Pylori Treatment Research Articles

Vegetable Extracts and Nutrients Useful in the Recovery from Helicobacter pylori Infection: A Systematic Review on Clinical Trials.

Helicobacter pylori (H. pylori) infections affect almost half of the world’s population, with gradually increasing incidence in developed countries. Eradication of H. pylori may provide significant benefits to the affected individual by healing a number of gastrointestinal and extra-digestive disorders. But due to increased microbial resistance and lack of patient adherence to the therapy, the eradication rate of H. pylori is below 80% with current pharmacological therapies. The usage of botanicals for their therapeutic purposes and medicinal properties have been increased in last decades. They can be use as alternative H. pylori treatments, especially against drug-resistant strains. Epidemiological studies have revealed that people with lower vegetable and micronutrient intake may be at increased risk of H. pylori infection. We have undertaken a review of clinical trials to evaluate the efficacy of vegetable extracts and micronutrients in patients with H. pylori. Various databases, such as Google Scholar, PubMed, Scopus, Web of Science, and the Cochrane Library, were searched for the articles published in English. A total of 24 clinical studies (15 for vegetable extracts and 9 for micronutrients) were selected to be reviewed and summarized in this article. Vegetable extracts (Broccoli sprouts, curcumin, Burdock complex, and Nigella sativa) and micronutrients (vitamin C and E) were not found to be as effective as single agents in H. pylori eradication, rather their efficacy synergized with conventional pharmacological therapies. Conversely, GutGard was found to be significantly effective as a single agent when compared to placebo control.

Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community

ObjectiveOur aim was to prospectively assess the antibiotic resistance rates in Helicobacter pylori strains in Europe in 2018 and to study the link between antibiotic consumption in the community and...

Helicobacter pylori Infection: Diagnosis and Therapy

Helicobacter pylori (H. pylori) is a spiral shape gram-negative bacillus and have flagella for motility in mucus environment. H. pylori is microaerophilic organism, slow growing and requires complex growth media in vitro. H. pylori infecting more than 50% populations in worldwide. Prevalence of H. pylori infection is higher in developing countries compared to developed one, and indicates that socioeconomic and living standard may play a major role in the distribution. This study aims to provide an overview of how to diagnose and manage Helicobacter pylori infection. This study reviewed various sources then reviewed as a literature review. The most successful regimens are triple and quadruple combinations, which consist of a PPI and two or three antibiotics for 7 – 14 days. Patient’s compliance and the use of drug to which strain of H. pylori has not acquired resistance are the most important factors in successful H. pylori treatment.

Risk of head and neck cancer in patients with peptic ulcers and the effect of Helicobacter pylori treatment

It remained inconclusive whether patients with peptic ulcer disease had a higher risk of head and neck cancer (HNC). Therefore, we enrolled 109,360 patients with peptic ulcer disease and matched for age and sex with 218,720 controls from the Taiwan National Health Insurance Research Database between January 1, 1997 and December 31, 2013.The HNC incidence rate was 1.33-fold higher in the peptic ulcer group than in the control group (7.52 vs. 5.68 per 100,00 person-years; crude relative risk: 1.33; 95% confidence interval [CI]: 1.08–1.63) after > 6 years of follow-up. However, in the peptic ulcer subgroup with H. pylori treatment, HNC risk was not significantly different from that of the control group (crude relative risk: 1.12; 95% CI: 0.86–1.46). Moreover, the population with peptic ulcers had the highest risk of laryngeal and hypopharyngeal cancer (adjusted HR: 2.27 [95% CI: 1.16–4.44] and 2.00 [95% CI, 1.13–3.55]), respectively. This observational study suggested that peptic ulcer disease is associated with an increased incidence of laryngeal and hypopharyngeal cancer and H. pylori treatment may have a role in preventing HNC in patients with peptic ulcer disease.

Helicobacter pylori-targeting multiligand photosensitizer for effective antibacterial endoscopic photodynamic therapy

Helicobacter pylori (H. pylori) infection is closely associated with the development of gastric inflammatory diseases and cancer. However, the continued abuse and misuse of antibiotics has accelerated the spread of antibiotic-resistant strains, which poses a tremendous challenge for antibiotic-based H. pylori treatment. In this study, a H. pylori-targeting photodynamic therapy (PDT) system is proposed that multiple 3′-sialyllactose (3SL)-conjugated, poly-l-lysine-based photosensitizer (p3SLP). p3SLP facilitates H. pylori-targeting PDT via the specific interaction between 3SL and sialic acid-binding adhesin (SabA) in the H. pylori membrane. p3SLP can be orally administered to H. pylori infected mice and irradiated using an endoscopic laser system. The gastrointestinal pathological analysis of the H. pylori-infected mice demonstrated significant H. pylori specific antibacterial effects of PDT without side effects to normal tissue. In addition, an anti-inflammatory response was observed at the site of infection after p3SLP treatment. Consequently, this study demonstrates the superior efficacy of anti-H. pylori PDT with p3SLP in H. pylori-infected mice, and this approach shows great potential for replacing antibiotic-based therapy.

A142 TRENDS IN HELICOBACTER PYLORI TREATMENT AND CURE IN EDMONTON: 2015–2020

Abstract Background Therapies for Helicobacter pylori infection have changed significantly over time due to changes in resistance patterns. In 2016, the Toronto H. pylori consensus guidelines recommended treatment for 14 days. First-line therapies are concomitant therapy with a proton-pump inhibitor (PPI) and clarithromycin-amoxicillin-metronidazole (CLAMET) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT). Second and/or third line therapies are PBMT or PPI-amoxicillin-levofloxacin (PAL) and the fourth line PPI-amoxicillin-rifabutin (PAR) for 10 days. Aims To describe and compare the efficacy of current treatment regimens for H. pylori infection in Edmonton. Methods This retrospective study reviewed records of patients treated for H. pylori infection at the University of Alberta Hospital (UAH) in Edmonton, Alberta from January 1, 2015 - November 1, 2020. Diagnosis of H. pylori infection and test-of-cure were documented with a positive urea breath test, stool antigen test, histology on endoscopy, or positive culture. Patients who had no post-treatment testing were excluded. The per protocol efficacy of different regimens was calculated as well as cumulative success rates when given as 2nd, 3rd or 4th line therapy. Results Overall, 170 of 237 (71.7 %) confirmed H. pylori cases achieved cure. The majority were female (64%) and 113 (48%) were born outside of Canada. CLAMET initiated at UAH had the highest success rate 41/45 (91%), and in referred patients who were previously treated was successful as first-line therapy in 45/70 (64%). Overall success rate of regimens were as follows (Table 1): CLAMET 49/98 (50%), PBMT 45/114 (40%), PAL 33/99 (33%), and PAR 16/31 (51%). Alternative regimens were not successful 27/223 (12%). Cultures and resistance profiles were available for 53 cases that failed initial treatment. Resistance to clarithromycin (84%), metronidazole (48%), and levofloxacin (41%) was highly prevalent (Figure 1). Conclusions Test-of-cure is important to verify H. pylori eradication as antibiotic resistance is common to clarithromycin, metronidazole, and levofloxacin when prior treatments failed. These results support the H. pylori treatment regimens recommended by the Toronto consensus guidelines. Funding Agencies None

Application of a semi-automatic, intensive follow-up for improving efficacy and adherence of Helicobacter pylori eradication therapy: A randomized controlled trial.

A complete understanding and good adherence are crucial for successful Helicobacter pylori eradication. Proper frequency of reminders might be helpful to both doctors and patients to maintain adherence during treatment. The study was to evaluate the influence of an intensive follow‐up system based on a clinical database on H. pylori eradication therapy. A total of 196 eligible patients were equally and randomly divided into an intensive follow‐up group and a control group. Both groups were administered bismuth‐containing quadruple therapy for 14 days. Patients in the intensive follow‐up group were informed of pre‐treatment, including the duration and potential adverse events. Subsequently, they received telephone follow‐ups on days 3 and 14 and 3 days before the urea breath test (UBT). The time points were automatically reminded by a follow‐up system in the established clinical database. The control group was only informed of pre‐treatment information. UBT was performed 4 weeks after treatment in both groups to assess the presence of H. pylori. The eradication rate, patient compliance, and adverse events were calculated and compared. The H. pylori eradication rates of the intensive follow‐up and control groups were 94.7% (90/95, 95% CI: 90%–99%) and 92.9% (78/84, 95% CI: 87%–98%), respectively, by PP analysis (p = 0.601), and 91.8% (90/98, 95% CI: 86%–97%) and 81.6% (80/98, 95% CI: 74%–89%) by ITT analysis (p = 0.035). Adverse events occurred in 9 intensive follow‐up group patients and 12 in the control group. Adherence was 96.9% (95/98) in the intensive follow‐up group and 85.7% (84/98) in the control group. Semi‐automatic intensive follow‐up contributed to a higher eradication rate and adherence to H. pylori treatment.

Clinical features & treatment of early-stage gastric mucosa-associated lymphoid tissue lymphoma.

Background & objectives:Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is a common marginal zone lymphoma. The stomach is the relatively common origin of the MALT lymphoma, now termed as extranodal marginal zone B-cell lymphoma. Gastric MALT lymphoma has good prognosis due to clinical response to treatment and favourable overall survival. In this study, clinical characteristics and treatment of patients of early gastric MALT lymphoma were retrospectively analysed.Methods:Seventy patients with stages I–II MALT-lymphoma treated from April 2003 to August 2015 were included. The most common symptoms were abdominal discomfort, nausea, vomiting and other digestive symptoms. Helicobacter pylori eradication was done in patients with proven H. pylori infection. Patients in whom H. pylori eradication therapy was not effective, alternative treatments options including chemotherapy, radiotherapy and surgery, were given.Results:Fifty two patients with H. pylori infection underwent anti-H. pylori therapy, the total effective rate of anti-H. pylori treatment was 92.3 per cent (48/52). Thirty two patients were given anti-tumour treatment, including chemotherapy, radiotherapy and surgery. The total effective rate was 90.6 per cent (29/32). The five-year overall survival rate and five-year progression-free survival rate were 93.4 and 84.2 per cent, respectively.Interpretation & conclusions:For patients with early gastric MALT lymphoma, anti-H. pylori treatment may be effective. Patients with poor results of anti-H. pylori treatment need to be treated with anti-tumour therapy.

Helicobacter pylori associated aberrant methylation genes in blood leukocyte and gastric mucosa.

Background and Aim: Methylation alterations may be involved in Helicobacter pylori-associated gastric carcinogenesis. This study aims to explore the potential H.pylori-associated methylation biomarkers in blood leukocyte and gastric mucosa.Methods: Five candidate H.pylori-associated aberrant methylation genes were selected from the previous genome-wide profiling panels and validated in blood leukocyte and gastric mucosa in multi-stages (case-control validation between H.pylori positive and negative subjects and self-control validation before and after anti-H.pylori treatment).Results: GNAS methylation level was decreased in blood leukocyte (62.07% v.s. 46.33%, p<0.001) and gastric mucosa (56.30% v.s. 32.42%, p<0.001) of H.pylori positive subjects compared to negative controls. While, MTERF1 methylation level was increased significantly in blood leukocyte (29.57% v.s. 56.02%, p<0.001) and gastric mucosa (31.10% v.s. 47.50%, p<0.001) of positive subjects compared to controls. After successful H.pylori eradication, the methylation levels were increased from 44.87% to 60.88% (p<0.001) for GNAS and decreased from 46.19% to 34.56% (p<0.001) for MTERF1 in blood leukocyte. Similar increasing and decreasing methylation alterations were also found for the two genes after successful eradication in paired gastric mucosa. In TCGA database, an inverse relationship was found between GNAS methylation and mRNA expression (r=-0.12, p=0.027). The GC cases with higher GNAS expression levels showed significantly worse survival (HR, 2.09, 95%CI, 1.22-3.57, p=0.007) compared to lower expression subjects.Conclusions: GNAS and MTERF1 methylation levels may be affected by H.pylori infection in gastric mucosa and blood leukocyte. GNAS may be involved in advanced stage of GC development, although the possible mechanism still needs further study in precancerous lesions.

Evaluation of Helicobacter pylori infection as a potential risk factor of acute ischemic cerebrovascular stroke

ABSTRACT Background Helicobacter pylori (H. pylori) is a very common gastrointestinal infection that varies clinically from asymptomatic to overt peptic ulcer disease. Although H. pylori had been linked to ischemic heart disease, still scanty of data available about H. pylori link to ischemic cerebrovascular stroke. Object Evaluation of H. pylori Infection as a Potential Risk Factor of Acute Ischemic Cerebrovascular stroke. Method In a case control study, we recruited 150 ischemic stroke patients (group A) further subdivided into two subgroups atherosclerotic ischemic stroke (group A1) and cardioembolic stroke (group A2), also asymptomatic 95 patients recruited as non-ischemic control group (group B). All subjects were investigated for chronic H. pylori infection using both serum H. pylori IgG antibody test and urea breath test. Statistical analysis was done for obtained data. Results Significant higher prevalence of H. pylori infection was found among atherosclerotic stroke group (group A1) 61.4% versus non atherosclerotic group (A2) 40% and control group (B) 35.8% (P value 0.003), furthermore, significant higher prevalence when comparing group A1 (atherosclerotic stroke) and control group B (P1 value 0.001), still non-significant higher prevalence when comparing group A2 (cardio embolic stroke group) and control group B (P2 value 0.618). Conclusion Chronic H. pylori infection is a curable potential risk factor for ischemic atherosclerotic stroke. However, further studies needed to investigate the beneficial effect of H. pylori treatment on ischemic stroke.

Helicobacteriology update

Helicobacter pylori colonises the gastric mucosa and is associated with various gastric diseases, including stomach cancer. At least 1 million new cases of stomach cancer cases are reported annually, and it is the fifth top cancer-killer in the world. Although H. pylori can be eradicated by a combination of antibiotics, the treatment success rate is declining due to the rise of antibiotic resistance. The same antibiotic combination must not be prescribed repeatedly. Susceptibility guided precision medicine is the most effective strategy to combat antibiotic resistant H. pylori cases. In addition, maintaining a stomach pH ≥6 during the antibiotic treatment is an important factor to increase cure rates. The new type of acid blocker, P-CABs, have shown promising results in H. pylori treatment. Natural products may suppress the H. pylori growth or relieve the symptoms but have not been successful in solving the root of the problem. New combination therapies show promise and the dream of 100% cure of the infection with minimal side effects from treatment seems achievable. The next decade will see combination therapies with newer acid blockers in widespread use at reasonable cost.

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain.

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.

Effect of Helicobacter pylori treatment on the long-term mortality in patients with type 2 diabetes.

Background/AimsMeta-analyses of randomized trials reported a non-significant increase in overall mortality risk after Helicobacter pylori eradication. In this study, we investigated whether H. pylori treatment is associated with increased risk of overall mortality in patients with type 2 diabetes.MethodsIn this retrospective population-based cohort study, we identified 66,706 patients treated for type 2 diabetes between 2002 and 2010 from the Korean National Health Insurance Service-National Sample Cohort. Patients who received H. pylori treatment (Hp-treatment cohort, 1,727 patients) were matched to those who did not (non-treatment cohort, 3,454 patients) at a 1:2 ratio. The primary outcome was overall mortality. The secondary outcomes were mortalities due to cardiovascular disease, cerebrovascular disease, or cancers. To estimate hazard ratio (HR) with confidential interval (CI), we used the Cox proportional-hazard model.ResultsDuring a median follow-up of 4.7 years, the overall mortality was 5.9% (101/1,727 patients) among patients in the Hp-treatment cohort and 7.6% (364/3,454 patients) among patients in the non-treatment cohort. Adjusted HR (aHR) for overall mortality in the Hp-treatment cohort was 0.74 (95% CI, 0.59 to 0.93; p = 0.011). The mortality risks due to cardiovascular disease (aHR, 1.34; 95% CI, 0.54 to 3.30; p = 0.529), cerebrovascular disease (aHR, 0.97; 95% CI, 0.37 to 2.55; p = 0.947), and cancer (aHR, 1.08; 95% CI, 0.68 to 1.72; p = 0.742) were not significantly different between the groups.ConclusionsIn type 2 diabetes patients, overall mortality did not increase after H. pylori treatment.

Efficacy Of Three Different Regimens In Eradication Of Helicobacter Pylori Infection In Nepalese Patients Of Gandaki Region

Background: Helicobacter pylori (H. pylori) is associated with the pathogenicity of gastro-duodenal ulcers and gastric cancers. Combination of several antimicrobial therapies and regimens have been advised for H. pylori treatment. But, resistance to various antibiotics regimens are being documented worldwide. The present study was undertaken to study the efficacy of commonly used 3 different regimens for eradication of H.pylori infection in Nepalese patients.&#x0D; Methods: A cross-sectional, hospital based study comprising of 405 subjects, was conducted. Each study patient underwent upper gastro-intestinal endoscopy followed by rapid urease test or histopathology from the biopsy sample for H. pylori detection. Patients were randomly subjected to 3 different H. pylori eradication regimen. After 4 weeks of therapy, patients were re-evaluated for persistence of H. pylori infection either by repeat UGI endoscopy followed by RUT or C14- Urea Breadth Test. Data analysis was done by SPSS 20.&#x0D; Results: Mean age of the patients was 34.4±8.72 years (M: F=1.5:1) with male predominance. H. pylori eradication rate was only 65.9% in patients using standard triple regimen using Amoxicillin, Clarithromycin and PPI (Group A). Eradication rate was greater (77.8%) with Levofloxacin based regimen (Group B) and 83.3%. with sequential regimen containing Amoxicillin followed by Clarithromycin and Tinidazole with PPI (Group C).&#x0D; Conclusion: The study demonstrates that the current standard Amoxicillin and Claritrhromycin based triple regimen has lowest eradication rate followed by levofloxacin based regimen. The sequential regimen was the most efficacious among the 3 different regimens for H. pylori eradication.

Adhesin HpaA of Helicobacter pylori Promoted Migration of AGS Cells via IL-21 Secretion from HpaA-induced CD4+T Cells

Background: As known, there is a high correlation between Helicobacter pylori infection and gastric carcinoma. Objectives: Concerning the important role of adhesin HpaA of H. pylori in the infection process, we aimed to explore whether HpaA promotes gastric cancer metastasis. Methods: In this study, the levels of IL-21, MMP-2, and MMP-9 in patients’ biopsies with H. pylori infection were compared with post-treatment condition. The levels of IL-21 from CD4+ T cells and culture supernatants with the recombinant HpaA treatment were detected, and then the levels of MMP-2, MMP-9, and metastasis were detected and verified via AGS cells co-cultured with aforesaid CD4+ T cells. Results: Our results showed that higher levels of IL-21, MMP-2, and MMP-9 in patients’ biopsies with H. pylori infection than without H. pylori infection. Adhesin HpaA induced more IL-21 via CD4+ T cells, and IL-21 induced high MMP-2 and MMP-9 via AGS cells. In particular, HpaA caused this serial reaction to improve the migration of AGS cells, and aptamer HA6 (our previous report) and anti-IL-21 mcAb reduced the above phenomenon remarkably. Conclusions: In summary, our research suggested that adhesin HpaA plays a significant role in the process of gastric carcinoma cell metastasis via IL-21 from HpaA-induced T cells, and aptamer HA6 may be a potential therapeutic agent for H. pylori treatment.

The efficacy and safety of Clostridium butyricum and Bacillus coagulans in Helicobacter pylori eradication treatment: An open-label, single-arm pilot study.

Background:Helicobacter pylori (H pylori) infection plays a critical role in gastritis-associated diseases, gastroduodenal ulcers, and even gastric cancer. Studies have shown that probiotics may exhibit antagonistic activity against H pylori.Methods:This study aimed to assess the efficacy and safety of monotherapy with Clostridium butyricum (C butyricum) and Bacillus coagulans (B coagulans) for H pylori treatment. Our research was an open-label, single-arm pilot study of H pylori eradication. Subjects diagnosed with H pylori infection as outpatients at Xijing Hospital were randomized (1:1:1) to receive 8 weeks of therapy with C butyricum (group A), B coagulans (group B), or C butyricum plus B coagulans (group C). H pylori status was assessed 1 to 2 weeks after treatment. The H pylori eradication rate according to intention-to-treat and per-protocol analyses was the primary outcome of study, and the delta over baseline score, adverse events, and compliance were the secondary outcomes. This study was registered at ClinicalTrials.gov (NCT 03857425).Results:A total of 150 subjects were consecutively enrolled from February 2019 to August 2019. The ITT analysis demonstrated that the 3 groups achieved similar eradication rates (18%, 20%, and 26%, respectively, P = .597). The PP analysis yielded a similar result (24.3%, 26.3%, and 32.5%, respectively, P = .703). None of the subjects reported adverse events during treatment. The 3 groups had comparable compliance rates (74% vs 76% vs 80%, P > .05).Conclusion:C butyricum and B coagulans may effectively inhibit H pylori to some extent, with rare adverse events, and thus may reduce the burden of antibiotic resistance.

S1614 Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Isolated to the Colon

INTRODUCTION: Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare non-Hodgkin B-cell lymphoma commonly seen in the stomach but can be found anywhere in the gastrointestinal tract. We present a patient found to have MALT lymphoma of the colon during a screening colonoscopy, which was initially thought to be a laterally spreading sessile serrated lesion. CASE DESCRIPTION/METHODS: A 56-year-old female presented for colorectal cancer screening. She reported having chronic abdominal pain and new increase in stool frequency in the setting of a rise in life stressors. The colonoscopy revealed a 4 cm Paris 0-IIa-IIc polyp of the transverse colon and the patient was referred for repeat exam with endoscopic mucosal resection of the lesion. During the colonoscopy, the polyp was lifted without issue but proved difficult to entrap in various polypectomy snares. A few small pieces of the polyp were eventually removed and collected while the rest of the lesion was left in situ and tattoos applied proximally and distally. Histology revealed marginal zone lymphoma. Computed tomography of the chest, abdomen, and pelvis was negative for metastatic disease and confirmed Stage 1 MALT lymphoma. H. pylori stool antigen test was positive and Strongyloides stercoralis IgG antibody was negative. A multi-disciplinary team decided that a transverse colectomy would be the best treatment strategy based on the patient’s wishes. The patient tolerated the transverse colectomy well. Her medical oncologist advised clinical follow up and imaging (as the lesion was visible on CT preoperatively) every six months for five years as well as repeat colonoscopy at 1 year from surgery. Finally, she was treated for H. pylori infection with quadruple therapy. DISCUSSION: MALT lymphoma of the colon is exceedingly rare. While treatment for gastric MALT lymphomas is well established, management of colonic MALT lymphoma is not. Treatment options can consist of surgical resection, chemotherapy, or radiation therapy based on staging. Although guidelines for Stage 1 colonic MALT lymphoma recommend surgical resection, a multi-disciplinary approach is essential. H. pylori infection is rarely associated with MALT lymphoma in the colon. Results are mixed regarding H. pylori treatment in these individuals, although there have been reports of lymphoma resolution following eradication therapy. Overall this case demonstrated the importance of a multidisciplinary approach in a rare case that was initially thought to be a lateral spreading lesion.Figure 1.: Paris 0-IIa-IIc polyp measuring 4.0 cm in the transverse colon.Figure 2.: Endoscopic mucosal resection (EMR) of the identified polyp.Figure 3.: H&E, ×400: High-power image of lymphoepithelial lesion, where neoplastic cells are invading the colonic epithelium.

EMPIRICAL VERSUS SUSCEPTIBILITY-BASED ERADICATION THERAPY FOR HELICOBACTER PYLORI INFECTION IN EGYPT

Background: The eradication rate of Helicobacter pylori has declined, mainly due to antimicrobial resistance. Objectives: To test the effectiveness of susceptibility guided therapy vs. the empirical triple therapy for first: line H pylori treatment in a region with high antimicrobial resistance. Patients and methods: The study was performed on 82 dyspeptic H. pylori patients arranged for esophagogastroduodenoscopy at Al-Hussein University Hospital between March 2019 to march 2020. Patients were randomly divided into two groups: group A consisted of 52 patients underwent endoscopy and gastric biopsies for culture and sensitivity and treated according to sensitivity results and group B consisted of 30 patients treated by empiric triple therapy. Eradication rates and drug compliance owing to adverse effects were compared between the two groups. Results: In total, 82 patients were enrolled (52 in culture and sensitivity-based therapy group and 30 in empirical therapy group) and 50 patients (60.1%) completed the protocols. The overall resistance rates to clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline, nitrofurantoin and rifampicin were 32.1%, 32.1%, 78.6%, 7.1%, 17.9%, 17.9% and 21.4% respectively. Empirical triple and antimicrobial susceptibility-guided eradication rates were, respectively, 53.3% and 85.7% by intention-to-treat and 64% and 96% by per-protocol analysis. Adverse events were reported in 16.6% of patients on empirical triple therapy and 21.4% of those on susceptibility-guided therapy. Conclusions: Culture-based eradication strategy demonstrated superior eradication efficacy than empirical therapy as a first-line therapy in a region with high levels of antimicrobial resistance.

European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients

ObjectiveThe best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.DesignInternational multicentre prospective non-interventional registry starting...

Effect of Helicobacter pylori on gastrointestinal microbiota: a population-based study in Linqu, a high-risk area of gastric cancer

ObjectiveGastrointestinal microbiota may be involved in Helicobacter pylori-associated gastric cancer development. The aim of this study was to explore the possible microbial mechanisms in gastric carcinogenesis and potential dysbiosis arising...