Helicobacter最新文献_第10页

Meta-analysis of Helicobacter pylori eradication therapy using vonoprazan as an acid suppressor compared with bismuth quadruple therapy 使用vonoprazan作为抑酸剂的幽门螺杆菌根除疗法与铋剂四联疗法的元分析比较。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-03-05 DOI: 10.1111/hel.13059

Hui Yang, Miao Zhang, Gang Ma, Jiaqi Yang, Kemei Wang, Shuangshuang Jiang, Jiaqiang Dong, Ying Han

Background

Vonoprazan, a novel acid suppressant, has recently emerged as a regimen for eradicating Helicobacter pylori. However, uncertainties exist about the effectiveness and safety of VPZ-based regimens compared with those of bismuth-based quadruple therapy in eradicating H. pylori. The present meta-analysis was performed to compare the effectiveness and safety of vonoprazan-based regimens with those of bismuth quadruple therapy in eradicating H. pylori.

Materials and Methods

All randomized controlled trials and non-randomized controlled trials comparing the vonoprazan-based therapy with the bismuth quadruple therapy were included in this meta-analysis. Information was also extracted by two evaluators, and if heterogeneity existed, a random-effects model was used to calculate the combined relative ratio and 95% confidence interval; otherwise, a fixed-effects model was used. And subgroup analyses were performed to explore the sources of heterogeneity.

Results

A total of 10 studies, comprising 2587 patients were included in the meta-analysis. The results showed that the combined eradication rate of patients treated with the vonoprazan-based regimen was significantly higher than that of patients treated with bismuth quadruple therapy, in both intention-to-treat and per-protocol analyses, and the differences were statistically significant. Among the intention-to-treat analyses results: (90.28% vs. 83.64% [odds ratio (OR) = 1.85, 95% confidence interval (CI) (1.27, 2.70), p = 0.001]); in the per-protocol analyses: (94.80% vs. 89.88%, [OR = 2.25, 95% CI (1.37, 3.69), p = 0.001]). The occurrence of adverse events was significantly lower in patients treated with vonoprazan-based regimens than in those treated with bismuth quadruple therapy, (14.50% vs. 25.89%, [OR = 0.49, 95% CI (0.32, 0.75), p = 0.001]).

Conclusions

For eradicating H. pylori, vonoprazan-based regimens are remarkably advantageous over bismuth quadruple therapy. Furthermore, vonoprazan-based regimens exhibit a lower rate of adverse events than bismuth quadruple therapy.

背景：沃诺普拉赞是一种新型抑酸剂，最近已成为根除幽门螺杆菌的一种疗法。然而，与基于铋剂的四联疗法相比，基于 VPZ 的疗法在根除幽门螺杆菌方面的有效性和安全性还存在不确定性。本荟萃分析旨在比较基于醋氯吡嗪的治疗方案与基于铋剂的四联疗法在根除幽门螺杆菌方面的有效性和安全性：本次荟萃分析纳入了所有比较以伏诺普拉赞为基础的疗法和四联铋剂疗法的随机对照试验和非随机对照试验。如果存在异质性，则采用随机效应模型计算合并相对比和95%置信区间；反之，则采用固定效应模型。并进行了亚组分析，以探讨异质性的来源：荟萃分析共纳入了10项研究，2587名患者。结果表明，在意向治疗分析和按方案分析中，接受以vonoprazan为基础的方案治疗的患者的综合根除率明显高于接受四联铋剂治疗的患者，且差异具有统计学意义。在意向治疗分析结果中：（90.28% 对 83.64% [比值比 (OR) = 1.85，95% 置信区间 (CI) (1.27, 2.70)，p = 0.001]）；在按协议分析结果中：（94.80% 对 89.88%，[比值比 (OR) = 2.25，95% 置信区间 (CI) (1.37, 3.69)，p = 0.001]）。采用vonoprazan治疗方案的患者不良反应发生率明显低于采用铋剂四联疗法的患者（14.50% vs. 25.89%，[OR = 0.49，95% CI (0.32，0.75)，p = 0.001]）：结论：在根除幽门螺杆菌方面，以vonoprazan为基础的治疗方案比四联铋剂疗法具有明显优势。此外，与四联铋剂疗法相比，以伏诺普拉赞为基础的疗法的不良反应发生率更低。

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引用次数: 0

Primary antibiotic resistance of Helicobacter pylori in India over the past two decades: A systematic review 过去二十年印度幽门螺杆菌的原发性抗生素耐药性：系统回顾。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-28 DOI: 10.1111/hel.13057

Spriha Dutta, Surbhi Jain, Kunal Das, Prashant Verma, Anup Som, Rajashree Das

Background

Helicobacter pylori antibiotic resistance has undergone vast changes in the last two decades. No systematic review has been done on the prevalence of antibiotic resistant H. pylori in India in the last two decades. We evaluated the pattern of resistance rates across various regions of India.

Materials and Methods

A systematic review of the geographical variations in antibiotic resistance pattern of H. pylori was conducted using PubMed, Google Scholar, Web of Science, Science Direct, etc. for articles published between January 1, 2000 and May 30, 2023. Random effects-model-based Cochran's Q test, I² statistics, and chi-squared tests were used to measure heterogeneity.

Results

The overall resistance was highest against metronidazole (77.65%) followed by amoxicillin (37.78%), levofloxacin (32.8%), clarithromycin (35.64%), furazolidone (12.03%), and tetracycline (11.63%). 14.7% of the H. pylori isolates were multi-drug resistant. Under meta-analysis of each antibiotic, high heterogeneity levels were observed having I² ranges from 86.53% to 97.70% at p < 0.0001. In sub-group analysis, Metronidazole has a stable rate of resistance as compared to other antibiotics. Other antibiotics have had a downtrend in the last 5 years except for levofloxacin, which has had an uptrend in the resistance rate for the past 5 years. Hence, one should avoid using metronidazole for any kind of first-line treatment.

Conclusions

Metronidazole resistance is high in most regions of India except Assam and Mumbai while clarithromycin is found to be ineffective in South India, Gujarat, and Kashmir. As compared to other antibiotics, resistance to amoxicillin is generally low except in certain regions (Hyderabad, Chennai, and the Gangetic belt of North India). Tetracycline and Furazolidone have the least resistance rates and should be part of anti- H. pylori regimens. The resurgence of high single and multidrug resistance to the commonly used drugs suggests the need for newer antibiotics and regular resistance surveillance studies.

背景：幽门螺杆菌的抗生素耐药性在过去二十年间发生了巨大变化。在过去二十年中，尚未对印度幽门螺杆菌的耐药性流行情况进行过系统回顾。我们评估了印度不同地区的耐药率模式：我们使用 PubMed、Google Scholar、Web of Science、Science Direct 等网站，对 2000 年 1 月 1 日至 2023 年 5 月 30 日期间发表的文章进行了系统综述，研究了幽门螺杆菌抗生素耐药模式的地域差异。采用基于随机效应模型的科克兰Q检验、I2统计量和卡方检验来衡量异质性：甲硝唑的耐药性最高（77.65%），其次是阿莫西林（37.78%）、左氧氟沙星（32.8%）、克拉霉素（35.64%）、呋喃唑酮（12.03%）和四环素（11.63%）。14.7%的幽门螺杆菌分离物具有多重耐药性。在对每种抗生素进行荟萃分析时，观察到了较高的异质性水平，其 I2 范围为 86.53% 至 97.70%，P 值为结论：除阿萨姆邦和孟买外，印度大部分地区对甲硝唑的耐药性都很高，而克拉霉素在南印度、古吉拉特邦和克什米尔则无效。与其他抗生素相比，除了某些地区（海得拉巴、钦奈和北印度恒河带）外，阿莫西林的耐药性普遍较低。四环素和呋喃唑酮的耐药率最低，应作为抗幽门螺杆菌方案的一部分。对常用药物的高单药耐药性和多药耐药性的再次出现表明，有必要采用更新的抗生素并定期进行耐药性监测研究。

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引用次数: 0

A pilot study evaluating high dose esomeprazole, bismuth subcitrate and amoxicillin for eradicating Helicobacter pylori infection in Iran 在伊朗开展的一项试点研究，对大剂量埃索美拉唑、次枸橼酸铋和阿莫西林根除幽门螺旋杆菌感染的效果进行了评估。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-27 DOI: 10.1111/hel.13061

Sepehr Tirgar Fakheri, Hajar Shokri-Afra, David Y. Graham, Zohreh Bari, Hafez Fakheri

Background

Helicobacter pylori (H. pylori) is strongly associated with peptic ulcer disease and gastric cancer. We evaluated two triple therapy regimens comprising esomeprazole, high dose bismuth, and different doses of amoxicillin for first-line H. pylori eradication.

Materials and Methods

Two hundred patients with dyspepsia and naive H. pylori infection were randomly assigned into two groups (n = 100). Both groups were treated for 14 days similarly with esomeprazole (40 mg, twice daily) and bismuth subcitrate (240 mg, three times daily), but the dose of amoxicillin was varied between Groups A (750 mg) and B (1000 mg) three times daily. Treatment compliance and side effect were evaluated following the therapies and after 8 weeks, a negative test of stool H. pylori antigen confirmed eradication.

Results

The two groups were comparable with respect to sex and age. According to intention to treat analysis, eradication rates were 80% (95% CI: 77.2%–82.8%) and 90% (95% CI: 84.1%–95.9%) in A and B groups, respectively (p = 0.22). Per-protocol eradication rates were 87% (95% CI: 80.4%–93.6%) and 92.8% (95% CI: 87.7%–97.9%), respectively (p = 0.23). Severe adverse effects were 3% and 2%, respectively (p = 0.34).

Conclusion

High dose esomeprazole, amoxicillin and bismuth achieved 92.8% cure rates per protocol in a country with a high background rate of resistance. Additional studies are needed to ascertain whether this therapy can be further improved. Until then, it can be recommended as a first-line H. pylori eradication in north of Iran.

背景：幽门螺杆菌（H. pylori）与消化性溃疡病和胃癌密切相关。我们评估了由埃索美拉唑、大剂量铋剂和不同剂量阿莫西林组成的两种三联疗法方案，用于一线根除幽门螺杆菌：将 200 名患有消化不良且未感染幽门螺杆菌的患者随机分为两组（n = 100）。两组患者均接受为期 14 天的埃索美拉唑（40 毫克，每天两次）和次枸橼酸铋（240 毫克，每天三次）治疗，但 A 组（750 毫克）和 B 组（1000 毫克）的阿莫西林剂量不同，每天三次。治疗后对治疗依从性和副作用进行了评估，8 周后，大便幽门螺杆菌抗原检测阴性证实根除了幽门螺杆菌：结果：两组患者的性别和年龄相当。根据意向治疗分析，A 组和 B 组的根除率分别为 80%（95% CI：77.2%-82.8%）和 90%（95% CI：84.1%-95.9%）（P = 0.22）。按协议根除率分别为 87%（95% CI：80.4%-93.6%）和 92.8%（95% CI：87.7%-97.9%）（P = 0.23）。严重不良反应分别为3%和2%（P = 0.34）：结论：在一个耐药性背景率较高的国家，大剂量埃索美拉唑、阿莫西林和铋剂按方案治疗的治愈率达到 92.8%。还需要进行更多的研究，以确定这种疗法能否得到进一步改进。在此之前，可以建议伊朗北部地区将其作为根除幽门螺杆菌的一线疗法。

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引用次数: 0

Comparison between the GastroPanel test and the serum pepsinogen assay interpreted with the ABC method—A prospective study GastroPanel 检测法与用 ABC 法解读的血清胃蛋白酶原检测法之间的比较--一项前瞻性研究。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-25 DOI: 10.1111/hel.13056

Sun-Young Lee, Yeon-Sun Ahn, Hee-Won Moon

Background and Aims

This study aimed to validate Helicobacter pylori serological and pepsinogen (PG) assays for detecting infection and gastric neoplasm.

Methods

Individuals who underwent serum Chorus H. pylori and HBI PG assays were included from May to September 2023. The GastroPanel test was performed using the same blood sample. HBI assay findings were interpreted with the ABC method using the criteria of corpus atrophy (PG I ≤ 70 ng/mL & I/II ≤3) and advanced corpus atrophy (PG I ≤ 30 ng/mL & I/II ≤2).

Results

A total of 144 H. pylori-infected and 184 non-infected Koreans were analyzed. The Chorus test (sensitivity 97.2%, specificity 89.1%) showed higher area under the curve (0.993 vs. 0.972, p = 0.003) than the GastroPanel test (sensitivity 95.8%, specificity 86.4%). Using the GastroSoft application, the incidence of gastric neoplasms was highest in the corpus atrophy group (50%), followed by the low acid-output (25.8%), H. pylori infection (11.6%), and antral atrophy (9.1%) groups. There were no gastric neoplasms in the normal and high acid output groups. Using the ABC method, the incidence of gastric neoplasms was highest in the corpus atrophy groups (23.8% in Groups C and D), followed by Group B (12.3%) and Group A (2.4%). Corpus atrophy interpreted with the GastroSoft showed poor agreement (k = 0.225) with corpus atrophy interpreted with the ABC method, whereas it showed excellent agreement (k = 0.854) with advanced corpus atrophy.

Conclusions

Although the Chorus test was more accurate than the GastroPanel test, both assays discriminated high-risk individuals by detecting atrophy or infection. There were no gastric neoplasms in the normal or high acid-output groups (GastroSoft application), and gastric neoplasm incidence was lowest in Group A (ABC method). Corpus atrophy determined by GastroSoft application is more consistent with advanced corpus atrophy determined by the ABC method than is corpus atrophy.

背景与目的本研究旨在验证幽门螺杆菌血清学和胃蛋白酶原（PG）测定在检测感染和胃肿瘤方面的有效性：方法：纳入 2023 年 5 月至 9 月期间接受血清 Chorus 幽门螺杆菌和 HBI PG 检测的个人。GastroPanel 检测使用相同的血液样本。HBI检测结果采用ABC法，以胃体萎缩（PG I≤70纳克/毫升，I/II≤3）和晚期胃体萎缩（PG I≤30纳克/毫升，I/II≤2）为标准进行解释：结果：共分析了144名感染幽门螺杆菌的韩国人和184名未感染的韩国人。Chorus 检验（灵敏度 97.2%，特异性 89.1%）比 GastroPanel 检验（灵敏度 95.8%，特异性 86.4%）显示出更高的曲线下面积（0.993 vs. 0.972，p = 0.003）。使用 GastroSoft 应用程序，胃体萎缩组的胃肿瘤发病率最高（50%），其次是低酸输出组（25.8%）、幽门螺杆菌感染组（11.6%）和前胃萎缩组（9.1%）。正常胃酸分泌组和高胃酸分泌组没有胃肿瘤。采用 ABC 法，胃体萎缩组的胃肿瘤发病率最高（C 组和 D 组为 23.8%），其次是 B 组（12.3%）和 A 组（2.4%）。用GastroSoft解读的胃体萎缩与用ABC法解读的胃体萎缩的一致性较差（k = 0.225），而与晚期胃体萎缩的一致性极佳（k = 0.854）：结论：虽然 Chorus 检验比 GastroPanel 检验更准确，但两种检验都能通过检测萎缩或感染来区分高危人群。正常组和高胃酸排出组（GastroSoft 应用程序）都没有胃肿瘤，A 组（ABC 方法）的胃肿瘤发病率最低。与胃体萎缩相比，GastroSoft 应用程序确定的胃体萎缩与 ABC 方法确定的晚期胃体萎缩更为一致。

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引用次数: 0

Helicobacter pylori antigens as immunomodulators of immune system 幽门螺杆菌抗原作为免疫系统的免疫调节剂。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-21 DOI: 10.1111/hel.13058

Zeynab Marzhoseyni, Mohammad Javad Mousavi, Somayeh Ghotloo

Helicobacter pylori (H. pylori) is one of the most prevalent human pathogens and the leading cause of chronic infection in almost half of the population in the world (~59%). The bacterium is a major leading cause of chronic gastritis, gastric and duodenal ulcers, and two type of malignancies, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. Despite the immune responses mounted by the host, the bacteria are not cleared from the body resulting in a chronic infection accompanied by a chronic inflammation. Herein, a review of the literature discussing H. pylori antigens modulating the immune responses is presented. The mechanisms that are involved in the modulation of innate immune response, include modulation of recognition by pattern recognition receptors (PRRs) such as modulation of recognition by toll like receptors (TLR)4 and TLR5, modulation of phagocytic function, and modulation of phagocytic killing mediated by reactive oxygen species (ROS) and nitric oxide (NO). On the other hands, H. pylori modulates acquired immune response by the induction of tolerogenic dendritic cells (DCs), modulation of apoptosis, induction of regulatory T cells, modulation of T helper (Th)1 response, and modulation of Th17 response.

幽门螺杆菌（H. pylori）是最普遍的人类病原体之一，也是导致全球近一半人口（约占 59%）慢性感染的主要原因。幽门螺杆菌是慢性胃炎、胃和十二指肠溃疡以及两种恶性肿瘤（胃腺癌和粘膜相关淋巴组织（MALT）淋巴瘤）的主要致病菌。尽管宿主做出了免疫反应，但细菌并没有被清除出体外，导致慢性感染和慢性炎症。本文回顾了有关幽门螺杆菌抗原调节免疫反应的文献。先天性免疫反应的调节机制包括模式识别受体（PRR）的识别调节，如类毒素受体（TLR）4 和 TLR5 的识别调节、吞噬功能调节、活性氧（ROS）和一氧化氮（NO）介导的吞噬杀伤调节。另一方面，幽门螺杆菌通过诱导产生耐受性的树突状细胞（DCs）、调节细胞凋亡、诱导调节性 T 细胞、调节 T 辅助细胞（Th）1 反应和调节 Th17 反应来调节获得性免疫反应。

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引用次数: 0

Eradication rate and adherence with high-dose amoxicillin and proton pump inhibitor as first-line treatment for Helicobacter pylori infection: Experience from University Hospital in Chile 大剂量阿莫西林和质子泵抑制剂作为幽门螺旋杆菌感染一线治疗的根除率和依从性：智利大学医院的经验。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-08 DOI: 10.1111/hel.13052

Christian von Muhlenbrock, Andrea Cordova, Paulina Nuñez, Nicole Pacheco, Karin Herrera, Rodrigo Quera

Introduction

In Chile, more than 70% of adults are infected by Helicobacter pylori. Clarithromycin should not be used in any regimen if there is >15% resistance to this antibiotic, being greater than 26% in our population. In this scenario, the effectiveness of triple therapy (proton pump inhibitor [PPI], clarithromycin, amoxicillin) was only 63.8%.

Aim

To evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study.

Methods

Patients with a positive urease test obtained in an upper digestive endoscopy were included. Any other previous H. pylori eradication regimen were excluded. All patients were treated with esomeprazole 40 mg three times a day and amoxicillin 750 mg four times a day for 14 days. The eradication rate of the dual therapy was evaluated with the H. pylori stool antigen test (the Pylori-Strip® test used) 6 weeks after completing the eradication treatment and with at least 14 days without PPI, being a negative result, confirmation of the effectiveness of this regimen.

Results

Of 122 patients, 106 had a negative H. pylori antigen in stool; The intention-to-treat and per protocol analysis, the eradication rates were 91.8% [95% CI: 87%–97%] and 94% [95% CI: 90%–98%], respectively. Four patients discontinued treatment due to adverse effects. Smoking and adherence to treatment were associated with eradication rate.

Conclusions

In this cohort of patients with H. pylori infection, high-dose dual therapy has a high eradication rate and good adherence, raising the possibility that it could be used as first-line therapy in our country. Studies with a larger number of patients should confirm these results.

简介在智利，70%以上的成年人感染幽门螺旋杆菌。如果对克拉霉素的耐药性大于 15%（在我国人群中大于 26%），则任何治疗方案都不应使用该抗生素。在这种情况下，三联疗法（质子泵抑制剂[PPI]、克拉霉素、阿莫西林）的有效率仅为 63.8%。目的：通过一项前瞻性、观察性和描述性研究，评估大剂量双重疗法（埃索美拉唑和阿莫西林）的根除率和安全性：方法：纳入在上消化道内窥镜检查中尿素酶检测呈阳性的患者。方法：纳入上消化道内镜检查中尿素酶检测呈阳性的患者，不包括之前使用过任何其他幽门螺杆菌根除疗法的患者。所有患者均接受埃索美拉唑 40 毫克、一天三次和阿莫西林 750 毫克、一天四次的治疗，共 14 天。在完成根除治疗 6 周后，通过幽门螺杆菌粪便抗原检测（使用的是 Pylori-Strip®检测试剂盒）评估双重疗法的根除率，如果检测结果为阴性，则证明该疗法有效：在122名患者中，106名患者的粪便中幽门螺杆菌抗原呈阴性；根据意向治疗和方案分析，根除率分别为91.8% [95% CI：87%-97%] 和94% [95% CI：90%-98%]。有四名患者因不良反应而中断治疗。吸烟和坚持治疗与根除率有关：在这批幽门螺杆菌感染患者中，大剂量双重疗法的根除率高且依从性好，因此有可能在我国用作一线疗法。对更多患者进行的研究应能证实这些结果。

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引用次数: 0

Helicobacter hepaticus and Helicobacter bilis in liver and biliary cancers from ATBC and PLCO 来自 ATBC 和 PLCO 的肝癌和胆道癌中的肝螺旋杆菌和胆螺旋杆菌。

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-08 DOI: 10.1111/hel.13053

Gwen Murphy, Neal D. Freedman, Christian C. Abnet, Demetrius Albanes, Amanda J. Cross, Wen-Yi Huang, Jill Koshiol, Katherine McGlynn, Dominick Parisi, Satu Männistö, Stephanie J. Weinstein, Tim Waterboer, Julia Butt

Background

Helicobacter species (spp.) have been detected in human bile and hepatobiliary tissue Helicobacter spp. promote gallstone formation and hepatobiliary tumors in laboratory studies, though it remains unclear whether Helicobacter spp. contribute to these cancers in humans. We used a multiplex panel to assess whether seropositivity to Helicobacter (H.) hepaticus or H. bilis proteins was associated with the development of hepatobiliary cancers in the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, and US-based Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).

Methods

We included 62 biliary and 121 liver cancers, and 190 age-matched controls from ATBC and 74 biliary and 105 liver cancers, and 364 age- and sex-matched controls from PLCO. Seropositivity to 14 H. hepaticus and H. bilis antigens was measured using a multiplex assay. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for major hepatobiliary cancer risk factors and Helicobacter pylori serostatus.

Results

Seropositivity to the H. bilis antigen, P167D, was associated with more than a twofold higher risk of liver cancer (OR: 2.38; 95% CI: 1.06, 5.36) and seropositivity to the H. hepaticus antigens HH0407 or HH1201, or H. bilis antigen, HRAG 01470 were associated with higher risk of biliary cancer (OR: 5.01; 95% CI: 1.53, 16.40; OR: 2.40; 95% CI: 1.00, 5.76; OR: 3.27; 95% CI: 1.14, 9.34, respectively) within PLCO. No associations for any of the H. hepaticus or H. bilis antigens were noted for liver or biliary cancers within ATBC.

Conclusions

Further investigations in cohort studies should examine the role of Helicobacter spp. in the etiology of liver and biliary cancers.

背景：在实验室研究中，螺旋杆菌可促进胆石形成和肝胆肿瘤，但目前仍不清楚螺旋杆菌是否会导致人类患上这些癌症。我们使用多重检测组来评估在芬兰α-生育酚、β-胡萝卜素癌症预防（ATBC）研究和美国前列腺癌、肺癌、结肠直肠癌和卵巢癌筛查试验（PLCO）中，肝脏螺旋杆菌或胆汁螺旋杆菌蛋白血清阳性是否与肝胆癌的发生有关：我们纳入了ATBC研究中的62例胆道癌和121例肝癌，以及190例年龄匹配的对照组；PLCO研究中的74例胆道癌和105例肝癌，以及364例年龄和性别匹配的对照组。使用多重检测法测量了14种肝吸虫和胆吸虫抗原的血清阳性率。根据主要肝胆癌风险因素和幽门螺杆菌血清状态调整了比值比（OR）和 95% 置信区间（CI）：结果：幽门螺杆菌抗原 P167D 血清阳性与肝癌风险高出两倍多有关（OR：2.38；95% CI：1.06，5.36），而幽门螺杆菌抗原 H. P167D 血清阳性与肝癌风险高出两倍多有关（OR：2.38；95% CI：1.06，5.36）。肝抗原 HH0407 或 HH1201 或胆管癌抗原 HRAG 01470 血清阳性与胆管癌风险较高有关（OR：5.01；95% CI：1.53，16.40；OR：2.40；95% CI：1.00，5.76；OR：3.27；95% CI：1.14，9.34）。在ATBC中，肝癌或胆道癌与任何肝癌或胆道癌抗原均无关联：结论：应在队列研究中进一步探讨螺旋杆菌在肝癌和胆道癌病因中的作用。

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引用次数: 0

Comparative analysis of large language models in medical counseling: A focus on Helicobacter pylori infection 医疗咨询中大语言模型的比较分析：聚焦幽门螺旋杆菌感染

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-06 DOI: 10.1111/hel.13055

Qing-Zhou Kong, Kun-Ping Ju, Meng Wan, Jing Liu, Xiao-Qi Wu, Yue-Yue Li, Xiu-Li Zuo, Yan-Qing Li

Background

Large language models (LLMs) are promising medical counseling tools, but the reliability of responses remains unclear. We aimed to assess the feasibility of three popular LLMs as counseling tools for Helicobacter pylori infection in different counseling languages.

Materials and Methods

This study was conducted between November 20 and December 1, 2023. Three large language models (ChatGPT 4.0 [LLM1], ChatGPT 3.5 [LLM2], and ERNIE Bot 4.0 [LLM3]) were input 15 H. pylori related questions each, once in English and once in Chinese. Each chat was conducted using the “New Chat” function to avoid bias from correlation interference. Responses were recorded and blindly assigned to three reviewers for scoring on three established Likert scales: accuracy (ranged 1–6 point), completeness (ranged 1–3 point), and comprehensibility (ranged 1–3 point). The acceptable thresholds for the scales were set at a minimum of 4, 2, and 2, respectively. Final various source and interlanguage comparisons were made.

Results

The overall mean (SD) accuracy score was 4.80 (1.02), while 1.82 (0.78) for completeness score and 2.90 (0.36) for comprehensibility score. The acceptable proportions for the accuracy, completeness, and comprehensibility of the responses were 90%, 45.6%, and 100%, respectively. The acceptable proportion of overall completeness score for English responses was better than for Chinese responses (p = 0.034). For accuracy, the English responses of LLM3 were better than the Chinese responses (p = 0.0055). As for completeness, the English responses of LLM1 was better than the Chinese responses (p = 0.0257). For comprehensibility, the English responses of LLM1 was better than the Chinese responses (p = 0.0496). No differences were found between the various LLMs.

Conclusions

The LLMs responded satisfactorily to questions related to H. pylori infection. But further improving completeness and reliability, along with considering language nuances, is crucial for optimizing overall performance.

背景大语言模型（LLM）是一种很有前途的医疗咨询工具，但其反应的可靠性仍不清楚。我们旨在评估三种流行的大语言模型作为幽门螺旋杆菌感染咨询工具在不同咨询语言中的可行性。材料与方法本研究于 2023 年 11 月 20 日至 12 月 1 日进行。三个大型语言模型（ChatGPT 4.0 [LLM1]、ChatGPT 3.5 [LLM2]和ERNIE Bot 4.0 [LLM3]）各输入了15个幽门螺杆菌相关问题，一次为英文，一次为中文。每次聊天都使用 "新建聊天 "功能，以避免相关性干扰造成的偏差。对回答进行记录，并将其盲法分配给三位审阅者，由他们按照三个既定的李克特量表进行评分：准确性（1-6 分不等）、完整性（1-3 分不等）和可理解性（1-3 分不等）。量表的可接受临界值分别定为最低 4 分、2 分和 2 分。最后进行了各种源语言和跨语言比较。结果准确性总平均分（标清）为 4.80（1.02），完整性总平均分（标清）为 1.82（0.78），可理解性总平均分（标清）为 2.90（0.36）。回答的准确性、完整性和可理解性的可接受比例分别为 90%、45.6% 和 100%。英文答卷的整体完整性可接受比例优于中文答卷（p = 0.034）。在准确性方面，LLM3 的英文答卷优于中文答卷（p = 0.0055）。在完整性方面，LLM1 的英文答案优于中文答案（p = 0.0257）。在可理解性方面，LLM1 的英文答案优于中文答案 (p = 0.0496)。不同的本地语文教师之间没有差异。结论 LLMs 对幽门螺杆菌感染相关问题的回答令人满意。但是，进一步提高完整性和可靠性，同时考虑语言的细微差别，对于优化整体性能至关重要。

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引用次数: 0

Low-dose or high-dose amoxicillin in vonoprazan-based dual therapy for Helicobacter pylori eradication? A systematic review and meta-analysis 在基于冯诺普拉赞的根除幽门螺杆菌双重疗法中使用小剂量阿莫西林还是大剂量阿莫西林？系统回顾和荟萃分析

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-02-05 DOI: 10.1111/hel.13054

Kun-Ping Ju, Qing-Zhou Kong, Yue-Yue Li, Yan-Qing Li

Background

The amoxicillin dose used in dual therapy to eradicate Helicobacter pylori varies across studies and the optimal amoxicillin dose for vonoprazan-based dual therapies remains unclear. We aimed to investigate the efficacy and safety of low- and high-dose amoxicillin in vonoprazan–amoxicillin dual therapy.

Materials and Methods

A comprehensive systematic review was conducted by searching databases from inception to October 2023. All trials that evaluated the effectiveness and safety of vonoprazan–amoxicillin dual therapy for eradicating H. pylori were included. Pooled eradication rate, incidence of adverse events, relative risks, and 95% confidence intervals are presented.

Results

Eighteen studies with 12 low-dose amoxicillin (VLA) and 13 high-dose amoxicillin (VHA) arms were included. The pooled eradication rates were 82.4% and 86.8% for VLA therapy, and 86.0% and 90.9% for VHA therapy by the intention-to-treat and per-protocol analyses, respectively. In the subgroup analysis stratified by duration, the eradication rates achieved in 7 days, 10 days, and 14 days treatments with VLA and VHA dual therapies were 80.8%, 84.2%, 83.1%, and 67.3%, 88.8%, 87.5%, respectively. In the four randomized controlled trials that directly compared VLA and VHA dual therapies, the efficacy was not statistically different in the intention-to-treat (76.9% vs 81.4%, p = 0.337) and per-protocol (81.6% vs 84.0%, p = 0.166) analyses. Additionally, the incidence of adverse events (p = 0.965) and compliance (p = 0.994) were similar in both groups.

Conclusion

VLA therapy demonstrated comparable efficacy and safety to VHA therapy, along with regional differences. An appropriately extended treatment duration may be critical for therapeutic optimization of vonoprazan–amoxicillin treatment.

背景在根除幽门螺旋杆菌的双重疗法中，不同研究采用的阿莫西林剂量各不相同，而基于冯诺普拉赞的双重疗法的最佳阿莫西林剂量仍不明确。我们旨在研究低剂量和高剂量阿莫西林在冯诺普拉赞-阿莫西林双重疗法中的疗效和安全性。材料与方法通过检索从开始到 2023 年 10 月的数据库，我们进行了一项全面的系统综述。纳入了所有评价过伏诺普拉赞-阿莫西林双重疗法根除幽门螺杆菌的有效性和安全性的试验。本文列出了汇总的根除率、不良事件发生率、相对风险和 95% 置信区间。结果共纳入了 18 项研究，其中 12 项为低剂量阿莫西林（VLA），13 项为高剂量阿莫西林（VHA）。通过意向治疗分析和按方案分析，VLA疗法的总根除率分别为82.4%和86.8%，VHA疗法的总根除率分别为86.0%和90.9%。在按疗程分层的亚组分析中，使用VLA和VHA双重疗法进行7天、10天和14天治疗的根除率分别为80.8%、84.2%和83.1%，以及67.3%、88.8%和87.5%。在直接比较VLA和VHA双重疗法的四项随机对照试验中，意向治疗分析（76.9% vs 81.4%，P = 0.337）和按方案分析（81.6% vs 84.0%，P = 0.166）的疗效无统计学差异。此外，两组的不良事件发生率（p = 0.965）和依从性（p = 0.994）相似。结论 VLA疗法的疗效和安全性与VHA疗法相当，但存在地区差异。适当延长治疗时间可能是优化冯诺普拉唑-阿莫西林治疗的关键。

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引用次数: 0

Machine learning models in predicting failure of Helicobacter pylori treatment: A two country validation study 预测幽门螺杆菌治疗失败的机器学习模型：两国验证研究

IF 4.4 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-01-25 DOI: 10.1111/hel.13051

Fang Jiang, Thomas K. L. Lui, Chengsheng Ju, Chuan-Guo Guo, Ka Shing Cheung, Wallis C. Y. Lau, Wai K. Leung

Background

The success rate of clarithromycin-containing Helicobacter pylori treatment had declined globally. This study aims to explore the role of different machine learning algorithms in predicting failure of H. pylori treatment.

Materials and Methods

We included 84,609 adult patients who had received the first course of clarithromycin-containing triple therapy for H. pylori in Hong Kong from 2003 to 2013 as training set. Results were validated in patients who had received similar triple therapy with 27,736 Hong Kong patients between 2014 and 2017 (internal cohort); and 18,050 UK patients between 2012 and 2017 (external cohort). The performance of 11 available machine learning algorithms were used to predict the failure of triple therapy. The performance was determined by the area under receiver operating characteristic curve (AUC).

Results

The treatment failure rates in the training, internal and external validation cohort was 5.9%, 9.5%, and 6.1%, respectively. In the internal validation set, Extra-Tree (ET) Classifier had the best AUC (0.88; 95% CI, 0.87–0.88), sensitivity (79.6%; 95% CI, 79.0–80.2) and specificity (79.4%; 95% CI, 79.0–79.8). In the external validation set, ET Classifier also had the best AUC (0.85; 95% CI, 0.85–0.86), sensitivity (80.1%; 95% CI, 79.5–80.9), and specificity (80.2%; 95% CI, 78.8–81.3). Top features of importance used by ET Classifier in predicting treatment failure included time interval between antibiotic use and triple therapy (48.8%), age (29.1%) and triple therapy regime (6.28%).

Conclusions

Machine learning algorithm, based on simple baseline clinical parameters, could help to identify patients at high risk of failure from clarithromycin-containing triple therapy for H. pylori.

在全球范围内，含克拉霉素幽门螺杆菌治疗的成功率有所下降。本研究旨在探索不同的机器学习算法在预测幽门螺杆菌治疗失败中的作用。

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引用次数: 0