Helicobacter最新文献

This article outlines how decision modeling can be used to optimize the cost-effectiveness of H. pylori screen-and-treat programs. Decision models enable the translation of data from pilot studies into locally tailored strategies by adapting test modalities, treatment options, and the need to retest specific to the local setting. We summarize existing evidence from modeling studies, which consistently demonstrate that H. pylori screen-and-treat is cost-effective across diverse populations. In addition, we discuss how decision modeling can support resource allocation, promote health equity, and guide implementation planning. Integrating H. pylori screen-and-treat into established preventive programs, such as colorectal cancer screening, may further increase efficiency and feasibility. The article concludes with a proposed research agenda to advance efficient H. pylori screen-and-treat programs across the globe.

Background: Helicobacter pylori (Hp) and its virulence factor Cytotoxin-associated gene A (CagA) have been linked to myocardial infarction (MI), but the mechanisms are unknown. This study aims to test if Hp infection and CagA are associated with pre-specified inflammatory and vascular biomarkers in patients with MI and to explore whether a broader biomarker panel can predict infection. Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality.

Materials and methods: Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre-selected biomarkers were evaluated. Exploratory analyses included all biomarkers using machine-learning models to predict Hp-status. Hp-status and the top predictors were analyzed for associations with outcomes using Cox regression.

Results: Median age was 65 years; 78% were male. Hp and CagA seroprevalence were 45% and 19%, respectively. Patients with Hp had elevated CRP (β = 0.26, 95% CI 0.01-0.51). Predictive performance of Hp-status was moderate (AUC 0.63-0.68). Exploratory analysis identified higher levels of C-C motif chemokine ligand 20 (CCL20) and immunoglobulin heavy constant gamma-3 (IGHG3), and lower levels of TNF-related apoptosis-inducing ligand (TRAIL) in patients with Hp-positivity. Elevated CCL20 and reduced TRAIL, but not Hp, were associated with MACE and all-cause mortality.

Conclusions: Hp may contribute to an inflammatory response in patients with MI, indicated by higher CRP and inflammatory/immune-modulatory biomarkers emerging as its top predictors. Although Hp was not associated with adverse outcomes after MI, its predictive inflammatory biomarkers were associated with MACE and mortality.

Trial registration: The study was not registered as a clinical trial, as it was an observational study.

Objective: To evaluate the associations of both baseline serological profiles and serological transitions of Helicobacter pylori infection patterns with the risk of precancerous gastric lesions (PGLs).

Design: We analyzed data from 6208 participants in the FuSion cohort who underwent gastroscopy examination, with available H. pylori antibody and pepsinogen measurements at both baseline and follow-up. H. pylori status defined by IgG antibodies (Ab) and pepsinogens (PG), classified participants into four ABC groups. Multivariable logistic regression evaluated associations with PGLs across baseline and transition statuses. Trend tests were performed across the ABC groups and infection transition categories.

Results: A significant increasing trend in the PGLs prevalence and severity was observed across the ABC groups (p for trend < 0.05). Analysis of infection transitions revealed graded risk increases for PGLs from consistently negative to remained positive groups. Interestingly, even participants who seroreverted remained at significantly elevated risks of atrophic gastritis (adjusted odds ratio [aOR] = 2.01, 95% CI: 1.67-2.43) and intestinal metaplasia (aOR = 1.72, 95% CI: 1.14-2.51) compared to the persistently negative participants. The sensitivity analyses excluding baseline PG-positive subjects yielded similar results.

Conclusion: Long-term exposure to H. pylori is associated with an increased risk of PGLs, and this risk may remain elevated even after seroreversion.

Background and aims: We evaluated the association between Fecal Immunochemical Test (FIT) results and the risk of gastroesophageal cancer (GEC) in a matched cohort, as well as the cost-effectiveness of a one-time esophagogastroduodenoscopy (EGD) for individuals who tested FIT-positive.

Methods: We formed a cohort of individuals aged 50-75 years who underwent FIT testing at Clalit Health in Israel from 2016 to 2019. For each person with a positive FIT result, we matched three individuals with negative results by age, gender, and H. pylori exposure. We used adjusted hazard ratios (adjHRs) to assess the association between a positive FIT result and the risk of GEC within 36 months. We calculated the incremental cost-effectiveness ratio (ICER) for a one-time EGD costing USD 350 in individuals who tested positive for FIT, and considered it cost-effective if below USD 50,000.

Results: The study included 150,391 individuals (47.6% female, median age 62.4 years). During follow-up, 202 cases of GEC were recorded: 0.17% in FIT-positive individuals (64/37,709) and 0.12% in FIT-negative individuals (138/112,682), adjHR 1.39 (95% CI 1.03-1.87). GEC was also associated with H. pylori exposure (adjHR 1.43, 95% CI 1.08-1.90) and immigration from high-risk countries. A one-time EGD demonstrated favorable cost-effectiveness across various scenarios, with an ICER of USD 25,535/QALY.

Conclusions: This matched-cohort study suggests that individuals with a positive FIT may have an increased risk of GEC, comparable to that of established high-risk populations. Adding a one-time EGD to colonoscopy for FIT-positive individuals may be a cost-effective approach for healthcare systems that can accommodate such interventions.

Background: Vonoprazan (VPZ), a potassium-competitive acid blocker, has shown promising efficacy in Helicobacter pylori (H. pylori) eradication. However, direct comparisons of VPZ-based dual therapy (V-DT), triple therapy (V-TT), and bismuth quadruple therapy (V-BQT) remain limited. This study aimed to evaluate and compare the efficacy, safety, and compliance of these three regimens as first-line treatments for H. pylori infection.

Methods: 375 adults were randomized (1:1:1) to receive V-DT (VPZ 20 mg bid + amoxicillin 1 g tid for 10 days), V-TT (VPZ 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid for 14 days), or V-BQT (VPZ 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid + bismuth 240 mg bid for 10 days). The primary outcome was H. pylori eradication rate by intention-to-treat (ITT), modified ITT (mITT), and per-protocol (PP) analyses. Secondary outcomes included adverse events and compliance.

Results: Eradication rates were 92.0% (95% confidence interval [CI]: 85.8%-96.1%), 89.6% (95% CI: 82.9%-94.3%), and 88.8% (95% CI: 81.9%-93.7%) in ITT; 94.3% (95% CI: 88.5%-97.7%), 94.9% (95% CI: 89.3%-98.1%), and 94.1% (95% CI: 88.2%-97.6%) in mITT; and 94.2% (95% CI: 88.4%-97.6%), 95.6% (95% CI: 90.0%-98.5%), and 94.8% (95% CI: 89.0%-98.1%) in PP analyses for V-DT, V-TT, and V-BQT, respectively. The efficacy of V-DT and V-TT was noninferior to that of V-BQT. Adverse events were significantly lower with V-DT (6.4%) than with V-TT (36.0%) and V-BQT (49.6%) (p < 0.001). Compliance exceeded 93% in all groups, with no significant differences (p = 0.250).

Conclusions: All three regimens achieved high eradication rates, with V-DT and V-TT being statistically noninferior to V-BQT. The 10-day V-DT regimen achieved eradication rates comparable to V-BQT with substantially fewer adverse events and reduced antibiotic use, supporting its potential as a simplified first-line option for H. pylori eradication.

Trial registration: Chinese Clinical Trial Registration Number: ChiCTR2300072857.

Background: The prevalence of Helicobacter pylori (H. pylori) infection in children is high. Current diagnostic methods, particularly invasive techniques like gastroscopy, pose challenges for pediatric populations, highlighting the need for reliable non-invasive alternatives.

Aims: This study aimed to evaluate the diagnostic value of salivary and urinary exosomes for detecting H. pylori infection and clarithromycin resistance in children.

Methods: Saliva and urine samples were collected from children prior to elective gastroscopy. Exosomal DNA was extracted and subjected to qPCR for the detection of H. pylori DNA and clarithromycin resistance. The sensitivity and specificity of the salivary and urinary exosome tests were calculated against the reference standard, and their performance in detecting resistance was compared with tissue-based results.

Results: Among 500 enrolled children, the H. pylori infection rate was 31.6%. Analysis of 500 salivary and 80 urine samples showed that salivary exosomes detected H. pylori with a sensitivity of 93.67% and specificity of 80.11%. Urinary exosomes offered higher specificity (90.56%) but lower sensitivity (62.96%). In the subset of 113 infected children tested for resistance, salivary exosome testing identified clarithromycin resistance in 17.70% of cases, showing a 91.15% concordance with gastric tissue testing (15.93%). The agreement between the two methods was substantial.

Conclusion: Salivary exosome-based detection represents a highly sensitive and well-tolerated non-invasive method for diagnosing H. pylori infection in children. It also demonstrates substantial agreement with invasive methods in identifying clarithromycin resistance, offering a promising tool to guide precise eradication therapy in the pediatric population.