Gastric carcinoma ranks tenth in incidence among all cancers in men and women in Germany. 5565 women and 9027 men received a diagnosis of gastric carcinoma in Germany in 2022. The German clinical practice guideline was comprehensively revised with the interdisciplinary participation of German specialty societies under the leadership of the German Society for Gastroenterology, Digestive and Metabolic Disorders, according to the methodological specifications of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). The new recommendations promote preventive measures in the presence of risk factors such as hereditary diseases or infection with Helicobacter pylori. Combinations of chemotherapy with immunotherapy, such as nivolumab, pembrolizumab, and tislelizumab, prolong median overall survival compared to chemotherapy alone (e.g., nivolumab plus chemotherapy, 14.4 vs. 11.1 months, HR 0.71) and markedly prolong 5-year survival to 16%. In patients with high claudin18.2 expression, the antibody zolbetuximab, combined with chemotherapy, prolongs median survival to 16.4 vs. 13.4 months (HR 0.77). For patients in good general health, further chemotherapy or biomarker-defined approved second-line (trastuzumab deruxtecan, pembolizumab) or third-line treatment (e.g., trifluridine tipirazole) and advanced molecular-pathological diagnostic testing should be offered at centers for personalized oncology in case of treatment failure. The biomarkers HER2, PD-L1, MSI, and claudin18.2 enable new targeted therapies in palliative situations with long-term improvement in outcome. The diagnostic evaluation of gastric carcinoma should include high-resolution video endoscopy, and its treatment should be stage-adapted and interdisciplinary. Monoclonal antibodies and immune checkpoint inhibitors are increasingly being used for palliative treatment. The new modifications to the clinical practice guideline will promote the use of uniform strategies for perioperative and palliative treatment and supportive measures.

The use of Helicobacter pylori stool antigen test is limited in Sri Lanka. The validity of the amplified IDEIA HpSt AR monoclonal antibody test was examined in 51 patients who underwent upper gastrointestinal endoscopy and multiple gastric biopsies for dyspeptic symptoms. Histology with both H&E and modified Giemsa was considered as the reference standard. There were 33 males and the mean age (SD) of study subjects was 49.4(15.4) years. Endoscopically, forty-three (84.3%) patients had abnormal findings in the stomach predominated by prepyloric erosions (53.5%). Histologically, all patients had features of chronic gastritis and activity was detected in 94.1% of patients. Histologically (both H&E and modified Giemsa) 82.4% of patients had morphological evidence of H. pylori in the gastric mucosa. Stool antigen test was positive only in 7 out of 51 (13.7%) patients. The sensitivity and specificity of the stool antigen test in this study were 11.9% and 77.8%, respectively. The negative and positive predictive values were 15.9% and 71.4%, respectively. A low concentration of H. pylori stool antigen below the required level of detection could be a plausible explanation for false negative results. Furthermore, decreased shedding of the organism with increasing chronicity of infection may be another reason. Infection of the local population with a hitherto unknown strain of H. pylori is worth considering. In conclusion, until further testing is done, the validity of amplified IDEIA HpSt AR monoclonal antibody test as H. pylori detection technique in the local population cannot be supported by our observations.

This study aimed to determine whether H. pylori or its antigens affect the age at which coeliac disease (CeD) was diagnosed. Participants over 20 years old from the HUNT4 survey were screened for CeD by measuring serum immunoglobulin A and immunoglobulin G antibodies against transglutaminase-2. H. pylori status was defined by detecting H. pylori-specific immunoglobulin G. H. pylori + participants had a mean age of 62.3 years, compared to 54.8 years for negative participants. In those with previously undiagnosed CeD (n = 43), higher antibody levels against GroEL were associated with an older age at sampling (67.2 years for GroEL-positive vs. 50.8 years for negative). Smaller age differences were noted for gGT (6.0 years), UreA (8.6 years), and HpcC (6.4 years), while vacA and cagA showed only minor differences. Participants with CeD and H. pylori + were older than those who were H. pylori-. The presence of antigens such as GroEL, gGT, and UreA appeared to be associated with this age difference. Aside from H. pylori infection in childhood, a cohort effect of H. pylori infection may partly explain the differences.

Empirical therapy versus tailored therapy for Helicobacter pylori infection? A systematic review.

Microalgae represent sustainable sources of bioactive compounds with potential health benefits. This study conducted a comprehensive proteomic analysis of Tetraselmis chuii (T. chuii) biomass to identify proteins capable of generating bioactive peptides (BAPs) through simulated orogastric digestion. In silico digestion and bioinformatic predictions indicated the release of antioxidant, anti-inflammatory, and antibacterial peptides. Molecular docking demonstrated strong interactions with targets implicated in oxidative stress, inflammation, and Helicobacter pylori (H. pylori) virulence. Biochemical assays and cell-based models confirmed antioxidant and anti-inflammatory activities in both the biomass and its digest, although no significant antibacterial effect against H. pylori was observed under the tested conditions. Considering the role of chronic inflammation in H. pylori-associated pathologies, these findings suggest that T. chuii may serve as a candidate for mitigating tissue damage driven by oxidative and inflammatory stress. Further research is required to address compound stability and optimize delivery strategies.

Helicobacter pylori (H. pylori) is a common pathogen that causes serious pathologies such as gastritis, ulcers, and gastric cancer. This study evaluates the therapeutic effects of melittin on H. pylori induced gastric injury, oxidative stress, and tissue damage in an in vivo model. Melittin was administered at two doses (10µg/kg and 40µg/kg) and outcomes were compared with standard antibiotic therapy. H. pylori infection significantly increased gastric urease activity, the pro-inflammatory cytokine IL-1β, and oxidative stress markers total oxidant status (TOS) and malondialdehyde (MDA); these increases were suppressed by melittin treatment. Melittin also enhanced antioxidant capacity total antioxidant status (TAS) and glutathione (GSH) and supported gastric tissue healing by reducing inflammation and neutrophil activity. Notably, 10µg/kg melittin led to a ~ 74% reduction in bacterial colony counts and decreased tissue damage. Histopathology confirmed that melittin lowered H. pylori colonization and inflammation scores. Furthermore, the higher dose (40µg/kg) showed more limited effects on oxidative stress than the lower dose. GSH levels improved with melittin. Melittin demonstrates antibacterial and anti-inflammatory activity against H. pylori associated gastric pathology, with several outcomes favoring the lower dose (10µg/kg). These findings indicate melittin as a promising therapeutic candidate; however, additional comprehensive studies are needed to support clinical translation.

Spasmolytic Polypeptide-Expressing Metaplasia (SPEM): the hidden linchpin in gastric carcinogenesis beyond the correa cascade.

The bacterium Helicobacter pylori (H. pylori) is widely recognized as a common pathogen strongly associated with several gastrointestinal disorders, including gastritis, peptic ulcers, and gastric cancer. Conventional treatment typically involves a combination of antibiotics and proton pump inhibitors, which, although effective, often lead to adverse effects and contribute to the growing issue of antibiotic resistance. In recent years, probiotics, defined as live microorganisms that confer health benefits when consumed in adequate amounts, have emerged as a potential supportive therapy for managing H. pylori infections. This review examines the role of probiotics in enhancing treatment outcomes, minimizing side effects, and supporting the eradication of H. pylori. Methodology: This review analysed clinical trials, meta‑analysis, and lab studies of Lactobacillus, Bifidobacterium, and Saccharomyces boulardii used alongside standard treatments. Key outcome measures included were eradication success, symptom alleviation, and reduction in complications. Conclusion: Findings from previous research demonstrate that probiotics, like Lactobacillus and Bifidobacterium, exhibit significant potential to improve eradication rates and reduce treatment associated side effects at doses of 10⁹–10¹⁰ CFU/day. When combined with conventional therapies, they offer a promising strategy to mitigate antibiotic resistance and improve patient adherence, though further large scale studies are essential to determine optimal protocols.

The glycan-rich surface of Helicobacter pylori plays a critical role in host-pathogen interactions and represents a promising target for therapeutic intervention. We report the synthesis and biological evaluation of a masked bis(pivaloyloxymethyl) phosphonate analogue of α-D-glucose 1-phosphate designed to inhibit glycoprotein biosynthesis in H. pylori. This prodrug strategy enhances bacterial uptake by neutralizing the phosphonate's dianionic charge, potentially enabling intracellular esterase-mediated release of the active phosphonate. Using metabolic oligosaccharide engineering (MOE) with Ac4GlcNAz, we demonstrate that the masked phosphonate exhibits dose-dependent inhibition of glycoprotein biosynthesis, whereas unmasked and cyclic phosphonate analogues show minimal activity. These findings highlight the potential of masked phosphonates as chemical tools for probing bacterial glycosylation and as leads for novel antibacterial agents.

Introduction.Helicobacter pylori infection is a major global health concern, and its increasing antibiotic resistance poses significant challenges to eradication therapy. Traditional methods for detecting H. pylori resistance are time-consuming and labour-intensive.Hypothesis/Gap Statement. The limitations of traditional methods highlight a critical need for a rapid, accurate and comprehensive approach to detect H. pylori resistance that can inform personalized treatment strategies and improve eradication outcomes.Aim. This study aimed to explore the potential of Raman spectroscopy as a rapid and accurate method for detecting H. pylori resistance to clarithromycin and levofloxacin.Methodology. We employed Raman spectroscopy to analyse the metabolic fingerprints of H. pylori strains treated with different concentrations of antibiotics. Principal component analysis and deuterium oxide labelling techniques were used to differentiate between resistant and susceptible strains.Results. Our results demonstrated that Raman spectroscopy can accurately predict H. pylori antibiotic resistance within 4–6 h, significantly reducing detection time compared with traditional methods.Conclusion. This study provides a promising approach for rapid and accurate detection of H. pylori antibiotic resistance, enabling personalized treatment strategies and improving eradication outcomes.

Background/Objectives: Helicobacter pylori infection is a key etiological factor in upper gastrointestinal bleeding (UGIB) due to its role in mucosal injury and ulcer formation. Despite its clinical relevance, data from the Colombian Caribbean are limited. This study aimed to describe the incidence and clinical–endoscopic features of H. pylori-associated UGIB in a high-complexity hospital in Barranquilla, Colombia. Methods: A retrospective cohort study was conducted including adults (≥18 years) admitted for UGIB between 2021 and 2023. Demographic, clinical, and endoscopic variables were obtained from institutional records. Non-parametric tests (Fisher’s exact, Wilcoxon rank-sum) were applied to compare sex and admission diagnosis. Multiple-correspondence analysis explored associations among clinical and pathological parameters. Significance was set at p < 0.05. Results: Among 329 patients with UGIB, 44 (13%) tested positive for H. pylori. The median age was 60 years, and 57% were male. Melena (48%) and hematemesis (45%) were the main presenting symptoms. Hypertension was significantly more frequent in men (45% vs. 15%, p = 0.04), while chronic gastritis was the most common histopathological finding (75%), followed by gastrointestinal ulcer (23%) and intestinal adenocarcinoma (16%). The majority of ulcers were Forrest IIA (50%), followed by III (40%) and IB (10%), with no sex differences (p > 0.92). Multiple correspondence analysis revealed that male patients tended to present melena and chronic gastritis, whereas females and older adults were more likely to exhibit hematemesis. Conclusions: H. pylori-associated UGIB in this cohort primarily affected older adults with chronic gastritis and hypertension. Recognition of these clinical–pathological profiles may guide early detection, targeted therapy, and prevention strategies in similar regional contexts.

Background and Objectives: Helicobacter pylori (H. pylori) infection remains one of the most common chronic bacterial infections worldwide and is associated with a wide range of gastrointestinal disorders, including gastritis, peptic ulcer disease, and gastric cancer. Increasing rates of antibiotic resistance, particularly to clarithromycin and fluoroquinolones, represent a major therapeutic challenge. The objective of this study was to determine the prevalence of resistance-associated mutations in H. pylori-positive gastric biopsy samples from western Romania. Materials and Methods: We conducted a prospective study from January to December 2024, enrolling 138 patients undergoing gastroscopy. Biopsies were collected from the gastric antrum, and H. pylori infection was confirmed using the rapid urease test (RUT). Positive samples were further analyzed with the GenoType HelicoDR assay to detect mutations in the 23S rRNA gene (clarithromycin resistance) and gyrA gene (fluoroquinolone resistance). Clinical, demographic, and endoscopic data were also collected. Results:H. pylori infection was confirmed in 41.3% of the patients (57), of whom 63.2% (36) were treatment-naïve and 36.8% (21) had prior eradication therapy. Among treatment-naïve patients, clarithromycin resistance was identified in 19.4%, whereas previously treated patients showed a markedly higher resistance rate of 47.6% (p = 0.018). All clarithromycin-resistant cases carried the A2147G (23S MUT3) mutation. Fluoroquinolone resistance was present in 13.9% of naïve patients and increased to 23.8% in those with prior eradication therapy, with resistance linked to gyrA mutations at codons 87 (N87K) and 91 (D91 variants). Combined resistance to both antibiotics was observed only in a subset of previously treated patients. Conclusions: Primary resistance to clarithromycin in western Romania exceeds the 15% threshold defined by international guidelines, making clarithromycin-based triple therapy unsuitable as an empirical first-line option. The findings support the use of bismuth quadruple therapy as the preferred empirical regimen in this region. Also, molecular testing proved effective for rapid identification of resistance-associated mutations.

The effects of family-based Helicobacter pylori infection control and management strategies in Southwest China households: a two-year retrospective cohort study

Autoimmune gastritis (AIG) is a chronic immune-mediated disease characterized by anti-parietal cell antibody (PCA) and corpus-predominant atrophy. However, epidemiological data on AIG remain limited in China where the prevalence of Helicobacter pylori (H. pylori) is high. This study aimed to estimate the prevalence and associated factors of AIG in a hospital-based population. This study enrolled subjects who underwent the first upper gastrointestinal endoscopy at Renji Hospital from August 2023 to August 2025. All participants received serological tests and histopathological evaluation, and demographic information and medical history were recorded. Individuals with prior history of H. pylori eradication were excluded. AIG was diagnosed by PCA positivity with corpus-dominant atrophy and/or intestinal metaplasia, regardless of H. pylori status. A total of 1378 subjects (mean age 53.7 years, 56.7% female) were included. The positive rates of PCA and IFA were 12.6% and 1.4%, respectively. Compared with PCA-negative individuals, PCA-positive subjects had significantly lower H. pylori infection rates and higher frequencies of coexisting autoimmune diseases, particularly autoimmune thyroid diseases (AITD). Overall, 54 subjects (3.9%) met the diagnostic criteria for AIG (mean age 56.3 years, 70.4% female), with 29.6% anemia, 27.8% coexisting AITD. Among AIG patients, intestinal metaplasia was present in 81.5%, pseudo-pyloric metaplasia in 42.6%, gastric neuroendocrine cell hyperplasia in 27.8%, and fundic gland polyps in 11.1%. This study provides a comprehensive estimate of AIG prevalence in Chinese population, identifying key associated factors, offering valuable data for early screening and risk assessment of AIG.

Diagnostic accuracy of non-invasive tests for helicobacter pylori infection in children: A multicenter retrospective study by SIGENP.

The IL-17 axis in gastric carcinogenesis: From inflammation to oncogenic transformation.

Increasing antibiotic resistance rates and cost constraints necessitate optimized Helicobacter pylori therapies. This trial compared the efficacy, safety, and cost-effectiveness of vonoprazan-amoxicillin dual therapy versus bismuth quadruple therapy for H. pylori eradication using China's centralized procurement antibiotics. In this multicenter, randomized, controlled trial, 534 treatment-naïve H. pylori-infected patients were assessed, with 450 patients ultimately assigned to the VNCDPA-dual (vonoprazan 20 mg BID + amoxicillin 1 g TID), B-quadruple (esomeprazole 20 mg BID + non-procurement amoxicillin 1 g BID + clarithromycin 500 mg BID + bismuth 600 mg BID), or BNCDPA-quadruple group (same as B-quadruple but with amoxicillin obtained via centralized procurement). Eradication rates were assessed using the urea breath test [per-protocol (PP) and intention-to-treat (ITT) analyses]. Adverse events (AEs) and costs were systematically evaluated. Eradication rates were comparable among groups [92.1% (B-quadruple) vs. 90.7% (BNCDPA-quadruple) vs. 91.7% (VNCDPA-dual) in PP analysis (p = 0.889); 85.3% vs. 84.7% vs. and 88.0% in ITT analysis (p = 0.947)]. VNCDPA-dual demonstrated superior safety, with significantly fewer AEs (6.8% vs. 17.9%-19%; p = 0.003), particularly dysgeusia (1.4% vs. 15.2%-15.6%; p < 0.001). Centralized procurement amoxicillin reduced costs by 44% (¥239 per course vs. ¥315 per course) without compromising efficacy. Compliance was highest in the VNCDPA-dual group (99% vs. 95.9.7%-95.2% in the quadruple groups, p < 0.04). This study confirms that 10-day vonoprazan-amoxicillin dual therapy (using National Centralized Drug Procurement antibiotics) demonstrates noninferior efficacy to bismuth quadruple therapy while offering superior safety, better compliance, and the advantage of shorter treatment duration. These findings support its adoption as a first-line regimen for large-scale H. pylori eradication programs.

Revisiting the Role of Helicobacter Pylori in Immune Thrombocytopenia: Insights from a Tertiary Care Centre in India

Current Artificial Intelligence (AI) models for detecting gastric Helicobacter pylori (HP) infection rely on single-images, lacking integration of multi-regional stomach data. We developed a multi-region, multi-image Convolutional Neural Network (CNN) model to enhance diagnostic accuracy. From Nanfang Hospital of Southern Medical University, 5,169 cases (104,437 images) were split into training (80%) and test (20%) sets. The models-single-image CNN and our multi-region CNN-were trained and tested for HP infection diagnosis. External validation used 696 cases (20,948 images) from three non-training hospitals (Baiyun Branch of Nanfang Hospital of Southern Medical University, Shunde Hospital of Southern Medical University, Shenzhen Second People's Hospital). (1) Validation results of multi-region and multi-image CNN model and single-image CNN model on the test set of Nanfang Hospital of Southern Medical University are given as follows: The accuracies are 95.1% vs. 93.3%, P < 0.05. The sensitivities are 96.5% vs. 94.4%, P < 0.05. The specificities are 93.4% vs. 92.2%, P > 0.05. The AUC are 99.0% vs. 98.1%. (2) The validation results of the multi-region multi-image CNN model and the single-image CNN model in the data set of non-training data source hospitals (Baiyun Branch of Nanfang Hospital of Southern Medical University, Shunde Hospital of Southern Medical University and Shenzhen Second People's Hospital) are given as follows. The accuracies are 89.7% vs. 77.6%, P < 0.01. The sensitivities are 90.2% vs. 82.4%, P < 0.01. The specificities are 89.1% vs. 72.9%, P < 0.01. The AUC are 92.5% vs. 82.4%. The multi-region, multi-image CNN significantly improves AI's accuracy, sensitivity, specificity, and generalizability in diagnosing gastric HP infection.

Treatment and eradication of Helicobacter pylori infection in Primary Care