Hpylori Eradication Research Articles

Spasmolytic polypeptide-expressing metaplasia associated with higher expressions of miR-21, 155, and 223 can be regressed by Helicobacter pylori eradication in the gastric cancer familial relatives.

Spasmolytic polypeptide-expressing metaplasia (SPEM) is a preneoplastic gastric cancer lesion related to epigenetic microRNA (miRNA) expression. This study elucidated whether Helicobacter pylori-infected first-degree relatives of patients with gastric cancer (GCF) are susceptible to have SPEM and correlated with miR-21, 155, and 223 expressions. We also validated whether SPEM and these miRNAs can be regressed after Hpylori eradication. We prospectively enrolled 148 GCF and 148 nonulcer dyspepsia (NUD) subjects without gastric cancer familial history as controls. Each case had received a panendoscopy to determine Hpylori status and gastric histology, including SPEM. The cases with SPEM were followed after Hpylori eradication to determine SPEM regression. The total RNA was extracted to analyze tissues miR-21, 155, and 223 before and after eradication. GCF subjects had a higher prevalence of Hpylori infection (73% vs 32%) and SPEM (42% vs 14%, P<0.01) than controls. The tissue miR-21, 155, and 223 in antrum were higher in cases with SPEM than in those without SPEM (P<=0.05). There was similar SPEM reversibility after Hpylori eradication between GCF subjects and controls (72% vs 69%, P=0.852). In the SPEM regressed cases, tissue miR-21, 155, and 223 decreased after Hpylori eradication (P<0.05). The H pylori-infected GCF subjects were prone to have SPEM with higher tissues miR-21, 155, and 223 expressions. Hpylori eradication can result in a 70% SPEM regression, accompanied by a decline in miR-21, 155, and 233 expression levels.

Twice daily short-message-based re-education could improve Helicobacter pylori eradication rate in young population: A prospective randomized controlled study.

To investigate the effects of twice daily short-message-based re-education (SMRE) before taking medicine for Helicobacter pylori (Hpylori) eradication. Treatment-naive patients with Hpylori infection were prescribed 14-day quadruple regimen consisting of lansoprazole 30mg, colloidal bismuth pectin 200mg, amoxicillin 1000mg, and clarithromycin 500mg twice daily. Patients were randomly allocated to SMRE group or control group. Patients in control group received oral and written instructions at outpatient clinic. In contrast, patients in the SMRE group received extra short messages including dosage and time of administration twice daily. Successful Hpylori eradication was assessed using the 13 C-urea breath test 6weeks after treatment. The compliance, adverse events, and patient satisfaction were also analyzed. A total of 310 patients were enrolled in the intention-to-treat (ITT) and 283 in the per-protocol (PP) analysis. For young patients, the eradication rates were significantly higher in SMRE group than those in control group in PP analysis (88.6% vs 71.2%, P=0.036), while for patients of all age groups, the eradication rate improvements were not statistically significant. The eradication rates in SMRE group and control group were 74.2% and 67.7% (P=0.211) in ITT analysis and 82.1% and 73.4% (P=0.078) in PP analysis, respectively. The compliance in SMRE group was significantly better than that in control group (84.8% vs 72.8%, P=0.011). Twice daily SMRE could improve the eradication rate in young population, as well as the compliance with treatment during Hpylori eradication.

Bismuth supplements as the first-line regimen for Helicobacter pylori eradication therapy: Systemic review and meta-analysis.

An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (Hpylori). Consequently, it has been considered that the first-line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first-line regimen for Hpylori eradication. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta-analysis of all randomized controlled trials comparing bismuth supplements with non-bismuth-containing regimens in Hpylori eradication was performed. RCTs of classic bismuth-containing quadruple therapy as a first-line regimen were excluded. We identified twenty-five randomized trials (3990 patients), and the total Hpylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57-2.13). Among these RCTs, there were 7 RCTs for bismuth add-on therapy, and the odds ratio was 2.81 (95% CI. 2.03-3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth-containing regimens were superior to non-bismuth regimens. Moreover, the incidence of total side effects was insignificant. Bismuth supplements as a first-line regimen could be effective, with bismuth add-on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin-resistant strains and would be the most viable alternative in clinical practice.

Aspirin and Risk of Gastric Cancer After Helicobacter pylori Eradication: A Territory-Wide Study.

Despite successful H. pylori (HP) eradication, some individuals remain at risk of developing gastric cancer (GC). Previous studies showed that aspirin was associated with a reduced GC risk. However, whether aspirin can reduce GC risk in HP-eradicated subjects remains unknown. We aimed to determine the chemopreventive effect of aspirin in HP-eradicated subjects. We identified subjects who had received a prescription of clarithromycin-based triple therapy for HP between 2003 and 2012 from a territory-wide health care database. The observation period started from commencement of HP therapy (index date), and the follow-up was censored at the end of the study (December 2015), death, or GC diagnosis. Aspirin use was defined as use once or more often weekly. Subjects who failed HP eradication or were diagnosed with GC within 12 months of HP therapy were excluded. The hazard ratio (HR) of GC with aspirin use was calculated by Cox model with Propensity Score adjustment for age, sex, comorbidities, and concurrent medications. All statistical tests were two-sided. The median follow-up was 7.6 years (interquartile range [IQR] = 5.1-10.3 years), and 169 (0.27%) out of 63 605 patients developed GC. The incidence rate of GC was 3.5 per 10 000 person-years. Aspirin use was associated with a reduced GC risk (HR = 0.30, 95% confidence interval [CI] = 0.15 to 0.61). The risk of GC decreased with increasing frequency, duration, and dose of aspirin (all Ptrend < .001). Aspirin use was associated with a frequency-, dose-, and duration-dependent reduction in GC risk after HP eradication. The effect was most prominent in those who used aspirin daily or for five or more years.

Levofloxacin based vs clarithromycin based sequential therapy in helicobacter pylori eradication; a randomized clinical trial.

This study was aimed to evaluating the efficacy of levofloxacin based sequential therapy vs clarithromycin based sequential therapy in h.pylori (HP) eradication. Several therapeutic regimen were investigated to treat HP infection. Sequential therapy is an alternative to classic triple therapy. In this randomized clinical trial, 200 HP infected patients randomly divided into two therapeutic groups .1-Levofloxacin based sequential regimen (group A); omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and levofloxacin for 7days. 2-clarithromycin based sequential regimen (group B): omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and clarithromycin for 7days. HP eradication was evaluated with urea breath test with carbon 13 (UBT) 6 weeks after the end of treatment. Per protocol eradication rates of group A and B were 87.6% and 76% respectively. By intention to treat analysis, eradication rate of group A and B groups were 85.1% and 73% respectively. Levofloxacin based sequential regimen was more effective than clarithromycin based sequential regimen (Pv=0.028). Adverse events were seen in 19.6% and 15.6% in group A and B respectively. Drug compliance was 97% in group A and 96% in group B. There was no significant difference between two groups in term of adverse events (p=0.470) and compliance (p=0.651). Levofluxacin based sequential therapy was more effective than Clarithromycin based sequential therapy in HP eradication. The suggested Levofluxacin based sequential therapy could be an alternative therapy in area with high clarithromycin resistance. Further studies are needed to confirm these findings.

Evaluation of the clinical characteristics, management, and prognosis of 103 patients with gastric mucosa-associated lymphoid tissue lymphoma.

The diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is difficult owing to its non-specific symptoms and various endoscopic findings. Treatments such as radiotherapy (RT) for localized and chemotherapy (CT) for advanced stages of the disease are employed. The aim of the present study was to examine the clinical characteristics and prognostic factors of Helicobacter pylori (H. pylori) eradication (HPE) in patients with gastric MALT lymphoma. The medical records of 103 patients with gastric MALT lymphoma for the period 2001–2013, were analyzed. The 103 median age of the patients was 53 years and the male to female ratio was 1:1. Serum lactate dehydrogenase and β2-microglobulin were within normal range. Macroscopically, the most commonly involved site was the antrum, followed by the corpus and fundus. A total of 97 patients (94%) tested positive for H. pylori. Forty patients (39%) had stage I, 35 patients (35%) had local or distant nodal involvement, 20 of 103 patients had stage IIIE (19%) and 8 of 103 patients had stage IV (7%) disease. Complete remission, after HPE, was achieved in 54 of the 69 patients (78%) that were H. pylori-positive and in 2 of the 4 patients (50%) that were H. pylori-negative. HPE had a superior trend in the H. pylori-positive patients although no significant difference was identified in the two groups (p=0.194). In patients with advanced disease, the 5-year progression-free survival (PFS) and overall survival (OS) estimates were significantly improoved for patients receiving HPE with CT or RT than those receiving CT or RT (p=0.046 and 0.035, respectively). The multivariate analysis revealed that, the advanced stages were independently associated with shorter PFS, and the modified-International Prognostic Index (m-IPI) (≥2) was associated with shorter OS. In conclusion, gastric MALT lymphoma had a favorable outcome with a high OS rate. HPE was an effective treatment for gastric MALT lymphoma. The patients with advanced stages and m-IPI (≥2) had a much worse prognosis.

Recent trends in peptic perforation

Introduction: The peptic perforation is one of the commonest abdominal surgical emergencies. Common causes are H.pylori, increased inadvertent use of NSAIDS, smoking and stress of modern life. During last few years there has been great revolution in availability of the newer broad spectrum antibiotics, better understanding of disease, effective resuscitation, prompt surgery under modern anaesthesia techniques, and intensive care unit resulted in reducing the mortality. Materials and methods: This prospective study was carried out in the department of surgery during period from 1st May 2009 to 30th November 2011. All were indoor patients with diagnosis of peptic perforation in stomach and/or duodenum excluding other sites. Each patient was study in detail with relevant clinical history, examination, laboratory investigations and management. The study comprised of total 50 patients operated for peptic perforation by various modalities. Results: the middle age group was commonest. Smoking, alcohol and stress were common etiological factors. The perforation was common in anterior surface of the first part of duodenum. Wound infection and bronchopneumonia were common post-operative complications. Discussion: The duration of perforation more than 24 hours and size of the perforation more than 1 cm has increase morbidity & mortality. Early diagnosis and prompt management of shock & septicaemia is important for better prognosis of patients. The simple closure with omentopexy of peptic perforation still remains the first choice as a treatment. H-pylori eradication treatment is mandatory after simple closure of the perforation to prevent recurrence of ulcer.

O1-041 - Front-Line Antibiotic Therapy in Early-Stage H. Pylori-Positive Gastric Diffuse Large B-Cell Lymphomas with or Without Malt Features

ABSTRACT Background Our earlier study showed that certain proportion of early-stage H. pylori (HP)-positive gastric diffuse large B-cell lymphoma (DLBCL) with features of mucosa-associated lymphoid tissue (MALT), DLBCL(MALT), could achieve long-term complete pathological remission (pCR) after frontline HP eradication therapy (HPE). In this retrospective, explorative study, we evaluate the efficacy of HPE on early-stage gastric DLBCL without features of MALT, the pure (de novo) DLBCL, in comparison with its efficacy on high-grade transformed gastric MALT lymphoma, the DLBCL(MALT). Methods A total of 50 patients of stage IE/IIE1, HP-positive gastric DLBCL with frontline HPE treatment were included. Of them, 16 patients with pure (de novo) DLBCL were retrospectively identified from medical/pathologic review and 34 patients with DLBCL (MALT) were an expanded cohort of one previously reported multicenter prospective study. pCR was defined as regression of DLBCL to Wotherspoon grade 2 or less in all histologic sections of follow-up endoscopic biopsies. Results HP infection was successfully eradicated in 100% (16/16) of the pure (de novo) DLBCL and 94.1% (32/34) of the DLBCL(MALT) patients. A total of 68.8% (11/16) of pure (de novo) DLBCL and 56.3% (18/32) of DLBCL(MALT) patients achieved pCR after HPE. The median time-to-pCR was 2.1 months (95% CI, 0.6–3.7) for pure (de novo) DLBCL and 5.0 months (95% CI, 2.8–7.5) for DLBCL(MALT) (P = 0.024). At a median follow-up of 7.7 years (95% CI, 4.5–10.9), all patients with pCR after HPE were alive and free of lymphoma, except one patient with pure (de novo) DLBCL died of lung cancer. Conclusions Similar to DLBCL(MALT), a substantial portion of early-stage, HP-positive gastric pure (de novo) DLBCL remains HP-dependent and responds to antibiotic treatment. Prospective studies to validate the findings are warranted.

Mo1565 Helicobacter pylori Infection and Development of Gastric Cancer a 10-Year Follow-up Population-Based Study in a High Incidence Area

Backgrounds & Aim: H. pylori (HP) infection is the most important etiology of gastric cancer (GC) in the world but it causes GC in only a minority of those infected .Eradication of HP can decrease the development of GC only in the subgroup of HP infected subjects without precancerous lesions. Strategies of HP eradication is still not well defined in countries with high mortality rates secondary to GC with almost universal HP infection in adults. The aim of the present study was to investigate the predictors of GC in an adult population with almost universal HP infection in an area with highest rate of gastric cancer in the world. Methods: 1011 healthy subjects 40 years and older, permanent residents of Ardabil and Meshkinshahr districts in northwest Iran, were randomly selected and enrolled in an endoscopic screening study during 2000 to 2001 year. Data on demographics and potential risk factors were collected using a well-structured questionnaire. Upper gastrointestinal endoscopy with multiple biopsy sampling was performed to detect HP infection and endoscopic precancerous lesions.Participants have been followed up until 2011. During followup period data on the occurrence of GC, mortality, and cause of death were obtained from cancer and death registries, and when neccessary by direct contacting to participants, and their families. The cumulative incidence and person-time incidence rate were calculated. The effect of other risk factors in addition to H. pylori infection on the risk of GC development were estimated by fitting multivariate hazard model using Cox proportional regression analysis, and were presented as hazard ratio (HR) and corresponding 96% confidence interval (95%CI). Results: During 10-year follow up, 36 participants (3.6%) developed GC yielding an incidence rate of 3.6 per 1000 person-years. The significant risk factors of GC included age over 50 (HR 4.8; 95%CI 1.4-16.2), a positive family history of stomach cancer (6.4; 3.1-13.1), smoking (5.7; 2.5-12.6), gastric atrophy (2.3; 1.0-5.1), intestinal metaplasia (4.5; 2.3-8.9) and presence of gastric ulcer (4.8; 1.9-11.5). Joint presence of precancerous lesion and one of the other risk factors significantly increased risk of stomach cancer as (46.5; 10.8-98.6) for a positive family history of stomach cancer; (27.6; 6.5-116.4) for smoking and (25.1; 16.3-105.3) for age>50. Conclusion: Combining the information on family history, lifestyle risk factors and the type of precancerous lesion may be helpful in order to identify high risk HP infected patients who need more intensive surveillance for early detection of GC. Key words: Stomach cancer, Precancerous lesions, Risk factors, H. pylori, Ardabil,Iran.

T1043 Impact of Missed Opportunities to Confirm Helicobacter pylori Eradication in Peptic Ulcer Disease

BACKGROUND: Eradication of H. pylori (HP) in the setting of peptic ulcer disease (PUD) reduces the risk of recurrent bleeding. Although it is recommended in the setting of PUD, confirmation of HP eradication is not always performed. Our aim was to evaluate HP eradication confirmation and its impact on ulcer recurrence and bleeding in patients presenting with acute PUD. METHODS: Consecutive patients were identified who presented to our center with gastrointestinal bleeding (hematemesis, melena, hematochezia, or decrease in hemoglobin by 2 g/dL plus guaiac positive stool). Demographic, clinical, as well as endoscopic results were retrospectively collected from the time of the initial endoscopy and at every clinical contact thereafter for a minimum of 2.5 years. RESULTS: Between January 2000 and December 2004 a total of 127 individuals (mean age 68 ± 11 years) were endoscopically confirmed to have peptic ulcers. Age was positively correlated with the number of comorbidities present (r=0.33, p<0.001) as well as admission to the ICU (r= 0.19, p=0.03). The cause of the ulcers was identified as NSAIDs alone in 50 (39%), H. pylori alone in 20 (16%), NSAIDs and H. pylori in 37 (29%), and non-NSAID non-H. pylori in 20 (16%). Among the 57 individuals with H. pylori associated ulcer disease, 52 (91%) received antibiotic treatment, however confirmation of eradication was attempted in only 19 (37%), and among those tested, treatment was successful in 16 (84%). Emergent rebleeding occurred in 18 (14%) of the cohort overall, and was correlated with the need for emergency transfusion prior to the initial endoscopy (r=0.34, p=0.028). The number of ulcers found on the initial endoscopy was also positively correlated with the chance of rebleeding (r=0.32, p=0.014). The lowest rate of rebleeding (13%) occurred in the HP eradicated group, while the rebleeding rate for the failed eradication group did not differ significantly from the group where HP eradication was not confirmed (33% vs. 33%). During follow-up endoscopy there was a trend towards more non-healed ulcers in the no-treatment/failure group (66.7%), and the group without HP eradication confirmation (33%) compared to the group that was successfully eradicated (25%). CONCLUSIONS: H. pylori eradication is not confirmed in many patients with associated peptic ulcer disease. These missed opportunities are associated with increased rates of emergent ulcer rebleeding and reduced ulcer healing rates. Further studies are required in large cohorts to assess the impact of failure to confirm eradication in H. pylori-associated ulcer disease.

One-Day Triple Therapy, Including Immediate-Release Omeprazole, for Eradication of Helicobacter pylori Infection

Purpose: Regimens to treat H. pylori (HP) are cumbersome for patients to take, expensive & frequently associated with undesirable side effects, all of which can negatively affect compliance & eradication rate. To achieve >80% eradication rate requires administration of 3–4 different meds, given for 7–14 days. A recent study found that a 1-day treatment (Tx) regimen of 4 drugs (lansoprazole, bismuth, metronidazole & amoxicillin) gave an eradication rate of 95% (Arch Intern Med 2003;163:2079). Effective 1-day Tx regimens, if confirmed to be effective, would simplify Tx and have great potential to improve patient compliance. An immediate release form of omeprazole (omeprazole/Na bicarbonate; Zegerid) has recently come onto the market. We hypothesized that this agent, which is immediately released, rapidly absorbed into the bloodstream & achieves prompt gastric pH buffering, might hold a clinical benefit over other PPIs when used in 1-day HP Tx regimens. Methods: We conducted a prospective single-arm open-label pilot trial looking at the efficacy of a 1-day regimen of immediate-release omeprazole, in combination with amoxicillin & clarithromycin, to eradicate HP. Patients were eligible for the study if they had HP infection documented by gastric Bxs taken at EGD for dyspepsia. Exclusion criteria included previous Tx of HP, antibiotic Tx in the previous 6 wks, age < 18 yrs, pregnancy, allergy to study meds, previous gastric surgery, hepatic insufficiency, IBD, & inability to give informed consent. Of 14 patients with Bx-documented HP infection, 6 met entry criteria and agreed to participate. They received 1-day of therapy with immediate-release omeprazole 40 mg, amoxicillin 1000 mg and clarithromycin 500 mg, with each given for a total of 3 doses (at 0 hrs, 4 hrs & 12 hrs). Patients did not receive any other PPIs during the subsequent study period. Four wks after their Tx, patients underwent urea breath testing to evaluate for HP eradication. Persistent HP infection was treated with a 14-day triple drug regimen. Results: We found that our 1-day Tx regimen failed to eradicate HP in all 6 patients. Conclusion: This pilot study showed that our 1-day triple drug regimen, which included immediate-release omeprazole, was not effective in the Tx of HP infection. Adding a fourth drug to the regimen could improve efficacy. Further studies of 1-day HP regimens are needed before they can be recommended for routine clinical practice.

Evaluation of 2 doses of clarithromycin with metronidazole and lansoprazole for 7 days in eradication of H. Pylori

OBJECTIVES: This study was designed: (1) to compare efficacy in eradicating H. pylori (HP) of 2 doses of clarithromycin (250mg vs 500mg) with lansoprazole 30mg and metronidazole 500mg all given bd for 7 days. (2) to assess pre treatment metronidazole and clarithromycin resistance (if any); on efficacy and (3) to compare mean symptom scores (MSS) in responders with non responders. METHODS: Of 81 dyspeptic patients gastroscoped, 55 (67.9%) who were CLO+ve on antral gastric biopsy evaluation were randomized to receive LMC250 or LMC500. Cultures for liP were performed on biopsies and antimicrobial susceptibility tests (metronidazole and clarithromycin) conducted on isolates. Baseline BFF (+= > 100 dpm) confirmed HP infection at entry. 4 weeks post treatment, B/T were repeated to confirm HP eradication. Repeat endoscopy, culture and sensitivity were performed in non responders. At 6 mths, a third B/r evaluated HP recurrence. MSS (0-4: epigastric pain, nausea, vomiting, heartburn, belching, bloating, pain relief after meals, hunger pains. Max=32) were scored at entry, 4 weeks and 6 months. RESULTS: 5155 (9.1%) CLO+ve patients were withdrawn (3 baseline -ve BFFs, 1 returned LMC, 1 culture result uncertain). 27150 (54%) CLO+ve, B/T+ve patients were culture+ve for HP. Isolates from 3/27 (11.1%) showed resistance to metronidazole only. At 4 weeks follow up 43/50 (86.0%) had -ve B/T;7/50 were B/T+ve culture-ve. All 21/43 responders re-tested by 6-mth B/T remained HP-ve. Of 6/7 non-responders re-tested at 6-mths, 5/6 remained HP+ve (1 late responder). MSS at entry: responders (13.9) non responders (18.6); at 4 weeks: responders (6.4) non responders (4.2). In vivo resistance to metronidazole did not occur.

&lt;i&gt;Helicobacter pylori&lt;/i&gt;除菌効果判定指標としての胃液中尿素濃度測定

The aim of the present study was to find the usefulness of gastric aspirated urea concentration in detection of the efficacy of eradication of H pylori (HP) by comparing with gastric ammonia concentration and serum pepsinogen I/II ratio. A total of 32 subjects (15 with gastric ulcer, 15 with duodenal ulcer, and 2 with gastro-duodenal ulcer) were infected with HP. HP infection was detected by microscopic examination of slides stained by Gram's method and treated with Pfeiffer fluid. All patients received lansoprazole (30mg, every morning) and ecabet sodium (2ｇ, twice a day) for 6 or 8 weeks. Patients also received amoxicillin (750mg, three times a day) for last 2 weeks. The clearance and eradication rates were 100% (20/20) and 60% (12/20) , respectivery. The eradicated group had significantly higher gastric urea and serum pepsinogen I/II levels, and significantly lower gastric ammonia level than before eradication and the non-eradicated group. There were few subjects overlapping in gastric ammonia and serum pepsinogen I/II levels, but no subjects overlapping in gastric urea level in the eradicated and the non-eradicated groups. Measurement of gastric urea level may provide a useful tool for detecting the efficacy of HP eradication.