Helicobacter最新文献

Background

In our center, RT-PCR was integrated as a routine method to diagnose Helicobacter pylori due to its higher availability after COVID-19 pandemics. The objective of this study was to assess the feasibility and performance of systematically performed RT-PCR for H. pylori detection and clarithromycin (CLA) resistance in a real-life clinical practice.

Materials and Methods

One hundred consecutive patients underwent an upper digestive endoscopy during which at least four biopsies (two from the antrum and two from the corpus) were obtained for RT-PCR and culture with antibiogram and four additional biopsies for histology. The results of H. pylori detection were compared among RT-PCR, histology, and bacterial culture, and the results of CLA susceptibility were compared between culture-based antibiogram and RT-PCR.

Results

Out of 100 patients, 64 were positive for H. pylori by RT-PCR, 66 by histology, and 53 by culture, with no statistically significant difference among the three methods (p > 0.05). CLA resistance was found in 8 out of 45 patients (17.7%) by culture and in 12 out of 64 patients (18.7%) by PCR. In 8 H. pylori-positive patients by culture, the antibiogram could not be realized due to lack of viability of the strains. In one patient, after a double checking, discrepant results were observed, requiring a complementary molecular analysis by the French National Reference Center for Helicobacters, which confirmed the existence of a double population of H. pylori strains within biopsies, with and without CLA resistance.

Conclusions

Our study demonstrates that in real-life clinical practice, RT-PCR is feasible and comparable in the ability to detect H. pylori and its resistance to CLA to bacterial culture with antibiogram and histology. Given its rapidity and limited dependence on the operator's interpretation, it appears preferable to the other methods.

Background

Treatment is indicated for all Helicobacter pylori infections. However, the best approach for H. pylori management remains unclear.

Methods

H. pylori eradication data from Hp-EuReg on treatment-naive patients in Slovenia from 2013 to 2023 were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence, and safety were analyzed. The effectiveness was assessed by modified intention to treat (mITT).

Results

Eight Slovenian medical institutions contributed data for 4016 treatment-naive patients to Hp-EuReg. Of these, 18% did not undergo confirmatory post-treatment; most who did received a urea breath test. Between 2013 and 2018, 7-day triple therapy with amoxicillin and clarithromycin was most frequently used in first-line treatment, with an 88% eradication rate. From 2019 to 2023, a 14-day high-dose PPI (esomeprazole 40 mg b.i.d.) triple therapy with amoxicillin and clarithromycin was used, showing a significantly higher effectiveness at 94% (p < 0.05). Quadruple bismuth-based therapy (esomeprazole 40 mg b.i.d., plus amoxicillin 500 mg, metronidazole 400 mg, and bismuth 120 mg, all q.i.d.) provided a 96.9% eradication rate, though this was not significantly better than the 14-day triple regimen. The H. pylori resistance rate to clarithromycin was 16% from 2013 to 2018, dropping to 13.5% from 2019 to 2023. Side effects were reported by 9.6% of patients, and treatment compliance was > 99%.

Conclusions

The study suggests that systematic data collection from routine clinical practice in Hp-EuReg can guide first-line H. pylori treatment. Established 90% treatment effectiveness threshold may serve as a surrogate marker for monitoring H. pylori resistance rates to antibiotics. In countries with a H. pylori resistance rate < 15%, such as Slovenia, the 14-day high-dose PPI amoxicillin-clarithromycin regimen is an optimal first-line empirical treatment.

Trial Registration: NCT02328131

Background

Helicobacter pylori infection is a significant contributing factor of gastric cancer. Metachronous neoplasms also pose a risk. The mechanism underlying the impact of H. pylori eradication on preventing metachronous gastric cancer is unclear. This study aimed to investigate immunity changes in gastric mucosa after H. pylori eradication and to identify mechanisms preventing metachronous recurrence.

Materials and Methods

Patients diagnosed with gastric neoplasm and H. pylori infection, who underwent endoscopic resection, were included. Thirty-six cases of metachronous neoplasms occurring after eradication (metachronous group) were compared to 36 controls matched for age, sex, atrophy, and metaplasia (control group). Histological features and immunohistochemical staining for T-cell (CD3, CD4, and CD8) and immune exhaustion (forkhead/winged helix transcription factor and programmed cell death-ligand 1) markers in the non-tumor-bearing mucosa were evaluated.

Results

In histologic features, glandular atrophy and intestinal metaplasia in the gastric mucosa significantly improved following H. pylori eradication in the control group (p < 0.001, 0.008), whereas they did not improve in the metachronous group (p = 0.449, 0.609). CD8 and CD8/CD3 ratios increased in the control group (p < 0.001, 0.04), but did not show differences in the metachronous group (p = 0.057, 0.245). The CD4/CD3 ratio and programmed cell death-ligand 1/CD4 expression significantly decreased after H. pylori eradication in the control group (p = 0.003, 0.042), but not in the metachronous group (p = 0.54, 0.55).

Conclusions

This observational study suggests that H. pylori eradication may prevent the recurrence of gastric neoplasia by improving histological inflammation and overcoming immune exhaustion.

Background

The management of Helicobacter pylori (H. pylori) infection encompasses different diagnostic and therapeutic procedures.

Materials and Methods

A survey was developed to investigate further factors of the clinical practice concerning the management of H. pylori infection that are currently not collected within the European Registry on H. pylori Management (Hp-EuReg). The survey was distributed among Spanish Hp-EuReg investigators, members of the Spanish Gastroenterology Association, and through social media.

Results

Overall, 128 investigators from all Spanish regions participated (79% from centers enrolling patients in the Hp-EuReg). Most participants (66%) reported having at least five diagnostic methods available. Culture was usually performed following the second-line failure (64%). Contrary to the recommendations, 17% of physicians did not investigate H. pylori infection in patients admitted for peptic ulcer bleeding, and 35% did not treat the infection right away. Furthermore, most investigators (95%) did not test for the infection in cohabitants, and 32% in gastric cancer relatives. The test-and-treat strategy was used in 84% of patients under 55 years without alarm symptoms, and in 15% of patients over 55 years. The majority (74%) did not confirm the penicillin allergy, only 26% were aware of the local clarithromycin resistance rate, and 37% periodically evaluated the efficacy of eradication treatments. Finally, most Spanish investigators (83%) followed the V Spanish Consensus, while up to 35% followed the Maastricht VI recommendation guidelines.

Conclusions

The management of H. pylori infection in Spain is suboptimal, even among Hp-EuReg investigators. We must optimize H. pylori management by implementing educational measures adapted to each setting.

Trial Registration

ClinicalTrials.gov: NCT02328131

Purpose

This meta-analysis aimed to assess the diagnostic performance of artificial intelligence (AI) based on endoscopy for detecting Helicobacter pylori (H. pylori) infection.

Methods

A comprehensive literature search was conducted across PubMed, Embase, and Web of Science to identify relevant studies published up to January 10, 2025. The selected studies focused on the diagnostic accuracy of AI in detecting H. pylori. A bivariate random-effects model was employed to calculate pooled sensitivity and specificity, both presented with 95% confidence intervals (CIs). Study heterogeneity was assessed using the I² statistic.

Results

Of 604 studies identified, 16 studies (25,002 images or patients) were included. For the internal validation set, the pooled sensitivity, specificity, and area under the curve (AUC) for detecting H. pylori were 0.91 (95% CI: 0.84–0.95), 0.91 (95% CI: 0.86–0.94), and 0.96 (95% CI: 0.94–0.97), respectively. For the external validation set, the pooled sensitivity, specificity, and AUC were 0.91 (95% CI: 0.86–0.95), 0.94 (95% CI: 0.90–0.97), and 0.98 (95% CI: 0.96–0.99). For junior clinicians, the pooled sensitivity, specificity, and AUC were 0.76 (95% CI: 0.66–0.83), 0.75 (95% CI: 0.70–0.80), and 0.81 (95% CI: 0.77–0.84). For senior clinicians, the pooled sensitivity, specificity, and AUC were 0.81 (95% CI: 0.74–0.86), 0.89 (95% CI: 0.86–0.91), and 0.92 (95% CI: 0.90–0.94).

Conclusions

Endoscopy-based AI demonstrates higher diagnostic performance compared to both junior and senior endoscopists. However, the high heterogeneity among studies limits the strength of these findings, and further research with external validation datasets is necessary to confirm the results.

Background

Helicobacter pylori colonizes the human stomach as a dominant member of the gastric microbiota and constitutively expresses flagellar motility for survival. Carbon storage regulator A (CsrA) is a posttranscriptional global regulator and a critical determinant of H. pylori's motility and pathogenicity. The regulation of H. pylori CsrA is still uncertain although in other species CsrA is reported to be antagonized by small RNAs and proteins. In this study, we attempted to unveil how CsrA is regulated and hypothesized that H. pylori CsrA activity is antagonized by a flagellar assembly factor, FliW2, via protein allosteric obstruction.

Materials and Methods

Multiple sequence comparisons indicated that, along its length and in contrast to fliW1, the fliW2 of H. pylori J99 is conserved. We then generated an isogenic ΔfliW2 strain whose function was characterized using phenotypic and biochemical approaches. We also applied a machine learning approach (AlphaFold2) to predict FliW2-CsrA binding domains and investigated the FliW2-CsrA interaction using pull-down assays and in vivo bacterial two-hybrid systems.

Results

We observed the reduced expression of major flagellin FlaA and impaired flagellar filaments that attenuated the motility of the ΔfliW2 strain. Furthermore, a direct interaction between FliW2 and CsrA was demonstrated, and a novel region of the C-terminal extension of CsrA was suggested to be crucial for CsrA interacting with FliW2. Based on our AlphaFold2 prediction, this C-terminal region of FliW2-CsrA interaction does not overlap with CsrA's N-terminal RNA binding domain, implying that FliW2 allosterically antagonizes CsrA activity and restricts CsrA's binding to flaA mRNAs.

Conclusions

Our data points to novel regulatory roles that the H. pylori flagellar assembly factor FliW2 has in obstructing CsrA activity, and thus FliW2 may indirectly antagonize CsrA's regulation of flaA mRNA processing and translation. Our findings reveal a new regulatory mechanism of flagellar motility in H. pylori.

Introduction

Epidemiological and experimental studies have suggested that chronic H. pylori infection may be associated with colorectal cancer (CRC), a topic of growing interest. The Bradford-Hill criteria are the mainstay of the epidemiological approach to causal inference. We aim to evaluate the epidemiological evidence based on the Bradford-Hill causality criteria and the association between H. pylori and CRC.

Methodology

A literature review of the databases search: Pubmed, ScienceDirect, Embase, SciELO, Cochrane, and Medline. There are no limits in a period. Information sources that were coherent with the objectives set were selected.

Results

Applying the Bradford Hill criteria, we can conclude that H. pylori is positively associated with CRC. The current epidemiological findings should stimulate future studies to explain how H. pylori interacts with intestinal dysbiosis and the role of H. pylori eradication in the treatment and prevention of CRC.

Conclusions

H. pylori reasonably meets the Bradford Hill criteria for causality. Further studies are required to consolidate the data and generate strategies to determine whether H. pylori eradication translates into decreased CRC incidence and mortality in large populations.