Pylori Treatment Research Articles

Detection of antimicrobial resistance genes of Helicobacter pylori strains to clarithromycin, metronidazole, amoxicillin and tetracycline among Egyptian patients

BackgroundAntibiotic resistance of Helicobacter pylori (H. pylori) treatment is on the rise, and is affecting the efficacy of current used therapeutic regimens. AimWe aimed to enhance the understanding of antimicrobial resistance rates of H. pylori strains recovered from patients at Theodor Bilharz Research Institute Hospital in Egypt, as a mandatory step before starting treatment. Subjects and methodsMutant genes conferring metronidazole, amoxicillin, clarithromycin, and tetracycline resistance were detected in 60 H. pylori strains recovered from patients who underwent upper endoscopic examination. Patients were considered to be infected with H. pylori when rapid urease test and detection of 16S rRNA in gastric biopsies recorded positive. Molecular detection of resistant genes to metronidazole (rdx gene) and amoxicillin (pbp1A gene) was carried out by conventional PCR followed by sequencing of PCR products. While detection of 23S rRNA gene conferring clarithromycin resistance and detection of 16S rRNA mutation gene conferring tetracycline resistance were carried out by real-time PCR. ResultsH. pylori resistance rates to metronidazole, and amoxicillin were 25% and 18.3% respectively. While for clarithromycin and tetracycline, point mutations in 23S rRNA types A2142G and A2143G and in 16S rRNA of H. pylori were assessed by real time PCR assay respectively. Resistance mutant genes were found to be 6.7% of clarithromycin and 1.7% of tetracycline. Combined resistance rates to metronidazole and amoxicillin was (11.6%) followed by metronidazole and clarithromycin (5%), while patterns of clarithromycin and amoxicillin (1.6%), metronidazole, clarithromycin and amoxicillin (1.6%) were revealed. ConclusionData concerning antimicrobial resistance genes play an important role in empiric treatment of H. pylori infection. According to our results, H. pylori resistance to metronidazole and amoxicillin was relatively high. Clarithromycin is still a good option for first line anti-H. pylori treatment. Combined resistant strains are emerging and may have an effect on the combination therapy.

Construction and optimization of pH-sensitive nanoparticle delivery system containing PLGA and UCCs-2 for targeted treatment of Helicobacter pylori.

The acidic environment of the stomach is a threat to the curative effect of antimicrobial drugs for the eradication of Helicobacter pylori (H. pylori) in the infected area. The conventional clinical formulations of antibiotics have low specificity to H. pylori, which disrupts the normal balance of intestinal microbiomes. Therefore, oral drug delivery system with better stability at low pH as well as higher specificity to target H. pylori would provide more effective strategy to eradicate H. pylori and reduce the side effect of antibiotics. Based on the construction of UreI-mediated targeted drug delivery system developed by our group, in this work, using urea-modified UCCs-2 as targeting moiety to the UreI channel protein which is specifically expressed on H. pylori, pH-sensitive amoxicillin-loaded AMX-PLGA/UCCs-2 nanoparticles produced by UCCs-2 and PLGA for targeted treatment of H. pylori infection were established. The nanoparticles were prepared by double emulsion-solvent evaporation method. To achieve a promising drug delivery system with favorable pH-sensitive properties, we adopted an orthogonal design to obtain the optimal formulation. The results showed that the optimized AMX-PLGA/UCCs-2 nanoparticles were in a favorable pH sensitive manner and exhibited low cytotoxicity, higher specificity and better anti-H. pylori efficiency than amoxicillin and non-targeting AMX-PLGA/Cs nanoparticle both in vitro and in vivo, which can protect the antimicrobial drugs against acidic environment and deliver them to targeted eradicate H. pylori in the infected location. The cellular uptake mechanism showed that AMX-PLGA/UCCs-2 nanoparticles are an effective UreI-mediated targeted drug delivery system for anti-H. pylori treatment, which can also be used as promising nanocarriers for oral delivery of other therapeutic drugs to targeted treat H. pylori.

Inappropriate treatment in Helicobacter pylori eradication failure: a retrospective study

Background: In recent years, success rates of empirical H. pylori therapies have fallen in many countries. Although antibiotic resistance and poor adherence are described as the main factors for treatment failure, in China, iatrogenic factors also play an important role.Objective: To investigate why patients experienced multiple failures, we performed a retrospective, single center study using questionnaires to identify causes of treatment failure other than antibiotic resistance.Methods: This study was conducted from January 2016 to July 2017 in a general hospital. Patients with at least two H. pylori treatment failures who completed the questionnaire were entered. The survey covered characteristics of the study population, regimens used, and adherence to therapy.Results: Two hundred and ninety three patients were included in the final analysis. The top three most antibiotic combinations as the first-line treatment were a PPI plus clarithromycin–metronidazole (24.6%, 72/293), clarithromycin–levofloxacin (23.5%, 69/293) and clarithromycin–amoxicillin (21.5%, 63/293). Clarithromycin-containing regimens were repeatedly used in 178 patients (60.8%) and levofloxacin-containing regimens repeatedly in 88 patients (30.0%). Fifty patients (17.1%) had poor adherence per treatment history and 32 (10.9%) stopped treatment because of nonmedical reasons.Conclusions: In order to increase the success of H. pylori eradication therapy, the effect of prior therapies needs to be given more consideration. Patient education to enhance adherence also needs to be improved.

Primary antibiotic resistance of Helicobacter pylori in Chinese patients: a multiregion prospective 7-year study

ObjectivesTo explore the characteristics of Helicobacter pylori resistance in China and the association between antibiotic resistance and several clinical factors. MethodsH. pylori strains were collected from patients in 13 provinces or cities in China between 2010 and 2016. Demographic data including type of disease, geographic area, age, gender and isolation year were collected to analyse their association with antibiotic resistance. Antibiotic resistance was detected using the Etest test and the Kirby-Bauer disc diffusion method. ResultsH. pylori were successfully cultured from 1117 patients. The prevalence of metronidazole, clarithromycin (CLA), azithromycin, levofloxacin (LEV), moxifloxacin, amoxicillin (AMO), tetracycline and rifampicin resistance was 78.2, 22.1, 23.3, 19.2, 17.2, 3.4, 1.9 and 1.5%, respectively. No resistance to furazolidone was observed. The resistance rates to LEV and moxifloxacin were higher in strains isolated from patients with gastritis compared to those with duodenal ulcer and among women. Compared to patients ≥40 years old, younger patients exhibited lower resistance rates to CLA, azithromycin, LEV and moxifloxacin. The resistance rates to CLA and AMO were higher in strains isolated more recently, and we also found that the prevalence of resistance to metronidazole, CLA, azithromycin and AMO were significantly different among different regions of China. ConclusionsThe resistance rates to metronidazole, CLA and LEV were high in China. Patient age, gender, disease and location were associated with the resistance of H. pylori to some antibiotics. Furazolidone, AMO and tetracycline are better choices for H. pylori treatment in China.

MALT Lymphoma: A Dramatic Change Before and After Treatment of H. pylori

Mucosa-associated lymphoid tissue (MALT) lymphoma is usually a low-grade neoplasia that is associated with Helicobacter pylori (H. pylori) infection. It accounts for 2-8% of all tumors of the stomach The clinical presentation of gastric MALT lymphoma is non-specific, and includes dyspepsia, epigastric pain, and less frequently, alarm symptoms, such as gastrointestinal bleeding or persistent vomiting. Here in, we present a 68 y/o male with a medical history of hypertension, dyslipidemia, chronic kidney disease (stage 3), osteoporosis, and anemia, who presented for evaluation of chronic epgiastric abdominal pain. Upper endoscopy showed a large ulcer just distal to the GE junction with raised edges and superficial necrosis (Figure 1A). Biopsy was consistent with MALT lymphoma and H. pylori. The patient was started on a 2 week course of proton pump inhibitor (PPI), clarithromycin, and amoxicillin. Eradication of H. pylori was confirmed by negative H. pylori stool antigen 4 weeks following completion of treatment regimen. After 8 months, repeat upper endoscopy demonstrated eradication of lymphoma (Figure 1B). Biopsies were negative for MALT lymphoma. While the frequency of MALT lymphoma is on the rise, it continues to be a rare clinical entity. Furthermore, though MALT lymphoma is a B-cell neoplasia, classic B symptoms are extremely rare. The treatment of MALT lymphoma targets H. pylori eradication as first line therapy where 75% of patients achieve remission. Data suggests that in H. pylori negative patients, H. pylori treatment has been successful in 15% of patients. For the management of patients who fail to achieve lymphoma remission following H. pylori eradication, alternative or second-line therapies include radiotherapy, chemotherapy and, in selected cases, surgery.Figure: Stomach MALT lymphoma before (A) and after (B) treatment.

Effect of Outpatient Status on Practice Management of H. pylori-associated Peptic Ulcer Disease

Introduction:Helicobacter pylori infection remains an important cause of peptic ulcer disease (PUD). The 2007 and updated 2017 American College of Gastroenterology guidelines indicate that patients with H. pylori-associated PUD should receive eradication therapy followed by confirmation testing to prove H. pylori eradication. The latter is relevant because initial H. pylori treatment is often only 70-85% successful and persistent H. pylori infection may be associated with recurrent ulcers and gastric malignancy. Despite guidelines, confirmation testing rates are modest (30-40%) for largely unexplored reasons. The aim was to identify barriers and predictors of receiving guideline-concordant confirmation testing. Methods: We performed a retrospective cohort study of patients with active H. pylori-associated PUD diagnosed in 2007-2015, who received standard eradication therapy and had follow-up within one year. Our primary outcome of interest was the effect of outpatient vs. inpatient status (at time of peptic ulcer diagnosis) on confirmation testing rates. We also compared confirmation testing rates in patients with vs. without repeat endoscopy and patients with vs. without gastroenterology follow-up. We used logistic regression models with propensity scores to control for age, sex, race, comorbidity status, insurance status, ulcer location and symptom persistence. Results: 67/152 (44%) patients received guideline-concordant confirmation testing. Outpatients (OR 3.9, 95% CI 1.8-8.8, p=0.0009) and patients who had gastroenterology follow-up (OR 9.7, 95% CI 3.2-29.0, p=0.0009) were significantly more likely to receive confirmation testing than their counterparts (Table 1). Repeat endoscopy was not a significant independent predictor of receiving confirmation testing.Table: Table. Independent predictors of receiving confirmation testing to prove H. pylori eradication in patients with H. pylori-associated peptic ulcer diseaseConclusion: This study provides some insight into the discrepancy between recommended and practiced management of H. pylori-associated PUD following eradication therapy. We identified outpatient status and gastroenterology follow-up as independent predictors of receiving guideline-concordant confirmation testing. These findings suggest a potential role for quality improvement initiatives, particularly during the transition of care from inpatient to outpatient setting, in order to optimize adherence to best practices.

Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions: 16-year follow-up of an eradication trial

ObjectiveTo evaluate the long-term effect of cumulative time exposed to Helicobacter pylori infection on the progression of gastric lesions.Design795 adults with precancerous gastric lesions were randomised to receive anti-H. pylori...

Are Synbiotics added to the Standard Therapy to eradicate Helicobacter pylori in Children Beneficial? A Randomized Controlled Study.

Aim:We aimed to evaluate the role of the addition of Bifidobacterium /actis-containing synbiotic to the triple therapy in the case of He/icobacter py/ori eradication, the dyspeptic symptoms, and reducing the side effects of antibiotics.Materials and methods:A total of 104 children aged between 5 and 17 years, who were histopathologically diagnosed with H. py/ori were enrolled in this study, of whom 100 were included in the analysis. Patients were randomly classified into two groups. In the first group, 50 patients were administered amoxicillin + clarithromycin + lansoprazole for 14 days and B. /actis-containing synbiotic. In the second group, 50 patients were treated with the standard triple therapy. All patients were given information after completion of therapy.Results:H. py/ori eradication was achieved in 88% in group I who received standard therapy with additional synbiotic and 72% in group II (p = 0.046). The number of patients in the second group who suffered from abdominal pain between the 3rd and 14th day of the treatment was higher (p < 0.05). The addition of probiotics to the triple therapy significantly reduced the frequency of diarrhea, but no significant difference was detected in the frequency of metallic taste (p = 0.04, p = 0.418 respectively).Conclusion:The addition of synbiotic to the triple therapy is effective for eradicating H. py/ori infection in children and is usually helpful to reduce or eliminate dyspeptic symptoms like abdominal pain, diarrhea, and vomiting. This study suggest that improved tolerance to the eradication treatment also reduces the treatment failure by adding probiotics and encourages the future study using probiotic supplementation in H. py/ori treatment.How to cite this article: Şirvan BN, Usta MK, Kizilkan NU, Urganci N. Are Synbiotics added to the Standard Therapy to eradicate He/icobacter Py/ori in Children Beneficial? A Randomized Controlled Study. Euroasian J Hepato-Gastroenterol 2017;7(1):17-22.

The “report card” to grade H. Pylori treatment regimens: is it achievable in realworld in areas with high clarithromycin resistance?

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Eucalyptus spp. outer bark extracts inhibit Helicobacter pylori growth: in vitro studies

Helicobacter pylori is the etiologic agent of several gastric disorders. The growing rates of unsuccessfulness of available antibiotics-based therapy led to the need for non-antibiotic compounds for H. pylori treatment. The antibacterial activity of Eucalyptus nitens and Eucalyptus globulus outer bark lipophilic extracts were evaluated against a panel of H. pylori strains, as well as the role of pure triterpenic acids and synthetic mixtures mimicking the natural extracts. Best results were obtained with E. nitens outer bark extract (MIC=64μg/mL) and it was demonstrated that after 6h of exposure to the MIC, there was a significant decrease (>50%) in H. pylori growth. Moreover, it was determined that the antibacterial effect of Eucalyptus spp. outer bark extracts was due to the synergetic effect of four triterpenic acids, namely betulinic, betulonic, ursolic and oleanolic acids. Our findings open new perspectives for development of anti-H. pylori therapies based on the use of these plant extracts.

36 Comparsion of effectiveness of two one week treatment regimens for H.Pylori in south of ireland patient cohort

Background H. pylori eradication rates for 7 day triple therapy regimens have decreased in many countries in recent years. Recent European guidelines recommend that standard triple therapy should not be used where local H. pylori resistance rates are greater than 15%. Aim Aim of study was to compare H. pylori eradication rates of one week, metronidazole vs Chlarithromycin based, triple therapy regimens in a south of Ireland patient cohort. Method From January 2015 to September 2016 undergoing upper GI endoscopy by two gastroenterologists at the Bon Secours Hospital Cork had H. pylori status determined by CLO test (BioHIT). All Clo positive patients received one of two seven day H. pylori treatment regimens; PPI, Amoxycillin, Clarithromycin (PAC) or PPI, Amoxycillin, Metronidazole (PAM). All treated patients were offered urea breath test (Diabact UBT)3- 4 months following treatment. Results Of 2595 patients having upper endosocpy 188 (7.2%) had positive CLO tests.45% (106/188) were females and mean age 56 (17 to 84 years).Of the 188 Clo positive patients,118 (63%) received PAC treatment and 70 (37%) received PAM treatment. Of the 118 PAC patients 83 (69%) attended for UBT and 24 (29%) were positive. Of the 70 patients treated with PAM 50 (71%) returned for UBT and 14 (28%) were positive. Conclusions In a patient cohort with relatively low H.pylori infection rates, one week based Clarithromycin and Metronidazole based triple therapy regimens achieved equivalent eradication of H.pylori (71% PAC,72% PAM). H. pylori eradication rates are somewhat higher than recently reported in Ireland, they are well short of current European guidelines and add further weight to the recommendation that one week triple therapy regimen should not be used in this country for first line H. pylori eradication.

P.02.4: Efficacy of Bismuth-Based Helicobacter Pylori Treatment in Patients with Atrophic Body Gastritis

P.02.4: Efficacy of Bismuth-Based Helicobacter Pylori Treatment in Patients with Atrophic Body Gastritis

Clinical, endoscopic and histopathological features of eosinophilic gastroenteritis in 76 children

Objective To analyze the clinical, endoscopic and histopathological features of eosinophilic gastroenteritis (EG) in children. Methods A retrospective study of 76 children with EG was performed to analyze clinical symptoms, laboratory and imaging results, endoscopic and pathological features, status of Helicobacter pylori (H.pylori) infection, treatment and outcomes. Results The main clinical symptoms were abdominal pain in 55.3%(42/76) cases, vomiting in 39.5% (30/76) cases and hematochezia in 38.2% cases(29/76). The hemoglobin level decreased significantly in 34 cases (44.7%, 34/76). Peripheral blood eosinophil (EOS) count increased significantly in 9 cases (11.8%, 9/76) and EOS percentage increased significantly in 13 cases(17.1%, 13/76). Total serum IgE elevated in 32 cases (54.2%, 32/59). There were also 18 cases (36.7%, 18/49) positive in serum allergen-specific immunoglobulin E (sIgE) test and 25 cases (32.9%, 25/76) positive in fecal occult blood test. Among 51 cases of abdominal ultrasound examination, there were 7 cases of ascites, 4 cases of pelvis fluid and 3 cases of intestinal wall change. Endoscopic examination in 76 cases showed 63 cases (82.9%) of mucosal hyperemia/edema, 20 cases (26.3%) of ulceration, 17 cases (22.4%) of erosion, 11 cases (14.5%) of nodularity or hyperplasia and 9 cases (11.8%) of normal mucosa. The pathological examination showed mucosal inflammation with a large number of EOS infiltration(≥20 per HPF). There were 12 cases(15.8%, 12/76) of H. pylori infection. Among the 76 cases, clinical symptoms improved significantly in 74 patients after treatment with dietary allergen avoidance, anti-allergy medications, antacids, montelukast and corticosteroid, and the total efficacy was 97.4%. The efficacy of dietary allergen avoidance, anti-allergy medications, antacids and montelukast was 93.8%(61/65). The efficacy of corticosteroid was 86.7%(13/15). Conclusion The clinical manifestations and endoscopic characteristics of EG in children lack specificity. In terms of diagnosis, the elevated total serum IgE and the positive sIgE test may be taken as reference for the diagnosis of EG. The definite diagnosis is based on pathological examination(EOS infiltration≥20 per HPF). While in terms of treatment, dietary allergen exclusion, anti-allergy medications, antacids and montelukast are highly effective, which can be taken as the first option. There is no need of corticosteroid as routine therapy. Key words: Endoscopy; Histopathology; Child; Eosinophilic gastroenteritis

Use of probiotics as an adjuvant to sequential H. pylori eradication therapy: impact on eradication rates, treatment resistance, treatment-related side effects, and patient compliance.

To evaluate the effect of probiotics administered as an adjuvant to sequential Helicobacter pylori (H. pylori) eradication therapy on treatment outcome and patient compliance. In total, 159 patients with H. pylori infection receiving sequential H. pylori eradication therapy were included in this randomized placebo-controlled study. Starting from day 0 of sequential eradication therapy (ERA), patients in the ERA+probiotic group [n=53, mean (SD) age: 47.7 (14.0) years, 54.7% were females] also received a probiotic supplement with Bifidobacterium animalis subsp. lactis B94 (1 capsule/day), patients in the ERA+placebo group [n=52, mean (SD) age: 46.4 (13.4) years, 51.9% were males] received placebo treatment (1 capsule/day), and patients in the ERA-only group [n=54, mean (SD) age: 46.3 (11.9) years, 55.6% were females] received no additional treatments. Eradication rates, patient compliance, and side effects of eradication therapy were recorded in each treatment group. Significantly higher eradication rates were noted in the ERA+probiotic group (86.8% vs. 70.8%, p=0.025) than in the combined ERA (ERA-only and ERA-placebo) group. Non-compliance with anti-H. pylori treatment was noted in 24 (15.1%) of 159 patients. Lower rates of first week treatment non-compliance due to diarrhea (1.88% vs. 12.26%, p=0.036) were noted in the ERA+probiotic group than in the combined ERA (ERA-only and ERA-placebo) group. Treatment resistance (p: 0.389) was similar between the groups, indicating pure antibiotic resistance without any compliance problems. The number needed to treat for an additional beneficial outcome (NNTB) was 6.2 (CI 95%, 3.5 to 28.9) for probiotic use. In conclusion, adjuvant administration of probiotic (B. animalis subsp. lactis) in 2-week sequential H. pylori eradication therapy is associated with a higher H. pylori eradication rate, lower first week diarrhea-related treatment discontinuation rates, less common self-reported side effects, and higher treatment compliance.

Helicobacter pylori antibody responses in association with eradication outcome and recurrence: a population-based intervention trial with 7.3-year follow-up in China

ObjectiveTo identify serum biomarkers that may predict the short or long term outcomes of anti-Helicobacter pylori (H. pylori) treatment, a follow-up study was performed based on an intervention trial in Linqu County, China. MethodsA total of 529 subjects were selected randomly from 1,803 participants to evaluate total anti-H. pylori immunoglobulin G (IgG) and 10 specific antibody levels before and after treatment at 1-, 2- and 7.3-year. The outcomes of anti-H. pylori treatment were also parallelly assessed by13C-urea breath test at 45-d after treatment and 7.3-year at the end of follow-up. ResultsWe found the medians of anti-H. pylori IgG titers were consistently below cut-off value through 7.3 years in eradicated group, however, the medians declined in recurrence group to 1.2 at 1-year after treatment and slightly increased to 2.0 at 7.3-year. While the medians were significantly higher (>3.0 at 2- and 7.3-year) among subjects who failed the eradication or received placebo. For specific antibody responses, baseline seropositivities of FliD and HpaA were reversely associated with eradication failure [for FliD, odds ratio (OR)=0.44, 95% confidence interval (95% CI): 0.27–0.73; for HpaA, OR=0.32, 95% CI: 0.17–0.60]. The subjects with multiple positive specific antibodies at baseline were more likely to be successfully eradicated in a linear fashion (Ptrend=0.006). ConclusionsOur study suggested that total anti-H. pylori IgG level may serve as a potential monitor of long-term impact on anti-H. pylori treatment, and priority forH. pylori treatment may be endowed to the subjects with multiple seropositive antibodies at baseline, especially for FliD and HapA.

Pleiotropic cytotoxicity of VacA toxin in host cells and its impact on immunotherapy.

Introduction: In the recent decades, a number of studies have highlighted the importance of Helicobacter pylori in the initiation and development of peptic ulcer and gastric cancer. Some potential virulence factors (e.g., urease, CagA, VacA, BabA) are exploited by this microorganism, facilitating its persistence through evading human defense mechanisms. Among these toxins and enzymes, vacuolating toxin A (VacA) is of a great importance in the pathogenesis of H. pylori. VacA toxin shows different pattern of cytotoxicity through binding to different cell surface receptors in various cells. Methods: To highlight attempts in treatment for H. pylori infection, here, we discussed the VacA potential as a candidate for development of vaccine and targeted immunotherapy. Furthermore, we reviewed the related literature to provide key insights on association of the genetic variants of VacA with the toxicity of the toxin in cells. Results: A number of investigations on the receptor(s) binding of VacA toxin confirmed the pleiotropic nature of VacA that uses a unique mechanism for internalization through some membrane components such as lipid rafts and glycophosphatidylinositol (GPI)-anchored proteins (GPI-AP). Considering the high potency of VacA toxin in the clinical presentations in infection and assisting persistence and colonization of H. pylori, it is considered as one of the pivotal components in production vaccines and monoclonal antibodies (mAbs). Conclusion: It is possible to generate mAbs with a considerable potential to convert into secretory immunoglobulins that could penetrate into the niche of H. pylori and inhibit its normal functionalities. Further, conjugation of H. pylori targeting Ab fragments with the toxic agents or drug delivery systems (DDSs) offers new generation of H. pylori treatments.

Effectiveness of 7-Day and 14-Day Moxifloxacin-Dexlansoprazole Based Triple Therapy and Probiotic Supplement for Helicobacter Pylori Eradication in Thai Patients with Non-Ulcer Dyspepsia: A Double-Blind Randomized Placebo-Controlled Study

Background:Helicobacter pylori (H. pylori) is important cause of peptic ulcer and gastric cancer. Moxifloxacin is effective antibiotic for treatment for H. pylori. However, there were limited studies as first line therapy. Probiotics had been shown to decrease therapy-related side-effect and increase eradication rate. Aim of this study was to evaluate the efficacy of moxifloxacin-dexlansoprazole based triple therapy with probiotic for H. pylori treatment in Thailand.Methods:Patients with H. pylori infected gastritis were randomized to receive 7- or 14-day moxifloxacin-dexlansoprazole based triple therapy with probiotic or placebo. Regimen consisted of 60 mg dexlansoprazole twice daily, 400mg moxifloxacin once daily, 1g clarithromycin MR once daily. Probiotic used in this study was 282.5mg Saccharomyces boulardii (S. boulardii) in capsule prescribed twice daily. CYP2C19 genotyping, antibiotic susceptibility tests, and CagA genotyping were also done. Successful eradication was defined as a negative 13C-urea breath test at least 4 weeks after treatment.Results:Total of 108 subjects was enrolled (27 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 29% fluoroquinolone, 19% metronidazole and 4% clarithromycin resistance. CYP2C19 genotyping demonstrated 43%, 47% and 11% were rapid, intermediate and poor metabolizers, respectively. CagA genes were positive in all patients. Eradication rates of 7-day and 14-day regimens with probiotic were 100%, and 93% respectively. There were no significant differences between eradication rate of 7-day and 14-day regimen with or without probiotics. Regarding side-effects, incidence of nausea, abdominal discomfort, bitter taste, and diarrhea were significantly lower in regimen with probiotic group compared with placebo(7.4%vs. 22.2%; p=0.028, 0.00%vs.14.8%; p=0.003, 35.2%vs.70.4%; p=0.0002, and 0.00%vs.9.3%; p=0.028, respectively).Conclusions:7-day moxifloxacin-dexlansoprazole therapy plus S. boulardii provide an reliable cure rate of H. pylori in non-ulcer dyspeptic patients in Thailand, independent of CYP2C19 genotype. Probiotic adding also decreased side effects during the treatment.

A cheap, simple high throughput method for screening native Helicobacter pylori urease inhibitors using a recombinant Escherichia coli, its validation and demonstration of Pistacia atlantica methanolic extract effectivity and specificity

Helicobacter pylori is the most frequent and persistent bacterial infection worldwide, and a risk factor for active gastritis, peptic ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Although combined antibiotics treatment is effective cases of antibiotic resistance are reported at an alarming rate. The H. pylori urease enzyme is essential for the bacteria establishment in the gastric mucosa, resulting urease inhibitors being sought after as effective and specific anti- H. pylori treatment. To-date, screening assays are based mostly on the analog plant urease enzyme but difference in properties of the plant and bacterial enzymes hamper these efforts. We have developed a screening assay based on recombinant Escherichia coli expressing native H. pylori urease, and validated this assay using thiourea and a methanolic extract of Pistacia atlantica. The assay demonstrated the thiourea and the extract to be potent urease inhibitors, with the extract having strong bacteriostatic activity against clinical isolates of H. pylori, including such with antibiotic resistance. The extract was also found to be neutral toward common probiotic bacteria, supporting its specificity and compatibility with digestive system desired microflora and suggesting it could be a good source for anti-H. pylori compounds.The assay has proven to be cheap, simple and native alternative to the plant enzyme based assay and could allow for high throughput screening for new urease inhibitors and could expedite screening and development of novel, better H. pylori remedies helping us to combat this infection.

Helicobacter pylori-induced chronic inflammation causes telomere shortening of gastric mucosa by promoting PARP-1-mediated non-homologous end joining of DNA

Helicobacter pylori infection leads to chronic gastritis and increased risk of gastric cancer. The mechanism involves chronic inflammation. We aimed to determine the mechanism by which H. pylori infection causes telomere shortening in inflammatory gastric mucosa. Gastric biopsy specimens were obtained from 20 patients with chronic gastritis or peptic ulcer caused by H. pylori infection. The specimens showed increased NF-κB and superoxide dismutase activities and elevated expressions of PARP-1 and γ-H2AX, all of which returned to normal levels after anti-H. pylori treatment, suggesting that oxidative DNA damage and PARP-1 overexpression might cause telomere shortening. In this report, we adopted DNA end joining assay and showed that H. pylori-infected gastric mucosa had increased alternative NHEJ (non-homologous end joining), implicating that telomere shortening was caused by inflammation-mediated overproduction of reactive oxygen species and PARP-1, leading to telomere shortening.

Sequential versus standard triple first-line therapy for Helicobacter pylori eradication.

Sequential versus standard triple first-line therapy for Helicobacter pylori eradication.