Helicobacter pylori infect about 50% of the world's population. The efficacy of treatment using standard regimens has declined in recent years, mainly due to widespread development of antibiotic resistance. Use of enhanced acid suppression and antibiotics with lower risk to resistance, will shape the future of treatment for H pylori. High-dose dual therapy (HDDT) can overcome the effect of CYP2C19 polymorphism thus enhancing acid suppression and may become an option in H pylori eradication.
To describe the eradication rate and side effects of HDDT in different metaboliser status relating to CYP2C19 polymorphism.
This is a hospital-based cross-sectional analytic study. A total of 63 H pylori-infected patients diagnosed using rapid urease test and histology were given HDDT for 14 days. Urea breath test was done 4 weeks after cessation of HDDT. CYP2C19 polymorphism was tested using the PCR-RFLP method. The eradication rates of HDDT were compared according to CYP2C19 polymorphism status.
Over all eradication rate of HDDT was 69.8% (95% CI 57%-80.8%). According to CYP2C19 polymorphism, 26.9% were homozygous extensive metabolisers (HomEM), 66.7% were heterozygous extensive metabolisers (HetEM) and 6.4% were poor metabolisers (PM). Eradication rate of HDDT was 82.4%, 69% and 25% in HomEM, HetEM and PM respectively. Only 16% of patients reported minor side effects.
Eradication rate of HDDT was fairly satisfactory for both homozygous and heterozygous extensive metaboliser states. This finding suggested that HDDT can overcome the effect of CYP2C19 polymorphism.
Gastric cancer (GC) is one of the most lethal malignancies worldwide, though a decrease in incidence. Helicobacter pylori is positively associated with gastric precancerous conditions. Detection of these conditions, namely atrophic gastritis (AG) and intestinal metaplasia (IM), and their association with H pylori infection is important for further detection and reduction of overall cancer incidence.
To detect the prevalence of H pylori infection and gastric precancerous conditions in patients with chronic dyspepsia by High Definition White Light Endoscopy (HD-WLE) and Narrow Band Imaging with Magnifying Endoscopy (NBI-ME).
This was a hospital-based descriptive study including chronic dyspeptic patients aged over 50 years. H pylori infection was diagnosed by a rapid urease test. AG and IM were detected by endoscopy (HD-WLE and NBI-ME) and confirmed by histology. Detection rates of each method were compared.
Totally 143 patients (55 males/88 females) with a mean age of 64.57 ± 9.957 years were included. H pylori infection rate was 53.84% (n = 77). Twenty-two patients with AG (44.9% of patients with atrophy) and 37.84% (14/37) of patients with IM have H pylori infection. There was a statistically significant difference in detection rates between HD-WLE and NBI-ME for IM (P=0.001) but not for AG (P=0.250).
H pylori infection is still high in Myanmar. There were significant associations between H pylori and gastric precancerous lesions. Detection of atrophic gastritis and intestinal metaplasia by routine usage of NBI-ME along with test and treat H pylori infection are the strategies to reduce the incidence of gastric cancer.
Both bismuth-based quadruple therapy (BQT) and concomitant therapy (CCT) are first-line regimens for Helicobacter pylori eradication. We compared the efficacy and adverse effects of both regimens in day-to-day clinical practice.
Adult patients with biopsy-proven H. pylori infection were included. Drug therapy was based on patient and physician preference. Both BQT and CCT regimens were given for 14 days. Efficacy was assessed using a stool antigen for H. pylori 4 weeks after treatment.
One hundred and twenty-nine consecutive patients were analysed, and the demographic characteristics of the two groups were similar. Treatment compliance was comparable in both regimens (P = 0.074), and 12/81 (14.8%) and 3/48 (12.5%) defaulted in BQT and CCT groups, respectively. 64.2% and 48% of patients reported some adverse effect in BQT and CCT groups (P = 0.10). Predominant adverse effects reported were nausea (41.9% vs 25%), black stools (29.6% vs 2%), vomiting (24.7% vs 6.25%) and loose stools (9.8% vs 20.8%) in BQT and CCT groups. Treatment efficacy of BQT and CCT regimen by intention-to-treat analysis was 87.7% (n = 71/81) and 79.2% (n = 38/48) (P = 0.321) and by per-protocol was 89.9% (n = 62/69) and 82.2% (n = 37/45) (P = 0.37).
Treatment efficacy with BQT is equivalent to CCT for H. pylori eradication. Both regimens have similar compliance rates, adverse events and affordability. With rising antibiotic resistance, BQT should be considered a better first-line option for H. pylori eradication.
Infection with Helicobacter pylori is globally prevalent. It is a chronic infection, standard treatment of which includes two antibiotics, amoxicillin and clarithromycin, plus a proton pump inhibitor used for 1 or 2 weeks. However, owing to increased resistance in our country, definitive eradication of H pylori is difficult. We conducted this study to evaluate the efficacy of a regimen using levofloxacin for successful eradication of H pylori infection.
This is a prospective study conducted at a tertiary care hospital. After informed written consent, all patients with proven H pylori infection (either by biopsy or by stool antigen test) were included in this study on the basis of other inclusion and exclusion criteria. Patients were given levofloxacin-based sequential therapy and stool for H pylori antigen was performed as per protocol to assess the eradication rate (ie, efficacy of levofloxacin-based regimen). Patients were required to fill a Performa for assessment of symptoms. Chi-square test was used for analysis. P < 0.05 was considered as significant.
A total of 149 patients with active H pylori infection were included. Out of 149 cases, 80 (53.7%) were male and 69 (46.3%) female. H pylori eradication was successfully achieved in 128 (85.9%) patients, 13 (8.7%) patients remained positive after eradication therapy and 8 (5.4%) patients lost follow up. No serious adverse event was observed.
Levofloxacin-based sequential therapy was highly effective (85.9%) against chronic H pylori infection.
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