Helicobacter Pylori Eradication Therapy Research Articles

Cost‑effectiveness Analysis of Helicobacter pylori Eradication Therapy in First-Degree Relatives of Patients with Gastric Cancer.

BackgroundHelicobacter pylori (H. pylori) eradication therapy has been shown to reduce the risk of gastric cancer in patients who have a family history of gastric cancer in first-degree relatives. The aim of this study was to assess the cost-effectiveness of H. pylori eradication therapy in a select population in the People's Republic of China.MethodsA Markov model was applied to evaluate the cost-effectiveness of H. pylori eradication therapy. The long-term costs of H. pylori eradication therapy were calculated from the Chinese perspective. Health outcomes were measured by quality-adjusted life years (QALYs). Epidemiological information and health utilities used in the model were collected from published literatures or statistical bureaus. A sensitivity analysis was conducted to explore the influence of parameters on the uncertainty of the model.ResultsCompared with the no eradication therapy group, H. pylori eradication therapy prolonged an average of 4.52 QALYs (32.64 QALYs vs 28.12 QALYs) and saved $3227.07 ($2472.83 vs $5699.90). The cost-effectiveness analysis demonstrated that no H. pylori eradication therapy cost more and produced less QALYs. It was dominated by H. pylori eradication therapy. The one-way sensitive analyses proved that the results were robust to the fluctuations of the input parameters.ConclusionH. pylori eradication therapy not only reduced the risk of gastric cancer in first-degree relatives of patients with gastric cancer but also was an economical strategy with lower costs and greater efficacy.

Modeling of Drug-Drug Interactions between Omeprazole and Erythromycin in the Cytochrome P450-Dependent System In vitro

In the present study an electrochemical system based on recombinant cytochrome P450 3A4 (CYP3A4) has been developed for analysis of potential drug-drug interactions between drugs prescribed for Helicobacter pylori eradication therapy. The drug-drug interaction between omeprazole (a proton pump inhibitor; PPI) and macrolide antibiotic erythromycin induced by cytochrome P450 3A4 was demonstrated. In the presence of omeprazole, the rate of erythromycin N-demethylation by CYP3A4, measured by the reaction product (formaldehyde) formation, decreased, while erythromycin had no effect on omeprazole metabolism evaluated using mass-spectrometry analysis of omeprazole sulfone as a metabolite formed during CYP3A4-dependent metabolism. These drug-drug interactions may be explained by a higher affinity of CYP3A4 for omeprazole (the spectral dissociation constant Kd = 18 ± 2 µM) than that for erythromycin (Kd = 52 µM). Using the developed model system, it is possible to analyze drug-drug interactions induced by cytochrome P450 3A4. The results obtained by means of in vitro experiments well correspond to the results of in silico modeling performed using the PASS program and PoSMNA descriptors, which also showed the possibility of drug-drug interactions between omeprazole and erythromycin at the level of biotransformation carried out by cytochrome P450 3A4.

The effect of presence of Helicobacter pylori on the severity and clinical course of Rosacea

Introduction: Rosacea is manifested by erythema and telangiectasias limited to the regions of cheeks, nose, chin and forehead. Data from the literature indicate a possible causal relationship between Helicobacter pylori infection in the gastrointestinal tract and rosacea, which is confirmed by the improvement of symptoms and clinical picture of rosacea after administered Helicobacter pylori eradication therapy. The aim of the paper was to determine the frequency of Helicobacter pylori infection in patients with rosacea and to examine the effect of the therapy for eradication of infection of this microorganism on the clinical course of rosacea. Methods: Sixty patients with a diagnosis of rosacea who were treated in 2018 at the Clinic for Skin and Venereal Diseases of the University Clinical Centre of Republic of Srpska were analysed. Patients were examined during their visit to a dermatologist (first week) and after applied therapy (sixth week). Subjects were divided into two groups-group I consisted of subjects in which, in addition to rosacea, the presence of Helicobacter pylori was registered and for whom the topical therapy and triple therapy for eradication of Helicobacter pylori were administered, and group II, which included subjects in which, in addition to rosacea, the presence of Helicobacter pylori was not registered and for whom only topical therapy was administered. Statistical processing was performed in the IBM SPSS Statistics 21 software package. Results: Helicobacter pylori infection was registered in 45 % of patients. Statistical significance was determined between the presence of Helicobacter pylori infection and the presence of pustules in patients with rosacea (p = 0.027), with an occurrence of pustules significantly more frequent in patients belonging to group I (55.6 %) than in patients belonging to group II (24.2 %). Conclusion: Therapy for eradicating Helicobacter pylori infection improves the clinical course of rosacea, especially in the stage of papules and pustules.

Optimization Strategies Aimed to Increase the Efficacy of Helicobacter pylori Eradication Therapies with Quinolones.

H. pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. Fluoroquinolones such as levofloxacin, or more recently moxifloxacin or sitafloxacin, are efficacious alternatives to standard antibiotics for H. pylori eradication. The aim of the present review is to summarize the role of quinolone-based eradication therapies, mainly focusing on the optimization strategies aimed to increase their efficacy. Several meta-analyses have shown that, after failure of a first-line eradication treatment, a levofloxacin-containing rescue regimen is at least equally effective, and better tolerated, than the generally recommended bismuth quadruple regimen. Compliance with the levofloxacin regimens is excellent, and the safety profile is favourable. Higher cure rates have been reported with longer treatments (>10–14 days), and 500 mg levofloxacin daily is the recommended dose. Adding bismuth to the standard triple regimen (PPI-amoxicillin-levofloxacin) has been associated with encouraging results. Unfortunately, resistance to quinolones is easily acquired and is increasing in most countries, being associated with a decrease in the eradication rate of H. pylori. In summary, a quinolone (mainly levofloxacin)-containing regimen is an encouraging second-line (or even third-line) strategy, and a safe and simple alternative to bismuth quadruple therapy in patients whose previous H. pylori eradication therapy has failed.

Effects of Helicobacter Pylori Infection on Serology and Intestinal Mucosal Changes in Pediatric Patients With Celiac Disease: A Retrospective Cohort Study.

IntroductionHelicobacter pylori (HP) and celiac disease (CD) can cause similar mucosal damage to the duodenal mucosa. For this reason, the relationship between these two diseases has been the subject of research recently. Our study aims to investigate the effects of HP infection on serology and pathology in pediatric patients with CD or potential celiac disease (PCD).MethodsIt is a retrospective cohort study conducted in the third-level education and research hospital between July 2017 and May 2019. The serological and pathological data of patients diagnosed with CD or PCD were compared statistically according to the presence of HP.ResultsAn analysis of the histopathological data of the endoscopic biopsy samples showed Helicobacter pylori in eight (50%) of PCD patients and 37 (41.6%) of CD patients. No significant difference was found between the two groups (P=0.531). We found that dokutransglutaminas antibody level (DTG) and endomysium antibody level (EMA) serology decreased significantly after HP eradication therapy in HP (+) PCD (P=0.002, P<0.001). Intestinal metaplasia was not present in PCH. However, intestinal metaplasia was present in five patients (13.5%) with HP (+) CD and two patients (3.8%) with HP (-) CD. However, that difference was not statistically significant between the two groups (P=0.095).ConclusionOur study demonstrated that HP may augment CD’s serology and serological improvement is possible after HP treatment particularly in HP (+) PCD. Therefore, we recommend re-perform diagnostic studies after HP treatment before commencing a gluten-free diet in HP (+) suspected CD cases.

The Prevalence of Multidrug Resistance of Helicobacter pylori and Its Impact on Eradication in Korea from 2017 to 2019: A Single-Center Study.

Antimicrobial resistance is one of the major factors determining the efficacy of Helicobacter pylori eradication therapy. This study aimed to estimate the recent prevalence of multidrug resistance of H. pylori and its impact on eradication in Korea. A total of 174 patients were prospectively enrolled at Chung-Ang University Hospital from 2017 to 2019. H. pylori strains were isolated from the gastric body and antrum. The minimum inhibitory concentrations of antibiotics were determined by the serial twofold agar dilution method. Eradication results were reviewed and analyzed in connection with antibiotic resistance. The prevalence of H. pylori infection was 51.7% (90/174). The culture success rate was 77.8% (70/90). The resistance rates for clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, and moxifloxacin were 28.6% (20/70), 27.1% (19/70), 20.0% (14/70), 18.6% (13/70), 42.9% (30/70), and 42.9% (30/70), respectively. The multidrug resistance (resistance to two or more classes of antimicrobials) rate was 42.9% (30/70). Dual resistance to clarithromycin and metronidazole was confirmed in 8.6% (6/70). Eradication with a first-line treatment was successful in 75% (36/48), and those who received second-line treatment all achieved successful eradication. The rate of multidrug resistance is increasing, and standard triple therapy (STT) is no longer an acceptable first-line option for H. pylori eradication in Korea.

Effect of Antibiotic Susceptibility and CYP3A4/5 and CYP2C19 Genotype on the Outcome of Vonoprazan-Containing Helicobacter pylori Eradication Therapy

Background: Helicobacter pylori eradication containing the potassium-competitive acid blocker, vonoprazan, achieves a higher eradication rate than therapy with proton pump inhibitors (PPIs). Because vonoprazan is mainly metabolized by CYP3A4/5, CYP genotype may affect the eradication rate. We investigated the influence of antibiotic susceptibility and CYP3A4/5 and CYP2C19 genotypes on the eradication rates. Methods: A total of 307 Japanese who were genotyped for CYP3A4 *1/*22, CYP3A5 *1/*3 and CYP2C19 *1/*2/*3/*17, and investigated for susceptibility to antimicrobial agents, received vonoprazan-containing regimens: (1) With amoxicillin and clarithromycin as the first-line treatment; (2) with amoxicillin and metronidazole as the second-line treatment; or (3) with amoxicillin and sitafloxacin as the third-line treatment. Results: The eradication rate was 84.5% (95% confidence interval [CI]: 78.9–89.1%) using first-line, 92.6% (95% CI: 82.1–97.9%) using second-line and 87.5% (95% CI: 73.1–95.8%) using third-line treatment. Infection with clarithromycin-resistant strains was a predictive factor for failed eradication (odds ratio: 5.788, 95% CI: 1.916–17.485, p = 0.002) in multivariate analysis. No significant differences were observed in the eradication rate of regimens among CYP3A4, CYP3A5 and CYP2C19 genotypes. Conclusions: Genotyping for CYP3A4 *1/*22, CYP3A5 *1/*3 and CYP2C19 *1/*2/*3/*17 before vonoprazan-containing eradication treatment may not be useful for predicting clinical outcomes.

Efficacy of Helicobacter pylori Eradication Therapy on Platelet Recovery in Pediatric Immune Thrombocytopenic Purpura-Case Series and a Systematic Review.

Evidence relating to the efficacy of Helicobacter pylori eradication therapy for chronic immune thrombocytopenic purpura (cITP) in childhood is inadequate. The aim of this retrospective study was to determine the efficacy of H. pylori eradication therapy for platelet response in pediatric patients with cITP in our hospital, and to perform a systematic review of previous reports about pediatric patients with cITP who were positive for H. pylori infection and were treated with H. pylori eradication therapy. Analysis of the data of pediatric patients with cITP in our hospital and a systematic review of digital literature databases of studies in pediatric patients with cITP were performed. Data of 33 pediatric patients with cITP from our hospital records showed that the prevalence of H. pylori infection and the rate of response to platelet therapy were 15% and 33.3%, respectively. Data of 706 pediatric patients from 18 previous reports showed that the prevalence of H. pylori infection and rate of platelet response were 23% and 43.8%, respectively. Eradication therapy for H. pylori infection in pediatric cITP patients can be expected to result in a response equivalent to that in the adult population, with fewer adverse effects than other treatments for cITP.

Clinical factors associated with initial Helicobacter pylori eradication therapy: a retrospective study in China

The eradication rate of Helicobacter pylori (H. pylori) has been decreasing every year, mainly due to the increase in antibiotic resistance. In fact, many other factors may affect H. pylori eradication. To analyze the clinical factors affecting the initial eradication therapy in Chinese patients with H. pylori infection. We conducted a retrospective study on 264 outpatients who were diagnosed with H. pylori-associated chronic gastritis and peptic ulcer disease between January and December 2015 at a large tertiary hospital in China. The patients were divided into three groups: ECA, RCA, and RCM (R: 20 mg rabeprazole, E: 40 mg esomeprazole, C: 0.5 g clarithromycin, A: 1.0 g amoxicillin and M: 0.4 g metronidazole). The patients were treated for 14 days and followed up for 1 year. The 14C-urea breath test (14C-UBT) was performed 4 weeks after the completion of the eradication therapy. The eradication rate was higher in ≥ 40-year-old patients than in < 40-year-old-patients (85.7% vs. 54.7%, p = 0.002). Multivariate analyses revealed only age ≥ 40 years to be significantly associated with a high H. pylori eradication rate [odds ratio (OR) 4.58, p = 0.003]. The H. pylori eradication rate in patients with duodenal ulcers was significantly higher than that in patients with gastric ulcers (79% vs. 60%, p = 0.012). Age could be a predictor of successful H. pylori eradication. Patients with duodenal ulcers had a higher H. pylori eradication rate than those with other lesions.

Proton pump inhibitor- and clarithromycin-based triple therapies for Helicobacter pylori eradication

Proton pump inhibitor- and clarithromycin-based triple therapies for Helicobacter pylori eradication

Changes in Gastric Microbial Composition before and after Helicobacter pylori Eradication Therapy

Owing to advancements in next-generation sequencing and non-culture-based microbial research techniques, we have recognized that many bacterial taxa other than &lt;i&gt;Helicobacter pylori (H. pylori)&lt;/i&gt; are present in the human stomach. Gastric microbial composition depends on gastric diseases, including gastritis, atrophic gastritis, intestinal metaplasia, and gastric cancer. Although &lt;i&gt;H. pylori&lt;/i&gt; is a major factor associated with gastric cancer development, other bacterial taxa may affect gastric carcinogenesis. Because the risk of gastric cancer development can be reduced through &lt;i&gt;H. pylori&lt;/i&gt; eradication, many investigators have studied the changes in the microbial composition in the stomach after &lt;i&gt;H. pylori&lt;/i&gt; eradication. The gastric microbiome in patients with &lt;i&gt;H. pylori&lt;/i&gt; infection typically shows abundance of &lt;i&gt;H. pylori&lt;/i&gt; and a low microbial diversity index. If we treat &lt;i&gt;H. pylori&lt;/i&gt;-infected patients with antibiotics, microbial diversity increases, and the relative abundance also increases in many bacterial taxa. Several studies suggested that the microbial composition in patients with &lt;i&gt;H. pylori&lt;/i&gt; infection could be restored by &lt;i&gt;H. pylori&lt;/i&gt; eradication therapy; however, there have been inconsistent findings of the abundant bacterial taxa after &lt;i&gt;H. pylori&lt;/i&gt; eradication in patients with atrophic gastritis and intestinal metaplasia. More studies are required to reach a definitive conclusion on restoration of the microbial composition after &lt;i&gt;H. pylori&lt;/i&gt; eradication according to the severity of gastric inflammation.

Effect of Bacillus clausii Capsules in Reducing Adverse Effects Associated with Helicobacter pylori Eradication Therapy: A Randomized, Double-Blind, Controlled Trial.

IntroductionAntibiotic treatment can alter the gut microbiome and cause short-term gastrointestinal adverse effects (AEs). This study assessed the efficacy of lyophilized capsules containing 2 × 109 spores of Bacillus clausii (Enterogermina®; Sanofi Synthelabo) in reducing AEs associated with Helicobacter pylori eradication therapy in Italy.MethodsIn this randomized, double-blind, single-center, phase IIIB study, 130 adult outpatients with H. pylori infection were assigned to receive one Enterogermina® capsule or placebo three times daily for 2 weeks (1:1). During week 1, all patients received clarithromycin 500 mg, amoxicillin 1 g, and rabeprazole 20 mg twice daily. The primary efficacy outcome was the presence of diarrhea in week 1.ResultsA total of 130 patients were randomized. The incidence of diarrhea in week 1 was 29% in the B. clausii group and 48% in the placebo group [relative risk (RR) 0.61; 95% confidence interval (CI) 0.39–0.97; p = 0.03]. The incidence of diarrhea remained lower with B. clausii than with placebo in week 2 (RR 0.38; 95% CI 0.14–1.02; p = 0.0422). In week 1, the number of days without diarrhea was significantly higher in the B. clausii group than in the placebo group (6.25 vs. 5.86; p = 0.0304). In both groups, the number of days without diarrhea increased significantly (p < 0.0001) from week 1 to week 2. A total of three AEs occurred in two patients in the placebo group, but none were serious.ConclusionsCompared with placebo, Enterogermina® reduced the incidence of, and the number of days with, diarrhea in patients receiving H. pylori eradication therapy. Enterogermina® was well tolerated.

Helicobacter pylori infection and eradication: Exploring their impacts on the gastrointestinal microbiota.

The rapid development of microbiota research has remolded our view of human physiological and pathological processes. Among all the gastrointestinal microorganisms, Helicobacter pylori (Hpylori) is probably the most notorious constituent. Although half of the adults worldwide are infected with Hpylori, their clinical manifestations vary widely, suggesting other microorganisms beyond Hpylori may play a role in determining clinical outcomes. Recently, many studies have put effort into elucidating the crosstalk within the human microbiota, some of which specifically explored the interplay between Hpylori and other gastrointestinal microbial members. In this work, we reviewed these potential interactions. Meanwhile, the impacts of Hpylori eradication therapy on gastrointestinal microbial homeostasis were summarized in terms of diversity, composition, functional capacity, and antibiotic resistance.

Efficacy of second-line regimens for Helicobacter pylori eradication treatment: a systemic review and network meta-analysis

BackgroundCurrent guidelines recommend bismuth-containing quadruple therapy (BQT) and quinolone-containing therapy after failure of first-line Helicobacter pylori eradication therapy. However, the optimum regimen of second-line eradication therapy remains elusive. We conducted...

Risk of subsequent prostate cancer in peptic ulcer patients who received helicobacter pylori eradication therapy: an Asian population-based cohort study

BackgroundStudies have shown diverse results regarding the association between H. pylori (HP) infection and the risk of malignancy. There is accumulating evidence relating HP infection to urological diseases. We investigated whether there was an association between HP-infected peptic ulcers and the subsequent risk of prostate cancer.MethodsWe collected HP-infected male patients from 1998 to 2008 from the Longitudinal Health Insurance Database (LHID). HP-infected patients were identified as those who had a diagnosis of peptic ulcers upon admission and received HP eradication therapy within 1 year after diagnosis. The date of HP infection diagnosis upon admission was defined as the index date. Patients aged < 20 years or with a cancer history were excluded. For each HP-infected patient, we selected four males without peptic ulcers or a history of HP eradication in the LHID for the comparison cohort according to propensity score matching by age, index year, and comorbidity. The risk of prostate cancer and associated risk factors was assessed by Cox proportional hazard regression.ResultsA total of 2620 HP infection treatment patients and 10,480 matched comparisons were selected. There were 36 patients in the HP-infected treatment cohort and 117 patients in the comparison cohort with documented prostate cancer development (1.52 and 1.21 per 1000 person-years, respectively). Compared to the comparison cohort, the HP infection cohort had a 1.26-fold increased prostate cancer risk in the Cox models after adjusting for matched-pairs (95% CI = 0.87–1.34). There were no significant differences in subsequent prostate cancer development between HP-infected treatment patients and the comparison cohort.ConclusionOur findings showed no significant association between HP-infected peptic ulcers and the subsequent risk of prostate cancer. Further studies are warranted to investigate whether this observation is attributable to an HP eradication policy.

Lack of significant differences between gastrointestinal tract microbial population structure of Helicobacter pylori-infected subjects before and 2years after a single eradication event.

According to recent estimates 80% of Latvian population is infected with Helicobacter pylori thus their susceptibility to numerous gastric tract diseases is increased. The 1st line H. pylori eradication therapy includes treatment with clarithromycin in combination with amoxicillin or metronidazole and a proton pump inhibitor. However, potential adverse events caused by such therapies to microbiome are insufficiently studied. This study aimed to evaluate the long-term effect of H. pylori eradication on human gastrointestinal tract (GIT) microbiome. The assessment of Hpylori eradication impact on GIT microbiome was done by analyzing 120 samples acquired from 60 subjects. Each individual was prescribed the following 10-day eradication regimen: Esomeprazolum 40mg, Clarithromycinum 500mg, and Amoxicillinum 1000mg, BID. Samples from each individual were collected before starting Hpylori eradication therapy, and 2years after the completion of the therapy in OC-Sensor (Eiken Chemical Co.) sample collection containers and stored at -86°C. Prior to DNA extraction, the samples were lyophilized, and total DNA was extracted using FastDNA Spin Kit for Soil. 16S V3 rRNA gene sequencing was done employing Ion Torrent PGM, and the obtained raw sequences were analyzed using vsearch and R (phyloseq, cluster packages). Alpha diversity measurements-observed OTUs, Chao1 and Shannon index did not differ significantly between the pre- and post-eradication states (two-tailed paired t test: P=.95; P=.71, P=.24, respectively). Unweighted and weighted UniFrac distances of beta diversity analysis indicated a non-specific pattern of sample clustering. Enterotype shift was observed for the majority of individuals comparing pre- and post-eradication study groups. Association analysis revealed that certain bacterial genera significantly correlated with age (eg, Dialister, Paraprevotella, Bifidobacterium), individual (eg, Thermotunica, Streptomyces, Faecalibacterium), and history of respiratory and/or allergic diseases (eg, Colinsella, Faecalibacterium). Redundancy analysis confirmed that the individual was a significant determinant of the subject's microbial community composition (ANOVA, 999 perm., P=.001) with the further lower impact of subject-specific medical history (eg, medication used as prescribed: P=.005, history of cardiovascular diseases: P=.005, history of respiratory, and/or allergic diseases: P=.015) and physiological (eg, age: P=.005, gender: P=.02) parameters. In the post-eradication study group, number of influential genera (n=260) was increased compared to the pre-eradication study group (n=209). Modest global differences at the community level exist between individuals before and after the eradication therapy; however, the microbiome structure is more related to the subject-specific parameters rather than by the eradication therapy itself.

Sex-specific Differences in Response to First-line Helicobacter pylori Eradication Therapy with vonoprazan, amoxicillin, and clarithromycin

Background: Although gender medicine has been promoted in medical research and patient care, limited information is available on sex-specific differences in response to first-line Helicobacter pylori eradication therapy. Therefore, this retrospective study investigated sex-specific differences in response to first-line H. pylori eradication therapy with vonoprazan, amoxicillin, and clarithromycin.Method: The study included 314 patients who received vonoprazan-based triple therapy (20 mg vonoprazan, 750 mg amoxicillin, and 200 or 400 mg clarithromycin; twice daily for 7 days) as first-line H. pylori eradication therapy at Fuyoukai Murakami Hospital from March 1, 2015, to April 30, 2019. First-line eradication rates were determined by intention-to-treat (ITT) and per protocol (PP) analyses. Sex-specific differences in the rate of drug-related treatment-emergent adverse events (TEAEs) were also monitored. Fisher’s exact test was used for identifying sex-specific differences.Results: First-line eradication rates were 95% in ITT and PP analyses regardless of sex, without significant sex-specific differences [ITT analyses: males 95.3% (203/213) vs. females 96.0% (97/101), p = 1.0; PP analyses: males 95.3% (203/213) vs. females 96.0% (95/99), p = 1.0]. However, the rate of drug-related TEAEs was significantly higher in females than in males [males 4.2% (9/213) vs. females 17.8% (18/101), p 0.001]. In particular, skin rash occurred only in females [males 0% (0/213) vs. females 10.9% (11/101), p 0.00001].Conclusion: Females experienced more drug-related TEAEs than males during first-line H. pylori eradication therapy with vonoprazan-based triple therapy. In particular, skin rash was observed only in females.

Study of the Completion of Follow-up After Helicobacter pylori Eradication Therapy

Background: Because no therapeutic regimens have an eradication rate of 100%, post-treatment evaluation is necessary to ensure that adequate eradication therapy for Helicobacter pylori has been provided. The fact that not all patients are evaluated after eradication therapy is a serious concern for both the medical care system and medical economy.Method: We performed a retrospective study of 411 patients who received first-line H. pylori eradication therapy at Fuyoukai Murakami Hospital from October 1, 2014 to March 31, 2016. We calculated the rate of post-treatment follow-up at 1 year after completing the eradication therapy. In addition, we excluded 76 patients who definitely received post-treatment evaluation because of follow-up appointments with gastroenterologists (n = 29) or return visits to other physicians (n = 47) and included 335 patients in the final study population. We used logistic regression models for identifying the relevant factors contributing to the completion of post-eradication follow-up.Results: The rate of completion of post-eradication follow-up was 78.8% (324/411). Multivariate analysis revealed that the adjusted odds ratios for age (≥ 48 years), gender (female) and preventive measures for gastric cancer (esophagogastroduodenoscopy after radiographic screening for gastric cancer and a desire to be examined for H. pylori infection) were 1.85 [95% confidence interval (CI): 1.11–3.09; p 0.05], 1.89 [95% CI: 1.07–3.34; p 0.05] and 4.01 [95% CI: 1.61–10.0; p 0.01], respectively.Conclusion: Age ≥ 48 years, female gender and preventive measures for gastric cancer were independently related to a higher rate of completion of post-eradication follow-up.

Endoscopic severe mucosal atrophy indicates the presence of gastric cancer after Helicobacter pylori eradication -analysis based on the Kyoto classification

BackgroundGastric cancer after Helicobacter pylori (HP) eradication is a crucial clinical challenge today as HP eradication therapy is widely performed. Detecting gastric cancer after HP eradication tends to be difficult with normal white-light endoscopy. In the present study, we aimed to identify easily-evaluated endoscopic findings that indicate the presence of gastric cancer after HP eradication so that endoscopists can consider additional detailed examinations at the site.MethodsWe analyzed the endoscopic images of 43 patients who underwent endoscopic submucosal dissection for early gastric cancer after HP eradication and 119 patients with an HP eradication history who underwent esophagogastroduodenoscopy for a medical checkup. Endoscopic findings were evaluated according to the Kyoto classification of gastritis (atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness) and map-like redness.ResultsPatients with gastric cancer had significantly higher total Kyoto risk scores; more atrophy, intestinal metaplasia, and diffuse redness; and a significantly higher prevalence of map-like redness compared with those without gastric cancer, in the univariate analyses. We used logistic regression analysis with forward selection based on the likelihood ratio to develop a model using atrophy and diffuse redness. Receiver operating characteristic analysis showed that a score of A2 in the Kyoto classification of gastritis (open-type atrophic pattern in the Kimura–Takemoto classification) was an endoscopic marker for the presence of post-HP-eradication gastric cancer.ConclusionsEndoscopic severe gastric mucosal atrophy is useful to screen patients for gastric cancer after HP eradication.

Helicobacter Pylori Eradication by Levofloxacin Based Triple Therapy in Patients with Peptic Ulcer Disease

Background: Clarithromycin resistance globally has challenged the success of conventional Clarithromycin based triple therapy for Helicobacter Pylori eradication. Levofloxacin has primarily been considered as a second-line treatment but may also be used as primary therapy. Recently, some studies have evaluated its efficacy as a valid alternative to standard antibiotics as first-line therapy for H. pylori infection. This study was intended to assess the eradication success of Levofloxacin based first-line triple therapy and also to see it’s compliance &amp; adverse effect profile.&#x0D; Materials and methods: This non-randomized single-arm clinical trial was carried out in the Department of Gastroenterology, BSMMU from March 2016 to March 2017 involving 123 H. pylori-positive patients with endoscopically proven peptic ulcer disease to assess the eradication success of levofloxacin based first-line triple therapy and also to see its compliance and adverse effect profile. H. pylori status were detected by urea breath test. Patients were treated with amoxycillin 1 gm 12 hourly, levofloxacin 500 mg 12 hourly and omeprazole 20 mg 12 hourly for 14 days and were followed-up at 2 months after completion of therapy for repeat urea breath test.&#x0D; Results: A total of 97 patients returned for followup. Male proportion was 63.41% and female was 36.58% with the median age of 57 years. On intention-to-treat analysis, the eradication rate of H. pylori was 65.85% and on per-protocol analysis, it was 83.50%. Total 15.44% patients developed adverse effects, all were mild to moderate in nature. One patient discontinued treatment because of epigastric pain and vomiting.&#x0D; Conclusion: Levofloxacin-based therapy was effective, well-tolerated and compliance was excellent; but the eradication rate was not satisfactory.&#x0D; JCMCTA 2020 ; 31 (1) : 102-107