Treatment Of Hp Infection Research Articles

Analysis of factors associated with Helicobacter pylori infection in severe pancreatitis patients and its effect on patient's prognosis.

To analyze the factors related to Helicobacter pylori (Hp) infection in patients with severe acute pancreatitis (SAP) and to observe the effect of Hp on SAP, and to provide a reference for future clinical prevention and treatment of Hp infection in SAP. A retrospective analysis was performed on 77 SAP patients admitted to Pingxiang People's Hospital between January 2020 and February 2022, with 33 Hp-infected individuals as the Hp-positive group and the other 44 patients being without Hp infection served as the Hp-negative group. First, the related factors of Hp infection in SAP patients were analyzed with multiple Logistic regression. Subsequently, the Acute Physiology and Chronic Health Evaluation II (APACHE II), Bedside Index for Severity in Acute Pancreatitis (BISAP) and Modified CT Severity Index (MCTSI) scores, as well as the levels of C-reactive protein (CRP), white blood cell (WBC), procalcitonin (PCT) and immunoglobulins A/M/G (IgA, IgM, and IgG) were recorded for inter-group comparisons. The adverse reactions and hospitalization time were also recorded. Besides, a six-month follow-up was carried out after discharge, and patients' quality of life was evaluated using the Short-Form 36 Item Health Survey (SF-36). Logistic regression analysis identified that history of Hp infection, long-term drinking, eating habits and history of biliary tract diseases were independent risk factors for Hp infection (all P<0.05). At 2 weeks after admission, higher APACHE II, BISAP and MCTSI scores were observed in Hp-positive group compared with Hp-negative group (all P<0.05). The Hp-positive group exhibited higher CRP, WBC and PCT levels while lower IgA, IgM and IgG levels during treatment compared to the Hp-negative group (all P<0.05). No difference was found in the incidence of adverse reactions between the two groups (P>0.05), but the hospitalization time of the Hp-positive group was significantly prolonged (P<0.05). The follow-up results determined better quality of life in the Hp-negative group, which resulted in higher SF-36 scores in various dimensions (P<0.05). The history of Hp infection, long-term drinking, eating habits, and history of biliary tract diseases are all independent risk factors for Hp infection. Hp infection exacerbates disease progression of SAP, adversely influences patients' recovery, impairs their immune function, and compromises their prognoses.

Antimicrobial combinations against Helicobacter pylori including benzoxadiazol-based flavodoxin inhibitors: in vitro characterization.

The antimicrobial resistance of Helicobacter pylori (Hp) currently poses a threat to available treatment regimens. Developing antimicrobial drugs targeting new bacterial targets is crucial, and one such class of drugs includes Hp-flavodoxin (Hp-fld) inhibitors that target an essential metabolic pathway in Hp. Our study demonstrated that combining these new drugs with conventional antibiotics used for Hp infection treatment prevented the regrowth observed with drugs used alone. Hp-fld inhibitors show promise as new drugs to be incorporated into the treatment of Hp infection, potentially reducing the development of resistance and shortening the treatment duration.

Modern aspects of Helicobacter pylori infection

A systematic review of current data on the structure and functions of Helicobacter pylori (Hp), pathogenesis, diagnosis and treatment of Hp-infection is presented. The relevance of the topic of helicobacteriosis is due to the proven connection of this infection with chronic, widespread diseases of the digestive organs among the population. The review used materials from the databases including PubМed, Medline, EMBASE, Scopus, Google Scholar, RSCI. A systematic review based on studies with a high degree of evidence has shown significant progress in the diagnosis and treatment of Hp-infection in recent years in adults and children. Coordination of the scientific search for the regularities of the formation of Hp-associated forms of pathology, continuous improvement of diagnostic technologies and the search for new therapies, periodic well-organized international revisions of standard methods of Hp diagnosis and treatment contribute to the creation of effective methods of Hp eradication, preservation of the optimal composition of the microbiota of the gastrointestinal tract and prevention of antibiotic resistance. Of particular importance for the prevention of complications of Hp-infection are original diagnostic algorithms using specialized endoscopic and molecular technologies before and after Hp eradication with long-term follow-up and the determination of the leading factors correlating with a high risk of stomach cancer. The review indicates the emergence of potentially effective and promising areas for the diagnosis and treatment of Hp-infection, including genetic modification of the Hp genome to ensure its existence as a human symbiont and a significant reduction in its pathogenic properties. At the same time, sequencing of a new generation reveals mutations in Hp genes associated with its pathogenicity and antibiotic resistance, which contributes to the creation of new classes of drugs to increase the effectiveness of Hp eradication with a decrease in the proportion of antibiotics and an increase in pathogenetically significant inhibitors of its pathogenic factors for the prevention of side effects, a significant reduction in the empirical use of several antibiotics and increased compliance to treatment.

Recombinant Helicobacter pylori Vaccine Delivery Vehicle: A Promising Tool to Treat Infections and Combat Antimicrobial Resistance.

Antimicrobial resistance (AMR) has become a global public health threat. Experts agree that unless proper actions are taken, the number of deaths due to AMR will increase. Many strategies are being pursued to tackle AMR, one of the most important being the development of efficient vaccines. Similar to other bacterial pathogens, AMR in Helicobacter pylori (Hp) is rising worldwide. Hp infects half of the human population and its prevalence ranges from &lt;10% in developed countries to up to 90% in low-income countries. Currently, there is no vaccine available for Hp. This review provides a brief summary of the use of antibiotic-based treatment for Hp infection and its related AMR problems together with a brief description of the status of vaccine development for Hp. It is mainly dedicated to genetic tools and strategies that can be used to develop an oral recombinant Hp vaccine delivery platform that is (i) completely attenuated, (ii) can survive, synthesize in situ and deliver antigens, DNA vaccines, and adjuvants to antigen-presenting cells at the gastric mucosa, and (iii) possibly activate desired compartments of the gut-associated mucosal immune system. Recombinant Hp vaccine delivery vehicles can be used for therapeutic or prophylactic vaccination for Hp and other microbial pathogens.

Comparative Study of Modified Silver Nitrate Staining for the Detection of Helicobacter pylori.

Background/Aims: Helicobacter pylori (Hp) infection is associated with a variety of diseases, such as benign lesions, precancerous lesions, and malignant lesions, especially diseases in the digestive system. Most people with Hp infection have mild early symptoms that are not easily noticed. Therefore, the diagnosis and treatment of Hp infection is particularly important. At present, there are many methods to detection Hp infection, but there is a lack of effective detection method with high sensitivity and specificity. On the basis of the existing detection methods, the modified silver nitrate staining method in this study improved the sensitivity and specificity of Hp detection.Materials and Methods:We selected gastric antrum and gastric angle mucosal biopsy tissues from 60 inpatients that were archived in the Pathology Department of Zhongnan Hospital of Wuhan University from July to December 2020. An Hp immunohistochemical assay, histochemical assay kit (methylene blue), and modified silver nitrate staining were used to measure the Hp infection positivity rate.Results:Comparison of Hp sensitivity and specificity among the 3 methods showed that the modified silver nitrate staining method was the most excellent. The sensitivity of modified silver nitrate staining method was 98.3%, which is statistically significantly higher compared with the other 2 methods.Conclusion:The modified silver nitrate staining method for Hp detection is convenient and effective, and could be widely used for clinical Hp detection.

The Trend of the Multidrug Resistance of &amp;lt;i&amp;gt;Helicobacter pylori&amp;lt;/i&amp;gt; Strains Isolated in Chengdu

Background: The treatment of Hp infection has been the most popular topic of the most attention and research by gastrointestinal disease workers, and the biggest problem in the treatment of Hp infection is Hp drug resistance to antibiotics, and Hp drug resistance is the main cause of Hp eradication failure. It is severe for the multidrug resistance of Hp. Objective: To investigate the changing trend of Helicobacter pylori (Hp) resistance to metronidazole, clarithromycin and amoxicillin in children and adults in Chengdu. Methods: The Hp strain determined the minimum antibacterial concentration (MIC) from 585 patients with upper gastrointestinal symptoms, metronidazole, clarithromycin and amoxicillin was measured by the E-test. Clinically isolated Hp strains were obtained by microaerobic condition culture as the diagnostic standard. Results: The Hp resistance to metronidazole and clarithromycin in children in Chengdu were: 17.65% (27/153) and 18.06 (78/432) in adults. The Hp resistance to metronidazole and amoxicillin in children in Chengdu were: 11.76% (18/153) and 13.19 (57/432) in adults. The Hp resistance to metronidazole, clarithromycin and amoxicillin in children in Chengdu were: 3.92% (6/153) and 10.41 (45/432) in adults. There were 76.92% of the strains which were resistant to metronidazole, 24.11% to clarithromycin, and 18.46% to amoxicillin. The drug resistance rate of Hp has increased year by year from 2017 to 2021 year, especially the drug resistance rate of Hp to clarithromycin and metronidazole has generally increased. Conclusions: The drug resistance rate of Hp has increased year by year from 2017 to 2021 year.

Comparative Evaluation of Clinical, Endoscopic and Histopathological Findings of Helicobacter Pylori-Associated Gastroduodenitis in Children

Background: Chronic colonization with Helicobacter pylori (Hp) has been shown to significantly increase the risk of gastric ulcer and duodenum as well as chronic gastritis in children and adults. Due to the importance of early detection and treatment of HP infection especially in children, this study aimed to compare the clinical, endoscopic and histopathological findings in children with HP gastroduodenitis and control group. Materials and Methods: In this cross-sectional study, all children referred to the gastroenterology clinic of children´s hospital, Qazvin, Iran, between 2016 and 2018, with a history of gastrointestinal complaints underwent upper gastrointestinal endoscopy if necessary, then tissue samples were taken, and rapid urease test was performed. Subsequently the patients were divided into two equal groups of 200: HP positive (patient group), and Hp negative (control group). Results: The mean age in the Hp positive group and in the control group was 8.11±3.68 and7.22±2.96 years, respectively (P<0.05). The most common clinical manifestation in the Hp positive group was chronic abdominal pain (n=66, P<0.001). Endoscopic examinations revealed that the evidence of mucosal erythema, erosions and nodular mass of the corpus, antrum and bulb were significantly higher in Hp positive group. Histopathologic studies also showed more evidence of corpus, antrum and bulb inflammation in the Hp positive group compared to the control group. Conclusion: Overall, based on the results of this study, it seems that endoscopic evidence of mucosal appearance of erythema, obvious nodularity and mucosal erosion in the corpus and antrum as well as bulb of duodenum in children with HP gastro- duodenitis has a diagnostic value.

Traditional Chinese medicine for Helicobacter pylori infection

Background:Helicobacter pylori (Hp) is the only bacterium in the stomach. It is characterized by its ability to adhere to gastric mucosa and cause a series of pathological changes in the gastric mucosa. Modern research shows that Hp is an important pathogenic factor for chronic gastritis, gastroduodenal ulcer, and gastric cancer. Triple, quadruple, and triple combinations of antibacterial drugs, proton pump inhibitors, and bismuth aluminate preparations have been developed in modern medical research. Sequential therapy is used to treat Hp, but antibiotic resistance and repeated infections still exist. A large number of clinical trials have proved that traditional Chinese medicine has a good therapeutic effect on Hp. In this systematic review, we aim to evaluate the efficacy and safety of traditional Chinese medicine in the treatment of Hp.Methods and analysis:We will search for publications from Web of Science, PubMed, Science Direct, Wan Fang Data Knowledge Service Platform, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), China National Knowledge Infrastructure (CNKI) and EMBASE, which should be published from inception to December 2020. Two researchers will independently perform the selection of the studies, data extraction, and synthesis. The Cochrane Risk of Bias Tool will be used to evaluate the risk of bias in the randomized controlled trials. Statistical analysis will be performed by using the Cochrane Review Manager (RevMan 5.3) software. The I2 test will be used to identify the extent of heterogeneity. We will use the Egger funnel chart to evaluate possible publication biases, in addition, when possible we will perform a subgroup/meta-regression analysis. The strength of the evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Results and conclusions:This study will systematically evaluate the efficacy of traditional Chinese medicine in the treatment of Hp infection, and provide evidence for the clinical application of this treatment. The results of the research will be published in a peer-reviewed journal.Ethics:This systematic review will evaluate the efficacy of traditional Chinese medicine for Hp infection. Because all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval.Trial registration number:INPLASY2020120057.

Association between Helicobacter pylori Infection and Occurrence of Anemia among Pregnant Women Attending Antenatal Care in Kulito Health Center, Halaba Zone, South Ethiopia, 2018.

Background Anemia in pregnancy is defined as a hemoglobin (Hb) concentration of less than 11 grams (gm)/deciliter (dl) in venous blood. Globally, it affects 1.62 billion people. In developing countries, anemia is a major cause of maternal and child morbidity and mortality. Globally, anemia contributes to 20% of all maternal deaths. Nearly 50% of the world's population is estimated to be infected with Helicobacter pylori (HP). High prevalence of HP among pregnant women was also reported in developing countries than developed ones. The association between HP infection and occurrence of anemia is not well known in Ethiopia. Therefore, the aim of this study was to determine the association between anemia and Helicobacter pylori infection among pregnant women attending antenatal care follow-up in Kulito Health Center, Halaba Zone, South Ethiopia. Methods Institution-based cross-sectional study was employed. Systematic random sampling procedure was employed to select 236 pregnant women who attended antenatal care at Kulito Health Center. An interviewer-administered questionnaire supplemented by laboratory tests was used to obtain the data. The collected data were analyzed by using SPSS version 20.0. Results The prevalence of anemia among antenatal care attendant pregnant women of Kulito Health Center was 27.5% with 36 (15.2%) of mild, 29 (12.3%) of moderate, and no severe cases of anemia. The overall prevalence of HP infection among study participants was found to be 129 (54.7%) (95% CI: 47.9–61.4). Factors significantly associated with anemia were presence of HP infection (AOR = 3.064, 95% CI: 1.336 7.027), low interpregnancy gap (AOR = 2.863, 95% CI: 1.245–6.582), being on the third trimester (AOR = 6.457; 95% CI: 1.276–32.729), and mid-upper arm circumference (MUAC) level <21 cm (AOR = 2.595, 95% CI: 1.044–6.450). Conclusion This study revealed that anemia and HP infection were highly prevalent among pregnant women attending the antenatal follow-up clinic in Kulito Health Center. HP infection, low interpregnancy gap, being on the third trimester, and MUAC less than 21 cm were the independent factors associated with anemia. Recommendation. Pregnant women should be aware that anemia is a problem that can be prevented by early prevention and treatment of HP infection and undernutrition, using family planning to widen the interpregnancy gap. Further experimental studies are warranted to determine the cause and effect of the association between anemia and HP infection.

Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics

In Japan, the prevalence of autoimmune gastritis (AIG) is assumed to be very low. With the recent rapid decrease in Helicobacter pylori (Hp) prevalence, reports on AIG are increasing. This multicenter registry study aimed to clarify the characteristics of AIG, especially its endoscopic appearance. A total of 245 patients with AIG from 11 institutions in Japan from January 2010 to October 2016 were included, and their clinical and endoscopic findings were evaluated. Mean age was 67.2±11.4years, and 63.7% of the participants were women. The most common approach to diagnose AIG was endoscopic examination. Repeated incorrect treatment for Hp infection, due to a false-positive result in 13 C-urea breath test, ranked third among the basis for diagnosis of AIG. Associated gastric lesions were type 1 neuroendocrine tumor (11.4%), adenocarcinoma (9.8%), and hyperplastic polyps (21.1%). Corpus pan-atrophy was the most common appearance (90.1%); however, remnant oxyntic mucosa was found in 31.5% of the patients (flat, localized type, 48.6%). Sticky adherent dense mucus and scattered minute whitish protrusions were also observed in approximately 30% of the patients. Despite the prevailing presumption of the antral mucosa remaining normal, 42.3% of the patients presented with various extents of atrophy, and patchy redness and circular wrinkle-like patterns were both observed in approximately 20% of the patients. The present study showed some prominent clinical characteristics and endoscopic findings of AIG. We believe that our study will facilitate the diagnosis of potential AIG.

β-Defensins in the Fight against Helicobacter pylori.

Antimicrobial peptides (AMPs) play a pivotal role in the innate immune responses to Helicobacter pylori (Hp) in humans. β-Defensins, a class of cationic arginine-rich AMPs, are small peptides secreted by immune cells and epithelial cells that exert antimicrobial activity against a broad spectrum of microorganisms, including Gram-positive and Gram-negative bacteria and fungi. During Hp infections, AMP expression is able to eradicate the bacteria, thereby preventing Hp infections in gastrointestinal tract. It is likely that gastric β-defensins expression is increased during Hp infection. The aim of this review is to focus on increased knowledge of the role of β-defensins in response to Hp infection. We also briefly discuss the potential use of AMPs, either alone or in combination with conventional antibiotics, for the treatment of Hp infection.

Helicobacter pylori infection contributes to placental impairment in preeclampsia: basic and clinical evidences.

Preeclampsia (PE) is a major cause of maternal and neonatal morbidity and mortality. Epidemiological association between Helicobacter pylori (Hp) infection and PE onset has been widely shown. The aim of this study was to analyze a possible correlation between Hp infection and the severity of clinical presentation of PE and to identify an immunologic mechanism triggered by Hp infection potentially contributing to the pathogenesis of PE. Sera from 93 preeclamptic women and 87 healthy pregnant women were tested for Hp infection by immunoassay and for anti-CagA antibodies by Western blot assay. The serologic results were correlated with the clinical features of PE. The functional effect of serum IgG fractions, positive or negative for Hp, from preeclamptic women or controls were tested on trophoblast and endothelial cell cultures and in a murine model of angiogenesis. Preeclamptic women showed higher seroprevalence of Hp infection (57.0%) compared to controls (33.3%) (P<.001). The seropositivity for CagA-positive strains of Hp was 45.2% in preeclamptic women vs 13.7% in controls (P<.001). In PE women, Hp infection was associated with abnormality of uterine arteries Doppler (P<.001). Hp+ IgG fractions from preeclamptic women bound to trophoblast and endometrial endothelial cell cultures, reducing in vitro invasiveness and angiogenesis, respectively, and inhibited angiogenesis in mice. Our data show, for the first time, an association between Hp infection and PE with abnormal uterine arteries Doppler velocimetry, suggesting a role for Hp infection in impairing placental development and increasing the risk to develop PE. This study opens the new perspective of a potential screening and treatment for Hp infection in pregnancy.

HELICOBACTER PYLORI (HP) INFECTION IN OBESE PATIENTS UNDERGOING ROUXEN- Y GASTRIC BYPASS; EFFICACY OF TWO DIFFERENT TREATMENT REGIMENS IN HP ERADICATION.

the ultimate cause for the increased incidence of gastric ulcer following Roux-en-Y gastric bypass (RYGB) remains unclear. Treatment of HP infection is recommended before surgery in countries with high prevalence such as Spain in other to diminish the risk. However, the current regimens used might not be adequate in view of the high failure rate for HP eradication. we reviewed 243 patients retrospectively undergoing RYGB and found 111 patients (45%) with HP infection. Therefore, we compared the eradication rate between 2 different regimens. 70 patients received OCA(Omeprazole:20 mg/12h, Clarithromycin 500 mg/12h and Amoxicillin 1 gram/12h for 10 days) while 41 patients received OLA (Omeprazole 20 mg/12 hours, Levofloxacin 500 mg/12hours and Amoxicillin 1 gram/12h for 10 days) for HP eradication. In 56/70 (80%) patients receiving OCA therapy HP was eradicated compared to 37/41 (91%) receiving OLA as first line therapy (p = 0.283). When used as second line therapy, in 13/14 (92%) patients receiving OLA HP was eradicated. clarithromycin resistance remains a matter of concern in this population while OLA seems to be a good alternative therapy for HP eradication, especially when OCA regimen fails.

Correlation between Helicobacter pylori infection in oral cavity and Helicobacter pylori infection in stomach in children

Helicobacter Pylori (Hp) is closely related to gastrointestinal diseases.Some scholars have proposed that Hp resides in the oral cavity and oral Hp is related to stomach Hp.The oral cavity has been implicated as a potential Hp reservoir and therefore may be involved in the reinfection or replapse of the stomach Hp after treatment of Hp infection. Key words: Helicobacter pylori; Oral cavity; Reinfection or relapse; Children

Sa1896 The Human Gastric Pathogen Helicobacter pylori Alters Intracellular Signaling by Inducing Truncated Forms of p53 Tumor Suppressor

patients (218 without current HP infection and 49 with successful eradication of HP infection) were HP negative status (HP-negative group), 107 patients (19 with failed eradication and 88 with no treatment of HP infection) were HP positive status (HP-positive group). The incidence of metachronous gastric cancer was compared in both groups, and the risk factors associated with the development of metachronous gastric cancer after ER was analyzed. Results: Median follow-up duration after ER was 4.1 years (range 1.0 10.5 years). During the follow-up period, metachronous gastric cancer developed in 16 patients (15.0% [16/ 107]) in the HP-positive group and in 15 patients (5.6% [15/267]) in the HP-negative group. The cumulative incidence of metachronous gastic cancer was significantly different between HP-negative and HP-positive groups (P= .003 by Log-rank test). In a multivariate Coxproportional hazard model, age . 65 years (hazard ratio [HR], 2.88; 95% confidential interval [CI], 1.28 6.49; P= .011), family history of gastric cancer (HR, 2.48; 95% CI, 1.11 5.53; P= .026), and HP-positive status (HR, 2.52; 95% CI, 1.24 5.14; P= .011) were associated with the development ofmetachronous gastric cancer. Conclusions: Persistent H. pylori infection after ER for EGC seems be associated with the development of metachronous gastric cancer during long-term follow-up period.

Sa1893 Primary Genotypic Resistance of Helicobacter pylori and Its Relations With Virulence Factors - A Multicenter Surveillance Program in Taiwan

patients (218 without current HP infection and 49 with successful eradication of HP infection) were HP negative status (HP-negative group), 107 patients (19 with failed eradication and 88 with no treatment of HP infection) were HP positive status (HP-positive group). The incidence of metachronous gastric cancer was compared in both groups, and the risk factors associated with the development of metachronous gastric cancer after ER was analyzed. Results: Median follow-up duration after ER was 4.1 years (range 1.0 10.5 years). During the follow-up period, metachronous gastric cancer developed in 16 patients (15.0% [16/ 107]) in the HP-positive group and in 15 patients (5.6% [15/267]) in the HP-negative group. The cumulative incidence of metachronous gastic cancer was significantly different between HP-negative and HP-positive groups (P= .003 by Log-rank test). In a multivariate Coxproportional hazard model, age . 65 years (hazard ratio [HR], 2.88; 95% confidential interval [CI], 1.28 6.49; P= .011), family history of gastric cancer (HR, 2.48; 95% CI, 1.11 5.53; P= .026), and HP-positive status (HR, 2.52; 95% CI, 1.24 5.14; P= .011) were associated with the development ofmetachronous gastric cancer. Conclusions: Persistent H. pylori infection after ER for EGC seems be associated with the development of metachronous gastric cancer during long-term follow-up period.

Clinical aspects of Helicobacter pylori infection

The Helicobacter pylori (Hp) infection is common. However, only 10-20% of infected individuals require antibacterial treatment. The main indications to such treatment are peptic ulcer disease, atrophic gastritis, dyspeptic symptoms, previous surgical procedure for gastric cancer, family history of gastric cancer and low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. The treatment may also be undertaken at the patient's request. To detect the infection the urease test (when the patient has indications for gastroscopy), the urea breath test or serologic test are most commonly used. A standard treatment of Hp infection consists of a 7-day administration of one of the proton pump inhibitors and 2 out of 3 antibiotics such as amoxicillin, clarithromycin and metronidazole. After failure of the first-line treatment, the recommended second choice treatment is a quadruple treatment regimen consisting of bismuth salts, tetracycline, metronidazole and proton pump inhibitor. European guidelines (Maastricht III) allow the use of the quadruple treatment regimen already as the first choice treatment and therapy prolongation up to 14 days. Ineffectiveness of the second-line treatment is an indication for antimicrobial susceptibility testing. New antibiotics used for Hp eradication are levofloxacin and rifabutin. Eradication treatment should be obligatorily assessed with the use of the urease or breath test only in patients with peptic ulcer bleeding. The current guidelines do not envisage an active search for Hp infection in an asymptomatic population and treating people infected with this bacterium, for gastric cancer prevention.

Helicobacter pylori infection and abdominal pain in children

The relationship between H. pylori(Hp) infection and recurrent abdominal pain(RAP) in children is not clear. Current data in the literature regarding a causal relationship between Hp infection and childhood RAP are conflicting. However, meta-analysis and most of the recently published studies have not supported an association between Hp infection and an increased prevalence of abdominal pain. Most published studies have some problems and have been criticized on methodological grounds. Most of the existing studies have not been designed to include double-blind placebo controls. And, because of the low incidence of Hp infection in children, they have a problem of obtaining sufficient numbers of the Hp infected children. There is also a concern about the heterogeneity of testing methodology in the studies and diagnostic accuracy problems of the non-invasive tests such as low sensitivity of the serology tests and false positive results of the UBT in children. And conflicting results may be explained, in part, by the poor definition of RAP or dyspepsia for the study subjects. To date, no consensus exists for the treatment of Hp-infected children with RAP. Some authors suggest the clinical efficacy of Hp. But others suggest that eradication of Hp is not associated with improvement of RAP. The problem of the most treatment studies is that they had usually no control groups and the number of the subjects was small. In order to make reasonable decisions about treatment of Hp infection in children with RAP, long-term, randomized, double blind, well controlled studies in large numbers of children will be required.

One-week quadruple therapy is an effective salvage regimen for Helicobacter pylori infection in patients after failure of standard triple therapy.

Standard triple therapy remains an important option for eradicating Helicobacter pylori (Hp) in developing countries because of its relatively low cost. However, salvage therapies after failure of this regimen remain undefined. The authors therefore investigate the efficacy of 1-week quadruple therapy as a second-line treatment of Hp infection after failure of standard triple therapy. Seventy-eight patients who failed Hp eradication using a 2-week bismuth-based triple therapy were enrolled and received a course of 1-week quadruple therapy (lansoprazole, 30 mg twice daily; bismuth subcitrate, 120 mg four times daily; clarithromycin, 500 mg twice daily; and amoxicillin, 1,000 mg twice daily) as a salvage regimen. The Hp status was reassessed 7 weeks after cessation of therapy. Among the 78 patients, Hp eradication was achieved in 65 (83%, 95% confidence interval = 75-91%) by intention-to-treat analysis. Only five (6%) patients had side effects, and all (100%) showed good drug compliance. Multivariate analysis disclosed that coffee drinking was an independent factor for treatment failure (odds ratio = 5.3, 95% confidence interval = 1.2-23.6, p = 0.028). The authors therefore conclude that their 1-week quadruple therapy is an effective salvage regimen for Hp infection after failure of standard triple therapy in the population examined. The benefits of this regimen include the high eradication rate, the short duration of treatment, fewer side effects, and good drug compliance. Coffee consumption possibly is an important factor in failure of the rescue regimen. The mechanisms underlying the association between coffee drinking and eradication failure require further research.