Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report

Efficacy and safety of tetracycline vs. amoxicillin in furazolidone-based rescue therapy for Helicobacter pylori: a real-world analysis

BACKGROUND AND AIM

Despite the increasing rates of antibiotic resistance, furazolidone-based regimens have demonstrated promise in Helicobacter pylori eradication. Therefore, this study aims to evaluate the comparative efficacy and safety of tetracycline versus amoxicillin in furazolidone-based quadruple therapy [bismuth quadruple therapy with furazolidone and tetracycline (BQFT) vs. bismuth quadruple therapy with furazolidone and amoxicillin (BQFA)] in rescue treatments.

METHODS

Patients who received BQFT or BQFA as rescue treatment were enrolled in this study. H. pylori status was determined using the 13C/14C urea breath test or histological examination. Eradication rates, adherence and side effects were carefully recorded.

RESULTS

A total of 342 participants were included. BQFT showed significantly higher eradication rates (modified intention-to-treat: 96.2% vs. 76%; per-protocol: 97.1% vs. 77.8%, P < 0.001), suggesting superior efficacy for patients with prior treatment failures. However, BQFA demonstrated fewer overall adverse effects (11.6% vs. 20.7%, P = 0.046), highlighting a tolerability advantage. Both groups showed similar symptom improvements and compliance rates.

CONCLUSION

BQFT exhibits superior efficacy with acceptable tolerability, making it a promising option for patients with refractory H. pylori infections. Clinicians should consider its benefits in cases of multiple prior eradication failures.

Assessment for antibiotic resistance in Helicobacter pylori: A practical and interpretable machine learning model based on genome-wide genetic variation

Helicobacter pylori (H. pylori) antibiotic resistance poses a global health threat. Accurate identification of antibiotic resistant strains is essential for the control of infection. In the present study, our goal is to leverage the whole-genome data of H. pylori to develop practical and interpretable machine learning (ML) models for comprehensive antibiotic resistance assessment. A total of 296 H. pylori isolates with genome-wide data were downloaded from the Bacterial and Viral Bioinformatics Resource Center (BV-BRC) and the National Center for Biotechnology Information (NCBI) databases. By training ML models on feature sets of single nucleotide polymorphisms from SNP calling (SNPs-1), antibiotic-resistance SNP annotated by the Comprehensive Antibiotic Resistance Database (SNPs-2), gene presence or absence (GPA), we generated predictive models for four antibiotics and multidrug-resistance (MDR). Among them, the models that combined SNPs-1, SNPs-2, and GPA data demonstrated the best performance, with the eXtreme Gradient Boosting (XGBoost) consistently outperforming others. And then we utilized the SHapley Additive exPlanations (SHAP) method to interpret the ML models. Furthermore, a free web application for the MDR model was deployed to the GitHub repository (https://H.pylori/MDR/App/). Our study demonstrated the promise of employing whole-genome data in conjunction with ML algorithms to forecast H. pylori antibiotic resistance. In the future, the application of this approach for predicting H. pylori antibiotic resistance would hold the potential to mitigate the empiric administration.

Reinvestigation into the role of lipopolysaccharide Glycosyltransferases in Helicobacter pylori protein glycosylation

Protein glycosylation has been considered as a fundamental phenomenon shared by all domains of life. In Helicobacter pylori, glycosylation of flagellins A and B with pseudaminic acid have been rigorously confirmed and shown to be essential for flagella assembly and bacterial colonization. In addition to flagellins, several other proteins including RecA, AlpA/B, and BabA/B in H. pylori have also been reported to be glycosylated and to be dependent on the lipopolysaccharide (LPS) biosynthetic pathway. However, these proteins have not been purified for sugar-specific staining or structural analysis to confirm the existence of carbohydrate motifs. Here, using a combined approach of genetics, protein purification, and sugar-specific staining, we demonstrate that RecA is not a glycoprotein. Moreover, using LPS-protein reconstitution experiments, we demonstrate that the presence of O-antigen containing full-length LPS interferes with the electrophoretic mobility of H. pylori RecA and many other proteins including AlpA/B on SDS-PAGE. Finally, we demonstrate that full-length LPS extracted from E. coli affects electrophoretic migration of H. pylori proteins, while full-length LPS extracted from H. pylori similarly influences the electrophoretic migration of E. coli proteins. The impact is more subtle with E. coli LPS compared to H. pylori LPS, indicating that the magnitude of effect of LPS effects on protein mobility is dependent on bacterial source of the LPS. These findings suggest that the effects of full-length LPS on protein electrophoresis may represent a more general phenomenon. As LPS is a unique component of virtually all Gram-negative bacteria, our data suggest that when observing protein electrophoretic mobility shifts between wild-type and LPS mutant strains or between subcellular fractionation samples, the influence of LPS on protein electrophoretic migration should be considered first, rather than interpreting it as potential protein glycosylation that is dependent upon LPS biosynthetic pathway.

Comparison of three different molecular biology assays (AllPlexTMH. pylori & ClariR assay, Amplidiag® H. pylori + ClariR and RIDA®GENE Helicobacter pylori) to detect Helicobacter pylori and clarithromycin resistance in stool samples

Helicobacter pylori detection and susceptibility profile using feces could optimize guided therapy, when endoscopy is not necessary. This study evaluated the performances of three tests: AllPlexH.pylori&ClariR, RIDAGENEHelicobacterpylori and AmplidiagH.pylori+ClariR assays on stool samples. Stool samples from a documented cohort (50 positive and 25 negative) were analyzed. The gold standard was a composite based on PCR targeting H. pylori and 23S rDNA mutations (A2142C, A2142G, A2143G) on gastric biopsies; and biopsy culture for H.pylori and susceptibility testing. For AllPlex, RidaGene and Amplidiag assays respectively: 55 (73.3%), 75 (100%), 54 (72%) samples could be analyzed; (for detection of H. pylori), sensitivity was 36% (95%CI]28;52%[); 32% (95%CI]21;46%[) and 93% (95%CI]87;100%[); specificity was 100% (95%CI]81;100%[), 83% (95%CI]68;91%[) and 57% (95%CI]33;79%[). (for the Clarithromycin resistance), sensitivity was 18% (95%CI]5;48%[), 25% (95%CI]9;53%[) and 67% (95%CI]39;86%[); specificity was 100% (95%CI]92;100%[). 92% (95%CI]83;97%[) and 97% (95%CI]89;99%[). Innovative technologies could become invaluable tools for mass testing after improvement.

Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025

At a population level, the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), and the European Society of Pathology (ESP) suggest endoscopic screening for gastric cancer (and precancerous conditions) in high-risk regions (age-standardized rate [ASR] > 20 per 100 000 person-years) every 2 to 3 years or, if cost-effectiveness has been proven, in intermediate risk regions (ASR 10-20 per 100 000 person-years) every 5 years, but not in low-risk regions (ASR < 10).ESGE/EHMSG/ESP recommend that irrespective of country of origin, individual gastric risk assessment and stratification of precancerous conditions is recommended for first-time gastroscopy. ESGE/EHMSG/ESP suggest that gastric cancer screening or surveillance in asymptomatic individuals over 80 should be discontinued or not started, and that patients' comorbidities should be considered when treatment of superficial lesions is planned.ESGE/EHMSG/ESP recommend that a high quality endoscopy including the use of virtual chromoendoscopy (VCE), after proper training, is performed for screening, diagnosis, and staging of precancerous conditions (atrophy and intestinal metaplasia) and lesions (dysplasia or cancer), as well as after endoscopic therapy. VCE should be used to guide the sampling site for biopsies in the case of suspected neoplastic lesions as well as to guide biopsies for diagnosis and staging of gastric precancerous conditions, with random biopsies to be taken in the absence of endoscopically suspected changes. When there is a suspected early gastric neoplastic lesion, it should be properly described (location, size, Paris classification, vascular and mucosal pattern), photodocumented, and two targeted biopsies taken.ESGE/EHMSG/ESP do not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection unless there are signs of deep submucosal invasion or if the lesion is not considered suitable for endoscopic resection.ESGE/EHMSG/ESP recommend endoscopic submucosal dissection (ESD) for differentiated gastric lesions clinically staged as dysplastic (low grade and high grade) or as intramucosal carcinoma (of any size if not ulcerated or ≤ 30 mm if ulcerated), with EMR being an alternative for Paris 0-IIa lesions of size ≤ 10 mm with low likelihood of malignancy.ESGE/EHMSG/ESP suggest that a decision about ESD can be considered for malignant lesions clinically staged as having minimal submucosal invasion if differentiated and ≤ 30 mm; or for malignant lesions clinically staged as intramucosal, undifferentiated and ≤ 20 mm; and in both cases with no ulcerative findings.ESGE/EHMSG/ESP recommends patient management based on the following histological risk after endoscopic resection: Curative/very low-risk resection (lymph node metastasis [LNM] risk < 0.5 %-1 %): en bloc R0 resection; dysplastic/pT1a, differentiated lesion, no lymphovascular invasion, independent of size if no ulceration and ≤ 30 mm if ulcerated. No further staging procedure or treatment is recommended.Curative/low-risk resection (LNM risk < 3 %): en bloc R0 resection; lesion with no lymphovascular invasion and: a) pT1b, invasion ≤ 500 µm, differentiated, size ≤ 30 mm; or b) pT1a, undifferentiated, size ≤ 20 mm and no ulceration. Staging should be completed, and further treatment is generally not necessary, but a multidisciplinary discussion is required. Local-risk resection (very low risk of LNM but increased risk of local persistence/recurrence): Piecemeal resection or tumor-positive horizontal margin of a lesion otherwise meeting curative/very low-risk criteria (or meeting low-risk criteria provided that there is no submucosal invasive tumor at the resection margin in the case of piecemeal resection or tumor-positive horizontal margin for pT1b lesions [invasion ≤ 500 µm; well-differentiated; size ≤ 30 mm, and VM0]). Endoscopic surveillance/re-treatment is recommended rather than other additional treatment. High-risk resection (noncurative): Any lesion with any of the following: (a) a positive vertical margin (if carcinoma) or lymphovascular invasion or deep submucosal invasion (> 500 µm from the muscularis mucosae); (b) poorly differentiated lesions if ulceration or size > 20 mm; (c) pT1b differentiated lesions with submucosal invasion ≤ 500 µm with size > 30 mm; or (d) intramucosal ulcerative lesion with size > 30 mm. Complete staging and strong consideration for additional treatments (surgery) in multidisciplinary discussion.ESGE/EHMSG/ESP suggest the use of validated endoscopic classifications of atrophy (e. g. Kimura-Takemoto) or intestinal metaplasia (e. g. endoscopic grading of gastric intestinal metaplasia [EGGIM]) to endoscopically stage precancerous conditions and stratify the risk for gastric cancer.ESGE/EHMSG/ESP recommend that biopsies should be taken from at least two topographic sites (2 biopsies from the antrum/incisura and 2 from the corpus, guided by VCE) in two separate, clearly labeled vials. Additional biopsy from the incisura is optional.ESGE/EHMSG/ESP recommend that patients with extensive endoscopic changes (Kimura C3 + or EGGIM 5 +) or advanced histological stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia, or changes in both antrum and corpus, operative link on gastritis assessment/operative link on gastric intestinal metaplasia [OLGA/OLGIM] III/IV) should be followed up with high quality endoscopy every 3 years, irrespective of the individual's country of origin.ESGE/EHMSG/ESP recommend that no surveillance is proposed for patients with mild to moderate atrophy or intestinal metaplasia restricted to the antrum, in the absence of endoscopic signs of extensive lesions or other risk factors (family history, incomplete intestinal metaplasia, persistent H. pylori infection). This group constitutes most individuals found in clinical practice.ESGE/EHMSG/ESP recommend H. pylori eradication for patients with precancerous conditions and after endoscopic or surgical therapy.ESGE/EHMSG/ESP recommend that patients should be advised to stop smoking and low-dose daily aspirin use may be considered for the prevention of gastric cancer in selected individuals with high risk for cardiovascular events.

Risk factors associated with Helicobacter pylori infection in the urban population of China: A nationwide, multi-center, cross-sectional study

OBJECTIVES

To assess the risk factors associated with Helicobacter pylori infection in the urban Chinese population.

METHODS

The study was conducted from March to November 2023, including 12,902 urban participants aged 18-60 years across 52 cities distributed over 26 provinces in China. Risk factors included socioeconomic status, lifestyles, and public understanding. Univariate and multivariate logistic regression analysis was used to calculate corrected odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

According to multivariate logistic regression, risk factors associated with significantly higher H. pylori infection rates included residency in developing (OR 1.27, 95% CI 1.13-1.43) and undeveloped cities (OR 1.15, 95% CI 1.02-1.29), obesity (OR 1.37, 95% CI 1.05-1.78), alcohol consumption (OR 1.16, 95% CI 1.05-1.29), tea consumption (OR 1.11, 95% CI 1.01-1.21), and soft drink consumption (OR 1.24, 95% CI 1.09-1.40). Conversely, individuals with moderate awareness (OR 0.79, 95% CI 0.71-0.88) and high awareness (OR 0.57, 95% CI 0.48-0.69) of H. pylori had lower infection rates.

CONCLUSION

Our findings highlight the importance of promoting a healthy lifestyle and improving the understanding of H. pylori in reducing the infection rate of the bacterial pathogen in the urban Chinese population.

Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicobacter pylori eradication

BACKGROUND

Helicobacter pylori (H. pylori) infection is a common chronic infection, and there are over half of the global population infected with H. pylori. It is still controversial whether the supplementation of Saccharomyces boulardii (S. boulardii) to bismuth quadruple therapy is beneficial for H. pylori eradication.

AIM

To determine the effects of S. boulardii supplementation to bismuth quadruple therapy on H. pylori eradication.

METHODS

We performed a systematic literature search across PubMed, Embase, Web of Science, and China National Knowledge Infrastructure for articles published up to October 2023. We calculated the pooled relative risk (RR) with the 95% confidence interval (CI). Statistical analyses were conducted using Stata/SE 15.1 software.

RESULTS

Ten randomized controlled trials were included. Notably, S. boulardii supplementation to bismuth quadruple therapy significantly improved H. pylori eradication rates (RR = 1.08, 95% CI: 1.04-1.12) and reduced the incidence of total adverse effects (RR = 0.53, 95% CI: 0.45-0.62). Specifically, it reduced the incidence of some gastrointestinal adverse effects and nonspecific adverse effects, including diarrhea (RR = 0.28, 95% CI: 0.22-0.36), constipation (RR = 0.32, 95% CI: 0.18-0.55), abdominal distention (RR = 0.39, 95% CI: 0.26-0.59), nausea (RR = 0.59, 95% CI: 0.36-0.97), and rash (RR = 0.49, 95% CI: 0.28-0.86). In the subgroup analysis, long-term eradication duration (> 10 days; RR = 1.08, 95% CI: 1.04-1.13) and S. boulardii supplementation to be started and stopped at the same time as eradication treatment (RR = 1.09, 95% CI: 1.04-1.14) were found to significantly improve the eradication rate regardless of the S. boulardii dose (500 mg/day, RR = 1.10, 95% CI: 1.03-1.17; 1000 mg/day, RR = 1.08, 95% CI: 1.03-1.12).

CONCLUSIONS

The addition of S. boulardii to bismuth quadruple therapy significantly increased H. pylori eradication rates and decreased the adverse effects. We recommend adding 500 mg/day S. boulardii concurrently with bismuth quadruple therapy and continuing this therapy for > 10 days for optimal H. pylori eradication efficacy.

Investigation of the inhibitory effects of immunoglobulin Y antibody against key epitopes of Helicobacter pylori UreB recombinant protein

Helicobacter pylori (H.pylori) is considered to be the most important gastrointestinal pathogen causing gastritis, gastric ulcers and even gastric cancer. The treatment of these infections has failed due to the rapidly increasing antibiotic resistance to standard treatment regimens and the lack of an effective vaccine. This study investigates the production and therapeutic potential of Immunoglobulin Y (IgY) antibodies targeting key epitopes of the H. pylori UreB recombinant protein. Given the increasing challenge of antibiotic resistance in H. pylori treatment, this research underscores the necessity for alternative therapeutic strategies. A specific region of the UreB gene, containing critical immunogenic epitopes, was amplified using Polymerase Chain Reaction (PCR) and cloned into the pET32b vector. The recombinant plasmid was expressed in Escherichia coli BL21 (DE3), and the UreB protein was purified via Ni-NTA affinity chromatography, confirmed by SDS-PAGE and Western blot analysis. Hens were immunized with the recombinant UreB protein, resulting in the generation of specific IgY antibodies. The purified IgY-UreB antibodies exhibited a remarkable reduction in urease activity by 84.53 % at a concentration of 10 mg/mL, effectively neutralizing this critical virulence factor. Additionally, in vitro assays demonstrated that IgY-UreB antibodies significantly inhibited the growth of H. pylori at a concentration of 5 mg/mL. These findings highlight the potential of IgY as a viable alternative to traditional antibiotic therapies, particularly in the context of rising antibiotic resistance. This study paves the way for the development of innovative immunotherapeutic strategies that may improve treatment outcomes for H. pylori infections.

Inhibitory effects of Lactobacillus reuteri strain I300 against Helicobacter pylori adhesion, invasion, and inflammatory response in gastric epithelial cells in vitro

The increasing rate of Helicobacter pylori (H. pylori) antibiotic resistance has attenuated the effectiveness of conventional antibiotic-based treatment regimens. This study was aimed at investigating the in vitro inhibitory effects of Lactobacillus reuteri (L. reuteri) strain I300 against H. pylori. The inhibitory effects of live L. reuteri I300 and its different formulations I300L, I300G, and I300T were examined on H. pylori adhesion and invasion to AGS cells. Auto-aggregation and co-aggregation assays and also scanning electron microscopy were performed, evaluating L. reuteri capacity to auto-aggregate and co-aggregate with H. pylori. RT-qPCR and ELISA were used to investigate the expression, and production level of inflammation-related cytokines TNF-α, IL-8, and IL-10. E-cadherin expression level was also measured, determining L. reuteri potential effect on AGS cells integrity. L. reuteri presented a time-dependent capacity to auto-aggregate and co-aggregate with H. pylori. Live L. reuteri and its formulations significantly reduced H. pylori adhesion and invasion of AGS cells. H. pylori treatment with L. reuteri reduced proinflammatory cytokines TNF-α and IL-8 production while increasing anti-inflammatory cytokine IL-10 production. L. reuteri promoted the epithelial cell-cell contact by upregulating E-cadherin expression. This study indicated L. reuteri I300 as a potential probiotic strain with co-aggregation capacity and inhibitory effects against H. pylori adhesion, invasion, and inflammation.

Metal-Organic Frameworks-Based Microrockets for Controlled and Sustained Drug Release

Gastritis, linked to chronic stress and poor diets, poses significant risks, including ulcers and gastric cancers. Current treatments involving frequent dosing of multiple drugs face challenges with patient nonadherence and antibiotic resistance. To overcome these issues, metal-organic framework (MOF)-based microrockets utilizing a zinc-powered engine were engineered with pH-sensitive coatings for targeted gastritis treatment. These microrockets can self-propel into the gastric mucus via bubble propulsion and slowly release pharmaceutical ingredients from MOF components. A poly(3,4-ethylenedioxythiophene) shell and pH-sensitive enteric coating is designed for protection of MOFs in acid while allowing sustained drug release at the mucosa's neutral pH. In vivo studies demonstrate these microrockets sustain a prolonged drug retention for 48 h. This biocompatible design represents a promising strategy for active and controlled drug delivery with sustained release in acidic environments, presenting the potential for diverse biomedical applications.

Untargeted metabolomic profiling for identifying systemic signatures of helicobacter pylori infection in a guinea pig model

Infections caused by the Gram-negative bacterium Helicobacter pylori (H. pylori) can lead to gastritis, gastric or duodenal ulcers, and even gastric cancer in humans. Investigating quantitative changes in soluble biomarkers associated with H. pylori infection offers a promising method for monitoring the progression of the infection, inflammatory response and potentially systemic consequences. This study aimed to identify, using an experimental model of H. pylori infection in guinea pigs, the specific metabolomic biomarkers in the serum of H. pylori-infected (32) versus uninfected (32) animals. The H. pylori status was confirmed through histological, molecular, and serological examinations. Metabolomic profiling was conducted using UPLC-QTOF/MS methods. The metabolomic biomarkers significantly associated with H. pylori infection were selected based on volcano plots and traditional univariate receiver operating characteristics (ROC). This study identified 12 unique metabolites significantly differentiating H. pylori-infected guinea pigs from uninfected ones. In summary, the metabolomic profiling of serum samples, in combination with ROC characteristics of the data, enhances the monitoring of H. pylori infection and related inflammatory responses in guinea pigs experimentally infected with these bacteria, with potential applications in humans for prediction the infection course and its systemic effects.

Lactic acid bacteria target NF-κB signaling to alleviate gastric inflammation

Helicobacter pylori (H. pylori) infection and the resulting gastric inflammation are major contributors to gastric cancer development. Probiotics, particularly Lactobacillus, are promising for their anti-inflammatory potential, yet their exact mechanisms in inhibiting H. pylori-induced inflammation are unclear. In our previous study, Lactiplantibacillus plantarum ZJ316 (L. plantarum ZJ316) demonstrated strong anti-inflammatory effects against H. pylori infection in vivo, but its precise mechanisms were not fully understood. Here, we aimed to investigate how L. plantarum ZJ316 inhibits the inflammatory response to H. pylori infection. Our results demonstrated that L. plantarum ZJ316 effectively reduced the expression of pro-inflammatory cytokines in H. pylori-infected AGS cells. Mechanistically, L. plantarum ZJ316 inhibited the NF-κB signaling pathway by preventing the degradation of IκBα, suppressing p65 phosphorylation, and blocking the nuclear translocation of phosphorylated p65. Treatment with the NF-κB inhibitor BAY 11-7082 further decreased tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and interleukin-1β (IL-1β) levels, confirming the inhibitory effect of L. plantarum ZJ316 on the NF-κB pathway. In H. pylori-infected mice, oral administration of L. plantarum ZJ316 significantly alleviated inflammatory cell infiltration, reduced TNF-α and pepsinogen II (PGII) levels, and increased interleukin-10 (IL-10) levels in serum. A comparative metagenomic analysis of the gastric microbiota revealed a decrease in Prevotella and Desulfovibrio, alongside an increase in Ligilactobacillus and Akkermansia, supporting the protective effects of L. plantarum ZJ316 and correlating with their decreased inflammatory response. In summary, administration of L. plantarum ZJ316 demonstrated robust anti-inflammatory effects against H. pylori infection by suppressing NF-κB signaling and promoting favorable changes in the gastric microbiota composition. Therefore, L. plantarum ZJ316 holds promise as a novel functional food for protecting the body against H. pylori infection.

Clarithromycin-resistant Helicobacter pylori in Africa: a systematic review and meta-analysis

BACKGROUND

In 2022, approximately 56.5% of adults and 47.1% of children and adolescents were affected by Helicobacter pylori (H. pylori) infection in Africa, and clarithromycin-resistant H. pylori (CRHp) strains have become global priority pathogens. Therefore, this study aimed to conduct the first comprehensive systematic review and meta-analysis of CRHp in Africa.

METHODS

This investigation was conducted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (The PRISMA 2020). Literature search of electronic databases (Google Scholar, African Journals Online, ResearchGate, PubMed, Embase, and Scopus) was performed using keywords "clarithromycin", "Helicobacter pylori", "African country name", "mutation in the 23S rRNA".

RESULTS

Sixty-five studies involving 5,313 H. pylori strains isolated over 26 years (1997-2022) from 23 African countries were included in this study. The samples from which CRHp was isolated included gastric biopsy (60/63; 95%), and stool (4/63; 6%). The pooled prevalence of CRHp in Africa was 27% (95% CI: 22, 33). There was a steady trend in the prevalence of CRHp isolated in Africa over the 26 years (R2 = 0.0001, p = 0.92, slope coefficient of -0.05x). Ten types of 23S rRNA mutations (conferring clarithromycin resistance) were identified, and included mainly A2143G (465 H. pylori strains out of 1178 tested) and A2142G (344 H. pylori strains out of 1027).

CONCLUSION

To enhance the accuracy and validity of surveillance data for H. pylori in Africa, there is an urgent need for implementing standardized microbiological methods for resistance detection. The prevalence of CRHp reported in this study was very similar to the overall global prevalence and there is a need for more representative studies on CRHp in Africa. While waiting for this, the treatment of H. pylori infections must be based on the guidelines of the AHMSG first Lagos consensus.

Identification and ultrasensitive quantification of H. pylori infections on gastric and stool human samples with a photonic label-free nanobiosensor

Helicobacter pylori is a widespread bacterium that infects the stomach, causing gastric disorders associated with high morbidity and mortality worldwide. Current methods for identifying and quantifying this pathogen rely on invasive and non-invasive tests. Although combining these methods allows accurate diagnosis, they have multiple drawbacks, and there is no single reliable gold standard test. New, more sensitive strategies involving molecular techniques, such as digital PCR, have been developed but require complex and expensive instruments. Herein, we implement and validat a nanophotonic bimodal waveguide (BiMW) biosensor for the sensitive and accurate detection of H. pylori in gastric biopsies and stool. This biosensor offers real-time, label-free detection, high sensitivity, and the capability to be integrated into compact devices. By employing monoclonal antibodies targeting specific membrane proteins found in H. pylori, the biosensor enables unique recognition of the bacterium, demonstrating its potential as an alternative diagnostic tool. The BiMW biosensor provides highly accurate H. pylori quantification in under 20 min, with limits of detection (LOD) of 89 ± 35 CFU/mL for antrum gastric biopsies and 82 ± 9 CFU/mL for stool samples. Clinical validation with 40 samples (20 gastric biopsies and 20 stool samples) showed sensitivity and specificity of 90 % for gastric biopsies and 95 % for stool samples, offering diagnostic reliability equivalent to semiquantitative ELISA tests and enabling more efficient and timely detection of H. pylori infections. This test can significantly improve the speed of diagnosis and contribute to the development of more effective strategies for H. pylori eradication.

Amoxicillin high-dose dual therapy for Helicobacter pylori primary eradication: Proton pump inhibitor and potassium-competitive acid blocker, which's better?

BACKGROUND

Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori (H. pylori).

AIM

To assess the efficacy and safety of high-dose dual therapy (HDDT) utilizing various highly potent antisecretory medications, thereby providing additional clinical guidance for H. pylori eradication.

METHODS

The study population comprised untreated H. pylori patients from three medical centers in central China. From February 10, 2024 to March 31, 2024, 439 subjects were randomly allocated to either the esomeprazole-amoxicillin (EA) or esomeprazole-amoxicillin-clarithromycin-bismuth (B-quadruple) group. Subsequently, from April 1, 2024 to May 10, 2024, 367 subjects were randomly assigned to either the vonoprazan-amoxicillin (VA) or vonoprazan-amoxicillin-clarithromycin (VAC) group. The study recorded treatment efficacy, adverse events, compliance, symptom alleviation, and associated costs.

RESULTS

EA-dual demonstrated non-inferiority to B-quadruple regimen in modified intention-to-treat (mITT) and per-protocol (PP) analyses (P < 0.025). However, the eradication rate of EA was lower than that of the B-quadruple group [70.59% vs 83.49%, 92.86% vs 98.38%, 93.94% vs 98.38%, intention-to-treat (ITT), mITT, PP respectively, P < 0.05]. In ITT, mITT, and PP analyses, VA-dual was non-inferior to VAC treatment (84.15% vs 83.15%, 96.25% vs 92.73%, 96.75% vs 93.75%, P < 0.025). No significant differences were observed in adverse events, compliance, and symptom relief between groups. VA exhibited the lowest cost. Antibiotic use within 2 years, poor compliance, and suburban residence were associated with reduced eradication efficacy (P < 0.05).

CONCLUSION

The HDDT based on vonoprazan demonstrated non-inferiority to the VAC triple regimen, suggesting its potential as a recommended first-line treatment for H. pylori eradication. While B-quadruple therapy showed better eradication rate than EA therapy, the latter proved non-inferior in mITT and PP analyses. Notably, antibiotic use within the preceding two years, adherence to treatment protocols, and patient residence emerged as critical factors influencing eradication success.

A Comparative Analysis of the Clinical Application of a Novel Helicobacter pylori Serum Antibody Typing Test and the 13C-Urea Breath Test

Background/Objectives: To compare and analyze the application of a Helicobacter pylori (H. pylori, Hp) serum antibody typing test (Hp-sATT) and the 13C-urea breath test (13C-UBT) in the diagnosis of Hp infection against an empirical therapy background. Methods: The detection of Hp-sATT using a combination of the quantum dot immunofluorescence method and the 13C-UBT was carried out in 237 patients who visited the Department of Gastroenterology at Beijing Tsinghua Changgung Hospital. The diagnostic consistency and correlation with gastric lesions of the two detection methods were analyzed by integrating the detection results, clinical information, and special staining of Hp in histopathological tissues (SS-Hp). Results: For the 13C-UBT, 104 (43.88%) cases were positive and 133 (56.12%) were negative. Positive results were found in 127 (53.59%) patients by using the Hp-sATT, with 67 (28.27%) cases of Type I Hp infection and 60 (25.32%) cases of Type II Hp infection. The consistency analysis between the Hp-sATT and 13C-UBT for all the patients showed a Kappa value of 0.339 (p < 0.001); the consistency analysis between the Hp-sATT and the 127 patients with SS-Hp showed a Kappa value of 0.427 (p < 0.001); and the consistency analysis between the 13C-UBT and the 127 patients with SS-Hp indicated a Kappa value of 0.621 (p < 0.001). However, in 191 patients without a history of Hp eradication, the consistency analysis results for the three methods improved, with Kappa values of 0.467 (p < 0.001) and 0.457 (p < 0.001) for the Hp-sATT with the 13C-UBT and SS-Hp, respectively, and 0.646 (p < 0.001) for the 13C-UBT with SS-Hp. In addition, a positive correlation was found between the signal values of anti-urease antibodies and the Delta Over Baseline (DOB) values of the 13C-UBT. The results also indicated that Hp-infected patients exhibited more pronounced gastric lesions, while cases with Type I Hp infection did not. Conclusions: In patients without a history of Hp eradication, the consistency between the Hp-sATT and 13C-UBT is moderate. However, Hp eradication therapy can reduce the consistency of the test results. When screening for Hp infection using the Hp-sATT, it is necessary to consider the patient's history of Hp eradication.

Furazolidone susceptibility of Helicobacter pylori isolated from patients with gastroduodenal diseases in Colombia

Estimates suggest that over 50% of the global population suffer from Helicobacter pylori infections. Nowadays, first-line quadruple therapy is recommended to eradicate the bacteria due to the increasing failures of the standard triple therapy. Thus, antibiotics such as furazolidone have emerged as a new treatment due to their success rate (>90%) in rescue therapies. Nevertheless, furazolidone is not routinely used for treatment of H. pylori in Colombia. Still, some Asian countries commonly prescribe it. This study aimed to determine the susceptibility of H. pylori to furazolidone in isolates from patients with gastroduodenal diseases in Colombia that were extracted from 2019-2022. A descriptive study was carried out with 179 patients with gastroduodenal diseases. Susceptibility was determined by the agar dilution method. The gene oorD from resistant isolates was amplified by polymerase chain reaction, and their PCR products were sequenced. The frequency of H. pylori equaled 23.5% (42/179); the bacterium was isolated in 84 gastric biopsies. Moreover, 1.7% (3/179) of patients had one resistant isolate to furazolidone in at least one of the two gastric biopsies, corresponding to 5.95% (5/84) of the isolates resisting furazolidone. Overall, three new mutations in the oorD gene occurred in one isolate, and two of the mutations in the five isolates had been reported in Iran, Brazil, and China. This research found low in vitro resistance of H. pylori isolates to furazolidone in Colombia. Finally, all five isolates showed mutations in the oorD gene.

Vonoprazan improves the efficacy of bismuth quadruple therapy containing doxycycline and metronidazole as first-line Helicobacter pylori treatment in penicillin-allergic patients: a randomized controlled trial

BACKGROUND

Helicobacter pylori eradication in penicillin-allergic patients presents challenges. Options of effective regimens are lacking in areas where tetracycline is unavailable.

OBJECTIVES

To evaluate the efficacy of replacing the proton pump inhibitor (PPI) with a potassium-competitive acid blocker (P-CAB, vonoprazan) in standard bismuth quadruple therapy containing doxycycline and metronidazole as a first-line treatment for H. pylori.

METHODS

This prospective randomized clinical trial enrolled 332 naive patients with H. pylori infection and penicillin allergy. Participants were randomly assigned in a 1:1 ratio to either the 14 day P-CAB/BDM group (vonoprazan 20 mg twice daily, colloidal bismuth 200 mg twice daily, doxycycline 100 mg twice daily and metronidazole 400 mg three times daily) or the 14 day PPI/BDM group (rabeprazole 10 mg twice daily, and the same dose of the three other drugs as in the 14 day P-CAB/BDM group).

RESULTS

Eradication rates in the P-CAB/BDM and PPI/BDM groups were 90.4% and 71.1% (P value for superiority was 0.013), respectively, by ITT analysis. The efficacy of P-CAB/BDM remained non-inferior and even superior to PPI/BDM therapy in all ITT, modified ITT and PP analyses. The overall frequency of adverse events (39.8% and 40.4%; P = 0.911) and compliance (88.0% and 91.0%; P = 0.372) were similar between P-CAB and PPI regimens. Patients with higher body surface area were significantly associated with eradication failure in both groups (P < 0.05).

CONCLUSIONS

The 14 day P-CAB/BDM therapy provided a satisfactory eradication rate of >90% (ITT analysis) and had a good safety profile as first-line H. pylori therapy, providing an alternative option for penicillin-allergic patients.

ACG Clinical Guideline: Diagnosis and Management of Gastric Premalignant Conditions

Gastric premalignant conditions (GPMC) are common and include atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric epithelial polyps. GPMC have an increased risk of progression to gastric adenocarcinoma. Gastric cancer (GC) in the United States represents an important cancer disparity because incidence rates are 2- to 13-fold greater in non-White individuals, particularly early-generation immigrants from regions of high GC incidence. The US 5-year survival rate for GC is 36%, which falls short of global standards and is driven by the fact that only a small percentage of GC in the US is diagnosed in the early, curable stage. This document represents the first iteration of American College of Gastroenterology guidelines on this topic and encompasses endoscopic surveillance for high-risk patients with GPMC, the performance of high-quality endoscopy and image-enhanced endoscopy for diagnosis and surveillance, GPMC histology criteria and reporting, endoscopic treatment of dysplasia, the role of Helicobacter pylori eradication, general risk reduction measures, and the management of autoimmune gastritis and gastric epithelial polyps. There is insufficient evidence to make a recommendation on upper endoscopic screening for GC/GPMC detection in US populations deemed high-risk for GC. Surveillance endoscopy is recommended for individuals at high risk for GPMC progression, as defined by endoscopic, histologic, and demographic factors, typically every 3 years, but an individualized interval may be warranted. H. pylori testing, treatment, and eradication confirmation are recommended in all individuals with GPMC. Extensive high-quality data from US populations regarding GPMC management are lacking, but continue to accrue, and the quality of evidence for the recommendations presented herein should be interpreted with this dynamic context in mind. The GPMC research and education agendas are broad and include high-quality prospective studies evaluating opportunistic endoscopic screening for GC/GPMC, refined delineation of what constitutes "high-risk" populations, development of novel biomarkers, alignment of best practices, implementation of training programs for improved GPMC/GC detection, and evaluation of the impact of these interventions on GC incidence and mortality in the US.

Meta-Analysis: Inverse Association Between Helicobacter pylori Infection and Eosinophilic Oesophagitis

BACKGROUND

Exposure to Helicobacter pylori (H. pylori) has been associated with a decreased risk of eosinophilic oesophagitis (EoE).

AIM

The aim of this study is to determine the association between H. pylori infection and EoE in this updated meta-analysis.

METHODS

We searched MEDLINE, Scopus and ISI Web of Science, through to November 2024. We included studies reporting the status of H. pylori infection in patients with and without EoE or oesophageal eosinophilia (EE). We used a random-effects model to pool estimates.

RESULTS

We analysed 19 studies including 1.704.821 subjects. H. pylori infection was associated with a 46% lower risk of EoE/EE (OR: 0.54, 95% CI 0.43 to 0.67). Comparable findings were observed when subgrouping studies by location or design. There was a nonsignificant decrease in odds for EoE in paediatric patients exposed to H. pylori (OR 0.57, 95% CI 0.26 to 1.24), and in studies using serology to diagnose H. pylori (OR: 0.41, 95% CI 0.16 to 1.04). We found lower odds of EoE compared with the overall findings in studies that diagnosed H. pylori only by gastric biopsy (OR 0.43, 95% CI 0.25 to 0.74) and in those published after 2019 (OR 0.44, 95% CI 0.28 to 0.68).

CONCLUSIONS

Exposure to H. pylori was significantly associated with decreased odds of EoE/EE. As a stronger protective effect was found in more recent studies, the epidemiology of this association may evolve and deserve to be further monitored.

Resistome and virulome determination in Helicobacter pylori using next-generation sequencing with target-enrichment technology

The identification of Helicobacter pylori infection from gastric biopsy samples requires PCR or bacterial cultures. However, it is difficult to culture H. pylori because it is a fragile bacterium. Next-generation sequencing (NGS) allows direct assessment of the resistome and virulome. Here we describe a new NGS method for studying the resistome and virulome of H. pylori directly from gastric biopsies, based on enrichment analyses and targeted sequencing of H. pylori DNA. In all, 19 DNA samples from human gastric biopsies that tested positive for H. pylori were analyzed. The Agilent SureSelectXT target-enrichment protocol was used with a custom bait library prior to sequencing using the Agilent MagnisDx NGS Library Prep System. NGS sequencing was performed on the Illumina iSeq 100 sequencer using RNA probes for virulence, resistance, and molecular typing genes. The method yielded significant results with a limit of detection of around 1.8e5 CFU per mL H. pylori. Mutations in the 23S rDNA sequence associated with macrolide resistance and in the quinolone resistance-determining region of gyrase A associated with levofloxacin resistance were correctly identified. The results of MLST phylogeny analyses performed after target-enrichment were consistent with those obtained via conventional Sanger sequencing. Among the cagA-positive isolates, the gene was detected correctly, and the vacA genotype was determined. In conclusion, our enrichment method enables rapid assessment of the resistome and virulome of H. pylori directly from fresh gastric biopsies.IMPORTANCEHelicobacter pylori, a bacterium that infects at least 50% of the world population, is often treated by probabilistic antimicrobial therapies due to the lack of antimicrobial resistance data provided by clinical laboratories to clinicians. However, targeted antimicrobial therapies are increasingly recommended to achieve efficient eradication with a limited impact on the gut microbiota and with fewer adverse events for the patient. Recent advancements in next-generation sequencing strategies have opened new opportunities in the diagnosis of H. pylori infection. The significance of our research is the development of a novel next-generation sequencing strategy based on target-enrichment. This approach enables the identification of the resistome and the virulome of H. pylori directly from gastric biopsies, providing clinicians with a broad overview of therapeutic options.

[Guideline on functional dyspepsia, a disorder of gut-brain-interaction (DGBI): S1 Guideline of the German Society for Neurogastroenterology and Motility (DGNM)]

Functional dyspepsia is common and classified as a disorder of gut-brain interaction (DGBI). The prevalence is estimated around 10 % of the population. Diagnosis is based on symptoms, which are based on the Rome IV criteria, in combination with diagnostic procedures that may include laboratory testing, Helicobacter pylori testing, upper gastrointestinal endoscopy, abdominal ultrasound, and other examinations, depending on the severity, duration and presence of alarming symptoms. Therapeutic procedures include psychoeducation, dietary counseling, mind-body procedures, psychotherapy and medication. The S1 guideline summarizes the current state of knowledge and allows a targeted approach based on the currently available medical evidence.

Asia-Pacific Survey on the Management of Helicobacter pylori Infection

BACKGROUND AND AIM

Gastric cancer (GC)-related incidence and mortality rates remain high owing to Helicobacter pylori infection in Asia, and the importance of primary and secondary prevention of GC has been well recognized. We aimed to investigate the extent of overall agreement among clinicians in the Asia-Pacific region regarding the management of H. pylori infection.

METHODS

The Upper Gastrointestinal (GI) Focus Group of the Asian Pacific Association of Gastroenterology-Emerging Leaders Committee developed an international survey, which was distributed to 98 clinicians in the Asia-Pacific region, compromising an online questionnaire focusing on the management of H. pylori infection.

RESULTS

Participants responded from Japan (15, 15.3%), Hong Kong (15, 15.3%), Thailand (33, 33.7%), Vietnam (23, 23.5%), Malaysia (4, 4.1%), Singapore (3, 3.1%), and others (5, 5.1%). The most common first-line eradication regimen was clarithromycin (CAM) triple therapy, including proton pump inhibitor (PPI), amoxicillin (AMPC), and CAM (64.3%) for 14 days (70.4%). The most common second-line eradication regimen was levofloxacin (LVX) triple therapy, including PPI, AMPC, and LVX (22.4%) for 14 days (67.3%). Eradication therapy was deemed necessary for all asymptomatic adults and minors (aged ≤ 17 years) currently infected with H. pylori by 81.6% and 64.3% of respondents, respectively, with 82.7% considering upper GI endoscopy for GC screening useful in the secondary prevention of GC.

CONCLUSION

There appears to be a growing consensus among clinicians, acknowledging the necessity of eradication therapy. We anticipate that this study will establish a new benchmark in preventive medicine aimed at eradicating GC in the Asia-Pacific region.

A survey of practice patterns and adherence to national and international guidelines on the management of Helicobacter pylori infection among gastroenterologists and gastroenterology fellows in India

BACKGROUND

Patients and primary care providers alike benefit greatly from the expertise of gastroenterologists when it comes to managing Helicobacter pylori (H. pylori) infection. However, information on gastroenterologists' practices in the management of H. pylori infection is scarce in this part of the world. This study aimed at evaluating the practice patterns of gastroenterologists and gastroenterology fellows in India.

METHOD

This was a cross-sectional questionnaire-based survey of gastroenterologists and gastroenterology fellows working in India.

RESULTS

Total 207 gastroenterologists and 53 fellows filled out the questionnaire. Responses were received from all around India. Approximately 70% of respondents perceive H. pylori to be a gastric pathogen, while 20% regard it as a commensal bacterium. While the proportion of respondents who chose a test and treat method (34.6%) for uninvestigated dyspepsia without alarm symptoms was comparable to empirical proton pump inhibitor (PPI) therapy (38.8%), about one-fifth chose a scope and treat strategy in this setting. Even in the absence of alarm signs, more than half of respondents (61.5%) preferred endoscopic biopsy to detect H. pylori. While rapid urease testing (RUT) was the preferred modality (80%) for detecting H. pylori, about one-third preferred single-site RUT (from the antrum). Only 40% followed the Updated Sydney protocol, while performing biopsies and a majority (78.8%) are unable to discontinue PPIs before testing for H. pylori. PPI-clarithromycin-based triple treatment was the preferred regimen (67%) for first-line eradication, while nearly a quarter of respondents did not utilize bismuth due to concerns about adverse effects.

CONCLUSION

The survey reveals a lack of adherence to the current H. pylori guidelines for diagnosis, testing and treatment among gastroenterologists and gastroenterology fellows in India. It is vital that scientific societies simplify guidelines, investigate challenges to their effective implementation and execute targeted interventions to increase adherence.

Cholesterol Functionalized Nanoparticles Are Effective against Helicobacter pylori, the Gastric Bug: A Proof-of-Concept Study

Helicobacter pylori chronic infection is the highest risk factor for the development of gastric cancer, being this Gram-negative bacterium classified as carcinogenic. The mounting resistance of H. pylori to antibiotics calls for innovative therapeutic strategies. Here, the proof-of-concept studies that support the development of a "trojan horse" therapeutic strategy based on cholesterol-grafted nanoparticles (Chol-NP) to counteract H. pylori infection are depicted. The bacterium ability to specifically recognize and bind to surface grafted cholesterol is demonstrated by its adhesion to cholesterol(Chol)-functionalized self-assembled monolayers (SAMs) on gold substrates (2D Chol-SAMs) in a concentration dependent manner, with optimal Chol-SAMs prepared with 25% Chol-polyethylene glycol (PEG)-thiol in solution (75% tetra(ethylene glycol)-thiol). These results further show that cholesterol functionalized gold nanoparticles (3D Chol-SAMs, Chol-NP) eradicate H. pylori at a minimum bactericidal concentration of 125 µg mL-1. Chol-NP kill H. pylori through internalization and membrane rupture, as observed by transmission electron microscopy (TEM). Chol-NP are cytocompatible (human gastric adenocarcinoma (AGS) cell line), non-hemolytic and innocuous to bacteria representative of the gut microbiota (Escherichia coli and Lactobacillus acidophilus). This study supports the further development of cholesterol functionalized biomaterials as an advanced and targeted treatment for H. pylori infection.

Research trends of nanomaterials in Helicobacter pylori: a bibliometric analysis from 2003 to 2023

Background

H. pylori infects approximately half of the global population and is associated with numerous diseases, posing a significant public health challenge. Recently, there has been increasing focus on researching nanomaterials for H. pylori. This study aims to visually evaluate the current status and trends of nanomaterials in H. pylori research by bibliometric analysis.

Methods

H. pylori-related nanomaterials publications were retrieved from WoSCC and articles meeting the criteria were included in the analysis. The data was analyzed by Microsoft Excel, CiteSpace, and VOS viewer.

Results

This bibliometric analysis included 177 publications on H. pylori and nanomaterials from 2003 to 2023. The study revealed a consistent increase in publications and citations. China leads in the number of publications, citation frequency, and maintains close relations with other countries. The International Journal of Biological Macromolecules and Biomaterials are the leading journals. Yu-hsin Lin is the most contributory scholar. Recent years have seen the special nanoparticles and targeted drug delivery remain a burgeoning research area.

Conclusion

We conducted a bibliometric analysis of H. pylori-related nanomaterials research and identified the current research direction and frontier in the application of nanomaterials for H. pylori.

Antibiotic resistance of Helicobacter pylori and related risk factors in Hunan Province: A multicenter study

BACKGROUND

Antibiotic resistance is a key factor influencing the treatment outcomes of Helicobacter pylori (H. pylori) infection. The antibiotic resistance spectrum of H. pylori varies in different regions. We investigated the current status of antibiotic resistance of H. pylori in Hunan Province and analyzed the factors related to such resistance to provide strategies for the accurate clinical treatment of H. pylori infection.

AIM

To understand the antibiotic resistance of H. pylori in Hunan Province and provide guidance for the clinical treatment of H. pylori infection.

METHODS

This study selected patients who underwent gastroscopy in five hospitals in Hunan Province from April 2022 to April 2023. The sensitivity of H. pylori to clarithromycin, levofloxacin, metronidazole, amoxicillin, furazolidone, and tetracycline was detected using the Agar dilution method.

RESULTS

H. pylori strains from a total of 566 patients were isolated and identified. The resistance rates of H. pylori strains to clarithromycin, levofloxacin, metronidazole, amoxicillin, furazolidone, and tetracycline were 49.2%, 37.8%, 76.1%, 2.3%, 1.4%, and 0.7%, respectively. The resistance rates to clarithromycin, levofloxacin, and metronidazole were high in the four regions of Hunan Province, and the overall resistance rates in central Hunan Province were higher than those in other regions. The resistance rates of H. pylori strains to clarithromycin and levofloxacin were significantly different among the different age groups (P < 0.05), with the elderly group having a higher resistance rate than the young group. The resistance rate of H. pylori strains to clarithromycin was greater in patients with atrophic gastritis, and the resistance rate to levofloxacin was the lowest in patients with peptic ulcers.

CONCLUSION

The resistance rate of H. pylori to amoxicillin, clarithromycin, and metronidazole is high in Hunan Province. Age, stomach disease, and H. pylori reinfection may affect the antibiotic resistance of H. pylori.

HELicobacter Pylori screening to prevent gastrointestinal bleeding in patients with acute Myocardial Infarction (HELP-MI SWEDEHEART) - Design and rationale of a cluster randomized, crossover, registry-based clinical trial

BACKGROUND

The role of Helicobacter pylori (H. pylori) screening and eradication on reducing upper gastrointestinal bleeding (UGIB) complications after acute myocardial infarction (MI) is uncertain. The HELicobacter pylori screening to prevent gastrointestinal bleeding in patients with acute MI (HELP-MI SWEDEHEART) trial aims to determine whether systematic H. pylori screening compared to usual care reduces UGIB, mortality, and cardiovascular outcomes after MI.

METHODS

A cluster randomized, crossover, registry-based clinical trial using SWEDEHEART as trial platform for study population definition and source for data collection in combination with nationwide Swedish health data registries. Thirty-five Swedish hospitals, organized into 18 clusters based on percutaneous coronary intervention networks, were randomized to either routine H. pylori screening for adults with acute type-1 MI or usual care. After 1 year, a 2-month blanking period was followed by a crossover to the alternate allocation for 1 year. The trial enrolment was concluded after one additional year of registry-based follow-up. The primary endpoint is UGIB. Secondary endpoints include all-cause death, cardiovascular death, readmission for MI, stroke, or heart failure. Endpoints will be reported combined (Net Adverse Clinical Events; Major Adverse Cardiac or Cerebrovascular Events) and separately. The primary analysis will include all available follow-up time corresponding to a maximum follow-up time of 3 years and 2 months.

CONCLUSION

HELP-MI SWEDEHEART aims to determine the utility of routine H. pylori screening to reduce UGIB and improve cardiovascular outcomes after MI. By integrating national registry follow-up data with a pragmatic trial design, it has the potential to provide evidence for the effect of the implementation of routine H. pylori screening as part of acute MI care.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05024864.

[Trends of antibiotic resistance of Helicobacter pylori in Moscow]

AIM

To determine the trends of primary antibiotic resistance of Helicobacter pylori strains isolated from patients living in Moscow.

MATERIALS AND METHODS

As part of a clinical and laboratory study, 123 gastric biopsy specimens from H. pylori-infected patients were analyzed from 2015 to 2024. H. pylori infection was verified by a rapid urease test and a 13C-urease breath test. The anaerobic culture technique was used. After identifying a pure culture, its susceptibility to four antibacterial agents (amoxicillin - AMC, clarithromycin - CLR, metronidazole - MET, tetracycline - TET) was determined by the disc diffusion method.

RESULTS

According to the data, the resistance in the overall pool (n=123) of the test samples to AMC was 4.88%, CLR 16.26%, TET 3.25%, and MET 46.34%. Dual resistance to CLR and MET was detected in 4.06% of strains. Among strains collected from 2015 to 2019 (n=28), resistance to AMC was 0.0%, CLR 10.71%, TET 0.0%, and MET 50.0%. The structure of antibiotic resistance of strains collected from 2020 to 2024 (n=95) was as follows: AMC - 6.32%, CLR - 17.89%, TET - 4.21%, MET - 45.26%.

CONCLUSION

There is a gradual tendency to increase the resistance of H. pylori to antibacterial agents such as AMC, CLR, and TET in Moscow, which is consistent with the data of other studies. This negative trend may eventually lead to decreased effectiveness of currently used eradication therapy regimens in Russia.

Efficacy and safety of Jinghua Weikang capsule combined with amoxicillin-furazolidone triple/quadruple therapies in the rescue treatment of Helicobacter pylori infection

Aim

To evaluate the efficacy and safety of Jinghua Weikang Capsule (JWC) combined with amoxicillin-furazolidone triple/quadruple therapies in the rescue treatment of drug-resistant H. pylori infection.

Methods

Patients who failed H. pylori eradication therapy at least once were enrolled and randomly assigned into four groups (1:1:1:1), as follows: The control group received 20 mg rabeprazole, 1,000 mg amoxicillin, 220 mg bismuth potassium citrate, and 100 mg furazolidone twice daily (b.i.d.) for 14 days; Group A received 240 mg JWC b.i.d. combined with 20 mg rabeprazole, 1,000 mg amoxicillin, and 100 mg furazolidone b.i.d. for 14 days; Group B received the same regimen as Group A for 14 days, followed by an additional 14 days of 240 mg JWC b.i.d.; and Group C received 240 mg JWC b.i.d. combined with 20 mg rabeprazole, 1,000 mg amoxicillin, 220 mg bismuth potassium citrate, and 100 mg furazolidone b.i.d. for 10 days. The primary outcome was H. pylori eradication at 4 weeks after treatment.

Results

Four hundred eighty-eight patients were included in this study. The intention-to-treat (ITT) eradication rates in the four groups were 85.2, 73.8, 78.7 and 75.4% (p = 0.136), while the modified intention-to-treat (MITT) eradication rates were 92.0, 84.9, 88.9 and 86.8% (p = 0.398), respectively. And the per-protocol (PP) eradication rates were 92.5, 85.4, 87.9 and 86.7% (p = 0.405), respectively. The eradication rates were comparable among the four groups. No statistically significant differences in eradication rates were observed between each of the three treatment groups and the control group (all p > 0.05). The eradication rate of H. pylori in group B demonstrated non-inferiority compared with the control group (p = 0.0415; 90% CI, -0.0965 to 0.0336). The four groups exhibited similar frequencies of overall adverse events (9.84, 5.74, 6.56%, 2.46%, p = 0.112).

Conclusion

The eradication rate of the JWC-containing regimen demonstrated no statistically significant difference compared with bismuth-containing quadruple therapy in the rescue treatment of H. pylori infection. The prolonged JWC treatment regimen exhibited non-inferiority in eradication rates. JWC-containing therapies can effectively reduce the incidence of adverse reactions and significantly alleviate certain clinical symptoms.

Clinical trial

https://clinicaltrials.gov/, identifier ChiCTR1800019326.

Helicobacter pylori multiplex serology and its dynamics within families during a 3-year prospective follow-up

OBJECTIVES

Transmission routes of Helicobacter pylori (Hp) have been extensively studied, but many aspects remain unclear. This study explored the dynamics of multiplex Hp serology within regular families during a 36-month prospective follow-up.

METHODS

Altogether, 329 families from the Finnish Family HPV study were subjected to sequential blood sampling and now tested also for six Hp proteins, HP0010, HP0073, HP0547, HP0875, HP0887, and HP1564, using multiplex serology assay.

RESULTS

Hp seropositivity, defined as being seropositive to at least three of the six Hp proteins, was more common among the fathers (20%) than mothers (10%). After maternal antibody decay, only a few children tested Hp-seropositive at later follow-up visits, indicating that acquisition of Hp infection is practically non-existent (0.4-2.0%) at an early age. No evidence was found to support the person-to-person transmission of Hp in this cohort because there was no correlation in Hp seropositivity or antibody levels between the spouses and/or their offspring, and individuals who were Hp-seropositive did not seem to increase the risk of other family members to co-test Hp-seropositive.

CONCLUSIONS

Our results perfectly agree with a recently published register-linkage study from Finland, where Hp and Hp-related co-morbidity are predicted to disappear among the native Finns during the 21st century.

Bibliometric analysis of Helicobacter pylori vaccine development from 1993 to 2023

Background

Helicobacter pylori infects half the global population and imposes a huge health burden. Developing a vaccine targeting H. pylori appears to be the most ideal preventive option. Based on Web of Science Core Collection (WoSCC) publications from 1993 to 2023, this study visually analyses the current status and trends of this field through bibliometric analysis.

Methods

H. pylori vaccine-related articles and reviews were retrieved from WoSCC. Microsoft Excel, CiteSpace, and VOS viewer were used to analyze the data.

Results

1,199 publications from 1993 to 2023 were included in this bibliometric analysis. The results of this analysis show an overall upward trend in the number of publications and citations in this field. The United States is undoubtedly the most important contributor to this field in terms of publications, citation frequency, and national cooperation. Vaccine has the highest number of publications. Thomas F. Meyer is one of the leading scholars in the field. The most frequently cited article is "Immunization of mice with urease vaccine affords protection against H. pylori infection in the absence of antibodies and is mediated by MHC class II-restricted responses." The literature and keyword analysis show that effective treatments and multi-epitope vaccines are focus area in this field. New antigen combinations (such as UreB, outer membrane vesicles, etc.) of H. pylori vaccines are novel research directions and frontiers.

Conclusion

Our study is the first bibliometric analysis of H. pylori vaccine research. By summarizing the current status of H. pylori vaccine research, our study highlighted the current research direction and frontier, providing valuable data for researchers to grasp the latest advancements and accelerate H. pylori vaccine development.

Hydrogel-Transformable Probiotic Powder for Targeted Eradication of Helicobacter pylori with Enhanced Gastric Mucosal Repair and Microbiota Preservation

Lactobacillus reuteri (L. reuteri) therapies represent a potentially effective approach to eradicating Helicobacter pylori (H. pylori). However, the difficulty in bacterial viability preservation and harsh gastric environment compromises the survival and on-target delivery of L. reuteri. This study presents a novel bacterium-mediated bacterial elimination strategy using an edible L. reuteri@HTP probiotic powder for targeted bacterial elimination. The probiotic powder is obtained by grinding a lyophilized hydrogel composed of L. reuteri, hyaluronic acid (HA), tannic acid (TA), and polyvinyl alcohol (PVA). Upon contact with water, the powder quickly transforms into a hydrogel, enhancing L. reuteri's survival in the harsh gastric environment and ensuring selective release at H. pylori-infected inflammatory sites. L. reuteri targets and reduces H. pylori colonization while secreting reuterin to eliminate the bacteria. Additionally, TA's antioxidant properties help alleviate inflammation, and HA supports gastric mucosal repair. L. reuteri@HTP powder preserves the integrity of the gut microbiota, facilitating the restoration of a healthy microbiome. In particular, the probiotic powder remains stable at room temperature for at least six months, providing a promising alternative to traditional antibiotics for H. pylori treatment. This strategy combines targeted eradication, mucosal healing, and microbiome restoration, offering a new approach to treating gastric infections.

Overcoming antibiotic-resistant Helicobacter pylori infection: Current challenges and emerging approaches

Recent studies have shown a noticeable increase in global Helicobacter pylori (H. pylori) resistance, with clarithromycin resistance surpassing 15% in various areas. However, inadequate epidemiological monitoring, especially in developing countries, and the absence of uniform testing methods lead to discrepancies between regions and a possible underestimation of resistance levels. The complexity of treating H. pylori is driven by its highly dynamic genome, which is prone to frequent mutations contributing to phenotypical resistance. The usual course of action in empirical treatment involves using a combination of various drugs simultaneously, leading to significant resistance selection pressure and potential side effects. The emergence of H. pylori strains resistant to multiple drugs is closely tied to failures in first-line treatment, highlighting the need to prevent further resistance by using optimal initial empirical therapy or regimens guided by antibiotic susceptibility testing, requiring a collection of mixed samples and multiple isolates for accurate assessment. The emergence of new treatments like potassium-competitive acid blockers offers a hopeful approach to decrease antimicrobial usage while still ensuring effectiveness in comparison to traditional therapies with proton pump inhibitors. Additionally, the use of probiotics is under investigation to identify specific strains and formulations that may mitigate therapy-associated adverse effects.

Antibiotic-free responsive biomaterials for specific and targeted Helicobacter pylori eradication

Gastric cancer is highly correlated with Helicobacter pylori (H. pylori) infection. Approximately 50 % of the population worldwide is infected with H. pylori. However, current treatment regimens face severe challenges including drug resistance and gut microbiota disruption. An integrative treatment with slight negative influences on intestinal flora, conforming with concepts of integrative prevention of gastric cancer, is urgently needed. Non-antibiotic responsive biomaterials can respond to different stimuli, including pH, enzymes, light, ultrasound and magnetism, under which biomaterials are specifically activated to perform antibacterial capabilities, while neutral intestinal microenvironments differ from gastric microenvironments or inflammatory sites and have no or minimal irradiation via precisely controlled exogenous stimuli, which may not only overcome antibiotic resistance but also avoid gut microbiota disorders. First, the latest progress in responsive biomaterials against H. pylori without gut microbiome disturbance and their anti-H. pylori performances are profoundly summarized. Second, the mechanisms against planktonic bacteria, biofilms and intracellular bacteria are discussed respectively. Finally, the strategies of specific and targeted H. pylori elimination by responsive biomaterials are introduced. Additionally, the challenges and the focus of future research on translation into clinical application are fully proposed. Antibiotic-free responsive biomaterials for specific and targeted H. pylori eradication represent an innovative approach.

Fucoidan-modified antibiotic-free nanovesicles: A multidimensional approach to eradicate intracellular and extracellular Helicobacter pylori and restore gastrointestinal homeostasis

Helicobacter pylori (H. pylori) infection affects nearly half of the global population, with biofilm formation and immune evasion contributing to chronic and recurrent infections, posing significant public health challenges. The robust immune evasion mechanisms and gene mutations of H. pylori not only result in a progressive decrease in clinical treatment efficacy but also increase bacterial resistance. Furthermore, antibiotic regimens have been shown to disrupt the diversity and richness of the gut microbiota. Given the challenges of eradicating H. pylori and adverse effects of antibiotics on host microbiota, this study introduces an antibiotic-free alternative strategy: fucoidan-modified kaempferol-loaded glycyrrhizic acid lipid nanovesicles (Fu-GaLip@KP). Kaempferol, supported by the nanovesicles, penetrates the mucus barrier, disperses biofilms, and eradicates bacteria. Additionally, glycyrrhetinic acid, a critical stabilizer for nanovesicles, restores lysosomal acidification and enhances the host's ability to eliminate intracellular bacteria. Notably, nanovesicles also reduce oxidative free radicals and inflammatory factor secretion, exhibiting superior efficacy in repairing gastric mucosal damage and mitigating inflammation. In vivo studies have demonstrated that Fu-GaLip@KP achieves anti-H. pylori efficacy comparable to triple therapy, while simultaneously restoring gut microbiota diversity and preventing dysbiosis. In summary, the antibiotic-free approach of Fu-GaLip@KP offers a comprehensive strategy for addressing H. pylori infection and related diseases.

Efficacy and Safety of Standard Triple Therapy for Helicobacter pylori Eradication in Latin America : A Systematic Review and Meta-Analysis

GOALS

To evaluate the efficacy and safety of standard triple therapy (STT) in Latin America.

BACKGROUND

Helicobacter pylori infection affects more than 50% of the Latin Americans and leads to gastric mucosa damage. Scarce data on effective therapeutic approaches in the region underscores the need for comprehensive information.

STUDY

The analysis included Randomized Controlled Trials published up to the year 2020, comparing STT with other treatments. Cumulative relative risks (RR) were estimated, with 95% CI, according to intention-to-treat (ITT) and per protocol (PP) analysis.

RESULTS

Eleven studies (clinical trials conducted between 1995 and 2013), revealed cumulative eradication rates of 78.31-90.63% (ITT) and 76.71-93.55% (PP). The eradication with the STT was superior to sequential therapy (ITT-RR: 10.6, 95% CI: 1.01 to 1.12) (PP-RR: 10.6, 95% CI: 1.02-1.11) and dual therapy (ITT-RR: 1.61, 95% CI: 1.13-2.30) (PP-RR: 1.72, 95% CI: 1.25-2.37), but is less effective than other triple therapies (PP-RR: 0.85, 95% CI: 0.78-092). Regarding adverse effects, diarrhea, metallic taste, nausea, vomiting, and headache were the most common symptoms across treatments. Abdominal pain was associated with STT (ITT-RR: 1.75, 95% CI: 1.07-2.86).

CONCLUSION

STT was a safe regimen but with acceptable efficacy (most eradication rates <90%). Due to rising clarithromycin resistance, the study suggests avoiding STT as a first-line treatment. These results must be considered with caution due to the low representativeness of several Latin American countries and the lack of recent high-quality randomized studies.

Analysis of antibiotic susceptibility and genomic characteristics of Helicobacter pylori by whole-genome resequencing in Northern China

INTRODUCTION

Helicobacter pylori (H. pylori) is a major human pathogen whose increased antibiotic resistance poses a serious threat to human health.

AIM

The aim of this study is to further explore the association between H. pylori resistance to clarithromycin, levofloxacin, metronidazole, amoxicillin, rifampicin, tetracycline and its genomic characteristics.

METHODOLOGY

Using H. pylori isolates, we studied their susceptibility to six antibiotics by the agar dilution method. By performing whole-genome resequencing of the H. pylori genomic DNA, the differences in single nucleotide polymorphisms (SNPs) between phenotype resistant and sensitive strains were statistically analyzed to identify potential mutation sites related to drug resistance, and the consistency between genotype and phenotype resistance was analyzed.

RESULTS

The drug resistance rates of 65 H. pylori isolates are as follows: clarithromycin 36.9%, levofloxacin 29.2%, metronidazole 63.1%, amoxicillin 7.7%, rifampicin 12.3%, and tetracycline 3.1%. Based on the whole genome resequencing results of H. pylori isolates, 10 new mutations that may be related to drug resistance were identified. There is strong consistency between the genotype and phenotype resistance of clarithromycin and levofloxacin.

CONCLUSION

The resistance rate to amoxicillin and tetracycline is relatively low in Northern China. and the above two antibiotics can be given priority for clinical treatment. It has a high resistance rate to metronidazole and should be avoided as much as possible, or combined with other drugs for treatment. The 10 mutations identified through analysis that only exist in drug-resistant strains may be associated with levofloxacin, metronidazole, amoxicillin, and rifampicin resistance, respectively. The results indicate that genotype testing of H. pylori can serve as a method for predicting its resistance to clarithromycin and levofloxacin.

Rapid diagnosis and precision treatment of Helicobacter pylori infection in clinical settings

Helicobacter pylori is a gram-negative bacterium that colonizes the stomach of approximately half of the worldwide population, with higher prevalence in densely populated areas like Asia, the Caribbean, Latin America, and Africa. H. pylori infections range from asymptomatic cases to potentially fatal diseases, including peptic ulcers, chronic gastritis, and stomach adenocarcinoma. The management of these conditions has become more difficult due to the rising prevalence of drug-resistant H. pylori infections, which ultimately lead to gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. In 1994, the International Agency for Research on Cancer (IARC) categorized H. pylori as a Group I carcinogen, contributing to approximately 780,000 cancer cases annually. Antibiotic resistance against drugs used to treat H. pylori infections ranges between 15% and 50% worldwide, with Asian countries having exceptionally high rates. This review systematically examines the impacts of H. pylori infection, the increasing prevalence of antibiotic resistance, and the urgent need for accurate diagnosis and precision treatment. The present status of precision treatment strategies and prospective approaches for eradicating infections caused by antibiotic-resistant H. pylori will also be evaluated.

Low-level primary clarithromycin resistance of Helicobacter pylori in Reunion Island

INTRODUCTION

The increasing resistance of Helicobacter pylori to clarithromycin leads to an ongoing adaptation of empirical first-line treatment for H. pylori infections.

PATIENTS AND METHODS

Prospective study (2022-2023) of 364 patients with no previous treatment for H. pylori infection, addressed for gastroduodenal endoscopy to the University Hospital of Reunion Island.

RESULTS

PCR tests (AllplexTMH. pylori & ClariRAssay, Seegene) performed on gastric biopsy samples detected H. pylori DNA in 100 samples (100/364; 27.5 %) and mutations conferring resistance to clarithromycin in 10 of the positive samples (10/100; 10 %). Prevalence of resistance determined by MICs (E-test method) was 41.2 % for metronidazole, 13.2 % for levofloxacin, 8.8 % for clarithromycin. No resistance was detected for tetracycline, rifampicin, and amoxicillin.

CONCLUSION

The prevalence of primary clarithromycin-resistant H. pylori in Reunion Island is below 15 %. Recommendation for the standard clarithromycin-based triple therapy as a first-line treatment can thus be maintained, even though antimicrobial susceptibility testing seems preferable.

Seven-Day Versus 14-Day Tegoprazan and Tetracycline-Containing Quadruple Therapy for First-Line Eradication of Helicobacter pylori Infection: A Randomized, Open-Label, Noninferiority Trial

BACKGROUND AND AIMS

Tegoprazan, a new class of drugs, is a potassium-competitive acid blocker (P-CAB) that inhibits gastric H+/K+-ATPase through a different mechanism than proton pump inhibitor. Tetracycline also has anti-Helicobacter pylori properties. However, only a few randomized controlled trials (RCTs) have investigated the efficacy of tegoprazan and tetracycline-containing quadruple therapy (TTQT) for treating H. pylori infections, which this RCT explored.

METHODS

This multicenter RCT included treatment-naïve adults with H. pylori infection who received 7 or 14 days of TTQT (50-mg tegoprazan, 220-mg bismuth potassium citrate, and 1000-mg amoxicillin twice daily with 500-mg tetracycline four times daily). The primary outcome was the eradication rate; secondary endpoints included the incidence of adverse events, treatment compliance, and regimen costs.

RESULTS

The study included 258 patients. The eradication rates in the 7- and 14-day groups were 90.70% (117/129, 95% confidence interval [CI]: 83.98%-94.89%) and 91.47% (118/129, 95% CI: 84.90%-95.45%), respectively, in the intention-to-treat analysis (difference: -0.78%; -7.01%-8.58%; noninferiority p < 0.001); 92.86% (117/126, 95% CI: 86.50%-96.48%) and 93.65% (118/126, 95% CI: 87.47%-97.02%), respectively, in the modified intention-to-treat analysis (difference: 0.79%; 95% CI: -6.36%-7.99%; noninferiority p < 0.001); and 94.35% (117/124, 95% CI: 88.29%-97.50%) and 95.12% (117/123, 95% CI: 89.24%-98.00%), respectively, in the per-protocol analysis (difference: -0.77%; 95% CI: -5.91%-7.48%; noninferiority p < 0.001). Significantly fewer adverse events occurred in the 7-day group than in the 14-day group (22.48% vs. 35.67%, p = 0.020). Treatment compliance did not differ between the two groups.

CONCLUSIONS

The 7- and 14-day TTQT efficacies for the first-line treatment of H. pylori infection were comparable, and fewer adverse effects occurred in the 7-day group. This trial has been registered at Clinical Trials.gov (NCT05997433).

Effects of amoxicillin dosage on cure rate, gut microbiota, and antibiotic resistome in vonoprazan and amoxicillin dual therapy for Helicobacter pylori: a multicentre, open-label, non-inferiority randomised controlled trial

BACKGROUND

Vonoprazan and amoxicillin (VA) dual therapy as a mainstream Helicobacter pylori regimen has gained momentum worldwide, but the optimum dosages remain unclear. We aimed to compare the efficacy and safety of VA dual therapy with 2 g amoxicillin or 3 g amoxicillin, and to assess the short-term effects of therapy on the gut microbiota and antibiotic resistome.

METHODS

We conducted an open-label, non-inferiority randomised controlled trial at 12 centres in China. Individuals infected with H pylori, aged 18-70 years, and without previous eradication therapy were recruited. Participants were randomly assigned at a 1:1 ratio (block size of six) to receive vonoprazan (20 mg twice a day) with either low-dose amoxicillin (1 g twice a day; LVA therapy) or high-dose amoxicillin (1 g three times a day; HVA therapy) for 14 days. Gastric biopsies were collected before treatment for detection of antibiotic resistance. Stool samples were collected at baseline, week 2, and week 8-10 for shotgun metagenomic sequencing. The primary outcome was the eradication rate of H pylori, assessed by 13C urea breath test, in both intention-to-treat and per-protocol analyses. Secondary outcomes were adverse events, adherence, antibiotic resistance, and alterations to the gut microbiota and antibiotic resistome. The margin used to establish non-inferiority was -0·10. The trial was registered with ClinicalTrials.gov, NCT05649709.

FINDINGS

Between Feb 13, 2023, and Jan 25, 2024, 504 patients (204 [40%] male and 300 [60%] female; mean age 43 years [SD 13]) were randomly assigned to LVA therapy or HVA therapy (n=252 in each group). No infections were resistant to amoxicillin. The H pylori eradication rate was 85·3% (215 of 252; 95% CI 80·4 to 89·2) in the LVA group and 86·5% (218 of 252; 81·7 to 90·2) in the HVA group in the intention-to-treat analysis (p=0·70) and 88·8% (213 of 240; 84·1 to 92·2) and 92·4% (218 of 236; 88·3 to 95·1), respectively, in the per-protocol analysis (p=0·18). The efficacy of LVA was non-inferior to HVA in the intention-to-treat analysis (risk difference -1·2%, 95% CI -7·3 to 4·9, p=0·0022) and the per-protocol analysis (-3·6%, -9·0 to 1·7, p=0·0085). 31 (12%) patients in the LVA group and 43 (17%) patients in the HVA group reported adverse events. Adherence to therapy was 97% in the LVA group and 96% in the HVA group. The diversity of gut microbiota decreased after treatment but was restored to baseline at week 8-10 in both groups. The abundance of beta-lactam-related resistance genes was increased at week 2 after treatment, and was restored to pretreatment level at week 8-10 for the LVA group but not the HVA group.

INTERPRETATION

LVA dual therapy was effective and non-inferior to HVA dual therapy as first-line treatment of H pylori infection and showed a non-lasting effect on the abundance of beta-lactam-related resistance genes. High amoxicillin dosage (eg, 3 g per day) is not required to achieve high cure rates with vonoprazan dual therapy.

FUNDING

National Natural Science Foundation of China, Project for Academic and Technical Leaders of Major Disciplines in Jiangxi Province, and Key Research and Development Program of Jiangxi Province.

Efficacy and Safety of Modified Bismuth Quadruple Therapy for First-Line Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study aimed to evaluate the efficacy of adding bismuth to conventional triple therapy (modified bismuth quadruple therapy [mBQT]) for Helicobacter pylori treatment-naïve patients in an era of increasing eradication failure. We performed a comprehensive literature search up to December 2024 using PubMed, Embase, and the Cochrane Library to investigate mBQT's benefits. The comparative treatments were as follows: (1) triple therapy without bismuth (TT), (2) non-BQTs (sequential and concomitant), and (3) classic BQT (cBQT) containing metronidazole and tetracycline. Randomized controlled trials (RCTs) were analyzed to compare eradication rates, adverse drug events, and patient compliance between the mBQT and comparison groups. In total, 9162 and 8449 patients from 43 trials in 35 RCTs were included in the intention-to-treat and per-protocol analyses, respectively. The mBQT group had a superior pooled eradication rate compared to the TT group (84.8% vs. 74.1%, p < 0.00001, and odds ratio [OR] = 2.02 [1.61-2.55]). The mBQT showed a similar eradication rate to the non-BQT and cBQT groups (80.8% vs. 80.2%, p = 0.55, and OR = 1.09 [0.83-1.43] in the non-BQT group; 81.5% vs. 83.0%, p = 0.36, and OR = 0.84 [0.59-1.21] in the cBQT group). Regarding adverse drug events, there was no significant difference between the mBQT and comparison groups (25.4% vs. 27.5%, p = 0.53, and OR = 0.95 [0.80-1.12]). The subgroup analysis showed that patient adherence to mBQT was significantly higher than to cBQT (96.4% vs. 93.3%, p = 0.004, and OR = 1.83 [1.21-2.77]). Our meta-analysis showed that mBQT was an effective and tolerable first-line therapy for H. pylori eradication.

Effectiveness of Susceptibility-Guided Therapy for Helicobacter pylori Infection: A Retrospective Analysis by Propensity Score Matching

Purpose

This study evaluates and compares the eradication rates of Helicobacter pylori (H. pylori) achieved through susceptibility-guided therapy (SGT) based on resistance genotyping and empirical therapy (ET).

Patients and Methods

A retrospective study was conducted at Beijing Chaoyang Hospital (2021-2023) on patients with H. pylori infection receiving initial eradication therapy. Resistance genotypes for clarithromycin and levofloxacin were identified using fluorescent PCR of gastric biopsy samples. Patients underwent a 14-day bismuth-containing quadruple therapy (BQT) and were evaluated via the C13 urea breath test (UBT). Based on genotyping or clinical judgment, 550 patients were assigned to SGT (n = 125) or ET (n = 425). The SGT group received personalized treatment based on genotype testing results, avoiding the use of antibiotics to which the bacteria were resistant. The ET group received the standard bismuth-containing quadruple therapy (BQT). Additionally, 29 ET patients underwent follow-up genotypic testing and eradication rates were analyzed retrospectively.

Results

SGT achieved higher eradication rates than ET (ITT: 94.4% vs 86.1%, P = 0.012; PP: 95.2% vs 87.6%, P = 0.016). In levofloxacin-resistant strains, SGT showed significantly higher eradication rates in the PP analysis (95.7% vs 50.0%, P = 0.049).

Conclusion

SGT exhibited remarkably superior eradication rates, notably in levofloxacin-resistant strains, proposing a compelling alternative for the treatment of H. pylori, particularly in instances of antimicrobial resistance.

Evaluation of the clinical significance of BTG1 gene expression and pepsinogen in serum and cancerous tissue and gastric atrophy

INTRODUCTION

This study aimed to assess the expression changes of BTG1, PGI, and PGII in tissues and serum of patients with gastric cancer, atrophic gastritis, and healthy individuals.

METHODS

QRT-PCR was used to measure BTG1, PGI, and PGII expression in 30 cancers, 30 atrophic gastritis, and 30 healthy tissue samples. Serum levels of PGI and PGII were measured using ELISA. Statistical tests included the Mann-Whitney U and independent T-test. Covariates like tumour stage and H. pylori status were considered.

RESULTS

BTG1 expression was significantly lower in cancer and gastritis tissues. Serum PGI and PGII levels were significantly reduced in cancer patients (P ≤ 0.001).

DISCUSSION

The PGI/PGII ratio in serum emerged as a strong non-invasive biomarker for distinguishing cancer from healthy individuals. While BTG1 provides insights into gastric carcinogenesis, its clinical utility is limited due to the need for tissue samples. The serum-based PGI/PGII ratio shows greater promise as a non-invasive screening tool for GC.

Declining eradication rates of Helicobacter pylori with standard triple therapy in Addis Ababa, Ethiopia

BACKGROUND

Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection, but it is encountered with drug resistance. The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H. pylori, 4-8 weeks post-therapy, with 86% sensitivity and 92% specificity.

AIM

To assess the H. pylori eradication rate of standard triple therapy and factors affecting the eradication rate.

METHODS

We conducted a prospective, multicenter follow-up study in Addis Ababa, Ethiopia, at selected healthcare facilities among dyspeptic patients with positive stool H. pylori antigen tests from June 1, 2023 to October 30, 2023 to assess the H. pylori eradication rate. After completing the standard triple therapy, the eradication was confirmed using a stool antigen test 4 weeks later. The data were analyzed using bivariate and multivariate logistic regression methods.

RESULTS

The H. pylori eradication rate was 85.4%. Patients with a previous diagnosis of H. pylori infection, smokers, and local alcohol consumption were associated with a lower H. pylori eradication rate, with adjusted odds ratio (AORs) of 0.159 [95% confidence interval (CI): 0.050-0.511], 0.206 (95%CI: 0.052-0.822), and 0.228 (95%CI: 0.052-0.997), respectively. Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement, AOR = 5.383, 95%CI: 1.74-21.089.

CONCLUSION

H. pylori eradication rate was lower than expected. Post-treatment testing is crucial to confirm eradication and guide further management, such as susceptibility testing.

Comparison of different microbiome analysis pipelines to validate their reproducibility of gastric mucosal microbiome composition

Microbiome analysis has become a crucial tool for basic and translational research due to its potential for translation into clinical practice. However, there is ongoing controversy regarding the comparability of different bioinformatic analysis platforms and a lack of recognized standards, which might have an impact on the translational potential of results. This study investigates how the performance of different microbiome analysis platforms impacts the final results of mucosal microbiome signatures. Across five independent research groups, we compared three distinct and frequently used microbiome analysis bioinformatic packages (DADA2, MOTHUR, and QIIME2) on the same subset of fastQ files. The source data set encompassed 16S rRNA gene raw sequencing data (V1-V2) from gastric biopsy samples of clinically well-defined gastric cancer (GC) patients (n = 40; with and without Helicobacter pylori [H. pylori] infection) and controls (n = 39, with and without H. pylori infection). Independent of the applied protocol, H. pylori status, microbial diversity and relative bacterial abundance were reproducible across all platforms, although differences in performance were detected. Furthermore, alignment of the filtered sequences to the old and new taxonomic databases (i.e., Ribosomal Database Project, Greengenes, and SILVA) had only a limited impact on the taxonomic assignment and thus on global analytical outcomes. Taken together, our results clearly demonstrate that different microbiome analysis approaches from independent expert groups generate comparable results when applied to the same data set. This is crucial for interpreting respective studies and underscores the broader applicability of microbiome analysis in clinical research, provided that robust pipelines are utilized and thoroughly documented to ensure reproducibility.IMPORTANCEMicrobiome analysis is one of the most important tools for basic and translational research due to its potential for translation into clinical practice. However, there is an ongoing controversy about the comparability of different bioinformatic analysis platforms and a lack of recognized standards. In this study, we investigate how the performance of different microbiome analysis platforms affects the final results of mucosal microbiome signatures. Five independent research groups used three different and commonly used bioinformatics packages for microbiome analysis on the same data set and compared the results. This data set included microbiome sequencing data from gastric biopsy samples of GC patients. Regardless of the protocol used, Helicobacter pylori status, microbial diversity, and relative bacterial abundance were reproducible across all platforms. The results show that different microbiome analysis approaches provide comparable results. This is crucial for the interpretation of corresponding studies and underlines the broader applicability of microbiome analysis.

The epidemiological study of family-based Helicobacter pylori screening and its benefits: a cross-sectional study

This study aimed to manage Helicobacter pylori (H. pylori) infection through a family-centered approach. It conducted a two-year follow-up on infected individuals' family members in Yichun, Jiangxi, China, to gain comprehensive insights into the transmission dynamics, treatment adherence, and associated risk factors of H. pylori within households. A retrospective analysis was performed on the data obtained from households in Yichun City that participated in the nationwide multicenter H. pylori prevalence study in 2021, along with the corresponding subsequent follow-up data. The collected information encompassed fundamental demographic details of the families, their lifestyle patterns, and the status of H. pylori infection. Among 514 households, 222 comprised two individuals, whereas 68 constituted larger families with five or more members. All member was infected in 9.34% of households. Larger family sizes (≥ 5 individuals) and higher generational counts were closely associated with H. pylori infection (e.g., family size > 6: OR 4.46, 95%CI 1.29 to 15.46). Adult age, marital status, and household members' infections were identified as primary risk factors (e.g., married individuals: OR 2.03, 95%CI 1.56 to 2.65). Students and previously uninfected individuals exhibited lower infection risks (e.g., tested as negative: OR 0.48, 95%CI 0.31 to 0.73). Maternal, paternal, or sibling infections were linked to increased risks of child infections (e.g., mother infected: OR 2.58 95%CI 1.37 to 4.87). Successful eradication in ≥ 2 individuals reduced the infection risk for other members (OR 0.25, 95%CI (0.07 to 0.89). H. pylori displayed noticeable clustering infection characteristics within families. This study lends support to family-based management strategies, but given suboptimal adherence to household management, there is a need to enhance education on the hazards of H. pylori before implementing screening programs.

Efficacy analysis of folic acid in chronic atrophic gastritis with Helicobacter pylori infection: a systematic review and meta-analysis

BACKGROUND

Current data indicate that supplements such as folic acid play a significant role in treating chronic atrophic gastritis (CAG). However, no meta-analysis article evaluates its efficacy comprehensively. Therefore, we conducted a meta-analysis to compare the effectiveness and safety of folic acid in the treatment of CAG with Helicobacter pylori (H. pylori) infection.

METHODS

Using a systematic review method, consider randomized controlled trials (RCT), including clinical trial reports, unpublished clinical trial data, and conference papers. A comprehensive search of the literature was conducted from all years up to June 2024. We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Vip, and Wanfang databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan5.4 and STAT15.1. Efficacy and safety outcomes were evaluated using risk ratio (RR) and 95% confidence intervals (CI).

RESULTS

16 randomized controlled trials with 1364 patients were included. Compared with conventional therapy, folic acid therapy had a higher total effective rate (95.09% vs.79.06%, pooled RR = 1.19, 95% CI: 1.12-1.26, p < 0.00001) and lower incidence of adverse events (11.64% vs. 14.04%, RR = 0.86, 95% CI: 0.46-1.60, p = 0.64). Moreover, folic acid can better improve gastric function and repair gastric mucosa (MD = 27.20, 95%CI:23.84-30.56, p < 0.00001).

CONCLUSIONS

For HP-related CAG, anti-HP treatment and folic acid supplementation should be started as early as possible. Gastric mucosal protective agents can improve the curative effect and can be selected according to the condition of patients with obvious adverse reactions. Our study provided evidence for their potential clinical use in the management of CAG. However, CAG-related studies in other countries and regions need to be further studied.

REGISTRATION

The logn number of our Meta-analysis on PROSPERO is 42,024,571,785.