Prior Eradication Research Articles

Clinical characteristics and outcomes of pediatric patients with autoimmune gastritis.

Autoimmune gastritis (AIG) is a rare chronic inflammatory disorder with potential long-term sequelae including gastric neoplasia. There is limited data on the natural history of pediatric AIG. We aimed to characterize the clinical course and outcomes of children with AIG. This was a multicenter retrospective study that included pediatric patients diagnosed with AIG between January 1, 2000 and December 31, 2021. Diagnosis of AIG was based on the demonstration of histological corpus-predominant atrophic gastritis, with or without positive antiparietal cell (APCA) or anti-intrinsic factor (IF) antibodies. Demographic, clinical, laboratory, endoscopic, and histologic data were retrieved, along with follow-up data. Thirty-three patients, (23 females, [69.7%], median age 12.0 [interquartile range 7.0-15.0] years at diagnosis) were identified. Twenty-two patients (66.7%) had positive APCA and/or anti-IF serology. The most common presenting manifestation was iron deficiency anemia (75%), and accompanying autoimmune disorders were significantly more common in patients with positive serology (62% vs. 18%, p < 0.05). Pseudo-pyloric or intestinal-type metaplasia was present at diagnosis in eightpatients (24%), and 11 additional patients (33%) developed metaplasia during a median follow-up time of 27 (17.5-48.3) months. One patient developed a type 1 gastric neuroendocrine tumor.Helicobacter pyloriwas identified in only one patient, while two patients had prior eradication. Endoscopic and histologic improvements weren't identified in any patients. AIG should be considered in patients with autoimmunity and resistant iron-deficiency anemia. H. pylori infection may not be associated with pediatric AIG. The development of neuroendocrine tumor in one patient, and the high rates of metaplasia, highlight the importance of surveillance.

Hepatitis C Virus as a Possible Helper Virus in Human Hepatitis Delta Virus Infection.

Previous studies reported that the hepatitis C virus (HCV) could help disseminate the hepatitis D virus (HDV) in vivo through the unrelated hepatitis B virus (HBV), but with essentially inconclusive results. To try to shed light on this still-debated topic, 146 anti-HCV-positive subjects (of whom 91 HCV/HIV co-infected, and 43 with prior HCV eradication) were screened for anti-HDV antibodies (anti-HD), after careful selection for negativity to any serologic or virologic marker of current or past HBV infection. One single HCV/HIV co-infected patient (0.7%) tested highly positive for anti-HD, but with no positive HDV-RNA. Her husband, in turn, was a HCV/HIV co-infected subject with a previous contact with HBV. While conducting a thorough review of the relevant literature, the authors attempted to exhaustively describe the medical history of both the anti-HD-positive patient and her partner, believing it to be the key to dissecting the possible complex mechanisms of HDV transmission from one subject to another, and speculating that in the present case, it may have been HCV itself that behaved as an HDV helper virus. In conclusion, this preliminary research, while needing further validation in large prospective studies, provided some further evidence of a role of HCV in HDV dissemination in humans.

Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients

BackgroundThe incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. Patients and methodsWe evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. ResultsWe included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08–0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06–0.69, p < 0.001), particularly allergic rhinitis and food allergy. ConclusionsWe observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

Refractory Helicobacter pylori infection in Australia: updated multicentre antimicrobial resistance.

Helicobacter pylori infection is responsible for considerable morbidity and mortality worldwide and eradication rates are falling globally because of increasing antimicrobial resistance. However, there is a paucity of local data to guide the choice of eradication therapy in Australia. This study aimed to evaluate current Australian rates of H. pylori antibiotic resistance in patients who had failed prior eradication therapy. A retrospective analysis of routine culture and antibiotic susceptibility data from two pathology laboratories servicing multiple tertiary referral hospitals in Western Australia (WA) and South Australia (SA), between 2018 and 2022, was performed. Rates of antimicrobial resistance and prevalence of multiresistant isolates in both SA and WA were calculated and comparison of temporal trends and differences between the two states was conducted. A total of 796 H. pylori isolates revealed a clarithromycin resistance rate of 82%, metronidazole 68%, amoxicillin 4.4% and tetracycline 0.5%. Resistance to levofloxacin was observed in 22% and rifampicin 14%. Rates of resistance to clarithromycin were lower in SA compared with WA (incidence rate ratio [IRR]: 0.69, P = 0.0001). Multiresistant isolates were discovered in 63% of patients, with lower rates in SA compared with WA (IRR: 0.74, P = 0.002). This first multicentre, multistate study of H. pylori resistance in Australian patients exposed to prior therapy demonstrated high rates of antimicrobial resistance, including levofloxacin (>20%). This raises concern about recommending levofloxacin in empirical second-line therapies. Increased monitoring and awareness of current H. pylori resistance rates in Australia are needed to guide local eradication practices.

In search of a substitution model for coca in Colombia: Buffalo, cocoa, and coffee in Peasant Reserve Zones

AbstractFor years Colombia has been the world's largest coca producer. Its public management of crops for illicit use has swung between eradication, substitution, and, recently legalization. Forced eradication has been shown to be ineffective, and legalization is an incipient option, so the Peace Agreement puts forward substitution as the path to follow. Yet, what kind of substitution does it suggest? This article analyzes voluntary substitution projects in Peasant Reserve Zones. While some projects have evolved locally due in part to strong peasant associations, they have not gained traction nationally. In general, the difficulties inherent in any business play a role, but there are also structural limitations such as continued fumigations, obligations of prior eradication, the costs of production and transportation due to the lack of infrastructure and public services, and the issue of land rights, which limits peasants' access to the formal funding established by the Peace Agreement.

Antibiotic-Free Helicobacter Pylori Eradication – Case Reports and Review of The Literature

Background: Standard Helicobacter pylori eradication therapy is based on proton pump inhibitors and antibiotics. There are, however, important limitations: increasing antibiotic resistance of Helicobacter pylori, medical contraindications, and an increasing unwillingness among patients to use antibiotics. Case presentations: We present three exemplary case reports of successful antibiotic-free Helicobacter pylori eradication therapies, one for each of these limiting categories: a 61-year-old female Caucasian patient refractory to prior eradication therapy, an 80-year-old female Caucasian patient with contraindication to antibiotics, and a 41-year-old male Caucasian patient refusing antibiotics. A review of the literature attempts to provide a scientific rationale for proton pump inhibitor-based and probiotics-supported Helicobacter pylori eradication. Conclusion: Antibiotics-free Helicobacter pylori eradication may offer a therapeutic option for patients in whom classical eradication therapy cannot be conducted or who are refractory to antibiotics. Clinical trials are needed to scientifically evaluate the concept presented here.

La infección por Helicobacter pylori se asocia con disminución del riesgo de esofagitis eosinofílica en pacientes mexicanos

BackgroundThe incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. Patients and methodsWe evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. ResultsWe included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08–0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06–0.69, p < 0.001), particularly allergic rhinitis and food allergy. ConclusionsWe observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

A behavioral economic assessment of the role of stakeholder preferences in managing an infectious wildlife disease

AbstractChronic wasting disease (CWD) in cervid populations poses substantial economic costs, and its management is resource intensive. Control of CWD is often subject to stakeholder‐dependent strategies that require active support and participation. The development of effective CWD management strategies and policies hinges on understanding stakeholder preferences, values and decision‐making behavior. Here we provide a basis for understanding the economic impacts of CWD, which are key to developing effective management strategies. We analyze stakeholder incentives from an economic perspective and discuss the effectiveness of prior management and eradication strategies. Our analysis discusses the integration of behavioral economics into evaluations of stakeholder preferences and its effect on decision‐making to produce optimal policy and management outcomes.

Antibiotics Resistance Prevalence of Helicobacter pylori Strains in Northwest China.

PurposeThis study aims to estimate the resistance rate of Helicobacter pylori (HP) to commonly used antibiotics and analyze the potential influencing factors in northwest regions of China.Patients and MethodsHP-positive patients visiting the outpatient department of multiple hospitals were enrolled in the study. Then, gastric mucosal biopsy specimens were collected for HP isolation, culture, and investigation of the resistance rate of HP to amoxicillin, metronidazole, tetracycline, levofloxacin, and clarithromycin by Epsilometer test (E-test) antibiotic susceptibility testing. In addition, multi-drug resistance, the influence of HP eradication history, age, and region of residence on drug resistance rate were analyzed.ResultsIn total, 198 HP clinical strains were successfully isolated and cultured. The resistance rates of amoxicillin, metronidazole, tetracycline, levofloxacin, and clarithromycin were 16.16%, 85.86%, 7.58%, 46.46%, and 55.05%, respectively. The multi-drug resistance rates demonstrated that dual and triple resistances were 30.30% and 22.73%, respectively. The quadruple resistance rate reached 9.60%. Our results revealed that the prior eradication history of HP significantly increased levofloxacin and clarithromycin resistance. Metronidazole and levofloxacin resistances significantly differed among different age groups, which presented an upward trend with increasing age. Drug resistance rates varied with geographic regions, especially amoxicillin and clarithromycin resistance, which were highest in Hexi Corridor and Longnan regions.ConclusionThe current situation of HP resistance to common antibiotics is severe. Tetracycline is the most sensitive antibiotic, followed by amoxicillin, the first choice for HP eradication. However, the eradication failure of HP may lead to an increase in the resistance rate. Therefore, it is necessary to strengthen the standardized diagnosis and treatment of HP to improve the primary eradication rate.

Efficacy and safety of high-dose esomeprazole-amoxicillin dual therapy for Helicobacter pylori rescue treatment: a multicenter, prospective, randomized, controlled trial.

Background:High-dose dual therapy (HDDT) with proton pump inhibitors (PPIs) and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of high-dose PPI–amoxicillin dual therapy and bismuth-containing quadruple therapy for H. pylori rescue treatment.Methods:This was a prospective, randomized, multicenter, non-inferiority trial. Patients recruited from eight centers who had failed previous treatment were randomly (1:1) allocated to two eradication groups: HDDT (esomeprazole 40 mg and amoxicillin 1000 mg three times daily; the HDDT group) and bismuth-containing quadruple therapy (esomeprazole 40 mg, bismuth potassium citrate 220 mg, and furazolidone 100 mg twice daily, combined with tetracycline 500 mg three times daily; the tetracycline, furazolidone, esomeprazole, and bismuth [TFEB] group) for 14 days. The primary endpoint was the H. pylori eradication rate. The secondary endpoints were adverse effects, symptom improvement rates, and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study. The HDDT group achieved eradication rates of 75.4% (248/329), 81.0% (248/306), and 81.3% (248/305) asdetermined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses, respectively. The eradication rates were similar to those in the TFEB group: 78.1% (257/329), 84.2% (257/305), and 85.1% (257/302). The lower 95% confidence interval boundary (−9.19% in the ITT analysis, − 9.21% in the MITT analysis, and −9.73% in the PP analysis) was greater than the predefined non-inferiority margin of −10%, establishing a non-inferiority of the HDDT group vs. the TFEB group. The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group (11.1% vs. 26.8%, P < 0.001). Symptom improvement rates and patients’ compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy, with fewer adverse effects and good treatment compliance, suggesting HDDT as an alternative for H. pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov, NCT04678492.

Identification of Helicobacterpylori-related gastric cancer risk using serological gastritis markers and endoscopic findings: a large-scale retrospective cohort study

BackgroundGastric cancer remains a severe public health problem worldwide, particularly in Japan. Recent studies have demonstrated that serum markers are beneficial for risk stratification in gastric cancer development. We aimed to evaluate the usefulness of serum markers either alone or in combination (serum markers plus endoscopy) for effective risk stratification of gastric cancer development.MethodsWe enrolled 22,736 patients aged 20–95 years who underwent blood sampling and endoscopic examination at Hiroshima University Hospital in Japan between 1990 and 2014. The serum pepsinogen (PG) levels and anti-Helicobacter pylori antibody (Hp-Ab) titers were evaluated in each patient. The enrolled patients were matched with the database of the Hiroshima Prefecture Regional Cancer Registry. We processed the medical records and excluded patients with possible confounding factors for PG levels, such as proton pump inhibitor use, prior successful eradication therapy, post-gastrectomy, severe hepatorenal dysfunction, Zollinger–Ellison syndrome, and autoimmune gastritis. Among the remaining 5131 patients, we reviewed records of endoscopic examinations and selected 1507 patients (mean age, 62.5 years; 985 men and 522 women) who underwent endoscopic examination more than three months after blood sampling.First, based on the ABC method, patients were classified as follows: High PG levels and negative Hp-Ab, group A, high PG levels and positive Hp-Ab, group B, low PG levels and positive Hp-Ab, group C, and low PG levels and negative Hp-Ab, group D. Group A was further classified into two subgroups using endoscopic findings: true A without atrophic gastritis and pseudo A with atrophic gastritis. All patients underwent annual endoscopy follow-up.ResultsAmong the 1,507 patients (mean age, 62.5 years; 985 men), 24 were diagnosed with newly developed gastric cancer. No significant difference in cancer development was found between group A (PG negative and Hp-Ab negative) and the other groups. Remarkably, no true A group subjects developed gastric cancer.ConclusionsThe combination of serum markers and endoscopic findings is essential for the risk evaluation of gastric cancer.

Mutations associated with Helicobacter pylori antimicrobial resistance in the Ecuadorian population.

We described the presence of Helicobacter pylori (HP) and estimated the prevalence of primary and secondary resistance using molecular detection in gastric biopsies of Ecuadorian patients. 66.7% (238/357) of the patients demonstrated the presence of HP using CerTest qPCR. Of these, 69.79% (104/149) were without previous HP eradication treatment and 64.42% (134/208) with prior HP eradication treatment. The mutation-associated resistance rate for clarithromycin was 33.64% (primary resistance) and 32.82% (secondary resistance), whereas that in levofloxacin the primary and secondary resistance was 37.38% and 42%, respectively. For tetracycline and rifabutin, primary and secondary resistance was 0%. Primary and secondary resistance for metronidazole and amoxicillin could not be evaluated by genotypic methods (PCR and sequencing). The analysis of mutations in gyrA, 23S rRNA and 16S rRNA is useful to detect bacterial resistance as a guide for eradication therapy following failure of the first-line regimen. This study carried out in an Ecuadorian population indicates that the resistance of HP to first-line antibiotics is high, which may contribute to the high rates of treatment failure, and other treatment alternatives should be considered.

Correlation Analysis Among Genotype Resistance, Phenotype Resistance, and Eradication Effect After Resistance-Guided Quadruple Therapies in Refractory Helicobacter pylori Infections.

ObjectivesThe antimicrobial resistance of Helicobacter pylori (H. pylori) in most countries and regions has increased significantly. It has not been fully confirmed whether the detection of H. pylori resistance gene mutation can replace antibiotic drug sensitivity test to guide the clinical personalized treatment. The objective of this study was to assess and compare the efficacy of different antimicrobial resistance-guided quadruple therapies in refractory H. pylori-infected individuals who had undergone unsuccessful prior eradication treatments.MethodsFrom January 2019 to February 2020, genotypic and phenotypic resistances were determined by polymerase chain reaction (PCR), whole genome sequencing (WGS) and broth microdilution test, respectively, in 39 H. pylori-infected patients who have failed eradication for at least twice. The patients were retreated with bismuth quadruple therapy for 14 days according to individual antibiotic resistance results. Eradication status was determined by the 13C-urea breath test.ResultsThe overall eradication rate was 79.5% (31/39, 95% CI 64.2–89.5%) in the intention-to-treat (ITT) analysis and 88.6% (31/35, 95% CI 73.5–96.1%) in the per- protocol analysis (PP) analysis. The presence of amoxicillin resistance (OR, 15.60; 95% CI, 1.34–182.09; p = 0.028), female sex (OR, 12.50; 95% CI, 1.10–142.31; p = 0.042) and no less than 3 prior eradication treatments (OR, 20.25; 95% CI, 1.67–245.44; p = 0.018), but not the methods for guiding therapy (p > 0.05) were associated with treatment failure. Resistance-guided therapy achieved eradication rates of more than 80% in these patients. The eradication rate of H. pylori in the phenotypic resistance-guided group was correlated well with genotype resistance-guided groups, including PCR and WGS.ConclusionCulture or molecular method guiding therapy can enable personalized, promise salvage treatments, and achieve comparably high eradication rates in patients with refractory H. pylori infection. The detection of H. pylori resistance mutations has a good clinical application prospect.Protocol Study Register[clinicaltrials.gov], identifier [ChiCTR1800020009].

How We Approach Difficult to Eradicate Helicobacter pylori

How We Approach Difficult to Eradicate Helicobacter pylori

Simulated Use of YY Male Stocking and Suppression for Eradicating Common Carp Populations

AbstractThe introduction and subsequent spread of Common CarpCyprinus carpiothroughout the world represent one of the most destructive and pervasive forces impacting aquatic ecosystems. Herein we use computer simulations to predict if stocking YY male carp in conjunction with manual netting or piscicide use could eradicate invasive Common Carp populations. Two forms of YY males were evaluated, including sperm‐producing (MYY) and egg‐producing (FYY) fish. A stochastic individual‐based population model was used to evaluate the effects of simulated management actions on both the abundance and extirpation probabilities of high‐ and low‐density populations. Results predicted that some YY male stocking scenarios alone could eradicate carp populations. For example, when stocking FYYcarp into low‐density populations, predicted extirpation probabilities exceeded 0.87 when stocking at least 50 carp/ha was maintained for at least 10 years. Additionally, a one‐time use of rotenone (to reduce the virtual population by 90%) plus stocking at least 50 FYYcarp/ha for at least 5 years into low‐density populations resulted in predicted extirpation probabilities exceeding 0.88. Favorable extirpation probabilities were also obtained by combining YY male stocking and either selective (i.e., no culling of stocked YY males) or non‐selective annual suppression. For example, FYYstocking with only 10% sustained, non‐selective suppression yielded extinction probabilities exceeding 95% in 15 years, while increasing suppression levels to 50% resulted in extirpation probabilities over 95% within 5 years. Without exception, MYYstocking functioned far less efficiently in simulations than FYYstocking, but MYYcarp did work in a small subset of low‐density scenarios and may also have prophylactic utility where prior eradication has occurred and where there is a high risk of re‐invasion. We conclude that stocking of YY male Common Carp is worthy of field testing, but additional simulations are needed to explore other questions not addressed in this study.

Antimicrobial resistance of Helicobacter pylori in an eastern German region.

Antimicrobial therapy is recommended to eradicate Helicobacter (H.) pylori in infected individuals. As first-line treatments are empiric, knowledge of antimicrobial resistance is key to successful eradication. We investigated primary resistance in an eastern German region to derive recommendations for eradication treatment. We used molecular genetic methods to examine Helicobacter rapid urease test (RUT) positive gastric specimens of 533 patients from Berlin and the federal state of Brandenburg with allegedly no prior eradication treatment. Tissue samples were removed from RUT and screened by real-time PCR for mutations conferring resistance to clarithromycin. In addition, 182 samples out of 533 were tested for resistance to levofloxacin and tetracycline. Primary resistances were 10.9% (58 out of 533) to clarithromycin; 13.7% (25/182) to levofloxacin; and 2.2% to tetracycline (4/182). Combined resistance to clarithromycin/levofloxacin was low (2.2%, 4/182). Female sex was significantly associated with clarithromycin resistance. Clarithromycin may be a suitable first-line antibiotic for about 90% of outpatients. A simple molecular test may help physicians avoid prescription of an ineffective first-line regimen.

Mo1265 WATS TESTING INCREASES DETECTION OF RECURRENT INTESTINAL METAPLASIA FOLLOWING COMPLETE ERADICATION OF INTESTINAL METAPLASIA IN TREATED BARRETT’S ESOPHAGUS WITH LOW-GRADE DYSPLASIA, HIGH-GRADE DYSPLASIA, OR INTRAMUCOSAL ADENOCARCINOMA

Wide area transepithelial sample biopsy with three-dimensional computer-assisted analysis (WATS, CDx Diagnostics, Suffern, NY) uses brush sampling to evaluate histologic features of a wide area of mucosa. A limited literature describes its yield for intestinal metaplasia (IM) in surveillance after successfully treated dysplastic Barrett’s esophagus (BE). To determine the additional yield for IM of WATS testing in addition to forceps biopsy (FB) in surveillance of BE following endoscopic treatment achieving complete eradication of intestinal metaplasia (CEIM). The WATS Registry is an ongoing multicenter U.S. study enrolling subjects undergoing WATS as part of usual care at 13 sites. Patients are aged 18 to 80 and are enrolled in one of three categories: diagnostic endoscopy for heartburn or regurgitation symptoms without a history of BE, surveillance endoscopy for already-diagnosed BE without prior endoscopic eradication therapy, or surveillance endoscopy for BE following eradication therapy. We analyzed all surveillance endoscopy visits for treated BE following CEIM. CEIM was defined as an endoscopy with negative FB for IM, negative WATS for IM (if taken), and no treatment given. We plotted product-limit estimates and Poisson models of the rate of recurrence of intestinal metaplasia using only the FB results to define recurrence compared with using both the FB and WATS testing results to define recurrence. In total, 384 endoscopies were performed for follow-up of treated Barrett’s esophagus with low-grade dysplasia, high-grade dysplasia, or intramucosal adenocarcinoma. Of these 384, 318 had CEIM, and 252 had one or more surveillance endoscopies at risk for recurrence (Table). The addition of WATS to FB increased the estimated rate of recurrence by rate ratio of 3.6 (95% confidence limits 2.0 – 6.0) (Figure). Among the 38 recurrences detected first or only on WATS, an irregular z-line was described in 9, one or more centimeters of columnar mucosa in 4, and a targeted FB was collected in 20. There were 16 recurrences detected on FB. Among the 38 WATS recurrences, concurrent cardia brushings or biopsies were available for 10, of which, 3 had IM of the cardia. The addition of WATS testing to FB substantially increased the detection of recurrent IM after eradication of BE with dysplasia or intramucosal carcinoma. Errant detection of cardia IM is not the likely source for most of these brushes, given that only 30% of those with cardia sampled separately showed IM of the cardia. The clinical implications and mechanisms of detecting recurrence on WATS testing versus FB remain uncertain, however, this increased detection of IM could have important implications for surveillance of treated BE.FigureProduct-limit estimate of the proportion of participants with recurrence of intestinal metaplasia detected by forceps biopsy alone compared to forceps biopsy and wide area transepithelial sample biopsy with three-dimensional computer-assisted analysis by time in years after the first registry visit with complete eradication of intestinal metaplasia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Safety and Efficacy of Nitazoxanide-Based Regimen for the Eradication of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

BackgroundHelicobacter pylori (HP) is the most common cause of gastritis worldwide. Clarithromycin-based triple therapy or bismuth-based quadruple therapy is usually considered the first-line treatment, however with around 30% failure rate for both regimens. Drug resistance of clarithromycin and metronidazole is a growing concern in some parts of the world. Therefore, there is a need for effective eradication regimen for HP. Nitazoxanide, a bactericidal thiazolide antibiotic, has been shown to be effective in HP infection. We conducted a systematic review and meta-analysis to evaluate the efficacy of nitazoxanide-based regimen for the eradication of HP.MethodsWe have searched PubMed, Embase, Ovid Medline and Cochrane library database from inception to December 9, 2020 to identify studies that utilized nitazoxanide in the treatment regimen for HP eradication. Our primary outcome was pooled eradication rate of HP.ResultsThirteen studies including 1,028 patients met our inclusion criteria and were analyzed in a meta-analysis. HP eradication was successful in 867 patients with a pooled eradication rate of 86% (95% confidence interval (CI): 79-90%) with 84% heterogeneity. A subgroup analysis that included 230 patients who failed other prior eradication regimens revealed a pooled eradication rate of 85% (95% CI: 69-94%) without heterogeneity. In a subgroup analysis, highest eradication rates were achieved with levofloxacin, doxycycline, nitazoxanide and proton pump inhibitor with a pooled eradication rate of 92% (88-95%).ConclusionNitazoxanide-based regimen is safe and effective in the eradication of HP infection. It is also successful as a salvage therapy in patients who have failed prior treatments.

Helicobacter pylori heteroresistance to clarithromycin in adults-New data by in situ detection and improved concept.

Clarithromycin (Cla) heteroresistance of Helicobacter pylori (Hpylori) infections is commonly assessed by comparing the resistance status of antrum and corpus biopsy samples and by demonstrating the discrepancy between them (interniche heteroresistance). However, fluorescence in situ hybridization (FISH) technique is capable of showing the synchronous presence of susceptible and resistant bacteria (intraniche heteroresistance), enabling the detection of heteroresistant Hpylori populations within one biopsy sample. Antrum and corpus biopsy specimens of 305 Hpylori-infected patients were investigated with an rRNA-targeted Cla-resistance FISH test. Anamnestic data were collected from the institutional electronic register. Prevalence rates of susceptible, homo- and heteroresistant cases were correlated with the anamnestic and clinicopathological data. Overall Cla-resistance rate was 23.9% (73 cases), consisting of 35 (11.5%) homoresistant and 38 (12.5%) heteroresistant cases. Thirty-five patients had at least one biopsy site where susceptible and resistant bacteria were present simultaneously. From this subset, 20 cases demonstrated intraniche heteroresistance on both sites. Prior Cla-based eradication attempts were more frequent in homoresistant than in susceptible and heteroresistant cases (P<.001, P<.001, respectively).Cla-containing therapy eradicated heteroresistant infections at a significantly lower rate in comparison with susceptible cases (P=.0112), but more effectively than homoresistants (P=.0393). The most frequent type of Cla-heteroresistance is the coexistence of susceptible and resistant Hpylori bacteria in the same location (intraniche heteroresistance). A previous Cla-based eradication attempt predisposes patients to homoresistant infection. Heteroresistance is characterized by a non-eradication-related background and intermediate characteristics in many respects when compared to susceptible and homoresistant cases.

408 WATS Brushings Are More Sensitive for Detecting Intestinal Metaplasia in Barrett’s Esophagus Than Concurrent Forceps Biopsies: Results From a National Registry

INTRODUCTION: Forceps biopsies (FB) are used to sample the esophageal mucosa for intestinal metaplasia (IM) to diagnose BE, confirm eradication of BE, and detect recurrence after treatment. FB are limited by their focal field of sampling. Wide area transepithelial sample biopsy with three-dimensional computer-assisted analysis (WATS3D, CDx Diagnostics, Suffern, NY) samples a wider area of mucosa, but its sensitivity in routine clinical settings is incompletely understood. Our aim was to determine the sensitivity of WATS compared to FB for IM in patients undergoing surveillance of non-dysplastic BE (NDBE). METHODS: The WATS Registry is an ongoing multicenter U.S. study enrolling subjects undergoing WATS as part of usual care at 13 sites. Patients are aged 18 to 80 and are enrolled in one of three categories: screening endoscopy for gastroesophageal reflux symptoms without a history of BE, surveillance endoscopy for already-diagnosed BE without prior endoscopic eradication therapy, or surveillance endoscopy for BE following eradication therapy. We analyzed all endoscopy visits where subjects underwent both WATS and FB for surveillance of prevalent, treatment naïve NDBE with not less than 1 cm of columnar mucosa. Given that all these subjects previously had both endoscopic and histologic evidence of BE, FB or WATS not demonstrating IM was assumed to represent sampling error. We calculated the sensitivity of WATS and FB for IM, manifest by goblet cell metaplasia, with 95% asymptotic confidence limits. RESULTS: This analysis included 454 endoscopies of patients with a previous diagnosis of BE, presenting for surveillance and undergoing both FB and WATS. We observed a higher (p = 0.005) overall sensitivity of WATS (63.0% (95% CL 58.6 – 67.4%) than FB (53.7% (95% CL 49.2 – 58.3%)) of diagnosing IM (Figure). In addition to the patients with IM on FB, greater than 1/3 more subjects (36%, 87/244) had IM on WATS. The sensitivity of WATS for IM was similar across demographic groups (Table). Sensitivity of both FB and WATS increased with the length of BE being sampled. CONCLUSION: WATS has higher sensitivity for detecting IM compared to concurrent FB in patients with a previous history of BE. The addition of WATS to FB in these patients results in an overall additional 36% detection of IM. Given the included patients had previously demonstrated IM in visible segments of columnar epithelium in the esophagus, the incremental yield of WATS likely represents sampling error by FB.