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Efficacy of Bismuth Quadruple Therapy in the Treatment of Helicobacter pylori-Infected Peptic Ulcer Children in Vietnam 四联铋疗法治疗越南幽门螺旋杆菌感染的消化性溃疡患儿的疗效。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-05 DOI: 10.1111/hel.13149
Thi Minh Phuong Do, Thi Huyen Trang Tran, Van Tinh Nguyen, Thi Phuong Mai Chu, Loi Nguyen, Kim Thanh Nguyen, Thi Bich Ngoc Hoang, Anh Le Huu Phuong, Yoshio Yamaoka, Linus Olson, Thi Viet Ha Nguyen

Background

The continuous increase in drug-resistant strains, the lack of novel antibiotics, and the fewer options available to combat antibiotic-resistant infections in pediatrics pose significant challenges to the eradication of Helicobacter pylori (H. pylori) in children. This study evaluated the efficacy of first-line therapy with bismuth quadruple therapy in H. pylori-positive pediatric patients with peptic ulcers.

Materials and Methods

136 patients (aged between 8 and 17 years) diagnosed with active peptic ulcers with H. pylori infection were enrolled in this study. Patients with H. pylori strain sensitive to tetracycline and metronidazole were assigned to bismuth quadruple therapy, including a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. Antibiotic resistance of H. pylori was analyzed by the Epsilometer test. Treatment efficacy was evaluated at 12 weeks based on H. pylori eradication and peptic ulcer healing rates. H. pylori infection status was evaluated by a 13C-urea breath test.

Results

Most isolates showed extremely high rates of resistance to commonly prescribed antibiotics used for children, including clarithromycin (97.0%) and amoxicillin (84.6%), while the low rate of resistance to levofloxacin (16.2%). The overall success rate of eradication therapy in the intention-to-treat and the per-protocol group were 86.0% and 89.3%, respectively. Peptic ulcer healing rates for total patients at 6 weeks and 12 weeks were 75.0% and 97.7%, respectively. There were no entail unpleasant adverse events, and peptic ulcer symptoms decreased steadily over time in all cases.

Conclusions

The bismuth quadruple therapy with a 2-week PPI pretreatment and followed by prolonged PPI was highly successful in eradicating H. pylori infection and healing ulcers in pediatric patients with active peptic ulcer. This might be preferable as a first-line empiric treatment regimen for H. pylori-positive pediatric patients with peptic ulcers, especially in populations with high rates of resistance to amoxicillin and clarithromycin.

背景:耐药菌株的不断增加、新型抗生素的缺乏以及儿科抗生素耐药感染可选方案的减少,给根除儿童幽门螺杆菌(H. pylori)带来了巨大挑战。本研究评估了幽门螺杆菌阳性的消化性溃疡儿科患者接受四联铋剂一线治疗的疗效。材料和方法:本研究共招募了136名确诊为幽门螺杆菌感染的活动性消化性溃疡患者(年龄在8至17岁之间)。幽门螺杆菌菌株对四环素和甲硝唑敏感的患者被分配接受铋剂四联疗法,包括质子泵抑制剂(PPI)、铋剂、四环素和甲硝唑。幽门螺杆菌的抗生素耐药性通过益普索试验进行分析。根据幽门螺杆菌根除率和消化性溃疡愈合率评估 12 周后的疗效。幽门螺杆菌感染状况通过 13C- 尿素呼气试验进行评估:大多数分离菌株对儿童常用抗生素的耐药率极高,包括克拉霉素(97.0%)和阿莫西林(84.6%),而对左氧氟沙星的耐药率较低(16.2%)。意向治疗组和按方案治疗组的根除疗法总体成功率分别为86.0%和89.3%。6周和12周时,所有患者的消化性溃疡愈合率分别为75.0%和97.7%。所有病例均未出现令人不悦的不良反应,消化性溃疡症状随时间推移稳步减轻:结论:铋剂四联疗法加上为期两周的 PPI 预处理和随后的长期 PPI,在根除幽门螺杆菌感染和治愈活动性消化性溃疡儿童患者的溃疡方面非常成功。对于幽门螺杆菌阳性的消化性溃疡儿科患者,尤其是对阿莫西林和克拉霉素耐药率较高的人群,这可能更适合作为一线经验性治疗方案。
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引用次数: 0
Map-Like Redness Development After Eradication Therapy for Helicobacter pylori Infection: Prospective Multicenter Observational Study 幽门螺杆菌感染根除疗法后出现的地图样红斑:前瞻性多中心观察研究。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-03 DOI: 10.1111/hel.13146
Sho Matsumoto, Mitsushige Sugimoto, Tomohiro Terai, Yasuhiko Maruyama, Shu Sahara, Shigeru Kanaoka, Yashiro Yoshizawa, Shuhei Unno, Masaki Murata, Takahiro Uotani, Tomohiro Sugiyama, Shigemi Nakajima, Kiyoyuki Hayafuji, Ken Haruma, Tomoari Kamada, Masakatsu Fukuzawa, Takashi Kawai, Takao Itoi

Background

Map-like redness, pathological intestinal metaplasia, is observed in one-fourth to one-third of patients 1 year after Helicobacter pylori eradication therapy, mainly in the corpus, and is a newly identified endoscopic risk factor for gastric cancer development after eradication. However, it is unclear whether intestinal metaplasia is present before eradication at the site where the map-like redness appears. We aimed to identify endoscopic findings that predict the occurrence of map-like redness before H. pylori eradication.

Materials and Methods

As a prospective multicenter trial, the characteristics of patients in whom map-like redness developed after eradication, and the association between the endoscopic severity of gastritis and the development of map-like redness in patients who underwent endoscopy before and 1-year after eradication were investigated.

Results

The rate of map-like redness in all 93 patients 1-year postsuccessful eradication was 30.1% (95% confidence interval [CI]: 21.0–40.5). All patients with map-like redness were endoscopically observed to have intestinal metaplasia before eradication, in the site that subsequently developed map-like redness. Patients who developed map-like redness were older, had more severe intestinal metaplasia and nodularity and a higher total score on the Kyoto Classification of Gastritis both before and after eradication than patients who did not. On multivariate analysis, map-like redness was found to be associated with posttreatment intestinal metaplasia (odds ratio: 8.144; 95% CI: 2.811–23.592).

Conclusions

In all patients who developed map-like redness after eradication, endoscopic intestinal metaplasia was observed at the site developed map-like redness before eradication therapy. Map-like redness was especially observed in patients with more severe intestinal metaplasia at 1-year after eradication. Such patients require increased attention at surveillance endoscopy, owing to generally having a higher risk of gastric cancer development.

Trial Registration

University Hospital Medical Information Network: UMIN000044707

背景:幽门螺杆菌根除治疗 1 年后,四分之一到三分之一的患者会出现地图样发红,即病理性肠化生,主要发生在胃体,这是新发现的根除后胃癌发生的内镜风险因素。然而,目前还不清楚在根除前出现地图样发红的部位是否存在肠化生。我们的目的是找出能预测幽门螺杆菌根除前出现地图样发红的内镜检查结果:作为一项前瞻性多中心试验,我们调查了根除幽门螺杆菌后出现地图样发红的患者特征,以及根除幽门螺杆菌前和根除幽门螺杆菌1年后接受内镜检查的患者的内镜下胃炎严重程度与出现地图样发红之间的关联:结果:所有93名患者在成功根除后1年出现地图样发红的比例为30.1%(95%置信区间[CI]:21.0-40.5)。所有出现地图样发红的患者均在根除前经内镜观察发现有肠化生,并在随后出现地图样发红的部位。与未出现地图样发红的患者相比,出现地图样发红的患者年龄更大,肠化生和结节更严重,根除前后的京都胃炎分类总分更高。多变量分析发现,地图样发红与治疗后肠化生有关(几率比:8.144;95% CI:2.811-23.592):结论:在所有根除治疗后出现地图样发红的患者中,根除治疗前出现地图样发红的部位均可观察到内镜下肠化生。尤其是在根除治疗后 1 年,在肠化生更为严重的患者中观察到了地图样发红。由于这类患者发生胃癌的风险通常较高,因此需要在监测内镜检查时给予更多关注:试验注册:大学医院医学信息网:UMIN000044707.
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引用次数: 0
Correction to Antimicrobial Resistance of Helicobacter pylori Isolated From Latin American Children and Adolescents (2008–2023): A Systematic Review 拉丁美洲儿童和青少年幽门螺杆菌对抗生素耐药性的修正(2008-2023 年):系统回顾。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-26 DOI: 10.1111/hel.13145
<p>C. Cabrera, J. Torres, C. Serrano, P. Gallardo, V. Orellana, S. George, M. O'Ryan, and Y. Lucero, “Antimicrobial Resistance of <i>Helicobacter pylori</i> Isolated From Latin American Children and Adolescents (2008–2023): A Systematic Review,” <i>Helicobacter</i> 29, (2024): e13101. https://doi.org/10.1111/hel.13101.</p><p>In the article, the errors detailed below were identified. These errors are due to an earlier version of the manuscript being published. These have been corrected in the online version of the article, and they do not affect the overall conclusions.</p><p> <b>Abstract</b> </p><p>The first sentence of the Results paragraph originally stated that out of 51 studies, 45 were excluded. This has been corrected to 44 excluded studies.</p><p>The second sentence of the Results paragraph originally read, “the quality of the six analyzed studies…was satisfactory.” This has been corrected to seven analyzed studies.</p><p>The fourth sentence of the Results paragraph originally read, “Clarithromycin resistance ranged from 8.0% to 26.7% (6 studies; 297 samples).” This has been corrected to 8.1%–79.6% (seven studies, 346 samples).</p><p> <b>Results</b> </p><p>In the second paragraph of section 3.1, it was originally stated that 16 studies were excluded and that eight were conducted solely in adult populations. This has been corrected to read that 15 studies were excluded and nine were conducted solely in adult populations.</p><p>In the first paragraph of section 3.2, it was originally stated that the quality of the six selected studies was assessed. This has been corrected to seven studies. Additionally, it was stated that the other four studies used statistical tools to validate their results. This has been corrected to six studies.</p><p>In the first paragraph of section 3.3, the first sentence originally read, “All six studies were cross-sectional observational studies, each including pediatric patients [7–12].” This has been corrected to “All seven studies were cross-sectional observational studies, each including pediatric patients [7–13].” Additionally, the fifth sentence originally stated that two of the studies evaluated antimicrobial resistance. This has been corrected to three studies.</p><p>In the second paragraph of section 3.4, the first sentence originally read, “Genotypic studies (Table 2) explored susceptibility to clarithromycin (<i>n</i> = 3; 139 samples).” This has been corrected to “Genotypic studies explored susceptibility to clarithromycin (<i>n</i> = 4; 188 samples).” Additionally, the second sentence originally read, “The mean rate of resistance to clarithromycin was 13.8%, with the A2143G mutation being the most frequently detected in these strains (87.5%, 14/16 tested), followed by the A2142G mutation (12.5%, 2/16 tested).” This has been corrected to, “The resistance to clarithromycin ranged between 8.1% and 79.6%, with the A2143G mutation as the most frequently detecte
C.Cabrera, J. Torres, C. Serrano, P. Gallardo, V. Orellana, S. George, M. O'Ryan, and Y. Lucero, "Antimicrobial Resistance of Helicobacter pylori Isolated From Latin American Children and Adolescents (2008-2023):https://doi.org/10.1111/hel.13101.In,发现了以下错误。这些错误是由于较早版本的稿件发表所致。这些错误已在文章的网络版中更正,且不影响总体结论。 摘要 结果段落的第一句话最初指出,在 51 项研究中,有 45 项被排除在外。结果段第二句原为 "六项分析研究的质量......令人满意"。结果段落第四句原为:"克拉霉素耐药率从 8.0% 到 26.7%(6 项研究;297 个样本)"。现更正为 8.1%-79.6%(7 项研究,346 个样本)。 结果 在第 3.1 节的第二段中,最初指出有 16 项研究被排除在外,其中 8 项研究仅在成人群体中进行。在第 3.2 节的第一段中,最初的说法是对所选的六项研究进行了质量评估。现更正为七项研究。此外,该段还指出其他四项研究使用了统计工具来验证其结果。在第 3.3 节第一段中,第一句原为 "所有六项研究均为横断面观察性研究,每项研究均包括儿科患者[7-12]"。现更正为 "所有七项研究均为横断面观察研究,每项研究均包括儿科患者[7-13]"。此外,第五句最初指出其中两项研究评估了抗菌药耐药性。在第 3.4 节第二段中,第一句原为 "基因型研究(表 2)探讨了对克拉霉素的敏感性(n = 3;139 个样本)"。现已更正为 "基因型研究探讨了对克拉霉素的敏感性(n = 4;188 个样本)"。此外,第二句原为:"对克拉霉素的平均耐药率为 13.8%,在这些菌株中最常检测到的是 A2143G 突变(87.5%,14/16 例检测),其次是 A2142G 突变(12.5%,2/16 例检测)"。现更正为:"对克拉霉素的耐药性介于 8.1%和 79.6%之间,其中最常检测到的是 A2143G 突变(38.5%,15/39 例检测),其次是 A2142G 突变(33.3%,13/39 例检测)"。 讨论 在第 5 段中,最初指出所纳入的六项研究中有四项报告了克拉霉素耐药值。在第 6 段中,最初的表述是六项研究中有四项报告了甲硝唑的药敏试验,现更正为七项纳入研究中有五项报告了克拉霉素的耐药值。在第 7 段中,最初的表述是,在 6 项研究中,有 3 项研究确定了对阿莫西林的耐药率。在第 7 段中,原先的表述是在 6 项研究中的 3 项中确定了对阿莫西林的耐药率,现更正为在 7 项研究中的 3 项中确定了对阿莫西林的耐药率。
{"title":"Correction to Antimicrobial Resistance of Helicobacter pylori Isolated From Latin American Children and Adolescents (2008–2023): A Systematic Review","authors":"","doi":"10.1111/hel.13145","DOIUrl":"10.1111/hel.13145","url":null,"abstract":"&lt;p&gt;C. Cabrera, J. Torres, C. Serrano, P. Gallardo, V. Orellana, S. George, M. O'Ryan, and Y. Lucero, “Antimicrobial Resistance of &lt;i&gt;Helicobacter pylori&lt;/i&gt; Isolated From Latin American Children and Adolescents (2008–2023): A Systematic Review,” &lt;i&gt;Helicobacter&lt;/i&gt; 29, (2024): e13101. https://doi.org/10.1111/hel.13101.&lt;/p&gt;&lt;p&gt;In the article, the errors detailed below were identified. These errors are due to an earlier version of the manuscript being published. These have been corrected in the online version of the article, and they do not affect the overall conclusions.&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;Abstract&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;The first sentence of the Results paragraph originally stated that out of 51 studies, 45 were excluded. This has been corrected to 44 excluded studies.&lt;/p&gt;&lt;p&gt;The second sentence of the Results paragraph originally read, “the quality of the six analyzed studies…was satisfactory.” This has been corrected to seven analyzed studies.&lt;/p&gt;&lt;p&gt;The fourth sentence of the Results paragraph originally read, “Clarithromycin resistance ranged from 8.0% to 26.7% (6 studies; 297 samples).” This has been corrected to 8.1%–79.6% (seven studies, 346 samples).&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;Results&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;In the second paragraph of section 3.1, it was originally stated that 16 studies were excluded and that eight were conducted solely in adult populations. This has been corrected to read that 15 studies were excluded and nine were conducted solely in adult populations.&lt;/p&gt;&lt;p&gt;In the first paragraph of section 3.2, it was originally stated that the quality of the six selected studies was assessed. This has been corrected to seven studies. Additionally, it was stated that the other four studies used statistical tools to validate their results. This has been corrected to six studies.&lt;/p&gt;&lt;p&gt;In the first paragraph of section 3.3, the first sentence originally read, “All six studies were cross-sectional observational studies, each including pediatric patients [7–12].” This has been corrected to “All seven studies were cross-sectional observational studies, each including pediatric patients [7–13].” Additionally, the fifth sentence originally stated that two of the studies evaluated antimicrobial resistance. This has been corrected to three studies.&lt;/p&gt;&lt;p&gt;In the second paragraph of section 3.4, the first sentence originally read, “Genotypic studies (Table 2) explored susceptibility to clarithromycin (&lt;i&gt;n&lt;/i&gt; = 3; 139 samples).” This has been corrected to “Genotypic studies explored susceptibility to clarithromycin (&lt;i&gt;n&lt;/i&gt; = 4; 188 samples).” Additionally, the second sentence originally read, “The mean rate of resistance to clarithromycin was 13.8%, with the A2143G mutation being the most frequently detected in these strains (87.5%, 14/16 tested), followed by the A2142G mutation (12.5%, 2/16 tested).” This has been corrected to, “The resistance to clarithromycin ranged between 8.1% and 79.6%, with the A2143G mutation as the most frequently detecte","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimal Duration of Bismuth-Containing Quadruple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis 根除幽门螺旋杆菌的含铋四联疗法的最佳持续时间:系统回顾与元分析》。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-23 DOI: 10.1111/hel.13144
Miao Duan, Qingzhou Kong, Hui Wang, Yueyue Li
<div> <section> <h3> Background</h3> <p>The eradication of <i>Helicobacter pylori</i> (<i>H. pylori</i>) is crucial due to its rising prevalence and increasing resistance. Bismuth-containing quadruple therapies (BcQTs) have been proposed as a viable treatment option; however, the optimal duration for it remains contentious. This systematic review and meta-analysis aimed to compare the clinical efficacy of short-term BcQT (defined as 7 or 10 days) with a standard 14-day course.</p> </section> <section> <h3> Methods</h3> <p>A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for randomized controlled trials published in English until June 20, 2024. Eligibility criteria were applied to identify relevant studies. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the included studies regarding eradication rates, adverse effects, and compliance. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was previously registered in PROSPERO under registration number CRD42024547773.</p> </section> <section> <h3> Results</h3> <p>This meta-analysis finally included 15 trials involving a total of 4505 patients. The eradication rates for short courses of BcQT were lower than those for the 14-day course (RR 0.96, 95% CI 0.93–0.99). However, the eradication rate for the 10-day therapy was comparable to that of the 14-day therapy (RR 0.98, 95% CI 0.95–1.00). Subgroup analyses of antibiotic combinations indicated that tetracycline and metronidazole combinations yielded similar <i>H. pylori</i> eradication rates in the 7-day versus the 14-day BcQT (RR 0.93, 95% CI 0.84–1.02). In the potassium-competitive acid blocker subgroup, the eradication rates remained similar across the 14-day group and the short-course treatment groups, whether evaluating the short-term treatment groups as a whole or the 7- and 10-day subgroups separately. Additionally, the adverse effects and compliance associated with the short course of BcQT were comparable to those of the 14-day therapy.</p> </section> <section> <h3> Conclusion</h3> <p>A 10-day course of BcQT may represent the optimal treatment duration. Nevertheless, the choice of antibiotic combination should be guided by the regional antibiotic resistance patterns of <i>H. pylori</i>, as combinations with lower resistance rates are more effective.</p> </section> <section> <h3> Trial Registration</h3> <p>PROSPERO number: CRD42024547773</p> </secti
背景:由于幽门螺旋杆菌(H. pylori)的发病率不断上升且耐药性不断增强,根除幽门螺旋杆菌(H. pylori)至关重要。含铋四联疗法(BcQTs)被认为是一种可行的治疗方案,但其最佳疗程仍存在争议。本系统综述和荟萃分析旨在比较短期 BcQT(定义为 7 天或 10 天)与 14 天标准疗程的临床疗效:方法:在PubMed、Embase、Web of Science和Cochrane图书馆对2024年6月20日前发表的英文随机对照试验进行了系统检索。采用资格标准来确定相关研究。计算了纳入研究中有关根除率、不良反应和依从性的总风险比 (RR) 和 95% 置信区间 (CI)。本系统综述和荟萃分析根据系统综述和荟萃分析首选报告项目(PRISMA)声明进行,之前已在 PROSPERO 注册,注册号为 CRD42024547773:这项荟萃分析最终纳入了 15 项试验,共涉及 4505 名患者。BcQT短期疗程的根除率低于14天疗程(RR 0.96,95% CI 0.93-0.99)。不过,10 天疗程的根除率与 14 天疗程相当(RR 0.98,95% CI 0.95-1.00)。抗生素组合的分组分析表明,四环素和甲硝唑组合在 7 天与 14 天 BcQT 中的幽门螺杆菌根除率相似(RR 0.93,95% CI 0.84-1.02)。在钾竞争性酸阻滞剂亚组中,无论是整体评估短期治疗组,还是分别评估 7 天和 10 天亚组,14 天组和短期治疗组的根除率仍然相似。此外,BcQT短期疗程的不良反应和依从性与14天疗程相当:结论:BcQT 10 天疗程可能是最佳治疗时间。结论:10 天疗程的 BcQT 可能是最佳治疗时间,但在选择抗生素组合时应考虑幽门螺杆菌的区域抗生素耐药模式,因为耐药率较低的抗生素组合更有效:试验注册:PROSPERO 编号试验注册:PROSPERO 编号:CRD42024547773。
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引用次数: 0
Influence of oipA Phase Variation on Virulence Phenotypes Related to Type IV Secretion System in Helicobacter pylori oipA 相位变异对幽门螺旋杆菌与 IV 型分泌系统相关的毒性表型的影响
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-23 DOI: 10.1111/hel.13140
Jing Lai, Sacheera Angulmaduwa, Myeong-A Kim, Aeryun Kim, Kavinda Tissera, Yong-Joon Cho, Jeong-Heon Cha

Background

oipA, an outer membrane protein of Helicobacter pylori, is linked to IL-8 induction and gastric inflammation, but its role is debated due to inconsistent findings. This study aims to explore the role of oipA phase variation in modulating the virulence traits of H. pylori, a bacterium strongly associated with the development of gastric cancer.

Material and Methods

American clinical isolate AH868 strain for naturally occurring phase variations of the oipA gene, and G27 strain for in vitro–induced phase variations were used to elucidate oipA's impact on key virulence phenotypes, including cell elongation, CagA phosphorylation, and IL-8 induction.

Results

Using AH868 strain, natural oipA phase variation does not affect cell elongation and IL-8 induction. Interestingly, however, in vitro–induced oipA phase variations in G27 strain uncovered that 9.4% of oipA “Off” transformants exhibit reduced cell elongation while all maintaining consistent IL-8 induction levels. Additionally, complementation of oipA “Off to On” status restores the cell elongation phenotype in 12.5% of transformants, highlighting the importance of oipA in maintaining normal cell morphology. Crucially, these variations in cell elongation are not linked to changes in bacterial adherence capabilities. Furthermore, the study shows a correlation among oipA phase variation, cell elongation, and CagA phosphorylation, suggesting that oipA influences the functionality of the Type IV secretion system. Whole-genome sequencing of selected transformants reveals genetic variations in bab paralogue, cagY gene, and other genomic regions, underscoring the complex genetic interactions that shape H. pylori's virulence.

Conclusions

Our research provides new insights into the subtle yet significant role of oipA phase variation in H. pylori pathogenicity, emphasizing the need for further studies to explore the intricate molecular mechanisms involved. This understanding could pave the way for targeted therapeutic strategies to mitigate the impact of H. pylori on human health.

背景:幽门螺杆菌的外膜蛋白oipA与IL-8诱导和胃部炎症有关,但由于研究结果不一致,其作用还存在争议。本研究旨在探讨 oipA 相位变异在调节幽门螺杆菌毒力特征中的作用,幽门螺杆菌与胃癌的发生密切相关:利用美国临床分离株AH868和体外诱导的G27来阐明oipA对关键毒力表型(包括细胞伸长、CagA磷酸化和IL-8诱导)的影响:结果:使用 AH868 菌株,天然 oipA 阶段变异不会影响细胞伸长和 IL-8 诱导。但有趣的是,体外诱导 G27 菌株的 oipA 相位变异发现,9.4% 的 oipA "关闭 "转化株表现出细胞伸长率降低,而所有转化株都保持了一致的 IL-8 诱导水平。此外,将 oipA "关闭 "状态补充为 "开启 "状态可恢复 12.5% 转化株的细胞伸长表型,这凸显了 oipA 在维持正常细胞形态方面的重要性。重要的是,细胞伸长的这些变化与细菌粘附能力的变化无关。此外,研究还显示了 oipA 相位变化、细胞伸长和 CagA 磷酸化之间的相关性,表明 oipA 影响了 IV 型分泌系统的功能。对所选转化株的全基因组测序揭示了bab旁系、cagY基因和其他基因组区域的遗传变异,强调了形成幽门螺杆菌毒力的复杂遗传相互作用:我们的研究为 oipA 相位变异在幽门螺杆菌致病性中微妙而重要的作用提供了新的见解,强调了进一步研究探索其中错综复杂的分子机制的必要性。这种认识可以为制定有针对性的治疗策略铺平道路,从而减轻幽门螺杆菌对人类健康的影响。
{"title":"Influence of oipA Phase Variation on Virulence Phenotypes Related to Type IV Secretion System in Helicobacter pylori","authors":"Jing Lai,&nbsp;Sacheera Angulmaduwa,&nbsp;Myeong-A Kim,&nbsp;Aeryun Kim,&nbsp;Kavinda Tissera,&nbsp;Yong-Joon Cho,&nbsp;Jeong-Heon Cha","doi":"10.1111/hel.13140","DOIUrl":"10.1111/hel.13140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>oipA</i>, an outer membrane protein of <i>Helicobacter pylori</i>, is linked to IL-8 induction and gastric inflammation, but its role is debated due to inconsistent findings. This study aims to explore the role of <i>oipA</i> phase variation in modulating the virulence traits of <i>H. pylori</i>, a bacterium strongly associated with the development of gastric cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>American clinical isolate AH868 strain for naturally occurring phase variations of the <i>oipA</i> gene, and G27 strain for in vitro–induced phase variations were used to elucidate <i>oipA</i>'s impact on key virulence phenotypes, including cell elongation, CagA phosphorylation, and IL-8 induction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using AH868 strain, natural <i>oipA</i> phase variation does not affect cell elongation and IL-8 induction. Interestingly, however, in vitro–induced <i>oipA</i> phase variations in G27 strain uncovered that 9.4% of <i>oipA</i> “Off” transformants exhibit reduced cell elongation while all maintaining consistent IL-8 induction levels. Additionally, complementation of <i>oipA</i> “Off to On” status restores the cell elongation phenotype in 12.5% of transformants, highlighting the importance of <i>oipA</i> in maintaining normal cell morphology. Crucially, these variations in cell elongation are not linked to changes in bacterial adherence capabilities. Furthermore, the study shows a correlation among <i>oipA</i> phase variation, cell elongation, and CagA phosphorylation, suggesting that <i>oipA</i> influences the functionality of the Type IV secretion system. Whole-genome sequencing of selected transformants reveals genetic variations in <i>bab</i> paralogue, <i>cagY</i> gene, and other genomic regions, underscoring the complex genetic interactions that shape <i>H. pylori</i>'s virulence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our research provides new insights into the subtle yet significant role of <i>oipA</i> phase variation in <i>H. pylori</i> pathogenicity, emphasizing the need for further studies to explore the intricate molecular mechanisms involved. This understanding could pave the way for targeted therapeutic strategies to mitigate the impact of <i>H. pylori</i> on human health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Tegoprazan-Containing Sequential Eradication Treatment Compared to Esomeprazole-Containing Sequential Eradication of Helicobacter pylori in South Korea, a Region With High Antimicrobial Resistance: A Prospective, Randomized, Single Tertiary Center Study 在抗菌药耐药性较高的韩国地区,含替戈拉赞的幽门螺杆菌序贯根除治疗与含埃索美拉唑的序贯根除治疗的疗效比较:一项前瞻性、随机、单一三级中心研究。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-22 DOI: 10.1111/hel.13143
Jung Won Lee, Nayoung Kim, Jongchan Lee, So Young Jo, Dong Ho Lee

Background

Treatment with potassium-competitive acid blockers has shown acceptable efficacy in Helicobacter pylori eradication. In regions like Korea, where the clarithromycin resistance rate is high, alternative combinations like non-bismuth quadruple therapies have shown favorable results. This study compared the outcomes of sequential eradication therapy with new potassium-competitive acid blocker tegoprazan and conventional esomeprazole-containing sequential therapy.

Materials and Methods

Patients with Helicobacter pylori (H. pylori) infection were consecutively recruited. Patients were allocated to either an esomeprazole-containing sequential or a tegoprazan-containing sequential therapy group. Sequential therapy comprised esomeprazole (40 mg) or tegoprazan (50 mg) plus amoxicillin (1000 mg) twice daily for the initial 5 days, followed by esomeprazole (40 mg) or tegoprazan (50 mg) with clarithromycin (500 mg) and metronidazole (500 mg) twice daily for the remaining 5 days. Eradication rate, compliance, and adverse events were recorded.

Results

A total of 406 patients with H. pylori infection were enrolled in the trial and analyzed per protocol. Eradication rate by intention-to-treat and per-protocol was 83.8% (95% confidence interval [CI]: 78.7–88.9) for esomeprazole-containing sequential therapy, and 87.1% (95% CI: 82.5–91.8) for tegoprazan-containing sequential therapy, with no statistical significance (p = 0.399). Additionally, there was no statistically significant difference in treatment compliance between the two groups. Nausea was more prevalent (23.3%, 27/202) with sequential tegoprazans than with esomeprazole-containing sequential therapy (14.2%, 29/204; p = 0.022).

Conclusion

Tegoprazan-containing 10-day sequential eradication treatment demonstrated similar eradication efficacy compared to esomeprazole-containing treatment, even in regions with high antimicrobial resistance, such as Korea.

Trial Registration

ClinicalTrials.gov: NCT06382493

背景:钾竞争性酸阻滞剂对根除幽门螺旋杆菌具有可接受的疗效。在韩国等克拉霉素耐药率较高的地区,非铋剂四联疗法等替代组合疗法显示出良好的效果。本研究比较了新型钾竞争性酸阻滞剂替戈普拉赞和传统的含埃索美拉唑序贯疗法的根除效果:连续招募幽门螺杆菌(H. pylori)感染患者。患者被分配到含有埃索美拉唑的序贯疗法组或含有替戈普拉赞的序贯疗法组。序贯疗法包括埃索美拉唑(40 毫克)或替戈普拉赞(50 毫克)加阿莫西林(1000 毫克),最初 5 天每天两次,随后 5 天埃索美拉唑(40 毫克)或替戈普拉赞(50 毫克)加克拉霉素(500 毫克)和甲硝唑(500 毫克),每天两次。对根除率、依从性和不良反应进行了记录:共有 406 名幽门螺杆菌感染患者参加了试验,并按照方案进行了分析。按意向治疗和按方案计算,含艾司奥美拉唑序贯疗法的根除率为 83.8%(95% 置信区间 [CI]:78.7-88.9),含替戈普拉赞序贯疗法的根除率为 87.1%(95% 置信区间 [CI]:82.5-91.8),无统计学意义(P = 0.399)。此外,两组患者在治疗依从性方面也无显著统计学差异。与含埃索美拉唑的序贯疗法(14.2%,29/204;p = 0.022)相比,使用替戈普拉赞序贯疗法的恶心发生率更高(23.3%,27/202):结论:与含埃索美拉唑的治疗相比,含替戈拉赞的10天序列根除治疗显示出相似的根除疗效,即使在韩国等抗菌药耐药性较高的地区也是如此:试验注册:ClinicalTrials.gov:试验注册:ClinicalTrials.gov:NCT06382493。
{"title":"Efficacy of Tegoprazan-Containing Sequential Eradication Treatment Compared to Esomeprazole-Containing Sequential Eradication of Helicobacter pylori in South Korea, a Region With High Antimicrobial Resistance: A Prospective, Randomized, Single Tertiary Center Study","authors":"Jung Won Lee,&nbsp;Nayoung Kim,&nbsp;Jongchan Lee,&nbsp;So Young Jo,&nbsp;Dong Ho Lee","doi":"10.1111/hel.13143","DOIUrl":"10.1111/hel.13143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Treatment with potassium-competitive acid blockers has shown acceptable efficacy in <i>Helicobacter pylori</i> eradication. In regions like Korea, where the clarithromycin resistance rate is high, alternative combinations like non-bismuth quadruple therapies have shown favorable results. This study compared the outcomes of sequential eradication therapy with new potassium-competitive acid blocker tegoprazan and conventional esomeprazole-containing sequential therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Patients with <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection were consecutively recruited. Patients were allocated to either an esomeprazole-containing sequential or a tegoprazan-containing sequential therapy group. Sequential therapy comprised esomeprazole (40 mg) or tegoprazan (50 mg) plus amoxicillin (1000 mg) twice daily for the initial 5 days, followed by esomeprazole (40 mg) or tegoprazan (50 mg) with clarithromycin (500 mg) and metronidazole (500 mg) twice daily for the remaining 5 days. Eradication rate, compliance, and adverse events were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 406 patients with <i>H. pylori</i> infection were enrolled in the trial and analyzed per protocol. Eradication rate by intention-to-treat and per-protocol was 83.8% (95% confidence interval [CI]: 78.7–88.9) for esomeprazole-containing sequential therapy, and 87.1% (95% CI: 82.5–91.8) for tegoprazan-containing sequential therapy, with no statistical significance (<i>p</i> = 0.399). Additionally, there was no statistically significant difference in treatment compliance between the two groups. Nausea was more prevalent (23.3%, 27/202) with sequential tegoprazans than with esomeprazole-containing sequential therapy (14.2%, 29/204; <i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tegoprazan-containing 10-day sequential eradication treatment demonstrated similar eradication efficacy compared to esomeprazole-containing treatment, even in regions with high antimicrobial resistance, such as Korea.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov: NCT06382493</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Bismuth Therapy in Eradicating Helicobacter pylori in Children—Data From the RENIHp Registry 铋疗法根除儿童幽门螺旋杆菌的疗效--来自 RENIHp 登记处的数据。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-09 DOI: 10.1111/hel.13142
Gonzalo Botija, Gonzalo Galicia, Beatriz Martínez, Carmen Cuadrado, Marta Soria, Sonia Fernández, Pedro Urruzuno, María-Luz Cilleruelo, SEGHNP H. pylori Working Group

Objectives

To evaluate the efficacy of colloidal bismuth subcitrate (CBS) therapy for the eradication of H. pylori in patients from a national pediatric registry of H. pylori infection.

Methods

The Spanish Registry of Children with H. pylori Infection (RENIHp) is a national, multi-center, prospective, non-interventional registry that includes children aged 5–18 years with H. pylori infection diagnosed by endoscopy. All patients in the registry who were treated with CBS between the period 2020 and 2023 were included in this study. The primary outcome was the eradication rate, which was assessed using a 13C-urea breath test or monoclonal antigen in the stool 6–8 weeks post-treatment.

Results

The registry included 682 patients, 38 (5.6%) of whom underwent treatment with CBS. Fifty percent (19/38) of patients had previously undergone unsuccessful eradication treatment. In 78.9% (30/38) of patients, treatment was guided by an antibiotic sensitivity test. In the remaining patients, an empirical approach was employed. The CBS therapies used were as follows: quadruple therapy with proton pump inhibitors (PPIs), CBS, amoxicillin, and metronidazole (MET) [18/38 (47.3%)]; quadruple therapy with PPIs, CBS, tetracycline, and MET [13/38 (34.2%)]; and other therapies [7/38 (18.4%)]. Thirty-two patients (84.2%) treated with CBS were followed-up with eradication monitoring. The overall eradication rate in patients treated with CBS was 93.8% (30/32, [95% CI: 85.4%–100%]), whereas it was 86.7% in patients in the registry who were not on CBS treatment (430/496, [95% CI: 83.3%–89.5%], p = 0.208). In the six patients with dual resistance to clarithromycin (CLA) and MET who were treated with quadruple therapy with CBS, the eradication rate was 100% (n = 6/6, [95% CI: 61.0%–100%]).

Conclusion

CBS therapies in our registry, although only used in selected cases and at lower than recommended levels, were very effective and showed an eradication rate of > 90%.

目的方法:西班牙幽门螺杆菌感染儿童登记处(RENIHp)是一个全国性的多中心前瞻性非介入性登记处:西班牙幽门螺杆菌感染儿童登记处(RENIHp)是一个全国性、多中心、前瞻性、非干预性登记处,登记对象包括经内镜检查确诊为幽门螺杆菌感染的 5-18 岁儿童。本研究纳入了登记册中 2020 年至 2023 年期间接受 CBS 治疗的所有患者。主要结果是根除率,通过13C-尿素呼气试验或治疗后6-8周粪便中的单克隆抗原进行评估:登记包括 682 名患者,其中 38 人(5.6%)接受了 CBS 治疗。50%的患者(19/38)曾接受过不成功的根除治疗。78.9%的患者(30/38)是在抗生素敏感性测试的指导下接受治疗的。其余患者则采用经验疗法。使用的 CBS 疗法如下:质子泵抑制剂 (PPI)、CBS、阿莫西林和甲硝唑 (MET) 四联疗法 [18/38 (47.3%)];PPI、CBS、四环素和 MET 四联疗法 [13/38 (34.2%)];其他疗法 [7/38 (18.4%)]。接受 CBS 治疗的 32 名患者(84.2%)接受了根除监测随访。接受 CBS 治疗的患者的总根除率为 93.8%(30/32,[95% CI:85.4%-100%]),而未接受 CBS 治疗的登记患者的总根除率为 86.7%(430/496,[95% CI:83.3%-89.5%],P = 0.208)。对克拉霉素(CLA)和 MET 双耐药的 6 名患者接受了 CBS 四联疗法,根除率为 100%(n = 6/6,[95% CI:61.0%-100%]):结论:在我们的登记中,CBS疗法虽然仅用于部分病例,且使用量低于推荐水平,但非常有效,根除率大于90%。
{"title":"Efficacy of Bismuth Therapy in Eradicating Helicobacter pylori in Children—Data From the RENIHp Registry","authors":"Gonzalo Botija,&nbsp;Gonzalo Galicia,&nbsp;Beatriz Martínez,&nbsp;Carmen Cuadrado,&nbsp;Marta Soria,&nbsp;Sonia Fernández,&nbsp;Pedro Urruzuno,&nbsp;María-Luz Cilleruelo,&nbsp;SEGHNP H. pylori Working Group","doi":"10.1111/hel.13142","DOIUrl":"10.1111/hel.13142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the efficacy of colloidal bismuth subcitrate (CBS) therapy for the eradication of <i>H. pylori</i> in patients from a national pediatric registry of <i>H. pylori</i> infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Spanish Registry of Children with <i>H. pylori</i> Infection (RENIHp) is a national, multi-center, prospective, non-interventional registry that includes children aged 5–18 years with <i>H. pylori</i> infection diagnosed by endoscopy. All patients in the registry who were treated with CBS between the period 2020 and 2023 were included in this study. The primary outcome was the eradication rate, which was assessed using a <sup>13</sup>C-urea breath test or monoclonal antigen in the stool 6–8 weeks post-treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The registry included 682 patients, 38 (5.6%) of whom underwent treatment with CBS. Fifty percent (19/38) of patients had previously undergone unsuccessful eradication treatment. In 78.9% (30/38) of patients, treatment was guided by an antibiotic sensitivity test. In the remaining patients, an empirical approach was employed. The CBS therapies used were as follows: quadruple therapy with proton pump inhibitors (PPIs), CBS, amoxicillin, and metronidazole (MET) [18/38 (47.3%)]; quadruple therapy with PPIs, CBS, tetracycline, and MET [13/38 (34.2%)]; and other therapies [7/38 (18.4%)]. Thirty-two patients (84.2%) treated with CBS were followed-up with eradication monitoring. The overall eradication rate in patients treated with CBS was 93.8% (30/32, [95% CI: 85.4%–100%]), whereas it was 86.7% in patients in the registry who were not on CBS treatment (430/496, [95% CI: 83.3%–89.5%], <i>p</i> = 0.208). In the six patients with dual resistance to clarithromycin (CLA) and MET who were treated with quadruple therapy with CBS, the eradication rate was 100% (<i>n</i> = 6/6, [95% CI: 61.0%–100%]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CBS therapies in our registry, although only used in selected cases and at lower than recommended levels, were very effective and showed an eradication rate of &gt; 90%.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic Review and Meta-Analysis: Bismuth Enhances the Efficacy for Eradication of Helicobacter pylori 系统回顾与元分析:铋能增强根除幽门螺旋杆菌的疗效。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-09 DOI: 10.1111/hel.13141
A Reum Choe, Chung Hyun Tae, Miyoung Choi, Ki-Nam Shim, Hye-Kyung Jung

Background

In the eradication of Helicobacter pylori, the efficacy of bismuth remains inconclusive. We aimed to compare the efficacy of bismuth on various H. pylori eradication regimens.

Methods

Randomized controlled trials were collected to compare the efficacy of bismuth to nonbismuth regimens in H. pylori eradication. We pooled information to study eradication, adverse events, and drug compliance. In addition, subgroup analyses for eradication efficacy were performed according to high or low clarithromycin-resistance area, bismuth drug form, and amount of bismuth element.

Results

Records for a total of 2506 patients in 15 trials from 13 randomized controlled studies were included. The eradication of H. pylori was superior when bismuth compared to nonbismuth regimen (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.33–2.00 in intention-to-treat [ITT]; OR = 2.05, 95% CI, 1.58–2.68 in per-protocol [PP] analyses), without significant difference in drug compliance or adverse events. Bismuth regimens in the high clarithromycin resistance area tend to enhance the eradication rate (OR = 1.66, 95% CI, 1.34–2.05 in ITT; OR = 2.22, 95% CI, 1.67–2.95 in PP analyses). Bismuth potassium citrate and bismuth subcitrate were more effective drug forms in regard to eradication rate. Bismuth at a dosage of < 500 mg/day was significantly higher for the eradication rate.

Conclusions

Bismuth to the H. pylori eradication regimens achieve a higher eradication rate, especially in the high clarithromycin resistance area. It could be an eradication option achieving sufficient resistance rates without increasing antibiotic resistance, side effects, or poor compliance.

背景:在根除幽门螺杆菌方面,铋剂的疗效仍无定论。我们旨在比较铋剂对各种幽门螺杆菌根除方案的疗效:我们收集了随机对照试验,以比较铋剂与非铋剂方案在根除幽门螺杆菌方面的疗效。我们汇总了研究根除率、不良事件和药物依从性的信息。此外,我们还根据克拉霉素耐药区的高低、铋剂的药物形式和铋元素的含量对根除效果进行了亚组分析:结果:共纳入了 13 项随机对照研究的 15 项试验中 2506 名患者的记录。与非铋剂方案相比,铋剂方案根除幽门螺杆菌的效果更佳(意向治疗[ITT]中的比值比[OR]=1.63,95%置信区间[CI],1.33-2.00;按方案[PP]分析中的比值比[OR]=2.05,95%置信区间[CI],1.58-2.68),但在用药依从性或不良事件方面无显著差异。克拉霉素耐药性高发区的铋剂方案往往会提高根除率(ITT OR = 1.66,95% CI,1.34-2.05;PP 分析中 OR = 2.22,95% CI,1.67-2.95)。就根除率而言,枸橼酸铋钾和次枸橼酸铋是更有效的药物形式。结论:铋的用量为枸橼酸铋钾和次枸橼酸铋钾:在幽门螺杆菌根除方案中加入铋剂可获得更高的根除率,尤其是在克拉霉素耐药率较高的地区。它可以作为一种根除方案,在不增加抗生素耐药性、副作用或依从性差的情况下达到足够的耐药率。
{"title":"Systematic Review and Meta-Analysis: Bismuth Enhances the Efficacy for Eradication of Helicobacter pylori","authors":"A Reum Choe,&nbsp;Chung Hyun Tae,&nbsp;Miyoung Choi,&nbsp;Ki-Nam Shim,&nbsp;Hye-Kyung Jung","doi":"10.1111/hel.13141","DOIUrl":"10.1111/hel.13141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the eradication of <i>Helicobacter pylori</i>, the efficacy of bismuth remains inconclusive. We aimed to compare the efficacy of bismuth on various <i>H. pylori</i> eradication regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Randomized controlled trials were collected to compare the efficacy of bismuth to nonbismuth regimens in <i>H. pylori</i> eradication. We pooled information to study eradication, adverse events, and drug compliance. In addition, subgroup analyses for eradication efficacy were performed according to high or low clarithromycin-resistance area, bismuth drug form, and amount of bismuth element.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Records for a total of 2506 patients in 15 trials from 13 randomized controlled studies were included. The eradication of <i>H. pylori</i> was superior when bismuth compared to nonbismuth regimen (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.33–2.00 in intention-to-treat [ITT]; OR = 2.05, 95% CI, 1.58–2.68 in per-protocol [PP] analyses), without significant difference in drug compliance or adverse events. Bismuth regimens in the high clarithromycin resistance area tend to enhance the eradication rate (OR = 1.66, 95% CI, 1.34–2.05 in ITT; OR = 2.22, 95% CI, 1.67–2.95 in PP analyses). Bismuth potassium citrate and bismuth subcitrate were more effective drug forms in regard to eradication rate. Bismuth at a dosage of &lt; 500 mg/day was significantly higher for the eradication rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bismuth to the <i>H. pylori</i> eradication regimens achieve a higher eradication rate, especially in the high clarithromycin resistance area. It could be an eradication option achieving sufficient resistance rates without increasing antibiotic resistance, side effects, or poor compliance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tracking the Helicobacter pylori Epidemic in Adults and Children in China 追踪幽门螺杆菌在中国成人和儿童中的流行情况。
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-28 DOI: 10.1111/hel.13139
Zixing Wang, Yaoda Hu, Ran Fei, Wei Han, Xiaoxiao Wang, Dongbo Chen, Shaoping She

Background

The Helicobacter pylori epidemic in China accounts for up to a third of gastric cancers worldwide. We aim to monitor the temporal and spatial dynamics of H. pylori infection in both adults and children across China.

Materials and Methods

We developed a surveillance system consisting of a data collection component that harnessed survey reports in natural populations and an analysis component that accounted for the differences in survey time and location, population age structure, and H. pylori detection method. System outputs were estimates of the prevalence of H. pylori in adults and children (aged ≤ 14 years) presented at three hierarchical levels (regional, provincial, and prefectural).

Results

The overall prevalence of H. pylori infection declined sharply in adults (63.3%, 52.5%, 43.4%, and 38.7%) and less sharply in children (23.1%, 26.1%, 16.0%, and 15.7%) in 1983–1999, 2000–2009, 2010–2014, and 2015–2019, respectively. The changes were asynchronous across regions, with the most marked declines in the Northwest, the Hong Kong-Macao-Taiwan region, and the East. We estimated that 457.6 million adults and 44.5 million children have been infected with H. pylori, with cross-province disparities in prevalence ranging from 24.3% to 69.3% among adults and 2.9% to 46.3% among children. In general, the risk level of gastric cancer increased as the prevalence of H. pylori increased. The correlation was statistically significant for both adult men (Spearman coefficient of correlation: 0.393, p = 0.0146) and women (0.470, p = 0.0029).

Conclusions

The tracking system would be important for the continuous and stratified tracking of the Helicobacter pylori epidemic across China and can be used to furnish an evidence base for the formulation of tailored prevention strategies.

背景:幽门螺杆菌在中国的流行占全球胃癌发病率的三分之一。我们旨在监测中国成人和儿童幽门螺杆菌感染的时空动态:我们开发了一个监测系统,该系统由数据收集部分和分析部分组成,前者利用自然人群的调查报告,后者考虑了调查时间和地点、人群年龄结构以及幽门螺杆菌检测方法的差异。系统的输出结果是成人和儿童(年龄小于 14 岁)幽门螺杆菌感染率的估计值,按三个层次(地区、省和都道府县)显示:1983-1999年、2000-2009年、2010-2014年和2015-2019年,成人幽门螺杆菌感染率分别为63.3%、52.5%、43.4%和38.7%,儿童感染率分别为23.1%、26.1%、16.0%和15.7%。各地区的变化并不同步,西北地区、港澳台地区和东部地区的下降最为明显。我们估计有 4.576 亿成人和 4450 万儿童感染了幽门螺杆菌,成人感染率的跨省差异从 24.3% 到 69.3%,儿童感染率的跨省差异从 2.9% 到 46.3%。一般来说,幽门螺杆菌感染率越高,患胃癌的风险就越大。成年男性(斯皮尔曼相关系数:0.393,P = 0.0146)和女性(0.470,P = 0.0029)的相关性在统计学上都很显著:结论:幽门螺杆菌追踪系统对持续、分层追踪幽门螺杆菌在中国的流行情况具有重要意义,可为制定有针对性的预防策略提供证据基础。
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引用次数: 0
Knowledge and Practices of Helicobacter pylori Infection Management Among Physicians in Gansu Province, China: A Cross-Sectional Study 中国甘肃省医生对幽门螺杆菌感染管理的认识和实践:横断面研究
IF 4.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-27 DOI: 10.1111/hel.13137
Na Liu, Qian Luo, Lingzhu Gou, Xiping Shen, Dekui Zhang

Background and Aims

Physicians' knowledge and practices regarding the diagnosis, treatment, and follow-up of Helicobacter pylori (H. pylori) infection can impact the effectiveness of eradication therapy. This study aimed to investigate the current state of knowledge and practices concerning H. pylori infection management among physicians in Gansu Province, northwest China.

Materials and Methods

From October to November 2023, 557 physicians from 14 cities and prefectures in Gansu Province participated in this multicenter cross-sectional study and completed a survey questionnaire.

Results

A total of 519 valid questionnaires were collected. 43.2% of the physicians supported H. pylori screening for high-risk populations or individuals with H. pylori–related diseases. The awareness of target screening populations varied among these physicians, ranging from 69.6% to 98.2%. Most physicians preferred the urea breath test (UBT) as the method for diagnosing H. pylori infection (98.3%) and for follow-up after eradication therapy (98.5%). 89.6% of the physicians preferred bismuth-containing quadruple therapy for initial eradication, with amoxicillin and clarithromycin being the most commonly used antibiotic combination (56.3%). In addition, 84.6% of the physicians indicated that they would inquire about the antibiotic usage history for most patients before treatment, 93.8% would ask patients about their previous eradication history, and 94.2% would inform patients about treatment-related considerations. However, only 43.5%, 27.7%, and 29.7% of the physicians were aware of the high resistance rates of H. pylori to clarithromycin, levofloxacin, and metronidazole, respectively, in Gansu Province. Subgroup analysis revealed that the performance of gastroenterologists, nongastroenterologists, and physicians from different levels of hospitals differed in the diagnosis, treatment, and follow-up of H. pylori infection.

Conclusions

Knowledge and practices regarding H. pylori infection management among physicians in Gansu Province, China, need further improvement. Strengthening targeted continuing education to increase the overall management level of H. pylori infection is recommended.

背景和目的 医生对幽门螺杆菌(H. pylori)感染的诊断、治疗和随访方面的知识和实践会影响根除治疗的效果。本研究旨在调查中国西北部甘肃省医生对幽门螺杆菌感染管理的知识和实践现状。 材料与方法 2023年10月至11月,来自甘肃省14个地市的557名医生参与了这项多中心横断面研究,并填写了调查问卷。 结果 共回收有效问卷 519 份。43.2%的医生支持对幽门螺杆菌高危人群或幽门螺杆菌相关疾病患者进行筛查。这些医生对目标筛查人群的了解程度各不相同,从 69.6% 到 98.2% 不等。大多数医生首选尿素呼气试验(UBT)作为诊断幽门螺杆菌感染的方法(98.3%)和根除治疗后的随访方法(98.5%)。89.6%的医生首选含铋四联疗法进行初始根除,阿莫西林和克拉霉素是最常用的抗生素组合(56.3%)。此外,84.6% 的医生表示会在治疗前询问大多数患者的抗生素使用史,93.8% 的医生会询问患者之前的根除史,94.2% 的医生会告知患者治疗相关注意事项。然而,只有 43.5%、27.7% 和 29.7% 的医生知道甘肃省幽门螺杆菌对克拉霉素、左氧氟沙星和甲硝唑的耐药率较高。分组分析显示,消化内科医生、非消化内科医生和不同级别医院的医生在幽门螺杆菌感染的诊断、治疗和随访方面的表现存在差异。 结论 中国甘肃省医生在幽门螺杆菌感染管理方面的知识和实践有待进一步提高。建议加强有针对性的继续教育,提高幽门螺杆菌感染的整体管理水平。
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