Treatment Of Helicobacter Pylori Infection Research Articles

Risk Factors and Prevention of Gastric Cancer Development—What Do We Know and What Can We Do?

Gastric cancer (GC) is one of the most common causes of cancer-related deaths. Gastric tumors show a high aggressiveness, which, in turn, contributes to a low survival rate of fewer than 12 months. Considering the above, it was decided to review the current scientific studies that indicate the potential prevention of gastric cancer and clarify the relationship between gastric cancer and the composition of the microorganisms inhabiting the human body. Accordingly, a review paper was prepared based on 97 scientific sources from 2011 to 2022. Particular attention was paid to the most recent scientific studies from the last five years, which account for more than 80% of the cited sources. Taking care of one’s overall health, including undertaking treatment for Helicobacter pylori infection, and following a diet high in anti-inflammatory and immunomodulatory ingredients are the most important factors in reducing the risk of developing gastric cancer.

Vonoprazan With Amoxicillin or Amoxicillin and Clarithromycin for the Treatment of Helicobacter pylori Infection.

To describe the pharmacology, efficacy, safety, and potential role of vonoprazan with amoxicillin or amoxicillin and clarithromycin for the treatment of Helicobacter pylori infection in adults. PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched using the terms: (vonoprazan OR voquezna) AND ("H. pylori" OR "Helicobacter pylori") AND amoxicillin with no date limitations up to November 3, 2022. Studies assessing the efficacy and safety of vonoprazan with amoxicillin and/or clarithromycin were included and divided into 3 groups based on different comparisons between treatment regimens used in each group. Ten clinical trials and 17 observational studies were included. Vonoprazan-based therapy demonstrated greater acid inhibition and similar or higher efficacy than proton-pump inhibitor (PPI)-based therapy in treatment-naïve patients and with clarithromycin-resistant infections. Proton-pump inhibitor-based therapies have not reached the desired successful eradication rate of 90% for H. pylori infection. Vonoprazan-based therapies being at least as effective as PPI-based therapies offer an alternative for patients with H. pylori infection. Vonoprazan-based therapies were effective and well tolerated for the treatment of H. pylori infection in adults. These regimens provide an important alternative with prolonged acid inhibition, lower potential for CYP2C19 polymorphism, and at least comparable efficacy and safety versus PPI-based therapies in patients with H. pylori infections. Thus, vonoprazan-based therapy should be considered for certain patients, for example, those with failure to PPI-based treatments.

Rational Design, Synthesis, Docking Simulation, and ADMET Prediction of Novel Barbituric‐hydrazine‐phenoxy‐1,2,3‐triazole‐acetamide Derivatives as Potent Urease Inhibitors

AbstractUrease is an important target for the treatment of Helicobacter pylori infection. In this study, several pharmacophores for the inhibition of urease were considered and coupled to design new molecules capable of acting as potent urease inhibitors. Literature review reveals that barbituric‐hydrazine, phenoxy‐1,2,3‐triazole, and acetamide moieties are pharmacophores for urease inhibition. Therefore, in this study, the barbituric‐hydrazine‐phenoxy‐1,2,3‐triazole‐acetamide scaffold was designed and twelve derivatives 9 a–l of it were synthesized and evaluated. The urease inhibition assay of these compounds revealed that all new title compounds, except for one compound, with IC50 values of 0.73 to 5.27 μM were more potent than standard inhibitor thiourea. The most potent compound inhibited urease in a mixed‐type inhibition mode and interacted as well with the urease active site. In silico drug‐likeness and toxicity studies of the most potent compounds predicted that these compounds passed successfully Lipinski's rule of five and had no carcinogenicity on the rat.

A Simplified Low-Dose 10-Day Quadruple Therapy with a Galenic Formulation of Bismuth Salicylate Is Highly Effective for Helicobacter pylori Eradication.

Earlier studies have shown that a modified low-dose bismuth quadruple therapy given for 10 to 14 days is highly effective for the treatment of Helicobacter pylori infection in Sardinia. However, bismuth is not universally available. We aimed to investigate the efficacy of a simplified low-dose 10-day quadruple therapy containing a galenic formulation of bismuth salicylate for H. pylori infection. Adult patients positive for H. pylori infection were assigned to a quadruple therapy containing a galenic formulation of bismuth salicylate (200 mg) plus tetracycline 500 mg, metronidazole 500 mg and rabeprazole 20 mg, given twice a day with the midday and evening meals for 10 days. A negative stool antigen test or 13C-Urea Breath Test defined successful eradication. Compliance and adverse events were recorded 30-40 days after the end of treatment. In this open-label pilot study, 42 patients were enrolled (mean age 54.1 ± 12.0 years; 64% female). Among the study participants, 35 were naïve to H. pylori treatment. The treatment regimen was completed by 41 patients, with an overall success rate of 95.1%. More specifically, the eradication rate was 95.1% PP; 95% confidence interval (CI) = 86.6-100 and 92.9% by ITT; 95%CI = 85.1-100%, respectively. For naïve patients, the cure rate was 97.1%. Compliance was excellent. Side effects were absent or mild overall. The modified low-dose 10-day quadruple therapy provided high eradication rates of H. pylori infection, despite the replacement of colloidal bismuth subcitrate with bismuth salicylate. In regions where bismuth is unavailable in the market, the galenic formulation should be a valid option.

7-yi Makmasterskyi mizhnarodnyi ohliadovyi kurs z vnutrishnoi medytsyny (7th McMaster International Review Course in Internal Medicine - MIRCIM) - 29.09-01.10.2022 (Krakiv, Respublika Polshcha)

On September 28 – October 1, 2022, the 7th MIRCIM 2022 international conference was held in Krakow (Poland). The conference, which brought together internal medicine doctors, family doctors, narrow specialists of a therapeutic profile, had eight sections corresponding to eight main sections of internal medicine – cardiology, endocrinology, pulmonology, nephrology, rheumatology, gastroenterology, hematology, chronic infections. Professors with international recognition from the USA, Canada, Germany, France, Great Britain, Israel, India, and Mexico had the lectures. In the endocrinological section, the determination of the content of thyroid hormone, the diabetes mellitus treatment new possibilities, the experience of diagnosis and treatment of glucocorticosteroid-induced adrenal insufficiency were discussed. In the section of cardiovascular diseases, the speakers proposed to discuss the issue of acute heart failure, differences in the occurrence and course of cardiovascular diseases in women and men. In the pulmonology session, the lectures on the modern treatment of asthma, the use of nonsteroidal anti-inflammatory drugs in patients with respiratory diseases exacerbations, and the issue of the chronic obstructive pulmonary disease severity course reducing were presented. The nephrology section was presented by the reports on the topics: “Infections and kidneys”, “Optimal nephroprotection in patients with chronic kidney disease”. Professor Tracy Balboni emphasized the importance of spiritual care in the treatment of the critically ill patients and the role of spirituality in medicine and health care in general. The gastroenterology block of reports was devoted to the tactics of management and treatment of helicobacter pylori infection, intestinal polyps and non-alcoholic fatty liver disease. As part of the hematology unit, Professor Andreas Greinacher spoke about heparin-induced, vaccine-induced and other immune thrombocytopenias. At the rheumatology section.

IMPACT OF HELICOBACTER PYLORI ON EARLY POSTOPERATIVE COMPLICATIONS AFTER SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The impact of Helicobacter pylori (HP) on postoperative outcomes after sleeve gastrectomy (SG) is still controversial. A systematic review and meta-analysis were performed to compare the incidence of early complications after SG between HP-positive and HP-negative patients. Eightretrospective comparative studies were included, comprising 4,877 individuals. The prevalence of HP infection in gastric resected specimens ranged from 7.77 to 43.20%. There were no statistically significant differences between groups for overall complications (OR 1.46; 95%CI 0.95-2.23; p=0.08), bleeding (OR 1.35; 95%CI 0.70-2.60; p=0.38), and leak (OR 1.74; 95%CI 0.80-3.81; p=0.17) rates. Theneed for routine screening and treatment of HP infection before SG remains ambiguous.

Proportion and risk factors of Minimal Hepatic encephalopathy in patients with Child A & B cirrhosis and its response to treatment of Helicobacter pylori infection

Proportion and risk factors of Minimal Hepatic encephalopathy in patients with Child A & B cirrhosis and its response to treatment of Helicobacter pylori infection

High-dose dual therapy versus bismuth-containing quadruple therapy for the treatment of helicobacter pylori infection: A meta-analysis of randomized controlled trials.

Helicobacter pylori (H. pylori) infection is one of the most important public health issues, and bismuth-containing quadruple therapy (BQT) is the first-line therapeutic option. This study aimed to compare the efficacy and safety of high-dose dual therapy (HDDT) and BQT in eradicating H. pylori. Randomized controlled trials (RCTs) were retrieved from Pubmed, Embase, and Cochrane Library to evaluate the effects of HDDT and BQT on H. pylori infection from 2002 to August 31, 2022 (last 20 years). A meta-analysis was conducted using Review Manager 5.4 and dichotomous data were estimated by the risk ratio (RR) and the 100% confidence interval (CI). A heterogeneity test and publication bias adjustment were carried out using Stata 12.0. 5604 participants from 14 RCTs were included in this meta-analysis. The eradication rates of H. pylori in the HDDT group and the BQT group were 87.46% and 85.70%, respectively. There was a bordered significant difference (RR = 1.02, 95% CI: 1.00 ~ 1.04, P = 0.03) in the intention-to-treat (ITT) analysis. Inconsistently, in per-protocol (PP) analysis, HDDT showed similar efficacy to BQT (89.97% vs 89.82%, RR = 1.00, 95% CI: 0.99 ~ 1.02, P = 0.67). HDDT showed fewer frequent adverse events than BQT (13.00% vs 31.05%, RR = 0.41, 95% CI: 0.33 ~0.50, P < 0.00001). After adjusting for publication bias, the tendency did not change (RR = 0.49, 95% CI: 0.44 ~ 0.55, P < 0.00001). The compliance of the HDDT group has no significant difference compared with the BQT group (95.88% vs 93.84%, RR = 1.01, 95% CI: 1.00 ~ 1.03, P = 0.14). HDDT achieved a non-inferiority eradication rate, fewer side effects, and similar compliance compared with BQT.

The efficacy of moxifloxacin-based triple-therapy in first-line treatment of Helicobacter pylori infection in Pakistan: randomized controlled trials

IntroductionThe challenge of eradicating &lt;i&gt;Helicobacter pylori&lt;/i&gt; through antibiotic treatment is still a significant concern due to the existence of antibiotic resistance. This study aimed to evaluate and compare the efficacy of sequential therapy based on levofloxacin versus triple therapy based on moxifloxacin in treating H. pylori infection in patients receiving first-line treatment.Material and methodsA total of 162 patients who were examined positive for &lt;i&gt;H. pylori&lt;/i&gt; were randomly assigned to either of 2 groups to receive the following: (a) levofloxacin 500mg BID, amoxicillin 1 g BID, and omeprazole 20 mg BID for the first 5 days, followed by levofloxacin 500 mg BID, tinidazole 500 mg BID, and omeprazole 20 mg BID (LAO-LTO group); or (b) moxifloxacin 400 mg OD, amoxicillin 1 g BID, and omeprazole 20 mg BID (MAO group) for 10 days.ResultsThe eradication rate of &lt;i&gt;H. pylori&lt;/i&gt; in the LAO-LTO group was 58.4% (45/77) and 76.3% (45/59), and in the MAO group it was 81.2% (69/85) and 92% (69/75), respectively, in ITT and PP analyses. Eradication rates of moxifloxacin-based triple therapies were significantly higher than those of levofloxacin-based regimens (p &lt; 0.001). The overall incidence of side effects and patient compliance was significantly lower in the moxifloxacin group (p &lt; 0.005) than in the levofloxacin group.ConclusionsMoxifloxacin-based triple therapy could be a significantly more effective first-line eradication treatment as compared to levofloxacin-based sequential therapy for &lt;i&gt;H. pylori&lt;/i&gt; infection in Pakistan.

Update on the second-line treatment of Helicobacter pylori infection: a narrative review.

A standard bismuth quadruple therapy, a fluoroquinolone-containing triple (or quadruple) therapy or a proton pump inhibitor (PPI)-amoxicillin high-dose dual therapy has been recommended as a second-line treatment for Helicobacter pylori infection by the Maastricht VI/Florence Consensus Report. The major shortcoming of levofloxacin-amoxicillin triple therapy is low cure rate for eradicating levofloxacin-resistant strains. With the rising prevalence of levofloxacin-resistant strains, levofloxacin-amoxicillin triple therapy cannot reliably achieve a high eradication rate for second-line treatment of H. pylori infection in most countries now. The present article aims to review current second-line eradication regimens with a per-protocol eradication rate exceeding 85% in most geographic areas. Recently, a novel tetracycline-levofloxacin quadruple therapy consisting of a PPI, bismuth, tetracycline, and levofloxacin for rescue treatment of H. pylori infection has been developed. The new therapy achieved a higher per-protocol eradication rate than levofloxacin-amoxicillin triple treatment in a randomized controlled trial (98% versus 69%). Additionally, the tetracycline-levofloxacin quadruple therapy also exhibits a higher eradication rate than amoxicillin-levofloxacin quadruple therapy. High-dose dual PPI-amoxicillin therapy is another novel second-line treatment for H. pylori infection. The new therapy can achieve an eradication rate of 89% by per-protocol analysis for the second-line treatment in Taiwan. Recently, levofloxacin-based sequential quadruple therapy and potassium-competitive acid blocker have also been applied in the second-line treatment of H. pylori infection. A meta-analysis revealed that a vonoprazan-based regimen has significant superiority over a PPI-based regimen for second-line H. pylori eradication therapy. In conclusion, the eradication rate of levofloxacin-amoxicillin triple therapy is suboptimal in the second-line treatment of H. pylori infection now. Currently, a standard bismuth quadruple therapy (tetracycline-metronidazole quadruple therapy), a tetracycline-levofloxacin quadruple therapy, an amoxicillin-levofloxacin quadruple therapy, a levofloxacin-based sequential quadruple therapy or a high-dose PPI-amoxicillin dual therapy is recommended for the second-line treatment of H. pylori infection.

Brief communication: global temporal trends in the efficacy of clarithromycin-based regimens for the treatment of Helicobacter pylori infection.

Helicobacter pylori eradication rates achieved with clarithromycin-based triple therapies are declining due to antibiotic resistance, but data regarding temporal changes in efficacy with these eradication therapies are scarce. To evaluate the efficacy of clarithromycin-based triple eradication regimens over time. A comprehensive literature review and time-trend analysis. Bibliographies of recently published systematic literature reviews were searched and supplemented with a targeted literature review conducted using Medline and Embase databases and ProQuest from conception to May 2021. Studies reporting H. pylori eradication rates of clarithromycin-based triple therapies were included and temporal trends were estimated using a random-effects model. Eradication rates for triple therapies containing proton pump inhibitors (PPIs), clarithromycin, and amoxicillin showed a significant decline over the past 23 years (p = 0.0315). However, this decline was not significant when eradication rates achieved with vonoprazan-based triple therapy were included (p = 0.3910). Vonoprazan-based triple therapy partially mitigated the decline in eradication rates seen with PPI-based triple therapy, likely due to more powerful acid suppression of vonoprazan.

Medical staff knowledge about the different regimens and plans of treatment for Helicobacter pylori infection in Buraydah, Saudi Arabia

Background: Helicobacter pylori (H. pylori) is one of the most common chronic infections. It is linked to the development of peptic ulcers and is considered an important factor in the development of gastric cancer. With an appropriate therapeutic regimen, the eradication of H. pylori infection can be achieved, gastritis can be cured, and we can alter its progression to the complications. In this study, we aimed to measure medical staff knowledge about the different regimens and treatment plans for H. pylori infection in Buraydah, Saudi Arabia. Methods: A 23-item questionnaire was filled out by 60 internal medicine physicians in the private sector to assess different variables regarding H. pylori knowledge and treatment. Results: A total of 40 responses were included [30 (75%) men, 26 (68%) &amp;lt; 45 years]. We found that a higher knowledge score was more associated with being a male (T = 2.397; p = 0.002) and those having sources of H. pylori&amp;apos;s information such as national meetings (T = 2.418; p = 0.020) and internet (T = 2.063; p = 0.046), while the differences in the score of knowledge among age (p = 0.992) and degree/title (p = 0.547) were not significantly different. Conclusion: There are knowledge discrepancies among the participants with a wide spread of data sources regarding H. pylori management, screening, and diagnosis. There was also a statistically valuable difference regarding physicians&amp;apos; choice of information source. Those who obtained their information through national meetings and internet sources were more knowledgeable than those who obtained it in another way. For future research, we suggest exploring the connection between information sources and the knowledge level and attitude concerning treatment plans.

Cost-Effectiveness of Vonoprazan-Based and Rifabutin-Based vs Other Regimens as First-Line Treatment of Helicobacter pylori Infection in the United States.

The economic and clinical implications of eradicating Helicobacter pylori ( H. pylori ) with vonoprazan-based and rifabutin-based regimens vs other existing prepackaged first-line treatment options in the United States are unknown. Therefore, we evaluated the cost-effectiveness of vonoprazan-based and rifabutin-based and other prepackaged regimens for the first-line treatment of H. pylori from the perspective of US healthcare payers. We used the state-transition Markov model to conduct a cost-effectiveness analysis of H. pylori eradication with clarithromycin triple, bismuth quadruple, vonoprazan dual, vonoprazan triple, and rifabutin triple regimens. In a cycle length of 2 months, the model estimated the expected costs (expressed in 2022 US$), expected quality-adjusted life-years (QALY), incremental cost-effectiveness ratios, and expected net monetary benefit over 20 years. In addition, we accounted for the present value of future costs and QALY by applying a 3% discounting rate. In this study, rifabutin triple therapy had a lower expected cost but was more effective than clarithromycin triple, bismuth quadruple, and vonoprazan dual regimens; hence, it dominated them. Vonoprazan triple therapy had a higher expected cost (US$ 1,172 vs US$ 1,048) and expected QALY (14.262 vs 14.256) than rifabutin triple therapy, yielding an estimated incremental cost-effectiveness ratio of US$ 22,573/QALY. The study suggested that vonoprazan triple treatment had the highest expected net monetary benefit and was the most cost-effective at willingness-to-pay thresholds between US$50,000 and US$150,000 per QALY, followed by rifabutin triple therapy. H. pylori infection eradication with vonoprazan triple therapy would provide the greatest net health and monetary benefit from the perspective of US healthcare payers.

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

ObjectiveTo evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe.DesignInternational, prospective, non-interventional registry of the clinical practice of European...

Evaluation of guidelines for diagnosis and treatment of Helicobacterpyloriinfection.

To systematically evaluate the quality of the guidelines for the diagnosis and treatment of Helicobacter pylori infection and to analyze the differences and reasons for the key recommendations in the guidelines. Databases and websites were systematically searched to obtain guidelines for the diagnosis and treatment of Helicobacter pylori infection. Four independent reviewers used the Guideline Evaluation Tool (AGREE II) to evaluate the included guidelines. The intraclass correlation coefficient (ICC) and Fleiss' kappa coefficient were used to measure the consistency of evaluation guidelines between guide reviewers. Differences between guidelines and the reasons for the differences were analyzed by comparing the recommendations of different guidelines and the evidence supporting the recommendations. A total of 17 guidelines for Helicobacter pylori infection were included in this study. The AGREE II scores of these guidelines were low overall, with 4 of them had a score of over 60%, which indicates that the guidelines are recommended, and 13 of them having a score ranging from 30 to 60%, which indicates that the guidelines are recommended but need to be revised, while no guideline had a score of 30% or less, which indicates that they were not recommended. The analysis of these guidelines found that there were some differences in the main recommendations. Not all guidelines recommend sequential therapy as the recommended therapy. Whether bismuth quadruple therapy should be used as the recommended first-line therapy is unclear. The antibiotic resistance rate is different in different regions. Combined with the local antibiotic sensitivity test, the eradication rate of Helicobacter pylori can be improved. There are significant differences in the quality of Helicobacter pylori infection guidelines and the key recommendations. Improving the deficiencies of existing guidelines is an effective way to develop high-quality guidelines and make reasonable recommendations for the treatment of Helicobacter pylori infection in the future.

Comparative Efficacy of 14-Day Tegoprazan-Based Triple vs. 10-Day Tegoprazan-Based Concomitant Therapy for Helicobacter pylori Eradication.

Tegoprazan, a novel potassium-competitive acid blocker, is currently available for the treatment of Helicobacter pylori infection. We compared the efficacies of tegoprazan-based triple and concomitant therapies in a real-world practice. Data of patients treated with a 14-day tegoprazan-based triple therapy (50 mg of tegoprazan + 1000 mg of amoxicillin + 500 mg of clarithromycin twice daily) or 10-day tegoprazan-based concomitant therapy (50 mg of tegoprazan + 1000 mg of amoxicillin + 500 mg of clarithromycin + 500 mg of metronidazole twice daily) were retrospectively reviewed. Primary endpoint was eradication rate in the intention-to-treat (ITT) population. Of the 928 included patients, 551 and 377 were treated with triple and concomitant therapies, respectively. Eradication rate from ITT analysis was 76.4% (95% confidence interval [CI], 72.7−79.8%) in the triple therapy group and 85.9% (95% CI, 82.2−89.2%) in the concomitant therapy group (p < 0.001). Eradication rate in the per-protocol analysis was also higher in the concomitant therapy group than in the triple therapy group (triple vs. concomitant therapy: 84.5% [81.1−87.5%] vs. 91.1% [87.8−93.8%]). Overall adverse event rate was 29.0% in the triple therapy group and 45.9% in the concomitant therapy group (p < 0.001). Adherence rate was similar between the two groups (triple vs. concomitant therapy: 90.0 vs. 92.6%, p = 0.180). Overall, the 10-day tegoprazan-based concomitant therapy had superior efficacy than the 14-day tegoprazan-based triple therapy for H. pylori eradication. Although concomitant therapy showed common adverse events, adherence was comparable between the two therapies.

A Study into the Electrochemical Behavior of Nano Antibiotics as A Promising Treatment for Helicobacter Pylori Infection by Cyclic Voltammetry

The helicobacter-pylori (H.pylori) bacteria that infects the digestive system is one of the bacteria that is intractable in routine treatments with antibiotics, as it has been studied using nano-antibiotics studied by the electrochemical behavior of three Nano antibiotics. The study aims to identify the extent of the effect of micro-antibiotics on the composition of the blood serum medium by electrochemical analysis using the cyclic voltammetric method and to compare it with nano-antibiotics. Three Nano-antibiotics such as Amoxicillin NPs, Azithromycin NPs, and Metronidazole NPs, and the mixture of the three nanoparticles as Nano-Kit were investigated in blood serum medium utilizing cyclic voltammetry methods by a glass carbonic electrode (GCE). The three nanoparticles in antibiotics were prepared by converting the micro antibiotic with a lyophilizer technique and characterization by field emission scanning electron microscopy (FESEM) with all antibiotics in Nano size. The results showed that all Nano compounds act as an antioxidant antibiotic in the blood serum medium. The study also included the electrochemical characterization of the Nano-kit of the mixture for the three Nano-biotics to prove anti-oxidative stress. It was found that the three nano-biotics have reduced current peaks without any oxidation peaks. The three nano-antibiotics can be an excellent treatment to eradicate H. pylori infection permanently. Therefore, the results of this research can be adapted to use the nano-kit of the mixture in the appropriate treatment of H.pylori infection.

S1631 Education on the Treatment of Helicobacter pylori Infection Improves Clinician Knowledge

Introduction: The prevalence of Helicobacter pylori infection in US adults is around 35%. Eradication of H. pylori is essential to the successful management of peptic ulcer disease, and the potential prevention of gastric cancer. The goal of this project was to assess the role of continuing medical education (CME) on improving learners’ knowledge regarding evidence-based treatment of H. pylori infection. Methods: Gastroenterologists (N =1499) and primary care physicians (PCPs; N =1224) participated in an online text-based CME/CE activity on the diagnosis and treatment of H. pylori infection (1). Educational effect was assessed using a repeated-pair design with pre-/post-assessment and 2 multiple choice questions. This assessed knowledge and included evaluation questions that gauged patient numbers and overall satisfaction with the education. We calculated relative improvement ([post%-pre%]/pre%) to examine change in percentage of correct responses. We used the chi-squared test for significance testing on the number of correct responses pre- to post-activity with P < 0.05 considered statistically significant. The online CME activity launched on October 15, 2021; data were collected on May 31, 2022. Results: Sixty-six percent of gastroenterologists and 60% of PCPs strongly agreed that this education increased their knowledge regarding evidence-based treatments for H. pylori infection. First line therapy for H. pylori infection: Gastroenterologists had a 308% relative increase (13%/53% pre/post; P < .05), and PCPs had a 360% relative increase (10%/46%, pre/post; P < .05) in knowledge regarding recommended first-line treatment of H. pylori infection (Figure). Antibiotic resistance and H. pylori treatment: Gastroenterologists had a 33% relative increase (55%/73%, pre/post; P < .05), and PCPs had a 162% relative increase (26%/68%, pre/post; P < .05) in knowledge about antibiotic resistance to clarithromycin in patients with H. pylori infection (Figure). Conclusion: We found significant improvement in knowledge among gastroenterologists and PCPs regarding evidence-based management of H. pylori infection. However, additional educational effort is required to close some clinical knowledge gaps regarding selection of first-line treatment for H. pylori infection and resistance to antibiotics, with particular emphasis on clarithromycin.Figure 1.: Pre and Post results for gastroenterologists and primary care physicians knowledge for first-line treatment of Helicobacter pylori.

Some Azo Compounds Containing Black Tea Processing Waste Catechins As Antioxidant and Urease Enzyme Inhibitory

Although various azo compounds containing some natural origin catechins had been synthesized and determined their dyeing properties for various textile products, azo compounds containing black tea waste catechins and their antioxidant capacity and urease enzyme inhibition were not investigated until this study. The urease enzyme is the most important enzyme that allows the bacteria Helicobacter pylori, which is considered the main factor of stomach cancer, to live in the stomach. Inhibition of this enzyme is very important for the treatment of Helicobacter pylori infection. It has been known that catechin extracts of natural origin inhibit the urease enzyme of Helicobacter pylori from literature. Black tea processing waste is a residue that is separated from the sieves during tea processing and has no economic value. The transformation of this residue into products that produce added value is very important because it contains many chemicals contained in the tea plant. &#x0D; In this study, some azo compounds containing black tea processing waste catechins were synthesized and investigated their antioxidant capacity, urease enzyme inhibition properties.

A randomized controlled trial to compare Helicobacter pylori eradication rates between the empirical concomitant therapy and tailored therapy based on 23S rRNA point mutations.

Background:Increasing clarithromycin resistance has led to changes in several guidelines for treatment of Helicobacter pylori infections. We compared the H. pylori eradication rates of the empirical concomitant therapy (CoT) and a tailored therapy (TaT) using dual-priming oligonucleotide-based polymerase chain reaction to detect mutations in the 23S rRNA gene that are related to clarithromycin resistance.Methods:Between June 2020 and May 2021, 290 patients were enrolled and randomly assigned to 2 groups. In the CoT group, the patients received rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 14 days. In the TaT group, point mutation-negative patients received rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice daily for 14 days and point mutation-positive patients received rabeprazole 20 mg twice daily, metronidazole 500 mg thrice daily, and bismuth 120 mg and tetracycline 500 mg 4 times daily for 14 days.Results:A total of 290 and 261 patients were included in the intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. A2142G and/or A2143G point mutations were identified in 28.6% of the patients. No significant difference in eradication rates were observed between the 2 groups as per ITT (CoT, 82.8% and TaT, 85.5%, P = .520) and PP (CoT, 88.6% and TaT, 94.6%, P = .084) analyses. In point mutation-positive patients, the eradication rates in the CoT group were lower than those in the TaT group as per ITT (69.8% and 87.5%, respectively, P = .050) and PP (76.9% and 97.1%, respectively, P = .011) analyses.Conclusion:CoT and TaT showed similar overall eradication rates for H. pylori. However, CoT eradication rate was suboptimal, especially in point mutation-positive patients.