Treatment Of Helicobacter Pylori Infection Research Articles

The second Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of Helicobacter pylori infection in adult patients in Ireland.

There has been an increase in resistance to many of the antimicrobials used to treat Helicobacter pylori (H. pylori) nationally and internationally. Primary clarithromycin resistance and dual clarithromycin and metronidazole resistance are high in Ireland. These trends call for an evaluation of best-practice management strategies. The objective of this study was to revise the recommendations for the management of H. pylori infection in adult patients in the Irish healthcare setting. The Irish H. pylori working group (IHPWG) was established in 2016 and reconvened in 2023 to evaluate the most up-to-date literature on H. pylori diagnosis, eradication rates and antimicrobial resistance. The 'GRADE' approach was then used to rate the quality of available evidence and grade the resulting recommendations. The Irish H. pylori working group agreed on 14 consensus statements. Key recommendations include (1) routine antimicrobial susceptibility testing to guide therapy is no longer recommended other than for clarithromycin susceptibility testing for first-line treatment (statements 6 and 9), (2) clarithromycin triple therapy should only be prescribed as first-line therapy in cases where clarithromycin susceptibility has been confirmed (statement 9), (3) bismuth quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) is the recommended first-line therapy if clarithromycin resistance is unknown or confirmed (statement 10), (4) bismuth quadruple therapy with a proton pump inhibitor, levofloxacin and amoxicillin is the recommended second-line treatment (statement 11) and (5) rifabutin amoxicillin triple therapy is the recommend rescue therapy (statement 12). These recommendations are intended to provide the most relevant current best-practice guidelines for the management of H. pylori infection in adults in Ireland.

Bioactive peptides as alternative treatment for Helicobacter pylori infection

The infection and chronic inflammatory response generated by Helicobacter pylori is a global health concern. This pathogen is characterized as a major risk factor in the development of gastric cancer and other diseases. Conventional eradication therapies are based on antibiotic regimens and as a consequence there is an increase in antimicrobial resistance of the pathogen strains, besides other potential side effects for the host. Therefore, it is necessary to explore new alternatives. This review delves into the realm of antimicrobial peptides, exploring their efficacy against H. pylori sourced from diverse origins. Furthermore, it sheds light on food-derived peptides exhibiting remarkable biological activity. These peptides exhibit promising effects on biomarkers associated with H. pylori infection, demonstrating anti-inflammatory and antioxidant properties validated through rigorous testing in both cell and animal models. Regarding the anti-inflammatory activity, the peptide VPY derived from soybean and the peptides derived from animal sources such as meat (β-Ala-His), egg (DEDTQAMPFR, DEDTQAMPF, MLGATSL, MSYSAGF, CR, FL, HC, LL, MK) and milk (IPAV) have reported a reduction of the cytokine IL-8, biomarker directly related to H. infection. For the antioxidant activity, peptides derived from milk (EAMAPK, AVPYPQ) and from Spirulina maxima (LDAVNR, MMLDF) have reduced ROS levels and could have a positive effect on the control of H. infection. Food-derived bioactive peptides with an anti-adhesive effect were also discussed. They derive from vegetable sources (corn, pea and wheat) and are capable of interacting with the host cells, interfering the adherence of H. pylori. Food-derived bioactive peptides have potential to avoid and/or mitigate undesired outcomes of infectious diseases due to the possibility of its application in nutraceuticals and food products, resulting in a preventive approach. Keywords: Helicobacter pylori, antibiotic resistance, bioactive peptides, antimicrobial peptides

Mucus and Biofilm Penetrating Nanoplatform as an Ultrasound-Induced Free Radical Initiator for Targeted Treatment of Helicobacter pylori Infection.

Helicobacter pylori (H. pylori) infection is closely associated with the development of various gastric diseases. The effectiveness of current clinical antibiotic therapy is hampered by the rise of drug-resistant strains and the formation of H. pylori biofilm. This paper reports a sonodynamic nanocomposite PtCu3-PDA@AIPH@Fucoidan (PPAF), which consists of dopamine-modified inorganic sonosensitizers PtCu3, alkyl radicals (R•) generator AIPH and fucoidan, can penetrate the mucus layer, target H. pylori, disrupt biofilms, and exhibit excellent bactericidal ability. In vitro experiments demonstrate that PPAF exhibits excellent acoustic kinetic properties, generating a significant amount of reactive oxygen species and oxygen-independent R• for sterilization under ultrasound stimulation. Simultaneously, the produced N2 can enhance the cavitation effect, aiding PPAF nanoparticles in penetrating the gastric mucus layer and disrupting biofilm integrity. This disruption allows more PPAF nanoparticles to bind to biofilm bacteria, facilitating the eradication of H. pylori. In vivo experiments demonstrate that ultrasound-stimulated PPAF exhibited significant antibacterial efficacy against H. pylori. Moreover, it effectively modulated the expression levels of inflammatory factors and maintained gastrointestinal microbiota stability when compared to the antibiotic treatment group. In summary, PPAF nanoparticles present a potential alternative to antibiotics, offering an effective and healthy option for treating H. pylori infection.

Exploring the Molecular Mechanisms of Macrolide Resistance in Laboratory Mutant Helicobacter pylori.

Resistance to clarithromycin, a macrolide antibiotic used in the first-line treatment of Helicobacter pylori infection, is the most important cause of treatment failure. Although most cases of clarithromycin resistance in H. pylori are associated with point mutations in 23S ribosomal RNA (rRNA), the relationships of other mutations with resistance remain unclear. We examined possible new macrolide resistance mechanisms in resistant strains using next-generation sequencing. Two resistant strains were obtained from clarithromycin-susceptible H. pylori following exposure to low clarithromycin concentrations using the agar dilution method. Sanger sequencing and whole-genome sequencing were performed to detect resistance-related mutations. Both strains carried the A2142G mutation in 23S rRNA. Candidate mutations (T1495A, T1494A, T1490A, T1476A, and G1472T) for clarithromycin resistance were detected in the Mutant-1 strain. Furthermore, a novel mutation in the gene encoding for the sulfite exporter TauE/SafE family protein was considered to be linked to clarithromycin resistance or cross-resistance, being identified as a target for further investigations. In the Mutant-2 strain, a novel mutation in the gene that encodes DUF874 family protein that can be considered as relevant with antibiotic resistance was detected. These mutations were revealed in the H. pylori genome for the first time, emphasizing their potential as targets for advanced studies.

Structural Insights into Potent Anti-Ulcer Agents for the Eradication of Helicobacter pylori

Abstract: Helicobacter pylori is the primary bacterium in the development of gastric cancer; thus, its eradication for the prevention and management of peptic ulcers is of utmost importance. Most primary or unexplained peptic ulcers are brought on by Helicobacter pylori infection, which also causes chronic inflammation. The lack of therapeutic compliance, antibiotic re-sistance, and the breakdown of antibiotics at gastric pH all contribute to the current eradication rates. Therefore, a recent area of focus is the hunt for novel therapeutics with great selectivity against H. pylori. This review focuses on elucidating the landscape of anti-H. pylori compounds derived from both synthetic drug design programs and natural sources. Emphasis is placed on understanding the structure-activity relationships of these compounds and their mechanisms of action. Furthermore, the potential of drug repurposing strategies to combat H. pylori infection is ex-plored. By providing a comprehensive overview of major classes of anti-H. pylori compounds, this study aims to guide the development of new medications for the treatment of Helicobacter pylori infection. Ultimately, this review highlights promising avenues for future research and therapeutic interventions in the management of H. pylori-associated gastric cancer..

Education, Prevention, and Treatment of Helicobacter pylori Infection by General Practitioners

General practitioners play a key role in the education and prevention of Helicobacter pylori infection. Through extensive knowledge dissemination, they effectively enhance public awareness of this bacteria and popularize relevant prevention and control methods. At the practical level, general practitioners combine rich clinical experience and professional knowledge to develop personalized treatment plans for patients and ensure the continuity and safety of treatment effects through meticulous follow-up work. In addition, they extend the prevention and treatment knowledge to the family and community, helping residents build comprehensive guidelines through health education and practical guidance. The leading role of general practitioners not only optimizes the prevention and treatment process of Helicobacter pylori infection but also closes the distance between doctors and patients, improving the overall quality of primary care. This people-oriented and continuous service model has profound significance for improving public health standards and promoting the development of primary care in the future.

Evaluating the potency of zoliflodacin against Helicobacter pylori: Invitro activity and conserved GyrB target.

The current standard treatment for Helicobacter pylori infection, which involves a combination of two broad-spectrum antibiotics, faces significant challenges due to its detrimental impact on the gut microbiota and the emergence of drug-resistant strains. This underscores the urgent requirement for the development of novel anti-H. pylori drugs. Zoliflodacin, a novel bacterial gyrase inhibitor, is currently undergoing global phase III clinical trials for treating uncomplicated Neisseria gonorrhoeae. However, there is no available data regarding its activity against H. pylori. We evaluated the invitro activity of zoliflodacin against H. pylori clinical isolates (n = 123) with diverse multidrug resistance. We performed DNA gyrase supercoiling and microscale thermophoresis assays to identify the target of zoliflodacin in H. pylori. We analyzed 2262 H. pylori whole genome sequences to identify Asp424Asn and Lys445Asn mutations in DNA gyrase subunit B (GyrB) that are associated with zoliflodacin resistance. Zoliflodacin exhibits potent activity against all tested isolates, with minimal inhibitory concentration (MIC) values ranging from 0.008 to 1 μg/mL (MIC50: 0.125 μg/mL; MIC90: 0.25 μg/mL). Importantly, there was no evidence of cross-resistance to any of the four first-line antibiotics commonly used against H. pylori. We identified GyrB as the primary target of zoliflodacin, with Asp424Asn or Lys445Asn substitutions conferring resistance. Screening of 2262 available H. pylori genomes for the two mutations revealed only one clinical isolate carrying Asp424Asn substitution. These findings support the potential of zoliflodacin as a promising candidate for H. pylori treatment, warranting further development and evaluation.

Response to Article "Kaempferia parviflora Extracellular Vesicle Loaded with Clarithromycin for the Treatment of Helicobacter pylori Infection" [Letter

Response to Article "Kaempferia parviflora Extracellular Vesicle Loaded with Clarithromycin for the Treatment of Helicobacter pylori Infection" [Letter

Spray-dried pH-sensitive chitosan microparticles loaded with Mycobacterium bovis BCG intended for supporting treatment of Helicobacter pylori infection.

Gram-negative spiral-shaped Helicobacter pylori (Hp) bacteria induce the development of different gastric disorders. The growing resistance of Hp to antibiotics prompts to search for new therapeutic formulations. A promising candidate is Mycobacterium bovis BCG (BCG) with immunomodulatory properties. Biodegradable mucoadhesive chitosan is a good carrier for delivering BCG mycobacteria to the gastric mucosal environment. This study aimed to show whether BCG bacilli are able to increase the phagocytic activity of Cavia porcellus-guinea pig macrophages derived from the bone marrow towards fluorescently labeled Escherichia coli. Furthermore, to encapsulate live BCG bacilli, in spray-dried chitosan microparticles (CHI-MPs), and assess the pH-dependent release of mycobacteria in pH conditions mimicking gastric (acidic) or gut (alkaline) milieu. Microparticles (MPs) were made of chitosan and coated with Pluronic F-127-(Plur) or N-Acetyl-D-Glucosamine-(GlcNAc) to increase the MPs resistance to low pH or to increase anti-Hp effect, respectively. Spray-drying method was used for microencapsulation of live BCG. The biosafety of tested CHI-MPs has been confirmed using cell models in vitro and the model of guinea pig in vivo. The CHI-MPs loaded with BCG released live mycobacteria at pH 3.0 (CHI-GlcNAc-MPs) or pH 8.0. (CHI-Plur-MPs). The CHI-MPs loaded with live BCG can be used for per os inoculation of Cavia porcellus to check the effectiveness of delivered mycobacteria in increasing anti-H. pylori host response.

Dispepsia: etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento

Dyspepsia is a set of symptoms originating in the gastroduodenal region. The term is complex and difficult to define; some symptoms are confused or overlap with other diseases. The main symptoms are burning or pain in the epigastrium, postprandial fullness, and early satiety. It is classified as organic or functional according to the origin of the symptoms. The pathophysiology of the latter is multifactorial, involving multiple factors such as slowing of gastric emptying, visceral hypersensitivity, or gastric accommodation, among others. It is an important disease with a significant prevalence in the population (20%) that generates high costs and an impact on patients’ quality of life. In order to diagnose it, it is essential to rule out an organic nature in patients with alarm symptoms by means of an oral panendoscopy. In the absence of these symptoms, the first step is to detect and treat Helicobacter pylori infection. If symptoms persist afterwards, first-line treatment is acid suppressant medications followed by tricyclic antidepressants and prokinetic agents.

Tailored therapy guided by genotypic resistance of clarithromycin and levofloxacin detected by polymerase chain reaction in the first-line treatment of Helicobacter pylori infection.

We aimed to explore the efficacy and safety of tailored therapy guided by genotypic resistance in the first-line treatment of Helicobacter pylori (H. pylori) infection in treatment-naive patients. Gastric mucosal specimens were taken during gastroscopy, and main mutations of clarithromycin- and levofloxacin-resistant genes were detected by polymerase chain reaction (PCR). Sensitive antibiotics were selected individually for treating H. pylori infection with tailored bismuth-containing quadruple therapy (BQT) consisting of esomeprazole 20 mg twice daily, bismuth potassium citrate 220 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, or levofloxacin 500 mg once daily, or metronidazole 400 mg four times daily. Safety and patient compliance were assessed 1-3 days after eradication. Treatment outcome was evaluated by urea breath test 4-8 weeks after eradication. One hundred and thirty-two treatment-naive patients with H. pylori infection were included. PCR results suggested resistance rates of 47.7% and 34.9% for clarithromycin and levofloxacin, respectively, and a dual resistance rate of 18.2%. Eradication rates of tailored BQT were 87.1% and 95.8% by intention-to-treat (ITT) analysis and per-protocol (PP) analysis, respectively. There was no statistically significant difference in the efficacy of 7-day clarithromycin-containing, 7-day levofloxacin-containing, and 14-day full-dose metronidazole-containing BQT (ITT analysis: P = 0.488; PP analysis: P = 0.833). The incidence of adverse events was 19.7%, and patient compliance was 97.7%. Tailored BQT guided by genotypic resistance can achieve satisfactory efficacy, safety, and patient compliance in the first-line treatment of H. pylori infection.

Traitement guidé des infections à Helicobacter pylori : évolutions des pratiques pour un diagnostic moderne et remboursé ?

AbstractDespite unanimous recommendations from international and national scientific societies and the HAS in 2017 to favor treatment of Helicobacter pylori infections guided by a sensitivity test carried out from gastric biopsies, almost all of the treated patients still receive empirical treatment poorly tolerated and source of the continuous development over forty years of the resistance of this bacteria to antibiotics. It is time for General Practitioners, Gastroenterologists and Biologists to coordinate and mobilize to promote the guided treatment of the most common chronic bacterial infection and thus enter into a process of proper use of antibiotics. The recent reimbursement of PCR detecting H. pylori and the mutations responsible for resistance to clarithromycin should remove one of the obstacles to this guided treatment strategy. We propose a new management algorithm for these infections taking into account the reimbursements recently obtained. Recent technological advances already make it possible to imagine a future integrating sensitivity tests from a non-invasive sample: stools, saving numerous unnecessary fiberoscopies at a time when recourse to a gastroenterologist is difficult. For this near future we propose a new algorithm of what will be the coordinated work of general practitioners, gastroenterologists and biologists.

Vonoprazan and amoxicillin dual therapy for 14 days as the first‐line treatment of Helicobacter pylori infection: A non‐inferiority, randomized clinical trial

AbstractBackgroundWe previously optimized the duration and dose of vonoprazan and amoxicillin dual therapy in China. The efficacy of vonoprazan with b.i.d. amoxicillin in comparison with vonoprazan‐containing quadruple therapy as the first‐line treatment of Helicobacter pylori infection has not been adequately evaluated.MethodsIn a non‐inferiority, randomized clinical trial, H. pylori infected and treatment‐naïve patients were randomly assigned to receive 14 days of either vonoprazan dual (vonoprazan 20 mg and amoxicillin 1 g twice daily) or quadruple therapy (vonoprazan 20 mg + amoxicillin 1 g + furazolidone 100 mg + bismuth potassium citrate 600 mg twice daily). H. pylori status was confirmed using 13C‐urea breath tests or fecal antigen test. The primary outcome was the H. pylori eradication rate following vonoprazan dual and quadruple therapy at 4–12 weeks. We also compared drug compliance to either regimen and documented their side effect.ResultsA total of 190 subjects were randomized. The eradication rate of vonoprazan dual and quadruple therapy were 87.4% and 92.6% (p = 0.23) by intention‐to‐treat analysis, respectively, and 96.5% and 97.7% (p = 0.63) by per‐protocol analysis, respectively. The efficacy of vonoprazan dual therapy was non‐inferior to vonoprazan‐containing quadruple therapy in per‐protocol analysis (p < 0.001; difference: −1.2%; 90% confidence interval: −5.4% to 3.0%).ConclusionVonoprazan with b.i.d. amoxicillin for 14 days provided similar satisfactory efficacy with vonoprazan‐containing quadruple therapy as a first‐line H. pylori treatment in China.

Vonoprazan (Voquezna) for erosive esophagitis.

The FDA has approved vonoprazan (Voquezna – Phathom), a potassium-competitive acid blocker, for healing and maintenance of healing of all grades of erosive esophagitis and relief of associated heartburn in adults. Vonoprazan is also available copackaged with amoxicillin (Voquezna Dual Pak) and with amoxicillin and clarithromycin (Voquezna Triple Pak) for treatment of Helicobacter pylori infection in adults.

Independent Risk Factors Predicting Eradication Failure of Hybrid Therapy for the First-Line Treatment of Helicobacter pylori Infection.

Hybrid therapy is a recommended first-line anti-H. pylori treatment option in the American College of Gastroenterology guidelines, the Bangkok Consensus Report on H. pylori management, and the Taiwan H. pylori Consensus Report. However, the cure rates of eradication therapy in some countries are suboptimal, and the factors affecting the treatment efficacy of hybrid therapy remain unclear. The aim of this study is to identify the independent risk factors predicting eradication failure of hybrid therapy in the first-line treatment of H. pylori infection. A retrospective cohort study was conducted on 589 H. pylori-infected patients who received 14-day hybrid therapy between September 2008 and December 2021 in ten hospitals in Taiwan. The patients received a hybrid therapy containing a dual regimen with a proton pump inhibitor (PPI) plus amoxicillin for an initial 7 days and a quadruple regimen with a PPI plus amoxicillin, metronidazole and clarithromycin for a final 7 days. Post-treatment H. pylori status was assessed at least 4 weeks after completion of treatment. The relationships between eradication rate and 13 host and bacterial factors were investigated via univariate and multivariate analyses. In total, 589 patients infected with H. pylori infection were included in the study. The eradication rates of hybrid therapy were determined as 93.0% (95% confidence interval (CI): 90.9-95.1%), 94.4% (95% CI: 93.8-97.2%) and 95.5%% (95% CI: 93.8-97.2%) by intention-to-treat, modified intention-to-treat and per-protocol analyses, respectively. Univariate analysis showed that the eradication rate of clarithromycin-resistant strains was lower than that of clarithromcyin-susceptible strains (83.3% (45/54) vs. 97.6%% (280/287); p < 0.001). Subjects with poor drug adherence had a lower cure rate than those with good adherence (73.3% (11/15) vs. 95.5% (534/559); p = 0.005). Other factors such as smoking, alcohol drinking, coffee consumption, tea consumption and type of PPI were not significantly associated with cure rate. Multivariate analysis revealed that clarithromcyin resistance of H. pylori and poor drug adherence were independent risk factors related to eradication failure of hybrid therapy with odds ratios of 4.8 (95% CI: 1.5 to 16.1; p = 0.009) and 8.2 (95% CI: 1.5 to 43.5; p = 0.013), respectively. A 14-day hybrid therapy has a high eradication rate for H. pylori infection in Taiwan, while clarithromycin resistance of H. pylori and poor drug adherence are independent risk factors predicting eradication failure of hybrid therapy.

Dynamics of the prevalence of &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection from 2015 to 2023

BACKGROUND: The global prevalence of Helicobacter pylori infection has decreased from 58.2% (1980–1990) to 43.1% (2011–2022). To develop clinical recommendations for prevention diseases associated with Helicobacter pylori, it is important to assess changes in Helicobacter pylori infection in the world and in the Russian Federation, in particular.&#x0D; AIM: To assess the dynamics of Helicobacter pylori infection among patients in St. Petersburg, who undergone 13С-urease breath test in the period from 2015 to 2023.&#x0D; MATERIALS AND METHODS: All the patients have been included in the descriptive study to conduct 13C-urease breath test. If the Delta Over Baseline was less than 2.5‰, the test was considered negative. The value of this indicator of more than 2.5‰ indicated infection with Helicobacter pylori. The database for subsequent statistical analysis included age, gender, the facts of prior eradicative therapy, test results, including degree of infection.&#x0D; RESULTS: Helicobacter pylori was detected in 32.7% (16,642; 95% confidence interval 32.3–33.1%) of the patients. Of the 50,884 study participants, 83.6% (42,543; 95% confidence interval 83.3–83.9%) of the patients had not received eradication therapy in the past (primary “naive” patients), 16.4% (8341; 95% confidence interval 16.1–16.7%) had undergone eradication therapy in the past therapy (treated “recurrent” patients). The average infection rate among primary patients was 36.1% (15,358; 95% confidence interval 35.6–36.6%), among recurrent patients — 15.4% (1284; 95% confidence interval 14.6–16.2%). From 2015 to 2017, a decrease in Helicobacter pylori infection was detected in “naive” and “recurrent” patients in all the groups by 14.8 and 21.1%, respectively, and from 2020 to 2023 — by 3.6 and 6.2%, respectively. The majority of both primary and recurrent patients showed a very high (IV) degree of infection — 73.0 and 66.5%, respectively.&#x0D; CONCLUSIONS: The study demonstrated significant reduction of Helicobacter pylori infection from 2015 to 2017 indicating that information from doctors about the importance of diagnosing and treating Helicobacter pylori infection is a priority task. The new coronavirus infection also had an impact on the incidence of the infection; however, it is still unclear what the negative consequences of the active use of antibacterial agents in patients with COVID-19 are, first of all, potential impact on Helicobacter pylori resistance to key antibacterial drugs.

Vonoprazan and amoxicillin dual therapy as the first-line treatment of Helicobacter pylori infection: A systematic review and meta-analysis.

Recent clinical trials have evaluated the efficacy of vonoprazan-amoxicillin (VA) dual therapy as the first-line treatment for Helicobacter pylori infection in different regions with inconsistent results reported. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of VA dual therapy compared to the currently recommended therapy for eradicating H. pylori. A comprehensive search of the PubMed, Cochrane, and Embase databases was performed using the following search terms: ("Helicobacter" OR "H. pylori" OR "Hp") AND ("vonoprazan" OR "potassium-competitive acid blocker" OR "P-CAB") AND ("amoxicillin" OR "penicillin") AND ("dual"). The primary outcome was to evaluate the eradication rate according to intention-to-treat and per-protocol analysis. The secondary outcomes were adverse events and compliance. A total of 15 studies involving 4, 568 patients were included. The pooled eradication rate of VA dual therapy was 85.0% and 90.0% by intention-to-treat and per-protocol analysis, respectively. The adverse events rate and compliance of VA dual therapy were 17.5% and 96%, respectively. The efficacy of VA dual therapy was superior to proton pump inhibitors-based triple therapy (82.0% vs. 71.4%, p < 0.01) but lower than vonoprazan-containing quadruple therapy (83.1% vs. 93.3%, p = 0.02). 7-day VA dual therapy showed lower eradication rates than 10-day (χ2 = 24.09, p < 0.01) and 14-day VA dual therapy (χ2 = 11.87, p < 0.01). The adverse events rate of VA dual therapy was lower than vonoprazan triple therapy (24.6% vs. 30.9%, p = 0.01) and bismuth-containing quadruple therapy (20.5% vs. 47.9%, p < 0.01). No significant difference of compliance was observed between VA dual therapy and each subgroup. VA dual therapy, a novel regimen, showed high efficacy as the first-line treatment for H. pylori eradication, which should be optimized before application in different regions.

Role of Proton Pump Inhibitors in the Management of Peptic Ulcer

Proton pump inhibitors (PPIs) have been used to treat a variety of conditions affecting the upper gastrointestinal tract including gastroesophageal reflux disease (GERD), esophagitis, Zollinger-Ellison syndrome (ZES) and dyspepsia. PPIs are also useful in the treatment of Helicobacter pylori infection as well as the prevention of upper gastrointestinal tract ulcers and bleeding in patients who are taking non-steroidal anti-inflammatory drugs (NSAIDs). It is critical to get the best clinical response possible for people with an upper gastrointestinal peptic disorder. This is dependent on the PPI used. Although all members of this class suppress active parietal cell acid secretion in the same way, there are minor variations in pharmacokinetic characteristics, metabolism and FDA-approved therapeutic indications among PPIs. Regardless of this, each is successful in treating GERD and peptic ulcers. Despite their overall effectiveness, PPIs have certain drawbacks, including short plasma half-lives and the need for meal-associated dosing, which can cause breakthrough symptoms in some people, particularly at night. This article discusses the current indications for PPIs in the treatment of peptic ulcers, as well as their pharmacokinetics and pharmacodynamics.

Efficacy and safety of probiotic-supplemented bismuth quadruple therapy for the treatment of Helicobacter pylori infection: a systematic review and meta-analysis.

We performed a meta-analysis to determine whether the addition of probiotics to the bismuth quadruple therapy (BQT) for Helicobacter pylori would improve the incidence of eradication and reduce that of side effects. Randomized controlled trials matching the inclusion criteria were collected from PubMed, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials. A Mantel-Haenszel random-effects model was used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs) for the incidences of eradication rate, side effects as a whole, diarrhea, and other side effects. Ten studies were selected for inclusion in the meta-analysis. The pooled RRs for the eradication rates in intention-to-treat and per-protocol analyses of the probiotic group vs. the control group were 1.07 (95% CI: 1.02-1.11) and 1.04 (95% CI: 1.00-1.07), respectively. Probiotic supplementation reduced the incidences of side effects (RR 0.58, 95% CI: 0.37-0.91), diarrhea (RR 0.41, 95% CI: 0.25-0.67), and bitter taste (RR 0.63, 95% CI: 0.40-0.99). The results of this meta-analysis support the use of probiotics in combination with BQT in the clinical management of patients with H. pylori infection.

Molecular Characterization and Mutational Analysis of Clarithromycin- and Levofloxacin-Resistance Genes in Helicobacter pylori from Gastric Biopsies in Southern Croatia.

Point mutations in the 23S rRNA, gyrA, and gyrB genes can confer resistance to clarithromycin (CAM) and levofloxacin (LVX) by altering target sites or protein structure, thereby reducing the efficacy of standard antibiotics in the treatment of Helicobacter pylori infections. Considering the confirmed primary CAM and LVX resistance in H. pylori infected patients from southern Croatia, we performed a molecular genetic analysis of three target genes (23S rRNA, gyrA, and gyrB) by PCR and sequencing, together with computational molecular docking analysis. In the CAM-resistant isolates, the mutation sites in the 23S rRNA gene were A2142C, A2142G, and A2143G. In addition, the mutations D91G and D91N in GyrA and N481E and R484K in GyrB were associated with resistance to LVX. Molecular docking analyses revealed that mutant H. pylori strains with resistance-related mutations exhibited a lower susceptibility to CAM and LVX compared with wild-type strains due to significant differences in non-covalent interactions (e.g., hydrogen bonds, ionic interactions) leading to destabilized antibiotic-protein binding, ultimately resulting in antibiotic resistance. Dual resistance to CAM and LVX was found, indicating the successful evolution of H. pylori resistance to unrelated antimicrobials and thus an increased risk to human health.