Pylori Eradication Therapy Research Articles

Adequate amounts of probiotics increase the success rate of Helicobacter pylori eradication therapy in children.

Adequate amounts of probiotics increase the success rate of Helicobacter pylori eradication therapy in children.

Место пробиотиков в эрадикационной терапии хеликобактерной инфекции

Eradication therapy occupies a key place in the treatment of Helicobacter pylori (HP) infections. The presence of HP in the human body can affect the composition of gut microbiota in several ways, including the direct effect of infection or as a consequence of HP eradication regimes. Nowadays, one of the measures to increase the eradication therapy efficacy and reduce the probability of antibiotic-associated disorders is the strategy of gut microbiome modulation. The article discusses the HP effects on the gut microbiota, methods for probiotic correction in conditions of HP infection and eradication therapy. Probiotics have a destructive effect on the biofilm formed by HP, and its destruction can increase the efficacy of antibacterial therapy. The most rational regimen is the administration of probiotics before and during eradication, or at least for two weeks. At the same time, probiotics should include a variety of bacterial strains with proven efficacy and a high safety profile. KEYWORDS: Helicobacter pylori, microbiota, eradication therapy, probiotics, probiotic correction, antibiotic-associated disorders, inulin. FOR CITATION: Osipenko M.F., Zhuk E.A., Drobysheva V.P., Litvinova N.V., Livzan M.A., Gaus O.V. Probiotics in the Helicobacter pylori eradication therapy. Russian Medical Inquiry. 2023;7(5):274–282 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-5.

Modern Approaches to <i>H. pylori</i> Eradication Therapy in Adults (Literature Review and Resolution of Experts Council)

Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates.

Helicobacter pylori: A Belittled Cause of Immune Thrombocytopenic Purpura (ITP) and Role of Helicobacter pylori Eradication Therapy for Treating ITP

Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by production of auto antibodies against platelet surface antigens. ITP affects women more often than men and is more common in children than adults. ITP is a diagnosis of exclusion after other identifiable etiologies have been ruled out. After the first report by Gasbarrini et al. (1998) showing rising platelet counts in ITP patients following Helicobacter pylori (HP) eradication therapy, there is growing evidence that highlights the role of HP in triggering ITP. The H-pylori infection induced ITP is validated by many proposed mechanisms such as molecular mimicry due to production of auto antibodies against H-pylori surface virulent factors (CagA) and cross reactivity of these antibodies with platelet surface antigens (GP IIb/IIIa, GP Ib/IX, and GP Ia/IIa), phagocytic perturbation due to enhanced phagocytic activity of monocytes, enhanced dendritic cell numbers and response, platelets aggregation due to presence of anti- H-pylori IgG and von Willebrand factor (vWf) and finally host immune response against H-pylori virulent factors CagA and VacA leading to ITP. Eradication of Helicobacter pylori infection has been variably associated with a platelet response in patients with immune thrombocytopenic purpura (ITP). Eradication therapy is simple and inexpensive, with limited toxicity and the advantage of avoiding long-term immunosuppressive treatment for those who respond. Although the evidence and follow-up are limited, it appears reasonable to routinely screen patients with ITP for H pylori, particularly in those populations with a high background prevalence of H pylori infection.

FREQUENCY OF HELICOBACTER PYLORI INFECTION AS DETECTED BY STOOL ANTIGEN TEST IN PATIENTS WITH FUNCTIONAL DYSPEPSIA

OBJECTIVES To determine H. Pylori frequency in patients presenting with functional dyspepsia using H. Pylori antigen test in the stool sample. MATERIALS AND METHODS One hundred and sixty-five adult patients presenting with symptoms suggestive of functional dyspepsia to the medical outpatients’ Department of Khyber Teaching Hospital Peshawar, were tested for Helicobacter Pylori by detecting stool Helicobacter Pylori antigen. Patients with chronic debilitating illnesses or peptic ulcer disease were excluded from the study. The frequency of the positive test was calculated. The independent-sample t-test and Chi-square test were used to compare the results for different variables. A P-value of 0.05 was considered significant. RESULTS Out of 165 patients, 54% were males and 46% were females. The mean age of the patients was 32±7 years, ranging from 18 to 52 years. The stool antigen test for H. Pylori was positive in 58% of patients. Proton pump inhibitor drugs significantly affect the positive results. Alanine aminotransferase levels were significantly different between the stool antigen-positive and stool antigen-negative patients. CONCLUSION Helicobacter Pylori infection is quite common in patients with functional dyspepsia. These patients with positive antigen tests should be treated with H. Pylori eradication therapy. KEYWORDS Helicobacter Pylori, Dyspepsia, Stool antigen test

The impact of Helicobacter pylori infection and eradication therapy containing minocycline and metronidazole on intestinal microbiota

BackgroundHelicobacter pylori (H. pylori) infection is associated with remodeling of gut microbiota. Many studies have found H. pylori infection and eradication therapy can alter the gut microbiota. However, few studies explored the impact of eradication therapy containing minocycline and metronidazole on gut microbiota.AimThe objective of the present study was to explore the changes of gut microbiota after H. pylori infection. Besides, learn more about the dynamic changes of gut microbiota during different stages of eradication treatment containing minocycline, metronidazole, bismuth agents and proton pump inhibitors.MethodsSixty stool samples from the patients with H. pylori infection before eradication, 14 and 42 days after eradication, and ten stool samples from non-infected individuals were collected. Subsequently, we performed 16S rRNA gene amplicon sequencing to analyze these samples, and the results were evaluated by using alpha diversity, beta diversity and microbial composition analyses. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was also used to predict the metabolic pathways according to the Kyoto Encyclopedia of Genes and Genomes database.ResultsThe alpha and beta diversity of the microbiota changed significantly in H. pylori infected individuals, but returned to baseline 42 days after eradication therapy. At the genus level, the abundances of Bacteroidetes, [Ruminococcus]_gnavus_group, Ruminococcaceae_Incertae_Sedis, Tuzzrealla, Butyricicoccus were significantly lower in the H. pylori infected group. Bacterial abundance was also dynamically changing during eradication treatment. In addition, PICRUST analysis found the levels of uronic acid metabolism, uncharacterized transport system, and biosynthesis of unsaturated fatty acids were higher in H. pylori infected individuals than in the non-infected group.ConclusionsIntestinal microbiota diversity, composition, functional predictions altered significantly after H. pylori infection, and gradually returned to healthy control levels after the application of eradication therapy containing minocycline and metronidazole in one month and a half.

Effect of H. pylori eradication on gastric preneoplastic lesions and gastritis progression

Background: It is assumed that the sequence of events in gastric cancer is as follows: chronic gastritis, atrophy, intestinal metaplasia (IM), dysplasia and carcinoma. It is also known that Helicobacter pylori (H.pylori) can be involved in the chain of these chronic phenomena. Objectives: This study investigated to compare the changes in the grades of gastric preneoplastic lesions over time in cases with H. pylori eradication and in cases where H. pylori could not be eradicated. In addition, it was aimed to retrospectively examine whether there was a significant change in the severity of gastritis and the degree of gastric preneoplastic lesion in cases in which H. pylori could be eradicated. Methods: Patients who had dyspeptic complaints and were diagnosed with H. pylori gastritis, atrophy and intestinal metaplasia or dysplasia were enrolled in the study between January 2009- January 2016. Patients who underwent H. pylori eradication therapy were included in the study in terms of surveillance programs for gastric carcinoma. The medical records of the patients were reviewed retrospectively. Atrophy, intestinal metaplasia and dysplasia grades were determined during the first endoscopy. The Operative Link for Gastritis Assessment (OLGA) and The Operative Link on Gastritis Intestinal Metaplasia Assessment (OLGIM) scores were recorded. Severe gastritis define as OLGA stage III-IV and/or OLGIM stage III-IV. Results: In total, 5736 patients were enrolled. 97 patients who were diagnosed with intestinal metaplasia and/or atrophy as a result of endoscopic biopsy and were followed up regularly by surveillance were included in our study. According to the initial endoscopy, gastric atrophy was detected in 75.3% (73) of the cases and intestinal metaplasia was detected in 75.3% (73). Severe gastritis was detected in 17.5% (17) and low-grade dysplasia was detected in 3.1% (3). According to the latest endoscopic biopsy results H. pylori was eradicated in 27.8% (27) of the cases. In the group with successful eradication of H.pylori, a statistically significant decrease was observed in the frequency of atrophy and intestinal metaplasia at the last visit. A nearly significant decrease was observed in the frequency of severe gastritis (p=0.06). Significant decreases were detected in OLGA (1.2 ± 1.0 vs. 0.4 ± 0.5) and OLGIM (1.3 ± 1.2 vs. 0.7 ± 0.9) scores. (p ˂ .001 and p=.03. respectively). In the group with successful eradication of H.pylori in a mean follow-up of 23.6 months, dysplasia disappeared in 2 patients who were found at the first visit. In the group with unsuccessful eradication of H.pylori, there was no significant change in the frequency of severe gastritis or dysplasia. Nearly significant (0.8 ± 0.6 vs. 0.5 ± 0.8. p=.052) change was detected in the OLGA score, while in the OLGIM score (1.4 ± 1.1 vs. 1.0 ± 1.1. p=.002) a significant decrease was detected. Conclusions: A statistically significant decrease in the frequency of atrophy and intestinal metaplasia, a significant decrease was also detected in OLGA and OLGIM scores were observed with the success of eradication of H. pylori in gastric cancer. A nearly significant decrease was observed in the frequency of severe gastritis. We believe that H. pylori eradication treatment should be performed in H. pylori-positive precancerous gastric lesions

A Population-Based Helicobacter pylori Eradication Strategy Is More Cost-Effective than Endoscopic Screening

BackgroundHelicobacter pylori (HP) eradication therapy is an efficient primary prevention method to reduce gastric cancer development. In Japan, biennial endoscopic screening for individuals aged 50 years and older is currently conducted as a national gastric cancer prevention program.AimsWe aimed to evaluate which strategy was the most optimal and cost-effective among HP eradication strategy, annual, biennial, and triennial endoscopic screening, and no screening as a national gastric cancer prevention program.MethodsWe developed a state-transition model for HP eradication strategy, annual, biennial, and triennial endoscopic screening, and no screening using a healthcare payer perspective and a lifetime horizon. We targeted a hypothetical cohort of the Japanese population in their 20 s to 80 s. The main outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, gastric cancer cases, and deaths from gastric cancer. We performed one-way, two-way, and probabilistic sensitivity analyses.ResultsHP eradication strategy was more cost-effective than endoscopic screening at any interval in all age groups. Cost-effectiveness was sensitive to HP infection rate. Cost-effective acceptability curves by Monte Carlo simulations for 10,000 trials demonstrated that HP eradication strategy was 100% cost-effective at a willingness-to-pay threshold of US$50,000 per QALY gained in all age groups. Over a lifetime, HP eradication strategy saves US$28.07 billion, increases 37.16 million QALYs, prevents 4.47 million gastric cancer cases, and saves 319,870 lives from gastric cancer.ConclusionA population-based HP eradication strategy is optimal and cost-effective for a national gastric cancer prevention program in Japan, replacing the current secondary prevention-focused biennial endoscopic screening.

Diagnosis and Treatment for Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma

Mucosa-associated lymphoid tissue (MALT) lymphoma, which was first reported in 1984, shows an indolent clinical course. However, the detailed clinicopathological characteristics of gastric MALT lymphoma have not been fully elucidated. We performed a literature search concerning the clinical features and treatment for gastric MALT lymphoma using PubMED. MALT lymphomas develop in single or multiple extranodal organs, of which the stomach is one of the most frequent sites; gastric MALT lymphoma accounts for 7% to 9% of all B-cell lymphomas, and 40% to 50% of primary gastric lymphomas. The eradication of Helicobacter pylori (H. pylori) is the first-line treatment for patients with gastric MALT lymphoma, regardless of the clinical stage. Approximately 60-90% of cases with stage I/II1 disease only achieve a complete histological response via H. pylori eradication. In patients who do not respond to H. pylori eradication therapy, second-line treatments such as watch-and-wait, radiotherapy, chemotherapy, rituximab immunotherapy, and/or a combination of these are recommended. Thus, H. pylori plays a causative role in the pathogenesis of gastric MALT lymphoma, and H. pylori eradication leads to complete histological remission in the majority of cases.

The cure rate of 10-day bismuth-containing quadruple therapy for Helicobacter pylori eradication is equivalent to 14-day: a systematic review and meta-analysis.

Helicobacter pylori (H. pylori) infection is a major cause of duodenal ulcers, gastric ulcers, and gastric cancer. However, the optimal duration for H. pylori eradication therapy remains controversial. Most studies have mainly focused on triple therapy, and there is insufficient research on bismuth-containing quadruple therapy. The aim of this study was to compare the clinical effect of the 10-day bismuth-containing quadruple treatment regimen with the 14-day regime in eradicating H. pylori. We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials published in English until May 2022 according to the eligibility criteria. Summary risk ratios (RRs) and 95% confidence intervals (CIs) for eradication rates, adverse effects, and compliance were calculated for included studies. Four studies, involving 1173 patients, were eligible for inclusion. The eradication rate was similar in the 10-day treatment group and the 14-day treatment group in the intention-to-treat analysis (RR 0.97, 95% CI 0.93 to 1.01). Meanwhile, the incidence of adverse effects was lower in patients who received 10days of treatment than in those who received 14days of treatment and patients' compliance was almost the same between two groups. Compared to the 14-day bismuth-containing quadruple regimens, 10-day regimens had similar efficacy and lower incidence of adverse effects. Therefore, the 10-day regimen is safe and well-tolerated and should be recommended for H. pylori infection.

Multiple Synchronous Mucosa-Associated Lymphoid Lymphomas Involving in the Stomach, Duodenum, Ileum, and Sigmoid.

Gastric MALToma is an extra-nodal marginal-type B-cell lymphoma. MALToma may occur secondary to chronic inflammation and autoimmunity. The most common gastrointestinal (GI) site of MALToma is the stomach, with approximately 50% of lesions occurring there. Synchronous upper and lower GI MALTomas rarely occur, with few cases reported. We present the case of a 67-year-old patient who presented asymptomatic and was found to have synchronous multifocal upper and lower GI MALTomas in the stomach, duodenum, terminal ileum, and sigmoid, which did not respond to H. Pylori eradication therapy.

Potential association of eEF1A dimethylation at lysine 55 in the basal area of Helicobacter pylori-eradicated gastric mucosa with the risk of gastric cancer: a retrospective observational study

BackgroundAlthough eradication therapy for chronic Helicobacter pylori (H. pylori) reduces the risk of gastric cancer (GC), its effectiveness is not complete. Therefore, it is also critically important to identifying those patients who remain at high risk after H. pylori eradication therapy. Accumulation of protein methylation is strongly implicated in cancer, and recent study showed that dimethylation of eEF1A lysine 55 (eEF1AK55me2) promotes carcinogenesis in vivo. We aimed to investigate the relationship between eEF1A dimethylation and H. pylori status, efficacy of eradication therapy, and GC risk in H. pylori-eradicated mucosa, and to reveal the potential downstream molecules of eEF1A dimethylation.MethodsRecords of 115 patients (11 H. pylori-negative, 29 H. pylori-positive, 75 post-eradication patients) who underwent upper gastrointestinal endoscopy were retrospectively reviewed. The eEF1A dimethyl level was evaluated in each functional cell type of gastric mucosa by immunofluorescent staining. We also investigated the relationship between eEF1AK55me2 downregulation by CRISPR/Cas9 mediated deletion of Mettl13, which is known as a dimethyltransferase of eEF1AK55me2.ResultsThe level of eEF1A dimethylation significantly increased in the surface and basal areas of H. pylori-positive mucosa compared with the negative mucosa (surface, p = 0.0031; basal, p = 0.0036, respectively). The eEF1A dimethyl-levels in the surface area were significantly reduced by eradication therapy (p = 0.005), but those in the basal area were maintained even after eradication therapy. Multivariate analysis revealed that high dimethylation of eEF1A in the basal area of the mucosa was the independent factor related to GC incidence (odds ratio = 3.6611, 95% confidence interval = 1.0350–12.949, p = 0.0441). We also showed the relationship between eEF1A dimethylation and expressions of reprogramming factors, Oct4 and Nanog, by immunohistochemistry and in vitro genome editing experiments.ConclusionsThe results indicated that H. pylori infection induced eEF1A dimethylation in gastric mucosa. The accumulation of dimethyl-eEF1A in the basal area of the mucosa might contribute to GC risk via regulation of reprograming factors in H. pylori eradicated-gastric mucosa.

Multiple Bismuth Quadruple Therapy Containing Tetracyclines Combined with Other Antibiotics and Helicobacter pylori Eradication Therapy.

Helicobacter pylori (HP) infection is closely associated with the development of chronic gastritis, peptic ulcer, and gastric cancer. However, the resistance rate of H. pylori strains to antibiotics such as clarithromycin, metronidazole, and levofloxacin has increased significantly, resulting in a significant decrease in the eradication efficacy of commonly used regimens. Tetracycline has received the attention of domestic and foreign scholars because of its low resistance. The purpose of this review is to provide an update on the tetracycline-containing bismuth quadruple eradication therapy for H. pylori infection and review the efficacy and safety of the regimens, hoping to provide guidance for clinical practice.

Assessing the Epidemiology, Treatment Patterns, and Economic Impact of Marginal Zone Lymphoma: A Review of the Literature

Background Marginal zone lymphoma (MZL) is a heterogenous group of lymphomas caused by malignant transformation of marginal zone B-cells, further classified into three subtypes: extra-nodal marginal zone lymphoma (EMZL), splenic marginal zone lymphoma (SMZL) and nodal marginal zone lymphoma (NMZL). In 2013, 5-year relative survival rates were reported at 88.7%, 79.7% and 76.5% for EMZL, SMZL and NMZL, respectively (US SEER database). Aims and objectives Evidence regarding incidence, treatment pattern, and associated cost for MZL is lacking. This study aims to evaluate the current evidence for epidemiology, treatment patterns, and economic burden associated with MZL. Methods Epidemiology and treatment pattern searches were conducted in Embase and Medline-in-process databases (January 2011-February 2022), by a single reviewer and validated by an independent reviewer; STROBE checklist used for critical appraisal. The economic search also included the Cochrane database (up to February 2022), conducted by two reviewers with a third to resolve discrepancies; Adapted Drummond's checklist used for critical appraisal. Relevant conferences websites were also searched. Reviews focused on adult patients with treatment naïve or relapsed/refractory (r/r) MZL. Results Of the 9089 records retrieved, 91 studies for epidemiology, 32 studies for treatment patterns (RWE: 20, treatment guidelines: 12), and 10 economic studies were included. The studies showed that MZL incidence varied by geographic location (0.5-2.6 per 100,000); and overall incidence of MZL increased over time. The incidence rate was reportedly higher for developing countries vs. western developed countries, older vs. younger patients, and patients of white race vs. other races. Among the MZL population, incidence rate per 100,000 was highest for EMZL/MALT (1.1-1.59), followed by NMZL (0.12-0.83) and SMZL (0.13-0.25). Site-specific incidence per 100,000 was highest for stomach MALT (0.13-0.44). The 5-year relative survival rates for MZL ranged from 61.2-92% and were generally higher in EMZL/MALT patients vs. other subtypes/overall MZL population. Guideline recommendations for patients with MZL consist of a combination of different therapies including radiotherapy, chemotherapy, immunotherapy and surgery. BTK inhibitors (ibrutinib, zanubrutinib), and rituximab-based combinations are recommended in r/r MZL. Analysis of real-world treatment patterns revealed rituximab±chemotherapy was the most prescribed systemic treatment across all lines of therapy. Common 1L non-systemic treatments included surgical resection (17-100%) and radiation therapy (1.2-86.8%). H. pylori eradication therapy was the most common 1L approach for H. pylori +ve gastric MALT patients. Treatment patterns for patients in subsequent lines were sparsely reported. A large US study (n=1162) reported that MZL patients not receiving an NCCN-recommended agent increased by LOT: 1L (11%), 2L (25%), and 3L (29%); 51% of MZL patients also received no systemic therapy. Studies reporting OS/PFS outcomes (n=4) and response rates (n=6) in real-world patients were limited and predominantly in the 1L setting (Table 1). Economic studies covered North America and APAC, assessing different measures of economic burden, in MZL sub-populations. No clear trends were observed for costs or resource use by the line of therapy. Overall cost of treatment and AE management was low for BTKi vs. immunotherapy/chemotherapy. Rituximab+bendamustine was shown to be a cost-effective treatment for MZL in Canada, but in the US it incurred greater costs and healthcare resource utilization vs. rituximab monotherapy - potentially indicative of their differing AE profiles. Conclusion Whilst MZL incidence varies by geography, incidence rates over time indicate a growing patient population, where the disease and economic burden will continue to increase. The 5-year relative survival rates are highest in EMZL/MALT patient subpopulations, but novel treatments are required across sub-types of MZL. Treatment patterns appear generally reflective of current guidelines, but systemic therapy was heavily reliant on rituximab-based treatment options. Evidence from the US reported that the need for novel therapies increases by LOT, but to further characterize real-world outcomes and treatment pathways in MZL (in particular r/r patients), additional studies are required. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Characteristics of basal gastric juice in Helicobacter pylori-associated gastritis before and after eradication therapy

Purpose: To evaluate the characteristics of basal gastric juice in Helicobacter pylori-positive patients before and after Helicobacter pylori eradication therapy. 
 Methods: This was a cross-sectional descriptive study on 150 gastritis patients admitted at the Hospital of Can Tho University of Medicine and Pharmacy. The patients were divided into 2 groups: study group (Helicobacter pylori gastritis patients) and control group (non-Helicobacter pylori gastritis patients). The pH, HCO3- concentration, and activities and concentrations of pepsin, lipase, and amylase were determined before and after treatment in study group. 
 Results: Patients with abnormal gastric juice comprised 76 % of the study population. Mean gastric potential of hydrogen (pH) was 2.31 (range: 1.64 - 7.68), while median concentration of HCO3- was 4.06 mmol/L (range: 0 - 73.04 mmol/L). The concentrations of pepsin, lipase, and amylase were 8.93, 0.93 and 1.38 ppm, respectively. Activities of pepsin, lipase, and amylase were 2.23, 0.28 and 0.04 U/mL, respectively. After the successful eradication of Helicobacter pylori, pH and HCO3- levels decreased, and there were significant differences in activities of pepsin and lipase before and after treatment (p < 0.05). Moreover, the levels of these parameters differed between patients in whom successful eradication was achieved and those in whom eradication failed (p < 0.05). The concentrations and activities of pepsin and lipase were statistically different between pre-treatment and post-treatment stages in both successful and failed Helicobacter pylori eradication categories (p < 0.05). 
 Conclusion: Basal gastric juice differs significantly between Helicobacter pylori-positive and Helicobacter pylori-negative patients. Intragastric ammonia produced by H. pylori may have a role in the increased pH of gastric juice.

Colonization by Various Morphological Forms of Helicobacter pylori in the Gingival Sulcus and Antrum of the Stomach.

Helicobacter pylori eradication therapy can be considered effective if the result of its implementation is removed including all roots and rootlets from which surviving H. pylori can repopulate in the gastric mucosa. One of the reasons for the ineffectiveness of eradication therapy can be the continuous presence of viable coccoid forms of H. pylori in the oral cavity. Therefore, anti-Helicobacter eradication therapy should be supplemented by the sanitation of the oral cavity. The objective of this study is to determine the frequency of occurrence of H. pylori in the gastric mucosa and in the oral cavity in patients with chronic periodontitis or with chronic gastritis using immunocytochemical method and to evaluate the pathophysiological relationship between periodontitis and HP-associated acid-dependent stomach diseases mediated by H. pylori. A group of patients with chronic gastritis (70 participants, 46 women, 24 men, age: 24 - 55 years) and another group with chronic periodontitis before the start of surgical treatment (61 participants, 30 women, 31 men, age: 20 - 60 years) were examined for НР bacterial cells using immunocytochemical methods of staining gastric biopsy and exfoliate samples from the gingival sulcus surface. The participants did not take any antimicrobial medication before and during the examination. Routine staining was also performed to view microbiota in smears for both groups. The participants signed a voluntary consent agreement to undergo routine medical examinations and join the study at the Nikiforov Russian Centre of Emergency and Radiation Medicine, EMERCOM of Russia, where the ethical committee was made. Immunocytochemical method could identify all stages of bacillary-coccoid transformation of H. pylori which accounted for 63.4-67.5% of cases. HP-antigenpositive bacteria were found in the oral cavity in both groups of examined patients. It was apparent that spiral forms of H. pylori were dominant over coccoid forms in the gastric mucosa in the antrum of the stomach, whereas coccoid forms of H. pylori were frequently found more in the oral cavity. Helicobacteriosis in the oral cavity was identified in chronic periodontitis. We found certain pathogenetic connections between inflammatory lesions of the oral cavity and diseases of the internal organs of the gastrointestinal tract. Accordingly, we suggest the necessity to use proper medication for oral cavity sanitation along with anti-Helicobacter eradication therapy to influence the HP reservoir in the oral cavity and gingival sulcus. Additionally, bacterial cells of HP reside in the oral cavity in coccoid forms; therefore, the coccoid form of HP should become the second principal target in treating HP.

Efficacy of Helicobacter pylori Eradication Based on Rabeprazole–Bismuth–Tetracycline–Tinidazole Regimen in Vietnamese Patients with Duodenal Ulcers

(1) Background: In Vietnam, H. pylori bacteria has a resistance rate of 63% to the antibiotic clarithromycin. The initial therapy of H. pylori eradication with a standard three-drug regimen has low efficacy. Objective: Assess the efficacy of H. pylori eradication therapy which uses a four-drug regimen of rabeprazole–bismuth–tetracycline–tinidazole in patients with duodenal ulcers. (2) Methods: We performed gastrointestinal endoscopy on patients with a diagnosis of duodenal ulcers, gastric mucosa biopsy for a rapid urease test, and histopathology to diagnose H. pylori bacteria before and after treatment. Treatment for eradication of H. pylori bacteria using a rabeprazole–bismuth–tetracycline–tinidazole regimen was prescribed for 14 days. (3) Results: The rate of successful H. pylori eradication treatment according to per protocol (PP) and intention to treat (ITT) was 91.3% (95%CI: 84.8–96.7) and 82.4% (95%CI: 74.5–89.2) respectively. The success rate of H. pylori eradication therapy in males was 96.0% (95%CI: 92–100), higher than in females, which was 70.6% (95%CI: 47.1–88.2), p < 0.01. (4) Conclusions: Treatment of H. pylori with rabeprazole–bismuth–tetracycline–tinidazole regimen is highly effective. Men had higher H. pylori eradication results than women.

Alarming antibiotics resistance of Helicobacter pylori from children in Southeast China over 6 years

The increasing rates of antibiotic resistance in Helicobacter pylori (H. pylori) are a major concern of the decreasing eradication rate. Large-scale and long-period studies on antimicrobial susceptibility of H. pylori in children are limited. This study aimed to describe the temporal changes of antibiotic resistance among children in southeast China. Gastric biopsies obtained from children were cultured for H. pylori from 2015 to 2020. Susceptibility to clarithromycin (CLA), amoxicillin (AML), metronidazole (MTZ), furazolidone (FZD), tetracycline (TET) and levofloxacin (LEV) was tested. Data from 2012 to 2014 reported previously were obtained for comparing the change in temporal trends of antibiotic resistance. A total of 1638 (52.7%) H. pylori strains were isolated from 3111 children recruited. The resistance rates to CLA, MTZ and LEV were 32.8%, 81.7% and 22.8%, respectively. There were 52.9% strains resistant to single resistance, 28.7% to double resistance, and 9.0% to triple resistance. The total resistance rate and resistance rates to CLA, MTZ, LEV, CLA + LEV and CLA + MTZ + LEV increased annually in a linear manner. All resistant patterns except single resistance increased obviously from 2015 to 2017 and 2018 to 2020 compared to that from 2012 to 2014. Double resistance to CLA + MTZ increased significantly with age. The resistance rate to CLA and triple resistance to CLA, MTZ and LEV increased in children with prior H. pylori treatment than that from children without prior treatment. The antibiotic resistance rates of H. pylori were high in a large pediatric population in southeast China from 2015 to 2020. Individual treatment based on susceptibility test is imperative and optimal regimens should be chosen in H. pylori eradication therapy.

Prospects for personalized Helicobacter pylori eradication therapy. Pro et contra

The article is devoted to debatable aspects of Helicobacter pylori eradication therapy. The eradication cancer-preventive effects are considered. A negative comorbidity between H. pylori infection and such diseases as gastroesophageal reflux disease, inflammatory bowel disease and bronchial asthma has been described. The perspectives of populational, individualized and personalized strategies for H. pylori eradication therapy assessment are given. Recommendations for individualized H. pylori eradication strategy implementation in practical healthcare are proposed.

Gastric cancer in a patient with chronic gastritis after <i>H. pylori</i> eradication: assessing the risks

Stomach cancer occupies a leading position in oncological morbidity and mortality worldwide. Approximately 800,000 people die from stomach cancer every year. In two-thirds of patients gastric cancer is diagnosed at a late stage, when radical treatment becomes impossible. Helicobacter pylori (H. pylori) infection is considered as the main etiological factor for gastric cancer. To stratify the risk of developing gastric cancer an assessment of morphological changes in the gastric mucosa using the Operative Link for Gastritis Assessment of Atrophic Gastritis (OLGA) system is used. The stage of gastritis plays a key role in determining an individual’s risk of developing stomach cancer. H. pylori eradication therapy is an effective method for preventing gastric cancer. However not in all patients the elimination of the infection can prevent the development of gastric cancer in the future. It is extremely important to identify a group of people with ex-helicobacter gastritis, who have a high risk of developing stomach cancer, and to take timely preventive measures in them. The purpose of this publication is to summarize and systematize the currently available data on the risk of developing gastric cancer in patients with H. pylori-associated gastritis, including those after successful eradication.