Eradication Failure Research Articles

Criminal Sanctions As an Eradication Strategy Of Corruption: A Critical Study from the Perspective of Islamic Criminal Law

The spirit of anti-corruption movement has been a motion since reformation era in 1998 and the government has issued various policies. Firstly, the policy relating to the substance of the law, the government has passed various laws and ratified international conventions. Secondly, the regulations concerning law enforcement agencies, the government has established the Corruption Eradication Commission, Corruption Crime Court, the Center for Reporting and Analyzing Financial Transactions (PPATK), the Witness and Victim Protection Agency (LPSK), and the establishment of internal supervisory bodies. However, these efforts seemingly face failure. The facts show that corruption increases in the executive, legislative and judicial institutions, from the center to the region level. The failure of corruption eradication can be one of the reasons that indicates the formulation of criminal sanctions in Law No. 20/2001 for corruption is weak, not appropriate for the negative impacts of the crime. Consequently, the punishment imposed has no deterrent effect for either the perpetrators or others. It is contrast to the concept of sanctions in Islamic criminal law, sanctions imposed on the perpetrators must be comparable with their evil deeds (Qur'an Surah 42, verse 40), with the aim to benefit for human both individual and collective. According to the concept, this article will examine criminal sanctions based on Islamic criminal law as an eradication strategy of corruption. The results of this article can be a consideration for the revision of the framework in formulating criminal sanctions contained in Law No. 20 / 20011 concerning corruption.

Effect of 25-hydroxyvitaminD on Helicobacter pylori eradication in patients with type2 diabetes.

SummaryBackgroundVarious studies have reported a lower Helicobacter pylori eradication rate and a more frequent reinfection rate in type 2 diabetes mellitus (T2DM). Vitamin D has anti-inflammatory and immunoregulatory activity and the role of the vitamin D receptor (VDR) in the antimicrobial activity against H. pylori has been reported. When it comes to the risk factors of H. pylori eradication, the function of vitamin D is not always taken into account. The aim of this study was to assess the role of 25-hydroxyvitamin D in H. pylori eradication in T2DM.MethodsIn this retrospective study data from 160 patients with T2DM who underwent eradication therapy for H. pylori in Anhui Provincial Hospital between July 2015 and September 2017 were analyzed. According to eradication status, patients were divided into two groups, the successful eradication group (n = 124) and the eradication failure group (n = 36). The following information was obtained from participants’ records before eradication treatment: age, sex, body mass index (BMI), duration of T2DM, prescription of medication use, smoking and drinking history. All patients were tested for glycated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL‑C), triglyceride (TG) and 25-hydroxyvitamin D (25-OHD) at baseline.ResultsThe H. pylori was eradicated in 124 (77.5%) patients, while in 36 (22.5%) patients the treatment was unsuccessful. The eradication failure group had a lower mean vitamin D concentration than the group with successful eradication (15.09 ± 7.72 ng/ml vs. 19.87 ± 6.35 ng/ml, p = 0.004). The estimated odds ratio (OR) for eradication failure in individuals with serum vitamin D deficiency (<20 ng/ml) compared to those with sufficient vitamin D levels (>30 ng/ml) were 1.489 (95% confidence interval, CI: 1.046–2.121, P = 0.027), Individuals with long duration of diabetes (≥10 years) had odds of eradication failure of 1.467 (95% CI: 1.017–2.114, P = 0.040) compared to subjects with short duration of diabetes (<10 years).ConclusionsLower 25-OHD was not only associated with H. pylori eradication failure but was also related to dyslipidemia in T2DM patients. Increasing serum 25-OHD to appropriate levels by activated vitamin D use may improve the eradication rate.

BEST POLYPECTOMY TECHNIQUE FOR SMALL AND DIMINUTIVE COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Polypectomy of colorectal polyps is the mainstay of colorectal cancer prevention. Identification of the best polypectomy technique is imperative. This review aims at comparing efficacy of nine different resection methods for small colorectal polyps (<10 mm). We searched and selected only randomized controlled trials. Primary outcome was complete resection rates of small polyps by histological eradication. Secondary outcomes were: adverse events, retrieval tissue failures rates and duration of procedure. Eighteen trials including 3215 patients and 5223 polyps were analysed. Overall, cold polypectomy had a significantly shorter time of procedure than hot polypectomy (RD -5.92, 95%CI -9.90 to -1.94, P<0.05), with no statistical difference on complete histological eradication (RD 0.08, 95%CI -0.03 to 0.19, P>0.05). Regarding cold polypectomy techniques, cold snare was found superior to cold forceps on complete and en-bloc resection rates and less time consuming. When comparing endoscopic mucosal resection (EMR) with hot-snare and cold-snare, the latter showed no-inferiority on histological eradication, adverse events or retrieval tissue failure rates. Cold polypectomy is the best technique for resection of small colorectal polyps. Among cold methods, dedicated cold snare was found superior on histological eradication. Cold snare endoscopic mucosal resection might be considered an option for polyps from 5 to 9 mm.

Eradication Failure of Helicobacter Pylori Among Children’s Population

Helicobacter pylori (H. pylori) is a Gram-negative bacterium responsible for the development of gastritis that may further progress to more severe conditions, peptic ulcer disease and gastric cancer [1,2]. H. pylori have infected from 80% to 90% of the population in Russia [3]. Despite the ongoing discussion on which H. pylori infected patients should be treated up till full eradication of the infection, eradication depending on the prevalence of strains resistant to antibacterial preparations using for treatment [4]. Currently, the eradication of H. pylori is managed by the use of a triple therapy, involving the co-administration of two antibiotics and a proton pump inhibitor or bismuth during ten or fourteen days [4,5].

Helicobacter pylori antimicrobial resistance during a 5-year period (2013-2017) in northern Spain and its relationship with the eradication therapies.

Antibiotic resistance is the main cause for Helicobacter pylori therapy failure. Frequently, empirical regimens have been recommended in patients with various H.pylori eradication failures. In patients with H.pylori-resistant to various families of antibiotics, the treatment guided by antimicrobial susceptibility testing allows the achievement of good eradication rates. To evaluate the effectiveness of susceptibility-guided antimicrobial treatment for H.pylori infection in patients with resistance to one or various families of antibiotics. A total of 3170 consecutive patients infected by H.pylori during 2013-2017 were tested for antimicrobial susceptibility. 66.6% patients showed resistance to one antimicrobial, 18.9% to two, and 2.4% to three families of antibiotics. A cohort of 162 H.pylori-positive patients were enrolled in this study. Forty-three with single H.pylori resistance to clarithromycin (CLR) were treated with omeprazole (PPI), amoxicillin (AMX), and levofloxacin (LVX)-OAL (31 subjects) or omeprazole, AMX, and metronidazole (MTZ)-OAM (12 patients) and 77 patients with dual H.pylori resistance (51 to CLR and MTZ, 12 to CLR plus LVX, and 14 to MTZ plus LVX) received OAL or OBTM (PPI, bismuth subcitrate, tetracycline, and MTZ), OAM, and OAC, respectively. Other 42 patients with triple H.pylori resistance (CLR, LVX, and MTZ) were treated with PPI, AMX, and rifabutin-OAR (18 subjects), PPI, AMX, and doxycycline-OAD (8), OADB (7), OBTM (6), and ODBR (3). All subjects received standard doses for 10days. Eradication rate was confirmed by 13 C-UBT. Adverse events were assessed by a questionnaire. Intention-to-treat analysis demonstrates that eradication rates using triple therapies in patients with H.pylori resistance to one and to two families of antibiotics were 93% and 94.8%, respectively. In subjects with H.pylori-resistant to three families of antibiotics, cure rate was higher in naïve patients treated with OAR-10days compared to those treated with bismuth-containing quadruple therapies (90% vs 75%). Adverse events were limited (18 of 162, 11.1%), all of them mild-moderate. The implementation of susceptibility-guided triple therapy for 10days leads to eradication rate ≥95% in naïve patients with H.pylori resistance to one or two families of antimicrobials. In naïve patients with H.pylori resistance to three families, OAR treatment achieved a 90% of eradication.

Recent trends in the prevalence of Helicobacter Pylori in symptomatic children: A 12-year retrospective study in a tertiary centre

ObjectiveHelicobacter pylori infection is common among Asians. However, evidence in the recent years has demonstrated a decrease in the prevalence of H. pylori infection among children and adults worldwide. Our aim was to update its prevalence in symptomatic children in our locality in the recent 12 years and compared to the results of our previous review published in 2005. MethodsA retrospective review was carried out between 2005 and 2017. All children who presented with dyspepsia or gastrointestinal bleeding and underwent oesophagogastroduodenoscopy with antral biopsy taken were included. Patient demographics, endoscopic, or histological diagnosis and the H. pylori status were recorded. Main ResultsA total of 602 patients were included. There was a statistically significant decreasing trend of H. pylori infection rate between 2005 and 2017 (p = 0.003). The overall infection rate from this study was 12.8%, compared to 25.6% from our previous review. Overall failure of eradication with first-line antibiotic therapy has increased to 29.3% from 10% in our previous review. ConclusionThere was a decrease in the prevalence of H. pylori infection among symptomatic children for the recent 12 years, comparing to our previous data from 2005. We hypothesize that the reduction in prevalence of H. pylori infection among adults and the decrease in the practice of sharing chopsticks during meals have led to a decrease in transmission of the bacteria among family members in Hong Kong. However, the failure of eradication with first line treatment was higher, possibly due to the increase in antibiotics usage and resistance. Level of EvidenceIII

Second-line rescue treatment of Helicobacter pylori infection: Where are we now?

At present, the best rescue therapy for Helicobacter pylori (H. pylori) infection following failure of first-line eradication remains unclear. The Maastricht V/Florence Consensus Report recommends bismuth quadruple therapy, or fluoroquinolone-amoxicillin triple/quadruple therapy as the second-line therapy for H. pylori infection. Meta-analyses have shown that bismuth quadruple therapy and levofloxacin-amoxicillin triple therapy have comparable eradication rates, while the former has more adverse effects than the latter. There are no significant differences between the eradication rates of levofloxacin-amoxicillin triple and quadruple therapies. However, the eradication rates of both levofloxacin-containing treatments are suboptimal. An important caveat of levofloxacin-amoxicillin triple or quadruple therapy is poor eradication efficacy in the presence of fluoroquinolone resistance. High-dose dual therapy is an emerging second-line therapy and has an eradication efficacy comparable with levofloxacin-amoxicillin triple therapy. Recently, a 10-d tetracycline-levofloxacin (TL) quadruple therapy comprised of a proton pump inhibitor, bismuth, tetracycline and levofloxacin has been developed, which achieves a markedly higher eradication rate compared with levofloxacin-amoxicillin triple therapy (98% vs 69%) in patients with failure of standard triple, bismuth quadruple or non-bismuth quadruple therapy. The present article reviews current second-line anti-H. pylori regimens and treatment algorisms. In conclusion, bismuth quadruple therapy, levofloxacin-amoxicillin triple/quadruple therapy, high-dose dual therapy and TL quadruple therapy can be used as second-line treatment for H. pylori infection. Current evidence suggests that 10-d TL quadruple therapy is a simple and effective regimen, and has the potential to become a universal rescue treatment following eradication failure by all first-line eradication regimens for H. pylori infection.

Polio in Pakistan: Political, Sociological, and Epidemiological Factors.

Pakistan, Nigeria, and Afghanistan remain the only countries in the world where polio is still a serious threat. This review article addresses the political, sociological, and epidemiological factors behind the failure in eradication. A relatively popular Nigerian conspiracy theory about polio vaccines spread in Pakistan and, as a result, there is some considerable resistance to polio vaccination. Conspiracy theories about vaccines have a long history, and the fact that polio vaccinators were used as spies in order to plan for Bin Laden’s death has made polio vaccination a bigger challenge. Furthermore, vaccination is strongly correlated with literacy and Pakistan is still struggling against illiteracy. However, these obstacles are by no means insurmountable, and a joint effort by the government, policymakers, education department, community mobilizers, and public health professionals can indeed make major improvements.

Eradication and containment of non-native forest insects: successes and failures

The problem of forest insect invasions is intensifying. Non-native forest insects are invading virtually every world region, and many are causing severe ecological and economic impacts. Biosecurity programs provide for intervention at various stages of the invasion process in order to mitigate the invasion problem. While preventing initial arrival of non-native insect species is a sound approach, such prevention is not always possible so additional measures are needed to manage invasions. Surveillance coupled with eradication is a valuable strategy for preventing the establishment of many new and potentially damaging species. Once non-native species are established, containment measures can be implemented to stop or slow the spread of these species in their non-native habitat. Here, we review how eradication and containment can be carried out as strategies for managing forest insect invasions. Several hundred programs have been implemented to eradicate non-native forest insects, with most programs proving successful. The vast majority of these eradication programs were implemented from 1970 onward. Pheromone-baited traps play a key role for detection and delimitation in most successful eradication programs. The isolation and synthesis of pheromones provided a key technology that facilitated forest insect eradications starting in the 1970s. Several examples are provided that illustrate both successful and failed eradication and containment programs. Consideration of historical experiences suggests the conditions that may lead to either success or failure of eradication and containment efforts.

Molecular Detection of Clarithromycin Resistance: Is It Predictive of Treatment Success?

Introduction: Clarithromycin is a commonly used antibiotic in PPI Triple therapy (PPI TT). However, significant (and increasing) treatment failure rates occur in the range of 10—30% with PPI TT. Eradication failure is thought to be primarily driven by resistance to clarithromycin which is reported to be up to 30%. The purpose of this study was to investigate if clarithromycin resistance, as determined by PCR detection of 23S mutations, predicted a heightened risk of Helicobacter pylori (Hp) eradication failure using clarithromycin—based PPI TT.1200 Figure 1 No Caption available.Methods: This study is designed as a prospective blinded cohort study. At 6 endoscopy centers, patients >18 y/o who previously had an esophagogastroduodenoscopy and were CLO test positive were included if they were treated with at least 10 days of PPI TT with clarithromycin. Evaluation of eradication was determined using a stool antigen test (HpSAg) at least 4 weeks after completion of PPI TT and off of all acid suppression. Clarithromycin resistance was evaluated using organisms isolated from the pretreatment CLO test biopsies via amplification and detection of 23S mutations using real—time PCR and melt curve analysis. CLO test tissue biopsies were stored at 4°C for up to 1 yr before extraction; amplifiable 23S target was obtained in all but 4 samples. Results: See Table 1. PCR testing was able to detect Hp DNA in 68/73 (93.1%) of stored CLO test samples. Using the PCR assay, clarithromycin resistance was 33.8% (23/68) in our population. Treatment emergent HpSAg results were compared to 23S testing and evaluated by Chi—square. There was no significant association between the 23S mutation for clarithromycin resistance and eradication after clarithromycin based treatment. Conclusion: Our study does not show a clinical correlation between molecular detection of clarithromycin resistance and clearance of H. pylori following PPI triple therapy. This may be due to a small sample size and high rate of eradication (68/73; 93.2%).

Effective antimicrobial activity of rifabutin against multidrug‐resistant Helicobacter pylori

Helicobacter pylori resistance to more than one antibiotic is the main reason for failure in bacterial eradication in a considerable number of patients. Rifabutin (RFB) with a broad-spectrum of antimicrobial therapy has been suggested for treatment of refractory multidrug-resistant infections. Helicobacter pylori isolates from 104 patients were examined for resistance to 5 currently used antibiotics and RFB, using agar dilution method. Twofold serial dilutions of antibiotics were used and MICs (μg/mL) determined as metronidazole (MTZ 8), clarithromycin (CLR 2), amoxicillin (AMX 1), tetracycline (TET 0.5), furazolidone (FRZ 0.5), and RFB (0.06). Of 104 H.pylori isolates, only 7 (6.7%) were sensitive to all the 6 antibiotics. However, 30 (28.8%) were resistant to one antibiotic, 28 (26.9%) to two, 19 (18.2%) to three, 14 (13.4%) to four, and 6 (5.7%) to five currently used antibiotics. Overall, 67(64.4%) of isolates were resistant to 2-5 currently used antibiotics and considered as multidrug-resistant (MDR), with 59 (88.1%) showing sensitivity to RFB and 8 (11.9%) resistance (P<0.05). Of 33 isolates resistant to both MTZ and CLR, 25 (75.7%) were sensitive to RFB and 8 (24.3%) resistant (P<0.05). In vitro antimicrobial effectiveness of RFB on MDR H.pylori including those with resistance to both MTZ and CLR was demonstrated. However, RFB efficacy decreased as the number of antibiotics responsible for MDR increased. Considering that RFB inhibits both extra- and intracellular H.pylori, it can be suggested as an effective antibiotic against of MDR H.pylori.

Smoking and Drinking Did Not Increase the Failure of Therapeutic Helicobacter pylori Eradication by Vonoprazan, Clarithromycin, and Amoxicillin

Aims: The influence of lifestyle-related factors, including smoking and drinking, was evaluated for Helicobacter pylori eradication therapy with vonoprazan or proton pump inhibitors (PPIs). Methods: Between 2012 and 2016, the medical records of 620 patients receiving H. pylori eradication therapy at Saiseikai Karatsu Hospital were evaluated. Patients had received vonoprazan (20 mg) or PPIs with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 days. The influence of lifestyle-related factors on eradication failure was determined in the 2 groups. Results: The eradication rates for vonoprazan and lansoprazole, rabeprazole, and esomeprazole were, respectively, 91.0, 73.8, 72.0, and 84.6%. The vonoprazan eradication rate was significantly higher than those for the PPIs (p < 0.01). Habitual smoking and drinking did not increase eradication failure, and smoking and drinking during the eradication period did not reduce the eradication rate. Metabolic syndrome-related factors including obesity, hypertension, and diabetes mellitus had no negative influence on the eradication rate. Eradication with vonoprazan was more effective compared with that achieved through the use of PPIs. Conclusion: Lifestyle-related factors including smoking and drinking did not exacerbate the H. pylori eradication failure, and vonoprazan was more effective than the PPIs.

Biofilm-Producing Ability of Bovine Extraintestinal Pathogenic Escherichia coli and Its Correlation with Attachment Factors

Background: Escherichia coli is recognized as a common cause of infection. Long-lasting presence of bacteria on biotic and abiotic surfaces and failure of bacterial eradication are predicted by biofilm production. Some extracellular frills of E. coli can be implicated in productive events, leading to biofilm formation by surface colonization. Objectives: In the present study, correlation of csgA (encoding curli fimbriae) and fimA (encoding a large subunit of type I fimberiae) gene expression with biofilm formation of extraintestinal bovine pathogenic E. coli strains was evaluated in different enrichment media. Methods: The microtiter plate-based crystal violet method was applied to examine the biofilm production of 30 E. coli strains in Luria-Bertani (LB) and Brain-Heart Infusion (BHI) broth with 1% sucrose. PCR assay was performed to determine the presence of the studied genes. Results: According to the results, 100% of isolates contained csgA genes, and 96.7% contained fimA genes. Using the BHI medium with 1% sucrose, 53.3% and 16.6% of strains were average and strong biofilm producers, respectively. On the other hand, by using the LB medium, 66.6% of isolates were poor biofilm producers, whereas none were strong biofilm producers. Conclusions: The BHI medium containing 1% sucrose was better detected in biofilm production, compared to the LB medium. Since the studied genes were present in non-biofilm producing isolates, the correlation of these genes with biofilm-producing ability is questioned.

The effect of vitamin D deficiency on eradication rates of Helicobacter pylori infection.

Background/AimMany studies have investigated risk factors other than antibiotic resistance linked to Helicobacter pylori (H. pylori) eradication failure. The aim of this study was to study the effect of serum levels of 25‐hydroxy‐vitamin D (25[OH]D) on eradication rates of H. pylori infection.MethodsThis study included 150 patients diagnosed with H. pylori gastritis using magnifying narrow‐band imaging endoscopy supported by stool antigen test. Serum 25‐OH vitamin D levels were measured via the Enzyme‐Linked Immune Sorbent assay (ELISA) method before starting eradication therapy of H. pylori infection. All patients were treated with clarithromycin‐based triple therapy for 14 days. H. pylori eradication was determined via a stool antigen test performed 4 weeks after the end of therapy. According to the serum level of 25‐OH vitamin D levels, the patients were divided into two groups: group I (sufficient) had a vitamin D level of ≥20 ng/mL, while group II (deficient) had a vitamin D level of <20 ng/mL.ResultsOur results revealed that eradication was successful in 105 (70%) patients and failed in 45 (30%) patients. The mean 25[OH]D level was significantly lower in the eradication failure group compared to the successful treatment group (14.7 ± 4.5 vs 27.41 ± 7.1; P < 0.001). Furthermore, there were significantly more patients with deficient 25[OH]D levels in the failed treatment group, 30 (66.6%), compared to the successful group, 10 (9.5%) (P < 0.001).ConclusionsOur results demonstrated that 25‐OH vitamin D deficiency may be considered a risk factor related to eradication failure of H. pylori infection. In addition, a further randomized trial to evaluate the effect of vitamin D supplementation in H. pylori eradication is mandatory.

Clinical relevance of point mutations in the 23S rRNA gene in Helicobacter pylori eradication: A prospective, observational study.

Clarithromycin-based triple therapy is prescribed worldwide for Helicobacter pylori eradication. However, increases in the clarithromycin resistance of H pylori are thought to be responsible for eradication failure. Here, we studied whether point mutations in domain V of the 23S rRNA gene can affect H pylori eradication failure in a prospective, open-label, observational study. Of the 755 enrolled patients, 299 patients (39.6%) had positive Campylobacter-like organism (CLO) tests. DNA sequencing analysis of H pylori 23S rRNA in 295 patients revealed that 2143G was the most frequent point mutation (24.7% of patients), followed by the 2182T mutation (11.5%). The overall eradication failure rate was 20.9% (42/201) in clarithromycin-based triple therapy. Patients with the 2143G had an approximately 60% eradication failure rate, which suggested that 2143G was a high-risk genotype for eradication failure. Patients with the 2182C genotype without 2143G had an 8.7% failure rate, and patients without 2143G or 2182C had only a 4.3% failure rate. The presence of 2143G, which was associated with previous eradication history and female sex, was an independent risk factor for eradication failure. In conclusion, the 2143G point mutation in the 23S rRNA of H pylori was an independent risk factor for eradication failure in clarithromycin-based triple therapy. Personalized tailored therapy based on the genotypes of 23S rRNA can increase eradication success rates in H pylori infections.

Genotyping and antimicrobial resistance patterns of Helicobacter pylori in human and dogs associated with A2142G and A2143G point mutations in clarithromycin resistance

BackgroundRoutes of transmission of Helicobacter pylori a class I carcinogen bacterium and the roles of animals have not been yet well determined. This study was carried out to investigate H. pylori phenotypically and genotypically in human and dogs to determine the antibiotic resistance patterns. As eradication therapy depends mainly on clarithromycin we evaluated 23S rRNA gene mutations associated with its resistance. ResultsA total of 150 human stool samples and 60 canine gastric biopsies were examined by nested PCR for the presence of H. pylori, 60% and 76.6% were positive respectively. Only 20 (22.2%) and 41 (89.1%) isolates were successfully cultured from human and canine samples respectively. Genotyping revealed a total of cagA+vacA+ combinations 76.6% (69/90) and 65.2% (30/46) in human and dogs, respectively. Allelic diversity in vacA gene was obviously observed, while cagA-vacA+ combinations were 23.3% (21/90) and 34.7% (16/46) in human and dogs, respectively. The antimicrobial susceptibility patterns of human exhibited the highest levels of resistance against Clarithromycin (60%), Trimethoprim (55%), metronidazole (45%), amoxicillin (45%) and cefsulodin (60%) antibiotics and comparatively lower for spiramycin (10%) and tetracycline (15%). Dogs strains showed the highest levels of resistance against Clarithromycin (53.6%), metronidazole (51.2%) and erythromycin (43.9%) antibiotics, on the other hand, the percent of resistant canine strains were comparatively lower for spiramycin (9.7%). Single point mutation of A2143G was detected as 25% (3/12), 18.1% (4/22) in human and dogs respectively. Single point mutation of A2142G was detected as 16.6% (2/12), 13.6% (3/22) in human and dogs, respectively. While dual mutations of both A2142G and A2143G were detected as 50% (6/12), 40.9% (9/22) in human and dogs, respectively. Conclusionoccurrence of elevated rates of A2142G and A2143G point mutations in clarithromycin resistant H. pylori isolates from human and dogs causing failure in treatment and eradication of the pathogen. The roles of animals need attention and further investigations.

High incidence of autoimmune gastritis in patients misdiagnosed with two or more failures of H. pylori eradication

Although autoimmune gastritis (AIG) is generally considered relatively rare, we frequently encounter AIG among patients at to our hospital who have experienced at least two episodes of Helicobacter pylori eradication failure. We investigated the incidence of AIG in consecutive patients who consulted our department for H. pylori eradication with reference to eradication history. A total of 404 consecutive patients who visited the H. pylori-specific out-patient unit of our hospital from June 2015 to June 2017 were enrolled. Of these, 137 were treatment-naive, 47 had failed treatment once (single failure), and 220 had failed treatment twice or more (multiple failures) by 13 C-UBT. Gastroscopy was performed in all patients. Culture tests of gastric mucosal samples were performed for H. pylori and other bacteria positive for urease activity. Anti-parietal cell antibody (APCA) was measured. Patients with severe atrophy in the gastric corpus and positivity for APCA were diagnosed as having AIG. A total of 43 patients were diagnosed as having AIG, of whom two were treatment-naive (1.5%, 2/137), 1 failed eradication once (2.1% 1/47), and 40 failed treatment at least twice (18.2%, 40/220). The incidence of AIG was significantly higher in the multiple failure group than in the single failure or treatment-naive groups. Urease-positive bacteria, such as Klebsiella pneumoniae and alpha-streptococcus, were identified in 33 of the 35 AIG patients who underwent culture testing. AIG patients were often misdiagnosed as refractory to eradication therapy, probably because achlorhydria in AIG might allow urease-positive bacteria other than H. pylori to colonise the stomach, causing positive 13 C-UBT results.

Clarithromycin resistance and female gender affect Helicobacter pylori eradication failure in chronic gastritis.

Background/AimsThe eradication rate of the first-line triple therapy (a proton pump inhibitor, clarithromycin, and amoxicillin) for Helicobacter pylori infection has gradually decreased in Korea. We evaluated whether clinical parameters, clarithromycin resistance, and CYP2C19 genotype can affect the eradication failure.MethodsA total of 203 patients with H. pylori-positive chronic gastritis were consecutively enrolled. They received clarithromycin-based triple therapy for 7 days. A clarithromycin resistance test was performed by detection of A2142G and A2143G point mutations in H. pylori 23S rRNA. The CYP2C19 genotype was examined for polymorphism G681A of exon 5 and G636A of exon 4 by polymerase chain reaction with restriction fragment length polymorphism. Eradication was assessed by a 13C-urea breath test 4 weeks after treatment.ResultsOf 203 patients, 190 completed the study. The eradication rate was 64.0% according to intention-to-treat analysis and 68.4% by per-protocol analysis. CYP2C19 genotypes were identified as follows: 75 poor metabolizers, 75 intermediate metabolizers, and 40 rapid metabolizers. Nonetheless, this polymorphism was not significantly associated with eradication failure (p = 0.682). Clarithromycin resistance was detected in 33/190 patients (17.4%), and their eradication rate was zero. Clarithromycin resistance (odds ratio [OR], 19.13; 95% confidence interval [CI], 9.35 to 35.09) and female gender (OR, 1.73; 95% CI, 1.15 to 4.25) were significantly associated with eradication failure. The other clinical parameters such as age, cigarette smoking, alcohol intake, the body mass index, hypertension, and diabetes were not significantly associated with eradication.ConclusionsClarithromycin resistance and female gender are factors affecting H. pylori eradication failure in patients with chronic gastritis.

Length of Barrett\u2019s segment predicts failure of eradication in radiofrequency ablation for Barrett\u2019s esophagus: a retrospective cohort study

BackgroundWe aim to investigate factors that may contribute to failure of eradication of dysplastic Barrett’s Esophagus among patients undergoing radiofrequency ablation treatment.MethodsA retrospective review of patients undergoing radiofrequency ablation for treatment of Barrett’s Esophagus was performed. Data analyzed included patient demographics, medical history, length of Barrett’s Esophagus, number of radiofrequency ablation sessions, and histopathology. Subsets of patients achieving complete eradication were compared with those not achieving complete eradication.ResultsA total of 107 patients underwent radiofrequency ablation for Barrett’s Esophagus, the majority white, overweight, and male. Before treatment, 63 patients had low-grade dysplasia, and 44 patients had high-grade dysplasia or carcinoma. Complete eradication was achieved in a majority of patients (57% for metaplasia, and 76.6% for dysplasia). Failure of eradication occurred in 15.7% of patients. The median number of radiofrequency ablation treatments in patients achieving complete eradication was 3 sessions, compared to 4 sessions for failure of eradication (p = 0.06). Barrett’s esophagus length of more than 5 cm was predictive of failure of eradication (p < 0.001).ConclusionsRadiofrequency ablation for dysplastic Barrett’s Esophagus is a proven and effective treatment modality, associated with a high rate of complete eradication. Our rates of eradication from a center starting an ablation program are comparable to previously published studies. Length of Barrett’s segment > 5 cm was found to be predictive of failure of eradication in patients undergoing radiofrequency ablation.

Key lime (Citrus aurantifolia) inhibits the growth of triple drug resistant Helicobacter pylori

BackgroundEradication rate for Helicobacter pylori (H. pylori) has decreased due to antibiotic resistance. Therefore, new strategies are needed to enhance H. pylori eradication, especially for H. pylori with high antibiotic resistance. The objective of this study was to evaluate anti-H. pylori activities of constituents from key lime (Citrus aurantifolia) and their possible inhibitory effects on urease activity of H. pylori.MethodsHelicobacter pylori strain ATCC 43526 and triple drug resistant (TDR) H. pylori strains were used in this study. Urease activities of H. pylori strains were measured by ammonia colorimetrical quantification using ELISA reader. Minimum inhibitory concentrations were determined by agar dilution method for antibiotics and by modified media dilution method for each constituent of Citrus aurantifolia (C. aurantifolia).ResultsCitrus aurantifolia extract decreased the number of colonies of H. pylori strain ATCC 43526 and TDR H. pylori stains. An increasing concentration of C. aurantifolia extract attenuated urease activities of H. pylori strain ATCC 43526 and TDR H. pylori strains. Among constituents of C. aurantifolia, citral and 4-hexen-3-one were found to be able to inhibit the growth of H. pylori strain ATCC 43526 and TDR H. pylori strains. Furthermore, citral and 4-hexen-3-one inhibited urease activities of H. pylori strain ATCC 43526 and TDR H. pylori strains in a dose-dependent manner.ConclusionCitrus aurantifolia has antimicrobial effect on TDR H. pylori strains, suggesting that C. aurantifolia might have therapeutic potential to control antibiotic-resistant H. pylori strains that cause eradication failure using other antibiotics.