Pylori Treatment Research Articles

Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review.

Although susceptibility-guided therapy is frequently recommended for Helicobacter pylori infection, the evidence available to date supporting this strategy is limited. The aim of the present article is to review the advantages and limitations of the susceptibility-guided and the empirical strategies to treat this infection. We performed a bibliographic search to identify studies investigating H. pylori susceptibility-guided therapy. Culture is not the only way to assess antibiotic resistance, as different polymerase chain reaction-based approaches have been developed as alternative methods. For detecting H. pylori antimicrobial resistance, a molecular approach based on a stool sample might enable more convenient, time-saving methods. Unfortunately, the antimicrobial susceptibility cannot be obtained in all cases. Furthermore, antibiotic susceptibility testing in clinical practice yields useful information only for a few antibiotics: clarithromycin, metronidazole, and quinolones. In addition, susceptibility towards clarithromycin and metronidazole in vitro does not necessarily lead to eradication in vivo. In the case of H. pylori therapy failure, we should not re-administer any of the antibiotics against which H. pylori has probably become resistant. Our updated meta-analysis showed that susceptibility-guided treatment is not better than empirical treatment of H. pylori infection in first-line therapy if the most updated quadruple regimens are empirically prescribed, and similar efficacy results were also demonstrated with the two strategies for second-line therapy. Cumulative H. pylori eradication rate with several successive rescue therapies empirically prescribed reaches almost 100%. Finally, the studies that have evaluated the cost-effectiveness of the susceptibility-guided treatment have achieved contradictory results. In summary, we can conclude that the evidence is too limited to support the generalized use of susceptibility-guided therapy for H. pylori treatment in routine clinical practice, either as first-line or as rescue treatment. Nevertheless, it would be recommended that susceptibility tests are performed routinely, even before prescribing first-line treatment, in specialized centers with an interest in H. pylori management.

Tracking the Virulent Helicobacter pylori Strains Instead of Its Pan-Screening to Prevent Gastric Cancer

Gastric colonization by Helicobacter pylori is associated with the development of chronic gastroduodenal disorders, including atrophic gastritis, duodenal ulcer, and gastric cancer. Mainly over the last three decades, exemplary research efforts and clinical trials have been aimed at achieving the best formulation and treatment regimens for mass eradication of H. pylori. Reflecting on these efforts, we would like to pose the following questions: Is it mandatory to aim for eradication of all H. pylori strains or only specific strains thereof? What populations should be selected for antibiotic therapy? Until now, the screen-and-treat strategy has been the best recommendation by the guidelines for clinicians caring for patients from high-risk populations, but targeting the virulent strains of H. pylori had not been considered. However, updated guidelines based on renewed concepts to improve H. pylori treatment could help clinicians better manage their patients who suffer from gastric cancer. Importantly, preventing gastric cancer will not be feasible by the screen-and-test strategy alone. Here, we present a commentary proposing a renewed consideration of H. pylori screening and treatment and their potential impact on H. pylori eradication in anticipation of preventing gastric cancer.

Treatment of Helicobacter pylori.

Helicobacter pylori eradication has become more challenging over the past decade due to increasing antimicrobial resistance, especially to clarithromycin and levofloxacin. We identified 508 recent publications on H. pylori treatment (published between January 2018 and June 2019), focusing on the most highly clinically relevant for this review. Declining H. pylori eradication rates with clarithromycin triple therapy have led to most guidelines recommending 14 days bismuth-based quadruple therapy or concomitant therapy as the best initial empiric regimen. Substituting amoxicillin for tetracycline or metronidazole in quadruple therapy, and a three-in-one pill version of the regimen, also appear effective. Vonoprazan, a potent acid inhibitor, can overcome much clarithromycin resistance in triple therapy. High-dose dual therapy (proton pump inhibitor with amoxicillin) is a promising alternative approach. Reviewing resistance patterns to select suitable first-line empiric therapies is important in high resistance regions. Molecular methods to evaluate H. pylori antimicrobial susceptibility promise to be simpler than standard microbiological culture. The cost-effectiveness of antimicrobial susceptibility testing in refractory cases remains unproven. Updating clinicians treating H. pylori is important to combat the emerging problems of multidrug antimicrobial resistance in H. pylori strains. Truly novel approaches to H. pylori eradication are needed.

Impact of Helicobacter pylori Eradication in Children with Acute Immune Thrombocytopenia: A Randomized Controlled Study

Background: At present, some evidence supports the role of Helicobacter pylori eradication in treating childhood immune thrombocytopenia (ITP). Objectives: This study was designed to investigate the association between H. pylori eradication and platelet count in children with acute ITP. Methods: Thirty children with a diagnosis of acute ITP and H. pylori infection were studied. This randomized and controlled study was done in Amir-Kabir Hospital, Arak, Iran. Patients were randomly allocated 1:1 to standard ITP and H. pylori treatments or standard ITP treatment. For 6 months, studied subjects had monthly follow-ups. Results: The mean ± standard deviation (SD) age was 11 years with a majority of females (67.9 % vs. 32.1 %). The mean platelet count was 16.93 ± 10.1 (109/L) in the ITP and H. pylori therapy group, and15.0 ± 3.8 (109/L) in the ITP therapy group at the baseline. After 1 week of treatment, mean platelet counts increased to 136.5 ± 55.20 and 124.0 ± 45.70 in the two groups, respectively (109/L). The differences between the two groups were not statistically significant at other time intervals. Children that received ITP and H. pylori therapies had a higher rate of gastrointestinal symptoms (P < 0.01). Conclusions: Our findings suggest that H. pylori eradication did not significantly affect the platelet count compared to standard ITP therapy in children with acute ITP.

Investigating effect of Helicobacter pylori treatment on improvement of non-alcoholic fatty liver parameters: a randomized trial

Background and objectiveThe correlation between the eradication of Helicobacter pylori (HP) and non-alcoholic fatty liver disease (NAFLD) is a controversial one. The aim of this study is to investigate the effect of Helicobacter pylori treatment on liver function tests and lipid profiles and to compare its effects with exercise therapy and diet alone.MethodThis was a double-blind randomized clinical trial conducted at Qazvin University of Medical Sciences. One hundred patients with NAFLD having a positive test for urea breath testing were randomly assigned into one of the intervention and comparison groups. The diet and physical activity program were given to two groups of patients for 8 weeks, three sessions per week. In addition to the above therapy, the patients in the intervention group also received HP treatment for 2weeks. The data corresponding to anthropometric and clinical features before and after the intervention were collected in both groups and compared using appropriate statistical methods.ResultsAfter the treatment interventions, the variables of weight, BMI, blood glucose, triglyceride, AST, ALT, total cholesterol, and LDL-C were significantly decreased in both groups (p < .05). In the between-group comparisons, only ALT was significantly lower in the intervention group (HP) (p < .05).ConclusionFindings of this study showed that the eradication of Helicobacter pylori could significantly improve the ALT index, but it had no additional effect on changes in metabolic indicators.Trial registrationRegistration number: IRCT2015042020951N2Name of trial registry: The study of treatment of Helicobacter pylori in improvement of non-alcoholic fatty liver diseaseThe date of registration: 2015-05-12Where the full trial protocol can be accessed: https://fa.irct.ir/trial/18489

1214 Quadruple Therapy Is Superior to Triple Therapy in the Treatment of Clarithromycin Exposed Helicobacter pylori

INTRODUCTION: Resistance of Helicobacter Pylori to antibiotics has reached alarming levels around the world, which has a great effect on efficacy of treatment. Little is known about its resistance pattern and optimal treatment within Brooklyn, New York. The objective of this study was to investigate whether triple or quadruple therapy is more effective in the treatment of H. Pylori, and whether prior clarithromycin exposure affects primary clinical outcomes. METHODS: A total of 598 patients were identified by retrospective chart review from January 2015 to January 2018 that satisfied our inclusion criteria; 272 of those patients were selected based on selection criteria. Patients were excluded from the study if they were less than 18 years of age, or were treated for recurrent H. Pylori infection. Descriptive statistics was used to compare continuous and categorical variables. RESULTS: Of the 272 patients identified, the median age was 50 ± 16 years. The majority (36%) of patients were Asian. Approximately 20.5% of patients were active smokers or had a history of smoking. 84% (n = 229) patients did not have prior clarithromycin exposure, while only 16% (n = 43) were exposed. 65% (n = 176) patients used triple therapy, while 35% (n = 96) used quadruple therapy for H. Pylori treatment. 79% (n = 214) patients had no recurrence, while 21% (n = 58) patients experienced treatment failure. Overall, triple therapy was associated with higher rates of treatment failure when compared to quadruple therapy (22% triple therapy vs 20% quadruple therapy). When prior clarithromycin exposure taken into account, treatment failure increased to about 28%. This effect was higher in patients treated with triple therapy than quadruple (28% vs 27%, respectively). However, due to small sample sizes, significance was not observed. CONCLUSION: Quadruple therapy appears to be more effective at treating H. Pylori overall and in the setting of prior clarithromycin exposure. While these findings may guide clinical decision making, larger head to head studies are needed to validate these findings.

1235 Risk Factors for Advanced Gastric Intestinal Metaplasia in a Multi-Ethnic United States Cohort

INTRODUCTION: Gastric intestinal metaplasia (GIM) is a precursor to gastric cancer (GC). The operative link for GIM (OLGIM) is a standardized histologic scoring system (ranging 0 to 4) used to evaluate severity of GIM; in prospective European studies, it has been shown to predict risk for progression onto GC. Use of OLGIM has not previously been described in North American populations. Risk factors for advanced GIM are poorly described in North America, and currently no screening recommendations exist for either GC or GIM. METHODS: We prospective enrolled patients between the ages of 30 and 84 scheduled to undergo outpatient endoscopy at Stanford University for the following indications 1) dyspepsia, 2) H. pylori assessment, 3) GC screening, or 4) GIM surveillance. At time of enrollment, all patients completed a standardized questionnaire inquiring about medical, family, dietary, and exposure history. Biopsies were performed from both antrum and body. Histologic scoring was performed according to a Standardized protocol, and OLGIM score assigned to each subject. We compared demographic, clinical, and environmental variables between subjects with GIM and subjects without GIM. We also compared subjects with advanced GIM (defined as OLGIM ≥ 2) with subjects without advanced GIM (OLGIM &lt; 2). Continuous variables were analyzed using Student's T-test, and categorical variables were analyzed using the Chi-squared test. RESULTS: 38 subjects with GIM, and 41 subjects without GIM were enrolled. Of the GIM group, 20 subjects demonstrated advanced GIM. Subjects with GIM were older (P = 0.001), more likely to have a history of H. pylori treatment (P = 0.002), and more likely to be first-generation immigrants (P = 0.008) compared to subjects without GIM (Figure 1). Subjects with advanced GIM were more likely to be older (P = 0.02), and more likely to be first-generation immigrants (P = 0.04) compared to subjects without advanced GIM (Figure 2). Gender, presence of symptoms, presence of medical comorbidity, family history, smoking status, and dietary preferences did not demonstrate significant differences between groups in this cohort. CONCLUSION: Age and immigration status, known risk factors for GC, may also be risk factors for advanced GIM. As advanced GIM significantly increases risk for GC, detection of advanced GIM may improve GC morbidity and mortality. Additional research should be focused on non-invasive testing to detect advanced GIM in North American populations.

Helicobacter Pylori Cytotoxin-Associated Gene A (CagA) and Gastric Carcinoma

Gastric cancer is a highly lethal disease. Establishment of H. pylori infection as a risk factor for this malignancy help identifying persons at increased risk. Studying the association between the genotypes of H pylori virulence factors and gastric carcinoma would have clinical implications in selecting patients who would benefit from H. pylori eradication treatment, with a subsequent reduced risk of gastric cancer. Many virulence factors are involved in the pathogenicity of H. pylori, including urease, vacuolating cytotoxin (a product of the vacA gene), and the immunogenic protein cagA, encoded by the cytotoxin-associated gene A (cagA). These virulence factors interact and modulate different cellular signaling pathways to induce a pro-inflammatory response or alter tight junctions and cell polarity, which finally favor metastasis. The cagA gene is a virulence gene located in the cag pathogenicity island of the bacterial genome and is frequently associated with more severe clinical outcomes. The cagA proteins can increase the virulence potencies of strains, by increasing host-cell cytokine production and altering protein tyrosine phosphorylation. Many studies revealed a possible association between H. pylori virulence factor cagA and its genotypes and the development of gastric carcinoma among patients, which would help in minimizing the risk of gastric carcinoma development by selecting patients who would benefit from H. pylori eradication. This review highlights how the upregulation of cagA gene could be a risk factor for developing gastric carcinoma and its potential relationship on the selection of patients who would benefit from H. Pylori treatment. Keywords:Cancer, cytokine, virulence

2989 To Determine the Frequency of Helicobacter pylori in Patients With Gastric Cancer

INTRODUCTION: Around the world, particularly in Asia and Eastern Europe, gastric disease remains a main source of malignant growth demise. A higher danger of advancement of gastric malignancy has been accounted for in patients with positive serologic tests for H pylori. This investigation is a push to demonstrate a relationship of H pylori as a cancer-causing agent and the seriousness of harm it is related with. H. pylori is perceived as a reason for constant gastritis, which might be viewed as the initial phase in a grouping of changes to the gastric mucosa perhaps bringing about malignancy. In this manner, the present examination investigated the presence of H. pylori disease in people with gastric malignant growth at tertiary consideration healing center. METHODS: The two year cross section study screened fifty cases of carcinoma stomach for H. pylori infection. The inclusion criteria were patients with carcinoma stomach confirmed by endoscopy and histopathology while the exclusion criteria patients received anti H pylori treatment within 6 months and the patients not willing/refuse to give consent for the study. All patients who presented with upper GI symptoms and suspected to have carcinoma stomach investigated in the form of complete blood count, ultrasound and upper gastrointestinal endoscopy. On endoscopy patient who had growth in the stomach biopsy was taken from and around the growth and subjected to Rapid urease test and histopathologic examination along with serology test for antibobies to H. pylori. The frequency/percentages (%) and means ± SD computed for study variables. RESULTS: During two year study period total fifty patients were explored for H. pylori infection. The frequency for male and female population was 32 (64%) and 18 (36%) with mean ± SD for age of male and female individuals was 55.83 ± 9.62 and 58.21 ± 8.72 respectively. The H. Pylori infection was positive in 30 (60%) patients while the growth exists in antrum 25 (50%), antrum and body 10 (20%), body 08 (16%), body and fundus 04 (8%), fundus 03 (6%) while regarding the histopathology well differentiated carcinoma 07 (14%), moderately differentiated carcinoma 10 (20%), poorly differentiated carcinoma 33 (66%). CONCLUSION: The existence of H. pylori observed in gastric carcinoma cases may lead to a spread of H. pylori in histologic sections and might describe the variation in H. pylori infection rates reported for patients with gastric cancer.

Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial

ObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.DesignBlinded randomized placebo controlled trial.SettingLinqu County, Shandong province, China.Participants3365 residents of a...

Helicobacter pylori and Its Antibiotic Heteroresistance: A Neglected Issue in Published Guidelines.

“Heteroresistance” is a widely applied term that characterizes most of the multidrug-resistant microorganisms. In microbiological practice, the word “heteroresistance” indicates diverse responses to specific antibiotics by bacterial subpopulations in the same patient. These resistant subpopulations of heteroresistant strains do not respond to antibiotic therapy in vitro or in vivo. Presently, there is no standard protocol available for the treatment of infections caused by heteroresistant Helicobacter pylori in clinical settings, at least according to recent guidelines. Thus, there is a definite need to open a new discussion on how to recognize, how to screen, and how to eliminate those problematic strains in clinical and environmental samples. Since there is great interest in developing new strategies to improve the eradication rate of anti-H. pylori treatments, the presence of heteroresistant strains/clones among clinical isolates of the bacteria should be taken into account. Indeed, increased knowledge of gastroenterologists about the existence of heteroresistance phenomena is highly required. Moreover, the accurate breakpoints should be examined/determined in order to have a solid statement of heteroresistance among the H. pylori isolates. The primary definition of heteroresistance was about coexistence of both resistant and susceptible isolates at the similar gastric microniche at once, while we think that it can be happened subsequently as well. The new guidelines should include a personalized aspect in the standard protocol to select a precise, effective antibiotic therapy for infected patients and also address the problems of regional antibiotic susceptibility profiles.

Warnings on the safety of quinolones: Should Helicobacter pylori treatment prescriptions be modified?

Warnings on the safety of quinolones: Should Helicobacter pylori treatment prescriptions be modified?

Development and Evaluation of Amoxicillin Loaded Carbopol 934P Mucoadhesive Microcapsules for Sustained Drug Release for H. pylori Treatment

Amoxicillin (α-amino-p-hydroxybenzyl-penicillin) is a semi-synthetic, orally absorbed and widely prescribed β-lactam antibiotic. It is now widely used for eradication of gastric Helicobacter pylori infection combined with a second antibiotic and an acid‐suppressing agent despite its short elimination half-life of one hour. The purpose of this study was to develop and evaluate amoxicillin loaded carbopol 934P mucoadhesive microcapsules for sustained drug release at the gastric mucosa to prolong the residence time of dosage form in the stomach and to achieve controlled drug release for more effective H. pylori eradication. Amoxicillin mucoadhesive microcapsules were formulated by ion gelation technique using 32 factorial designs. A 32 full factorial design was used to derive the statistical equation, ANOVA analysis, contour plots and 3D response surface plots. FT- IR (4000 cm-1- 450 cm-1) analysis of amoxicillin and with polymers was performed by using potassium bromide pellet method. Different polymer ratios of carbopol 934P and sodium alginate were used to formulate by nine formulations (F1 to F9) amoxicillin mucoadhesive microcapsules. The prepared formulations were characterized by determining their percentage of yield, particle size, percentage of entrapment efficiency, swelling index, percentage of mucoadhesion and percentage of drug release. Amoxicillin and used polymers are found to be compatible with no interaction reported by FTIR analysis. The optimized formulation (F9) exhibited a high drug entrapment efficiency of 96.04±0.03%, particle size of 847.2518±0.06 μm, yield of 98.86±0.01%, swelling index of 120.09±0.06%, and mucoadhesion of 67.00±0.02 after 8 h. A successful sustained drug release was achieved for more than 14 h. In-vitro dissolution test for optimized formulation (F9) demonstrated a slower release behavior in 0.1N hydrochloric acid followed by linear release profile in pH 7.4 phosphate buffer. The drug-to-polymer-to-polymer ratio had a more significant effect on the dependent variables. The release kinetic study of optimized formulation (F9) displayed a good fitting with zero order behavior and Korsmeyer-Peppas model has confirmed a non-Fickian release. The developed mucoadhesive amoxicillin microcapsules were observed to have adhered strongly with gastric mucosa with approximately 14 h of prolonged stay expecting improved bioavailability and reduced dosing frequency and subsequently improving patient’s compliance. The concentration of carbopol 934P and sodium alginate had highly significant effects on depended variables. The present study concludes that amoxicillin mucoadhesive microcapsules can be effectively used for the more effective treatment of H. pylori infection.

Potential roles of Helicobacter pylori treatment, body mass index and waist circumference in the causation of erosive esophagitis: a randomized clinical trial (HEROES-GERD)

In recent decades, the prevalence of gastroesophageal reflux disease (GERD) and obesity has been increasing while Helicobacter pylori infection has been decreasing. To evaluate if H. pylori treatment, excess body weight and other anthropometric measurements are associated with incident erosive esophagitis, as a secondary objective of a trial which tested the efficacy of treatment of H. pylori on the symptoms of functional dyspepsia. Upper gastrointestinal endoscopy and anthropometric assessments were performed, at baseline and after 12 months, in H. pylori positive patients with functional dyspepsia who had no baseline reflux symptoms or esophagitis. Patients were randomly assigned to receive omeprazole, amoxicillin, and clarithromycin (antibiotic group; n = 201) or omeprazole plus placebo (control group; n = 203). The primary outcome was the incidence of esophagitis 12 months after randomization, according to treatment groups, and the association of BMI and other anthropometric measurements. Four hundred and four patients were included (mean age, 46.1 years; 78.7% women). The 12-month follow-up endoscopic esophagitis rates for the antibiotic and control groups were 10.9% (22/201) and 9.4% (19/203), respectively (p = 0.60). The number needed to harm was 67. Baseline anthropometric measurements were performed in 94% (380/404) of patients. The 12-month follow-up esophagitis rates for overweight and normal body weight patients were 13.6% (29/213) and 6.0% (10/167), respectively (p = 0.015); rates for patients with and without increased baseline waist circumference were 15.4% (24/156) and 6.7% (15/224), respectively (p = 0.006). Following logistic regression, only the combination of increased baseline body mass index and waist, but not H. pylori treatment, was independently associated with new-onset esophagitis (OR 2.88; 95% CI: 1.28-6.45). Excess body weight and concomitant increased waist circumference, but not H. pylori treatment, predicts new-onset esophagitis.

In Vitro and In Vivo Activities of Zinc Linolenate, a Selective Antibacterial Agent against Helicobacter pylori.

Helicobacter pylori is a major global pathogen, and its infection represents a key factor in the etiology of various gastric diseases, including gastritis, peptic ulcers, and gastric carcinoma. The efficacy of current standard treatment for H. pylori infection including two broad-spectrum antibiotics is compromised by toxicity toward the gut microbiota and the development of drug resistance, which will likely only be resolved through novel and selective antibacterial strategies. Here, we synthesized a small molecule, zinc linolenate (ZnLla), and investigated its therapeutic potential for the treatment of H. pylori infection. ZnLla showed effective antibacterial activity against standard strains and drug-resistant clinical isolates of H. pyloriin vitro with no development of resistance during continuous serial passaging. The mechanisms of ZnLla action against H. pylori involved the disruption of bacterial cell membranes and generation of reactive oxygen species. In mouse models of multidrug-resistant H. pylori infection, ZnLla showed in vivo killing efficacy comparable and superior to the triple therapy approach when use as a monotherapy and a combined therapy with omeprazole, respectively. Moreover, ZnLla treatment induces negligible toxicity against normal tissues and causes minimal effects on both the diversity and composition of the murine gut microbiota. Thus, the high degree of selectivity of ZnLla for H. pylori provides an attractive candidate for novel targeted anti-H. pylori treatment.

Impact of Previous Exposure to Macrolide Antibiotics on Helicobacter pylori Infection Treatment Outcomes.

Helicobacter pylori (H. pylori) guidelines, including the recent ACG clinical guideline, recommend avoiding clarithromycin-based triple therapy (TT-C) among patients with past macrolide exposure. Data to support this recommendation are scarce, and the impact of macrolide exposure on quadruple therapies is unclear. We aimed to determine the impact of macrolide exposure on the efficacy of H. pylori treatment in our region. We searched the Clalit Health Services database to identify subjects aged 25-60 years who underwent the first-ever C-urea breath test between 2010 and 2015. Patients who underwent a previous H. pylori stool antigen test or gastroscopy were excluded. Pharmacy dispensation data were retrieved. We identified 7,842 subjects (36.1% male individuals, age: 40.3 ± 10.5 years), including 3,062 (39.0%) with previous macrolide exposure. The efficacy of TT-C was 74.3% and 82.4% among subjects with and without macrolide exposure, respectively (odds ratio (OR), 0.62; 95% confidence interval (CI), 0.55-0.70; P < 0.0001). TT success was adversely affected by exposure to clarithromycin (55.5%; OR, 0.31; 95% CI, 0.24-0.39; P < 0.0001), roxythromycin (74.4%; OR, 0.65; 95% CI, 0.58-0.74; P < 0.0001), and erythromycin (73.9%; OR, 0.72; 95% CI, 0.57-0.89; P < 0.01) but not by exposure to azithromycin. A greater time elapsed because exposure to clarithromycin and roxythromycin was associated with higher eradication (OR, 1.007; 95% CI, 1.002-1.012; P < 0.01 and OR, 1.004; 95% CI, 1.002-1.006; P < 0.0001). A higher dose of clarithromycin and roxythromycin was associated with a lower likelihood of successful eradication (OR, 0.99988; 95% CI, 0.99982-0.99996; P < 0.01 and OR, 0.99981; 95% CI, 0.99971-0.99992; P < 0.001). The efficacies of sequential and concomitant therapies were 82.7% and 81.3%, respectively, and were not significantly affected by macrolide exposure. TT-C is adversely affected by previous exposure to macrolide antibiotics. Sequential, concomitant, and bismuth-based treatment may be preferred in this setting.

Evaluation of Clarithromycin and Metronidazole Resistance of Helicobacter Pylori Infection in Symptomatic Iranian Children

Helicobacter Pylori (H. pylori) as a gram-negative bacterium is the most common infection of the gastrointestinal tract, and worldwide it affects the children over three years of age. H. pylori could cause gastrointestinal and extra-intestinal manifestations. Antibiotic resistance can happen primarily and occurs during treatment. We aimed to evaluate the resistance gene of H. pylori obtained from gastric biopsy by polymerase chain reaction (PCR) method in Iranian children over 3 years old. Materials and Methods This study was a cross-sectional to evaluate the resistance gene of H. pylori obtained from gastric biopsy by polymerase chain reaction method for metronidazole and clarithromycin in children over three years old referring to the Mofid Children's Medical Center in Tehran, Iran. Results: Finally, data from seventy-nine samples included (mean age=10.7 years and male gender = 60.8%). Beta Globulin (BG) gene were detectable in 75 (94.93%) specimens of 79 (100%). Seventeen out of 75 specimens showed positive results for molecular detection of H. pylori. The results of RFLP-PCR technique showed that mutation of RdxA gene in seven of 17 (41.1%) for Metronidazole resistance and one case of 17 (5.8%) mutation of 23Y RNA gene that leads to clarithromycin resistance. Conclusion: Regarding the results of our study, it is better to check microbial resistance by culture and antibiogram for the antibiotic regimen of the first and second line of H. pylori treatment in children.

Effects of periodontal therapy on eradication and recurrence of Helicobacter pylori infection after successful treatment.

ObjectivesThis study aimed to evaluate the effects of periodontal therapy on the efficacy of Helicobacter pylori eradication and on the recurrence of infection after eradication.MethodsWe conducted a prospective randomized trial on 698 gastric H. pylori-infected patients, of whom 347 received gastric H. pylori treatment alone and 342 received gastric H. pylori treatment plus periodontal therapy. The presence of H. pylori and associated virulence genes were detected by real-time polymerase chain reaction.ResultsAfter eradication of gastric H. pylori infection, the recurrence of gastric H. pylori was significantly lower in the gastric H. pylori treatment plus periodontal therapy group than in the group receiving gastric H. pylori treatment alone (OR 0.67; 95% CI 0.45 to 0.99), whereas the eradication rate was not significantly different (OR 0.87; 95% CI 0.68 to 0.98). There was a close relationship between the presence of H. pylori in saliva and its presence in the stomach.ConclusionsThe oral cavity is an important reservoir for gastric H. pylori infection. Adjunctive periodontal therapy could enhance the efficiency of H. pylori treatment and reduce the recurrence of gastric H. pylori infection.

Association of &lt;i&gt;Helicobacter pylori &lt;/i&gt;Treatment with Hepatic Encephalopathy Risk in Cirrhotic Patients: A Population-Based Cohort Study

Background: Helicobacter pylori treatment may reduce the risk of hepatic encephalopathy (HE) by reducing ammonia production and changing the gut microbiota; however, a large-scale clinical study remains lacking. We aimed to investigate the effect of H. pylori treatment on HE risk through a cohort study. Methods: Using Taiwan's National Health Insurance Research Database from the years 1997 to 2011, 215,288 cirrhotic patients were screened. In order to avoid immortal time bias, patients in the H. pylori-treated and untreated cohorts were followed up from the last day of H. pylori treatment and the matched dates of starting their follow-up, respectively. After excluding patients aged < 18 years, those without underlying cirrhosis, those with an HE history, and those with any malignancies; 1,229 patients (the treated group) were randomly matched 1:2 with 2,458 patients (the untreated group) by means of propensity scores. Both cumulative incidences of, and hazard ratios (HRs) for, HE occurrence were analyzed after adjusting for competing mortality risk. Findings: The cumulative incidence of HE in the treated group was significantly lower than that in the untreated group after 1 year (3.00%, 95% confidence interval [CI]: 1.99-4.01 vs. 6.42%, 95% CI: 5.41-7.43), and after 3 years (6.33%, 95% CI: 4.82-7.85 vs. 11.21%, 95% CI: 9.84-12.58; P< 0.001). In multivariable regression analysis, H. pylori treatment was independently associated with a reduced HE risk (HR 0.54, 95% CI: 0.41-0.71; P< 0.001). Sensitivity subgroup analyses also verified this association, including those patients with (HR 0.53, 95% CI: 0.35-0.81) or without (HR 0.56, 95% CI: 0.39-0.81) liver decompensation. Interpretation: H. pylori treatment was significantly associated with a reduced risk of HE in cirrhotic patients. Funding Statement: The Ministry of Science and Technology (108-2321-B-075-002), National Yang-Ming University (107F-M01), the Ministry of Health and Welfare (MOHW108-TDU-B-211-124019), and Taipei Veterans General Hospital (V108E-004-1 and 107VACS-003), Taiwan. Declaration of Interests: The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. Ethics Approval Statement: The Institutional Review Board of Taichung Veterans General Hospital approved the present study (CE19004B).

FACTORS CONTRIBUTING TO CHRONIC URTICARIA/ANGIOEDEMA AND NUMMULAR ECZEMA RESOLUTION - WHICH FINDINGS ARE CRUCIAL?

SUMMARYWhen working with dermatology patients, the question sometimes arises which diagnostic tests and tools should be used for workup, particularly in cases of chronic urticaria (CU) and discoid nummular eczema, where the treatment of associated systemic diseases and infections may be crucial for patient outcome. The aim was to investigate retrospectively the influence of associated diseases on skin disease outcomes based on medical records of CU and nummular eczema patients in comparison to controls. We included patients admitted to our Dermatology Department over a 6-year period and analyzed their laboratory findings, related factors and outcomes recorded after two years of workup and treatment. Compared to controls, CU patients had a significantly higher prevalence of positive Helicobacter (H.) pylori findings (p=0.020), confirmed allergies (p=0.006), increased IgE (p=0.011) and pathologic thyroid findings (p=0.049), whereas nummular eczema patients only had significantly higher positive H. pylori findings (p=0.046). Meaningful regression of both dermatoses was recorded after treatment of associated diseases, with significant benefit from H. pylori treatment. This indicated that the diagnosis of associated infections (particularly H. pylori and urogenital infections), confirmed allergies, endocrine disorders (particularly of thyroid gland in CU patients) and serum malignancy markers could play a crucial role, as their treatment may improve disease outcomes.