori in Adults With Functional Dyspepsia: A Randomized Double-Blind Placebo-Controlled Trial.

Increasing the effectiveness of eradication therapy is an important task in gastroenterology. The aim of this study was to evaluate the efficacy and safety of postbiotic containing inactivated (nonviable) Limosilactobacillus (Lactobacillus)reuteri DSM 17648 (Pylopass) as adjuvant treatment of Helicobacter pylori eradication in patients with functional dyspepsia (FD). This randomized, double-blind, placebo-controlled, multicenter, parallel study included H. pylori -positive patients with FD. The postbiotic group received Pylopass 200 mg bid for 14 days in combination with eradication therapy (esomeprazole 20 mg bid + amoxicillin 1,000 mg bid + clarithromycin 500 mg bid for 14 days) and another 14 days after the completion of eradication therapy. The study was registered in the ISRCTN registry (ISRCTN20716052). Eradication efficiency was 96.7% for the postbiotic group vs 86.0% for the placebo group ( P = 0.039). Both groups showed significant improvements in quality of life and reduction of most gastrointestinal symptoms with no significant differences between groups. The overall number of digestive adverse effects in the postbiotic group was lower than in the placebo group. Serious adverse effects were not registered. The postbiotic containing inactivated L. reuteri DSM 17648 significantly improves the effectiveness of H. pylori eradication therapy in FD and decreases overall number of digestive adverse effects of this therapy.