Pylori Eradication Therapy Research Articles

Features of duodenogastric refl ux in gastric ulcer

At the moment the approach to the treatment of gastric ulcer (GU) does not depend on the location of the ulcer in one or another part of the stomach. We compared gastric secretion, duodenogastric refl ux characteristics and Helicobacter pylori infection in patients with “high” and “low” gastric ulcers. 96 patients with recurrent GU were examined; 71.9% of men and 28.1% of women. In 58 patients, a “high” localization of the ulcer was detected, and in 38 patients, a “low” (pyloroantral) ulcer was diagnosed. All patients underwent esophagogastroduodenoscopy and daily intragastric pH-metry prior to the appointment of antisecretory therapy. The data were compared with the results of healthy volunteers. The frequency of detection of Helicobacter pylori infection was comparable with diff erent localization of gastric ulcer. We were able to show that with “high” ulcers, intragastric acidity in terms of fundal and antral pH and its circadian dynamics were comparable to healthy people. With “high” ulcers, the frequency of duodenogastric refl ux was close to normal, but their total duration was higher due to an increase in the proportion of prolonged and high refl ux. With “low” gastric ulcers, we noted a very high and monotonous acidity in the body and antrum of the stomach, combined with a decrease in the frequency and duration of duodenogastric refl ux. Consequently, both “high” and “low” stomach ulcers suggest the appointment of antisecretory drugs. At the same time, the detection of “high” stomach ulcers associated with excessive duodenogastric refl ux can be considered as a basis for prescribing bismuth tricalium dicitrate, including as part of the Helicobacter pylori eradication therapy, or ursodeoxycholic acid.

Modern opportunities to improve the effectiveness of eradication therapy on a clinical case

Today, one of the significant and urgent problems of gastroenterology is Helicobacter pylori infection, which is one of the most common causative agents of chronic infections in humans. The problems of its diagnosis, and to a greater extent therapy, continue to be the subject of numerous consensuses and recommendations. The effectiveness of Helicobacter pylori eradication therapy is quite acute, taking into account both the characteristics of the microorganism itself, the growing antibiotic resistance and the decrease in patients’ adherence to therapy. The choice of treatment regimen is determined by a number of regional characteristics, including indicators of H. pylori resistance to clarithromycin and nitroimidazole, as a result of which regional recommendations are being developed in a number of countries. At the same time, the summary data on the resistance of H. pylori to clarithromycin in Russia do not allow us to speak about high rates of this problem. Therefore, clarithromycin can be used in first-line therapy as an effective component of eradication therapy. At the same time, an important measure to improve the effectiveness of H. pylori eradication is to increase the adherence of patients to therapy, which consists in talking with the patient, providing complete information about the disease, its complications, the need to follow all recommendations and taking prescribed drugs, keeping a patient diary, and, if necessary, telephone contact with the patient. In addition, it is possible to influence compliance by increasing it by prescribing a fixed combination of drugs in one package. An example of this approach is the drug combination of omeprazole, clarithromycin and amoxicillin. This article presents a small review of the literature on the reasons for unsuccessful H. pylori eradication, considers possible ways to improve it, and analyzes a clinical case with a discussion of rational pharmacocorrection.

S3745 An Uncommon Case of Helicobacter pylori-Negative Gastric MALT Lymphoma

Introduction: Gastric MALT (mucosa-associated lymphoid tissue) lymphoma is a type of non-Hodgkin's lymphoma with concomitant H. pylori infection. Approximately 5-10% of patients are not. Recent studies on H. pylori-negative gastric MALT lymphomas have suggested that H. pylori eradication therapy is effective in a proportion of patients with this disease and could even be considered a first-line treatment. Here, we present this uncommon and unique case. Case Description/Methods: A 58-year-old man, with PMH of prostate cancer and DVT not on anticoagulation, was initially admitted for seizures and altered mental status under the impression of bacterial meningitis. He had an upper GI bleed during the same hospitalization, and an inpatient upper endoscopy showed a Forrest 1a ulcer in the gastric fundus s/p clipping (Fig 1A). A repeat upper endoscopy three months later showed gastric erythema and a 6 mm non-bleeding healing gastric ulcer in the fundus (Fig 1B). The pathology report of antrum biopsy showed fundic and transitional zone gastric mucosa, mild chronic gastritis without intestinal metaplasia or dysplasia, and the presence of a few atypical lymphocytes. The body biopsy showed fundic/body type gastric mucosa, and findings were compatible with low-grade B-cell lymphoma, favoring extranodal marginal zone lymphoma of MALT lymphoma (Fig 1C). The patient was empirically treated for H. pylori with Bismuth-based quadruple therapy. The patient improved on follow-up with GI. Hematology-Oncology is currently planning for FISH for t(11;18) and/or MYD88 mutation status to assist in the differential, as the H. pylori strain was negative on biopsy. Discussion: Several theories describe pathways for lymphoid proliferation in H. pylori-negative patients, but the exact mechanism has yet to be determined. Currently, it is deemed multifactorial. There is a high incidence of translocation (11;18)(q21;q21) in H. pylori-negative MALT lymphomas is seen. Using radiation therapy for patients with early-stage (Lugano I/II) gastric MALT lymphomas that are negative for H. pylori infection is recommended, with clinical remission rates of up to 100%. Conversely, organ-preserving therapy has no added benefit and surgical treatment is rarely pursued. Therefore, it is recommended to eliminate the presence of H. pylori and evaluate for this translocation. Recent studies have suggested that H. pylori eradication therapy is effective in some proportion of these patients and could be considered a first-line treatment.Figure 1.: A) Upper endoscopy image of Forrest Class 1a ulcer s/p two clips. There is a spurting gastric ulcer with spurting hemorrhage. B) Upper endoscopy of gastric erythema and a 6 mm non-bleeding healing gastric ulcer in the fundus. C) Pathology: Low power view, H&E stain, of antrum biopsy showing fundic and transitional zone gastric mucosa, mild chronic gastritis without intestinal metaplasia or dysplasia, and the presence of a few atypical lymphocytes Immunohistochemistry studies showed atypical lymphocytes CD20+, CD79a+, PAX5+, CD5-, CD10-, BCL6-, BCL2+, CD43+, CyclinD1-, BCL6, and CD10, highlighting very small, scattered, disrupted germinal centers. CD3 and CD5 highlighted numerous admixed T-cells. Ki-67 was overall low (5-10%). Kappa(ish) and Lambda(ish) stains showed that the plasma cells were kappa-restricted, and had low mitotic activity, supporting the diagnosis of marginal zone lymphoma.

Effect of metronidazole resistance on Helicobacter pylori eradication regimens.

Guidelines suggest bismuth-containing quadruple therapy (BQT) or concomitant therapy (CT) as first-line therapy in our geographic area. Both schedules contain metronidazole. We aimed to evaluate the effect of metronidazole resistance to Helicobacter pylori (H. pylori) eradication therapy. We recruited treatment-naïve subjects with H. pylori infection who received either CT or BQT during January 2020 and December 2021. Before therapy, a fecal sample was collected using the THD fecal test device from each patient. H. pylori DNA was extracted and mutations of rdxA and frxA genes and A2143G for metronidazole and clarithromycin resistance were investigated using real-time polymerase chain reaction with a high-resolution melting curve. Ninety-six patients were enrolled, including 29 received BQT and 67 received CT. The overall eradication rate was 94.8% (100% for BQT and 92.5% for CT). Metronidazole resistance was found in 18 (18.8%) subjects, while clarithromycin resistance was found in 19 (19.8%). All 18 patients with metronidazole resistance achieved successful eradication (five treated with BQT and 13 with CT). The eradication rate in metronidazole-sensitive strains was 93.6%. Of these, 24 received BQT with 100% success, and 54 had CT with five failures (successful eradication in 90.7%). Two patients with treatment failure were resistant to clarithromycin, and the remaining three were susceptible to both clarithromycin and metronidazole. No statistical significance was observed in the eradication rate between metronidazole-resistant and -sensitive strains (100% vs 93.6%, P=0.58). Metronidazole resistance does not influence the eradication rate of BQT and CT regimens in our geographical area, even if such results need to confirmed in a larger sample.

Inflammatory Bowel Disease and Helicobacter pylori: Protective or Present?

Lay Summary This article describes the prevalence of inflammatory bowel disease in patients with gastritis, duodenitis, and peptic ulcer disease, stratified by Helicobacter pylori infection. Inflammatory boweld is less prevalent in patients with H. pylori, and no increased risk of IBD is seen after H. pylori eradication therapy.

Circumferential Gastric Wall Thickening With Lymphadenopathy

Question: A 78-year-old Japanese man with a history of hypertension and abdominal aortic aneurysm visited our hospital for epigastric discomfort lasting more than a week. Blood examination revealed mildly elevated white blood cell counts (9900/μL) and normal red blood cell and platelet counts. Biochemical analyses indicated no specific abnormalities except mildly elevated C-reactive protein levels (1.89 mg/dL, normal range <0.14 mg/dL). Serum tumor marker levels, including carcinoembryonic antigen and carbohydrate antigen 19-9, were within the normal ranges. Although Helicobacter pylori infection was detected via serum antibody test, he had not received eradication therapy previously. Contrast-enhanced computed tomography (CT) showed circumferential gastric wall thickening with hyperenhancement on the mucosal surface, accompanied by infrapyloric lymphadenopathies (Figure A). Minimal ascites was found around the liver and in the pelvis. On fluorodeoxyglucose (FDG) positron emission tomography–CT, the thickened gastric wall and swollen lymph nodes showed intense accumulation of FDG with a maximum standardized uptake value of 5.23 and 4.33, respectively (Figure B). Moreover, minor mucosal erosions and ulcerations on the gastric body and the antrum were observed during esophagogastroduodenoscopy (EGD) (Figure C). The distensibility of the gastric wall by CO2 insufflation was not impaired on EGD. Endoscopic mucosal biopsies were performed on the thickened gastric wall with ulcerations. What is the most likely diagnosis here, and how should these lesions be treated? Look on page 339 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult. Gastric linitis plastica (GLP), a distinct subtype of gastric cancer characterized by thickening and rigidity of the gastric wall,1Vivier-Chicoteau J. Lambert J. Coriat R. et al.Development and internal validation of a diagnostic score for gastric linitis plastica.Gastric Cancer. 2020; 23: 639-647Crossref PubMed Scopus (10) Google Scholar was primarily suspected from the imaging findings. Perigastric lymphadenopathies and ascites suggested lymph node metastases and peritoneal dissemination, reflecting the aggressive behavior of GLP.1Vivier-Chicoteau J. Lambert J. Coriat R. et al.Development and internal validation of a diagnostic score for gastric linitis plastica.Gastric Cancer. 2020; 23: 639-647Crossref PubMed Scopus (10) Google Scholar However, the biopsy obtained from the margins of the ulceration did not reveal any malignant cells suggestive of GLP. Hematoxylin and eosin (HE) staining showed infiltration of numerous histiocytes and noncaseating granuloma formation (Figure D). Because the superficial biopsy often results in inconclusive diagnosis of GLP, laparoscopic resection of the swollen infrapyloric lymph nodes was performed to obtain a more substantial amount of tissue. HE staining of the surgically resected lymph nodes showed the formation of multiple small-size epithelioid granulomas (Figure E). To determine the etiology of granuloma formation, various kinds of immunohistochemical studies were performed. Accumulation of H pylori was observed inside the granuloma of both gastric mucosa (Figure F) and lymph nodes (Figure G) with the use of H pylori–specific antibody (B0471; Dako, Denmark) whereas Epstein-Barr virus or tuberculosis was not detected by in situ hybridization or Ziehl-Neelsen staining. In addition, the possibility of gastric sarcoidosis was low because the serum angiotensin-converting enzyme level was not elevated and gastric granuloma was negative for immunostaining of monoclonal antibody against Propionibacterium acnes (D371-3; MBL, Japan).2Yamaguchi T. Costabel U. McDowell A. et al.Immunohistochemical detection of potential microbial antigens in granulomas in the diagnosis of sarcoidosis.J Clin Med. 2021; 10: 983Crossref PubMed Scopus (17) Google Scholar,3Inomata M. Ikushima S. Awano N. et al.Upper gastrointestinal sarcoidosis: report of three cases.Intern Med. 2012; 51: 1689-1694Crossref PubMed Scopus (16) Google Scholar Therefore, the diagnosis of granulomatous gastritis associated with H pylori infection was made. Successful H pylori eradication therapy with vonoprazan, amoxicillin, and clarithromycin improved his symptoms. Furthermore, gastric wall thickening on CT as well as gastric mucosal ulcerations on EGD disappeared entirely 6 months after the H pylori eradication (Figures H and I), which further verified the diagnosis. This case highlights that granulomatous gastritis associated with H pylori infection needs to be considered in the differential diagnosis when encountering H pylori–positive cases exhibiting circumferential gastric wall thickening with lymphadenopathy.

A Review on Helicobacter pylori Infection

Helicobacter pylori (H. pylori) was first identified in 1982 by the Australian physicians Barry Marshall and Robin Warren. Helicobacter pylori is also known as Campylobacter pylori. It is a gram-negative, micro-aerophilic, spiral (helical) bacterium usually found in the stomach. H. pylori infection is one of the most common and chronic bacterial infection, affecting approximately half of the world's population. Peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma and gastric cancer all are linked to H. pylori. There are various diagnostic procedures to detect H. pylori infection and the choice of one approach over another is based on a number of considerations including accessibility, benefits and drawbacks of each method, cost, and the age of the patients. When H. pylori infection is diagnosed, doctor determines the therapy on the basis of patient's clinical status. Generally, eradication of H. pylori is recommended for treatment and prevention of the infection. In most of the cases H. pylori infections are cured with triple therapy. Moreover, quadruple therapies, sequential therapies and concomitant therapies have been developed as major alternative options to treat H. pylori infection. In this review pathophysiology, prevalence, transmission, clinical sign &amp; symptoms, risk factors, and diagnostic techniques used to detect H. pylori infection as well as H. pylori eradication therapy regimens are discussed.&#x0D; Keywords: Diagnosis, Helicobacter pylori, Treatment, Hybrid therapy, Concomitant therapy, Sequential therapy

Is Helicobacter Pylori a Reason for Unexplained Iron Deficiency Anemia: A Systematic Review.

Iron deficiency anemia (IDA) is a worldwide public health problem affecting millions, with developing nations accruing a significant disease burden. Helicobacter pylori (H. pylori) has been proposed in many studies as a causative factor for unexplained iron deficiency anemia. In this systematic review, we searched PubMed, Google Scholar, and ScienceDirect to come up with five cross-sectional studies and five Randomized Controlled Trials (RCTs), which evaluated the association between H. pylori and unexplained iron deficiency anemia and the response of IDA to anti-H. pylori therapy. H. pylori eradication therapy included triple therapy (proton pump inhibitor, clarithromycin, amoxicillin) or quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) for 10-14 days. Quadruple therapy was used if there is a penicillin allergy or a local antibiotic resistance level of more than 15% to clarithromycin. The cross-sectional studies concluded that H. pylori infection was associated with low serum ferritin levels. The RCTs confirmed that H. pylori are associated with iron deficiency anemia by demonstrating improvement in markers of iron status (ferritin, hemoglobin, Mean Corpuscular Volume (MCV), serum transferrin receptor levels) with H. pylori eradication therapy. In a nutshell, this systematic review concludes that H. pylori testing and treatment must be considered as a differential diagnosis of unexplained IDA in all age groups and serves as a benchmark for more randomized clinical trials to prove causation.

Analysis of Barrett’s Esophagus and Its Risk Factors: A Cross-Sectional Study of 10,122 Subjects at a Japanese Health Examination Center

Introduction: Helicobacter pylori eradication is expected to significantly change the prevalence of Barrett’s esophagus (BE). However, few reports on this relationship exist. We analyzed the risk factors of BE using the current consensus on length of BE considering H. pylori infection status. Methods: We analyzed 10,122 individuals (5,962 men; mean age = 52.9 ± 9.9 years) who had undergone esophagogastroduodenoscopy as part of a medical checkup. Correlations among factors including H. pylori infectious status, endoscopic findings, and BE ≥1 cm were analyzed. Results: Prevalence of BE, long-segment BE, and esophageal adenocarcinoma was 22.5%, 0.014%, and 0%, respectively. Logistic regression analysis showed that the risk factors for BE were hiatal hernia (odds ratio [OR]: 2.89 [2.59–3.24]), female sex (OR: 0.52 [0.46–0.59]), social drinking (OR:0.77 [0.68–0.87]), H. pylori eradication therapy (OR: 1.34 [1.19–1.51]), proton pump inhibitor (PPI) use (OR: 1.52 [1.18–1.96]), bile reflux (OR: 1.18 [1.04–1.33]), age ≥50 years (OR: 1.13 [1.02–1.26]), and nonsteroidal anti-inflammatory drug (NSAID) use (OR: 1.29 [1.02–1.62]). Although reflux esophagitis (RE) was more common in H. pylori-negative patients (17.2%) than in those after H. pylori eradication therapy (11.8%, p < 0.00001), the latter was correlated with BE, disputing RE as a strong risk factor for BE. Therefore, we conducted a subgroup analysis; most of the risk factors except for PPI use (p = 0.75), H2-receptor antagonist use (p = 0.078), and atrophic gastritis absence (p = 0.72) were positively correlated with BE after H. pylori eradication therapy compared with H. pylori-negative status. Conclusions: H. pylori eradication, bile reflux, PPI use, and NSAID use were risk factors for BE along with hiatal hernia, male sex, and older age.

The efficacy of vonoprazan combined with different dose amoxicillin on eradication of Helicobacter pylori: an open, multicenter, randomized clinical study.

BackgroundThe use of vonoprazan (VPZ) has improved the Helicobacter pylori (H. pylori) eradication therapy in Japan. There is no agreement on the dosage and frequency of amoxicillin administration in the VPZ dual treatment in China. We aimed to investigate the clinical effectiveness and safety of 3 treatment regimens using VPZ as an acid-suppressing medication to eradicate H. pylori.MethodsThis experiment involved an open, multicenter, randomized, and parallel controlled clinical investigation. A total of 230 newly diagnosed H. pylori-infected patients were then randomly assigned to 1 of 3 groups: (I) H-VA (high-dose amoxicillin combined with VPZ): VPZ 20 mg b.i.d with amoxicillin 750 mg q.i.d for 7 days; (II) L-VA (low-dose amoxicillin combined with VPZ): VPZ 20 mg b.i.d plus amoxicillin 500 mg q.i.d for 7 days; (III) VAC (amoxicillin combined with VPZ and clarithromycin): VPZ 20 mg b.i.d plus amoxicillin 750 mg plus clarithromycin 500 mg for 7 days. At least 4 weeks after treatment, the urea breath test (UBT) was reexamined. The effectiveness of various regimens was assessed based on compliance, safety, and eradication rate.ResultsThe regimen effectiveness was 63.5% (54/85) in the H-VA group, 58.3% (49/84) in the L-VA group, and 60.7% (37/61) in the VAC group, according to intention to treat (ITT) analysis. According to per protocol (PP) analysis, the eradication rate of the H-VA group was 65.1% (54/83), that of the L-VA group was 66.2% (49/74), and that of the VAC group was 64.9% (37/57). There was no discernible difference in the eradication rate across the 3 regimens, as shown by the results of ITT analysis (χ2=0.032, P=0.984) and PP analysis (χ2=0.480, P=0.786). The rate of adverse effect was 16.90% in the H-VA group, 13.20% in the L-VA group, and 24.10% in the VAC group. There was no discernible difference in the incidence of adverse effect between the three groups (χ2=2.784, P=0.266).ConclusionsNone of the 7-day elimination regimens investigated in this study, which included the acid-suppressing medicine VPZ and either a dual treatment paired with amoxicillin, or a triple treatment combined with amoxicillin and clarithromycin, achieved an acceptable eradication rate of H. pylori. Further research is required to identify an effective and safe treatment regimen.Trial RegistrationChinese Clinical Trial Registry identifier: ChiCTR2000040955.

Increasing Helicobacter pylori clarithromycin resistance in Australia over 20 years.

Helicobacter pylori infection is responsible for considerable morbidity and mortality worldwide, and eradication rates are falling in many countries, primarily due to clarithromycin and metronidazole resistance. There is a paucity of contemporary Australian data, which we sought to address by evaluating local rates of resistance of H. pylori to amoxicillin, clarithromycin, metronidazole and tetracycline over the past 20 years. All gastric biopsy specimens collected at endoscopy to detect H. pylori infection at a single centre underwent routine culture and antibiotic susceptibility testing between 1998 and 2017. Specimens from 12 842 patients were cultured for H. pylori, of which 1473 positive cultures were tested for antibiotic susceptibility. Antibiotic resistance to clarithromycin increased by 3.7% per year (incidence rate ratio [IRR] 1.037; P = 0.014) over 20 years, with a corresponding 5.0% annual increase in minimum inhibitory concentration (MIC) (odds ratio 1.050; P < 0.001). Since 2010, average clarithromycin resistance has exceeded 20%, with >25% of isolates resistant in the past 2 years of data capture. In contrast, rates of resistance to metronidazole (35.3%), amoxicillin (0.14%) and tetracycline (0.34%) and their MIC have remained stable. Review of a representative sample (n = 120; 8%) of these patients revealed that only 5% had documented prior H. pylori eradication therapy. Over the past 20 years there has been a substantial rise in clarithromycin resistance, with stable metronidazole resistance and low rates of resistance to amoxicillin and tetracycline. Current first-line H. pylori eradication therapy may fail to achieve adequate eradication rates, and optimal first-line therapy in Australia should be revisited.

Relationship between Helicobacter pylori infection and gastrointestinal microecology.

The prevalence of Helicobacter pylori (H. pylori) infection has exceeded 50% worldwide, and it is considered a high-risk factor for chronic gastritis, peptic ulcer, gastric adenocarcinoma, gastroesophageal reflux disease and functional dyspepsia. H. pylori drug resistance is a common problem worldwide. In recent years, the relationship between H. pylori infection and gastrointestinal microecology has received much attention. H. pylori infection changes the structure and composition of gastrointestinal microflora by regulating the gastrointestinal microecological environment, local pH value, cytokines and antimicrobial peptides, and immune response and then plays a crucial role in the occurrence and development of digestive system tumors, liver metabolism and extragastrointestinal diseases. The quadruple strategy of H. pylori eradication can also aggravate gastrointestinal microflora disorder. However, probiotics can reduce intestinal flora changes and imbalances through different mechanisms, thus enhancing the efficacy of H. pylori eradication therapy and reducing adverse reactions caused by eradication therapy. Therefore, this paper reviews the relationship between H. pylori infection and gastrointestinal microecology and its clinical application, providing a basis for clinical treatment.

Current knowledge and "myths" about celiac disease among physicians in the Republic of Kazakhstan: A countrywide cross-sectional study.

BackgroundCeliac disease (CD) is a common genetically predisposed autoimmune condition affecting the gut and other organs. Disease awareness is one of the key components of early case identification. This study aimed to assess awareness about CD among primary care physicians, who are the front-liners in suspecting the diagnosis, and other medical specialists.Methods and findingsThe questionnaire for this survey-based study was created based on the latest international guidelines on CD and included a consent form, 5 general questions (age, gender, etc.), and 10 specific questions concerning CD. Overall, 232 respondents from 13 country provinces (out of 14) and two republican cities were recruited for this study. Of them, 110 (47.4%) were primary care physicians and 122 (52.6%) other medical specialists, including 10 (4.3%) gastroenterologists. A scoring system was used to classify the level of awareness of participants into 3 categories, namely, poor, fair, and good. Analysis of responses revealed poor awareness in 59.4% of physicians, associated with work in republican/province/district/rural/village hospitals (p = 0.004), male gender (p = 0.006), and age of 40–50 years (p = 0.02). The most common “myths” about CD were the following: “symptoms are always obvious in children” or “in adults” (92.5 or 88.4% of respondents, respectively); “genetic mutation HLA DQ2/DQ8 causes the development of CD in all carriers of the mutation” (51.3%); “CD is a disease of children only” (12.5%); and “is triggered by dairy products” (8.6%). Genotyping of HLA DQ genes has been recommended in case of CD suspicion by every third respondent and was advocated as a “golden standard” confirmatory test by every fifth respondent. A quarter of respondents revealed their incorrect treatment strategies: gluten-free diet for 1 month, dairy-free diet, Helicobacter pylori eradication therapy, or responded that did not know how to treat. Overall, 93.5% of respondents expressed intention to learn more about CD, while the rest 6.5% thought that they knew enough, although their knowledge was poor.ConclusionThis study revealed a poor level of awareness among physicians in Kazakhstan and identified common misconceptions about CD, which potentially could lead to incorrect application of diagnostic tests, delay in diagnosis, and inefficient treatment. Development and implementation of educational programs as well as promotion of self-learning would increase awareness and unravel misconceptions.

Improved gut microbiome recovery following drug therapy is linked to abundance and replication of probiotic strains

ABSTRACT Probiotics have been used for decades to alleviate the negative side-effects of oral antibiotics, but our mechanistic understanding on how they work is so far incomplete. Here, we performed a metagenomic analysis of the fecal microbiota in participants who underwent a 14-d Helicobacter pylori eradication therapy with or without consumption of a multi-strain probiotic intervention (L. paracasei CNCM I-1518, L. paracasei CNCM I-3689, L. rhamnosus CNCM I-3690, and four yogurt strains) in a randomized, double-blinded, controlled clinical trial. Using a strain-level analysis for detection and metagenomic determination of replication rate, ingested strains were detected and replicated transiently in fecal samples and in the gut during and following antibiotic administration. Consumption of the fermented milk product led to a significant, although modest, improvement in the recovery of microbiota composition. Stratification of participants into two groups based on the degree to which their microbiome recovered showed i) a higher fecal abundance of the probiotic L. paracasei and L. rhamnosus strains and ii) an elevated replication rate of one strain (L. paracasei CNCMI-1518) in the recovery group. Collectively, our findings show a small but measurable benefit of a fermented milk product on microbiome recovery after antibiotics, which was linked to the detection and replication of specific probiotic strains. Such functional insight can form the basis for the development of probiotic-based intervention aimed to protect gut microbiome from drug treatments.

Effects of probiotics on gastric microbiota and its precombination with quadruple regimen for Helicobacter pylori eradication.

This study aimed to assess the efficacy and safety of probiotics for Helicobacter pylori (H.pylori) eradication therapy as well as their effects on gastric microbiota. Patients who had failed H. pylori eradication therapy for at least twice were prospectively enrolled during March 2019 and March 2021. A 2-week administration of compound Lactobacillus acidophilus probiotic (1g thrice daily) followed by a 10-day quadruple bismuth-containing H. pylori eradication therapy was administrated. Endoscopy was performed, and gastric biopsy samples were obtained for drug sensitivity testing and 16S rRNA gene sequencing before and after probiotic treatment. Eradication was evaluated by the 13 C-urea breath test at least 4 weeks after treatment completion. Adverse events (AEs) were recorded. Thirty-seven patients were included. Probiotic supplementation had no effects on the diversity, community structure, and composition of gastric microbiota and no inhibition on H.pylori activity. However, it increased some of the beneficial bacteria such as Blautia, Dorea, and Roseburia (P < 0.05). The overall eradication rate was 97.3% (95% confidence interval [CI] 91.8%-100%). AEs, mainly dizziness, nausea, diarrhea, and chest distress, were detected in six individuals, all of which were resolved upon cessation of antibiotic administration. Dyspeptic symptoms were improved after probiotic supplementation and at treatment completion (both P < 0.001). H. pylori-infected individuals might benefit from probiotics followed by a quadruple bismuth-containing eradication therapy. Further studies with large sample sizes are warranted.

Impact of Helicobacter pylori eradication timing on the risk of thromboembolism events in patients with peptic ulcer disease: a population-based cohort study

ObjectivesTo evaluate the impact of Helicobacter pylori eradication on venous thromboembolism (VTE) events, and the differences between early and late treatment timing.DesignA population-based cohort study.SettingTaiwan’s National Health Insurance Research Database.ParticipantsA...

The Resolution of Severe Iron-Deficiency Anemia After Successful Eradication of Helicobacter pylori in Teenagers.

In this case series, 7 H. pylori-infected patients with recurrent and/or refractory IDA (12-16 y old) received successful eradication therapy and were then followed for a median of 20 months (range, 9-76 mo) after oral iron supplementation therapy (1-4 mo) was discontinued. Five patients of our study cohort participated in rigorous sports activities. No visual appearance of ulcerations or erosions was found by esophagogastroduodenoscopy. In all patients studied, the gastric biopsies showed histological evidence of chronic gastritis without significant atrophy and intestinal metaplasia. Compared with the baseline (median values: hemoglobin, 6.3 g/dL; serum iron, 9 μg/dL; serum ferritin, 1.5 ng/mL), values of hemoglobin (P < 0.001), serum iron (P < 0.005), and ferritin (P < 0.001) significantly increased, on average, 2-3 months after eradication therapy and these iron indices were maintained at the same or higher levels at the endpoint of follow-up (median values: 14.2 g/dL, 102 μg/dL, and 29.3 ng/mL, respectively). No patient had recurrence of IDA at the time of final follow-up. H. pylori infection can be closely associated with recurrent or refractory IDA in teenage children. It is speculated that increased iron demands as a result of growth spurt in adolescents may play a synergistic role in combination with H. pylori in the pathogenesis of IDA.

The effects of kefir consumption on human health: a systematic review of randomized controlled trials.

Kefir, a traditional, fermented-milk beverage, has increasingly been promoted for various health benefits. The evidence from systematic reviews, however, is limited. Evidence from randomized controlled trials testing oral consumption of fermented-milk kefir on any outcome of human health or disease. A systematic search of 4 electronic databases (PubMed, Scopus, Allied and Complementary Medicine Database, and Cochrane Trials) from inception to July 31, 2021, was conducted. Data extraction and risk-of-bias assessments were conducted by 2 reviewers independently. A total of 18 publications reporting the results of 16 studies were included. Per the narrative analysis, fermented-milk kefir may have potential as a complementary therapy in reducing oral Streptococcus mutans, thereby reducing dental caries risk, and in Helicobacter pylori eradication therapy. Kefir may further aid treatment of adult dyslipidemia and hypertension, although evidence was very limited. Safety was only assessed in 5 of the 18 included publications, and 12 of the studies had an overall high risk for bias. Kefir is a dairy product with a unique microbiological profile that appears to be a safe for generally healthy populations to consume. However, efficacy and safety data from high-quality human trials are essential before any recommendations may be made for conditions of the oral and gastric microbiota and metabolic health. PROSPERO registration no. CRD42020211494.

Comparison of Efficacy of Conventional Triple Therapy and Non Bismuth Quadruple Therapy for Helicobacter Pylori Eradication

Objective: To compare the efficacy of conventional triple therapy and non bismuth quadruple therapy for helicobacter pylori eradication. Setting: Gastroenterology Department, Lady Reading Hospital Peshawar. Study Design: Randomized control trial. Duration: 6 months 15th August, 2018 to 15th February 2019. Materials and Methods: In this study a total of 111 patients were observed. Patients were put in two groups, group A triple Helicobacter pylori eradication therapy and group B non-bismuth quadruple Helicobacter pylori eradication therapy. Randomization of patients to either treatment group was done through lottery method. All patients were worked up with detailed history and clinical examination to look for any known allergy to drugs used in this study, to document any comorbidity and to exclude alarm features, baseline investigations including complete blood count, Random blood sugar, liver function tests and renal function tests. H pylori stool antigen was reported from Lady Reading Hospital laboratory at time of inclusion and four weeks after completion of therapy. The purpose and benefits of study was explained to patients and written consent for participation in study was obtained. Patients were asked on follow up about adherence to the treatment. Results: In this study mean age in Group A was 44 years with SD ± 2.77. Whereas mean age in Group B was 42 years with SD ± 3.12. In Group A 55% patients were male and 45% patients were female. Where as in Group B 58% patients were male and 42% patients were female. More over Group A (triple Helicobacter pylori eradication therapy) was effective in 75% patients. Where as Group B (non-bismuth quadruple Helicobacter pylori eradication therapy) was effective in 94% patients and was not effective in 6% patients. Conclusion: Our study concludes that non bismuth quadruple therapy is more effective than triple therapy in the treatment of Helicobacter pylori eradication. Keywords: Conventional triple therapy, Non-bismuth quadruple therapy, Helicobacter pylori eradication

Family-based Helicobacter pylori infection status and transmission pattern in central China, and its clinical implications for related disease prevention.

BACKGROUND Helicobacter pylori (H. pylori) has characteristics of family cluster infection; however, its family-based infection status, related factors, and transmission pattern in central China, a high-risk area for H. pylori infection and gastric cancer, have not been evaluated. We investigated family-based H. pylori infection in healthy households to understand its infection status, related factors, and patterns of transmission for related disease prevention.AIMTo investigate family-based H. pylori infection status, related factors, and patterns of transmission in healthy households for related disease prevention.METHODSBlood samples and survey questionnaires were collected from 282 families including 772 individuals. The recruited families were from 10 selected communities in the greater Zhengzhou area with different living standards, and the family members’ general data, H. pylori infection status, related factors, and transmission pattern were analyzed. H. pylori infection was confirmed primarily by serum H. pylori antibody arrays; if patients previously underwent H. pylori eradication therapy, an additional 13C-urea breath test was performed to obtain their current infection status. Serum gastrin and pepsinogens (PGs) were also analyzed.RESULTSAmong the 772 individuals examined, H. pylori infection rate was 54.27%. These infected individuals were from 246 families, accounting for 87.23% of all 282 families examined, and 34.55% of these families were infected by the same strains. In 27.24% of infected families, all members were infected, and 68.66% of them were infected with type I strains. Among the 244 families that included both husband and wife, spouse co-infection rate was 34.84%, and in only 17.21% of these spouses, none were infected. The infection rate increased with duration of marriage, but annual household income, history of smoking, history of alcohol consumption, dining location, presence of gastrointestinal symptoms, and family history of gastric disease or GC did not affect infection rates; however, individuals who had a higher education level showed lower infection rates. The levels of gastrin-17, PGI, and PGII were significantly higher, and PGI/II ratio was significantly lower in H. pylori-infected groups than in H. pylori-negative groups. CONCLUSIONIn our study sample from the general public of central China, H. pylori infection rate was 54.27%, but in 87.23% of healthy households, there was at least 1 H. pylori-infected person; in 27.24% of these infected families, all members were infected. Type I H. pylori was the dominant strain in this area. Individuals with a higher education level showed significantly lower infection rates; no other variables affected infection rates.