Helicobacter最新文献_第10页

Improvement in Helicobacter pylori Eradication Among Adults Receiving Semaglutide: A Population-Based Propensity-Score-Adjusted Analysis 接受西马鲁肽的成人幽门螺杆菌根除的改善：基于人群的倾向评分调整分析

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2025-02-04 DOI: 10.1111/hel.70014

Asaf Ness, Zohar Levi, Rachel Gingold Belfer, Ram Dickman, Doron Boltin

Background

Glucagon-like peptide-1 (GLP-1) receptor agonists delay gastric emptying and are used for the treatment of diabetes (DM) and obesity. Successful treatment of Helicobacter pylori (H. pylori) infection depends upon a precise dosing schedule. We aimed to examine the impact of GLP-1 drugs on antibiotic treatment for H. pylori.

Methods

Adults with a new diagnosis of H. pylori infection who received treatment between 2014 and 2023 were identified in the Clalit Health Services database. Subjects were divided into groups based on diagnoses of DM and obesity, and exposure to GLP-1 drugs. A 1:2 propensity-score matched dataset was used to determine the effect of GLP-1 drugs on eradication success.

Results

We identified 426 individuals who received, and 36,436 who did not receive GLP-1 drugs. Eradication among those who did and did not receive GLP-1 drugs was 86.6% and 83.7%, respectively (p = 0.059 across subgroups). Eradication among those who received semaglutide was 93.8% (OR 2.78, 95% CI 1.32–5.83, p = 0.007). Eradication in subjects who received dulaglutide (88.6%) or liraglutide (81.4%) was not significantly changed. When applying a propensity-score-adjusted analysis, eradication remained significantly increased among individuals who received semaglutide (OR 2.89, 95% CI 1.24–6.74, p = 0.014). Additional independent predictors of successful eradication included male sex, high socioeconomic status, quadruple therapy, and older age (p < 0.001 for all).

Conclusions

Co-administration of semaglutide and antibiotics for H. pylori infection is associated with an increased likelihood of successful eradication.

胰高血糖素样肽-1 （GLP-1）受体激动剂可延迟胃排空，用于治疗糖尿病（DM）和肥胖。幽门螺杆菌感染的成功治疗取决于精确的给药计划。我们的目的是研究GLP-1药物对幽门螺杆菌抗生素治疗的影响。方法在Clalit Health Services数据库中筛选2014 - 2023年间接受治疗的新诊断为幽门螺杆菌感染的成人。根据糖尿病和肥胖的诊断以及GLP-1药物的暴露程度，将受试者分为不同的组。使用1:2倾向评分匹配数据集来确定GLP-1药物对根除成功的影响。结果426人接受GLP-1药物治疗，36436人未接受GLP-1药物治疗。接受GLP-1药物治疗和未接受GLP-1药物治疗的根除率分别为86.6%和83.7%（亚组间p = 0.059）。接受西马鲁肽治疗的患者根除率为93.8% （OR 2.78, 95% CI 1.32-5.83, p = 0.007）。接受杜拉鲁肽（88.6%）或利拉鲁肽（81.4%）治疗的受试者根除率无显著变化。当应用倾向评分校正分析时，接受西马鲁肽的个体根除率仍然显著增加（OR 2.89, 95% CI 1.24-6.74, p = 0.014）。成功根除的其他独立预测因素包括男性、高社会经济地位、四联疗法和年龄较大（所有p <； 0.001）。结论：西马鲁肽联合抗生素治疗幽门螺杆菌感染与成功根除的可能性增加有关。

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引用次数: 0

Efficacy of Rifabutin-Based Helicobacter pylori Eradication Regimen in Korea With High Prevalence of Tuberculosis Infection 以利福布汀为基础的幽门螺杆菌根除方案在韩国肺结核高发人群中的疗效

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2025-02-04 DOI: 10.1111/hel.70011

Yuri Kim, Jeong Hoon Lee, Hee Kyong Na, Kee Wook Jung, Ji Yong Ahn, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung

Background

As the antibiotic resistance and treatment failure rates of Helicobacter pylori are rising, the need for rescue therapy with rifabutin for H. pylori eradication (HPE) is also increasing. Therefore, in this study, we investigated the efficacy, resistance status, and adverse events in patients receiving rifabutin-based HPE.

Materials and Methods

Between January 2020 and December 2022, 3006 patients underwent esophagogastroduodenoscopy (EGD) with H. pylori culture tests. Of these, culture results were successfully obtained from 1792 patients, who were subsequently enrolled in our study. The medical records of these patients were retrospectively reviewed, and their clinical features and outcomes assessed.

Results

Among the 1792 patients, 14 (0.8%) were rifabutin-resistant. A total of 665 (37.1%) patients had multidrug-resistant (MDR) H. pylori infections. Patients with rifabutin-resistant H. pylori infections had a significantly higher rate of tuberculosis treatment history (2.8% vs. 28.6%, p < 0.001) and MDR H. pylori infections (49.6% vs. 85.7%, p < 0.001) than those in the rifabutin-susceptible H. pylori group. Among the 45 patients who received the rifabutin-based HPE regimen, 44 (97.8%) had MDR H. pylori infection, and 35 (77.8%) underwent rifabutin-based HPE as a third-line treatment or beyond. A total of 31 (68.9%) showed successful eradication. Nineteen (42.2%) patients experienced at least one symptom of adverse events; however, the severity of side effects was mild, and no patient discontinued treatment because of this.

Conclusions

The rifabutin-based HPE regimen could be an effective and safe treatment method. It is particularly considered a viable therapeutic option for patients who require HPE but have previously failed to respond to multiple HPEs.

背景随着幽门螺杆菌耐药性和治疗失败率的上升，利法布汀对幽门螺杆菌根除（HPE）的抢救治疗需求也在增加。因此，在本研究中，我们调查了接受利法布汀类HPE的患者的疗效、耐药状况和不良事件。材料和方法在2020年1月至2022年12月期间，3006例患者接受了食管胃十二指肠镜检查（EGD）并进行了幽门螺旋杆菌培养试验。其中，成功获得了1792例患者的培养结果，这些患者随后被纳入我们的研究。回顾性回顾了这些患者的医疗记录，并评估了他们的临床特征和预后。结果1792例患者中，14例（0.8%）出现利法布汀耐药。665例（37.1%）患者存在多药耐药（MDR）幽门螺杆菌感染。耐利法布丁幽门螺杆菌感染患者的结核病治疗史（2.8%比28.6%,p < 0.001）和耐多药幽门螺杆菌感染（49.6%比85.7%,p < 0.001）均显著高于利法布丁敏感幽门螺杆菌组。在45名接受利法布汀HPE方案的患者中，44名（97.8%）患有耐多药幽门螺杆菌感染，35名（77.8%）接受了利法布汀HPE作为三线或以上治疗。31例（68.9%）成功根除。19例（42.2%）患者出现至少一种不良事件症状；然而，副作用的严重程度是轻微的，没有患者因此停止治疗。结论以利法布汀为基础的HPE方案是一种安全有效的治疗方法。对于需要HPE但先前多次HPE无效的患者，它被认为是一种可行的治疗选择。

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引用次数: 0

Managing Helicobacter pylori as an Infectious Disease: Implementation of Antimicrobial Stewardship 管理幽门螺杆菌作为一种传染病：抗菌药物管理的实施。

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2025-02-03 DOI: 10.1111/hel.70013

Jen-Yu Hsu, Un-In Wu, Jann-Tay Wang, Wang-Huei Sheng, Yee-Chun Chen, Shan-Chwen Chang

Helicobacter pylori is prevalent globally and implicated in various gastric diseases and malignancies. Rising antibiotic resistance has increasingly compromised the effectiveness of standard H. pylori eradication therapies. This review explores the role of antimicrobial stewardship (AMS) as a structured approach to optimizing H. pylori management through the “5D” strategy: Diagnosis—utilizing advanced diagnostic tools to accurately detect bacterial resistance; Drug—selecting antibiotics tailored to resistance profiles and patient-specific factors; Dosage—optimizing dosing and frequency based on pharmacokinetic properties to maximize efficacy; Duration—employing shorter treatment courses where supported by evidence; and Discontinuation—balancing the benefits and risks of repeated antibiotic treatments. We discuss recent advances in diagnostic technologies, such as polymerase chain reaction and next-generation sequencing, and their impact on therapeutic decision-making. Additionally, we evaluate treatment regimens, with a particular focus on emerging alternatives such as regimens containing potassium-competitive acid blockers. Given the growing global resistance and limited pipeline for new antibiotics, we advocate for a more strategic and resource-conscious approach to H. pylori management, integrating AMS principles within the “One Health” framework to address the pathogen's transmission across humans, animals, and the environment. With advancements in resistance testing and diagnostics, H. pylori therapies are likely to become increasingly personalized and precise. To achieve this, effective AMS implementation necessitates interdisciplinary collaboration to maximize therapeutic outcomes, minimize adverse effects, combat resistance, and reduce healthcare costs.

幽门螺杆菌在全球范围内普遍存在，与各种胃疾病和恶性肿瘤有关。不断上升的抗生素耐药性已经越来越危及标准的幽门螺杆菌根除疗法的有效性。这篇综述探讨了抗菌药物管理（AMS）作为通过“5D”策略优化幽门螺杆菌管理的结构化方法的作用：诊断-利用先进的诊断工具准确检测细菌耐药性；根据耐药概况和患者特异性因素量身定制的药物选择抗生素；基于药代动力学特性的剂量优化剂量和频率，以最大限度地提高疗效；在有证据支持的情况下，采用较短的疗程；停药——平衡重复抗生素治疗的益处和风险。我们讨论了诊断技术的最新进展，如聚合酶链反应和下一代测序，以及它们对治疗决策的影响。此外，我们评估治疗方案，特别关注新兴的替代方案，如含有钾竞争酸阻滞剂的方案。鉴于全球耐药性日益增长，新抗生素开发渠道有限，我们提倡对幽门螺杆菌的管理采取更具战略性和资源意识的方法，将AMS原则纳入“同一个健康”框架，以解决病原体在人类、动物和环境中的传播问题。随着耐药检测和诊断的进步，幽门螺杆菌治疗可能变得越来越个性化和精确。为了实现这一目标，有效的AMS实施需要跨学科合作，以最大限度地提高治疗效果，最大限度地减少不良反应，对抗耐药性，并降低医疗成本。

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引用次数: 0

Should Metronidazole Be Included in Second-Line Treatment After Standard Triple Therapy for Helicobacter pylori?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 幽门螺杆菌标准三联治疗后，甲硝唑是否应纳入二线治疗？随机对照试验的系统回顾和荟萃分析。

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2025-01-27 DOI: 10.1111/hel.70010

Hideki Mori, Toshihiro Nishizawa, Kohei Morioka, Motohiko Kato, Takanori Kanai

Background and Aim

Although standard triple therapy remains the first-line eradication treatment for H. pylori worldwide, it is unclear whether metronidazole should be included empirically in second-line eradication treatments. The aim of this study was to compare the efficacy of metronidazole-containing regimens with that of metronidazole-free regimens after failure of first-line eradication using standard triple therapy.

Methods

PubMed, the Cochrane Library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in this systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results

Thirteen eligible RCTs were included, with a total of 2039 patients assigned to metronidazole-containing (975 patients) or metronidazole-free (1064 patients) regimens. Metronidazole-containing regimens had significantly lower eradication failure rates than regimens without metronidazole (OR 0.55; 95% CI, 0.39–0.78). Subgroup analysis based on the regional risk of metronidazole resistance demonstrated that metronidazole-containing regimens had lower eradication failure rates not only in low-risk regions but also in high-risk regions (OR, 0.29; 95% CI, 0.11–0.74 and OR, 0.66; 95% CI, 0.49–0.91, respectively).

Conclusion

After failure of standard triple therapy, secondary eradication treatment regimens containing metronidazole demonstrate higher eradication rates than those without metronidazole.

背景和目的：虽然标准三联疗法仍然是世界范围内根除幽门螺杆菌的一线治疗方法，但目前尚不清楚甲硝唑是否应该纳入二线根除治疗。本研究的目的是比较使用标准三联疗法在一线根除失败后，含甲硝唑方案与不含甲硝唑方案的疗效。方法：检索PubMed、Cochrane图书馆和Igaku-Chuo-Zasshi数据库，以确定符合纳入本系统评价和荟萃分析的rct。计算95%置信区间（ci）的比值比（ORs）。结果：纳入13项符合条件的随机对照试验，共2039例患者被分配到含甲硝唑（975例）或不含甲硝唑（1064例）方案。含甲硝唑方案的根除失败率显著低于不含甲硝唑方案(OR 0.55；95% ci, 0.39-0.78)。基于甲硝唑耐药区域风险的亚组分析表明，含甲硝唑方案不仅在低风险地区，而且在高风险地区根除失败率更低(OR, 0.29；95% CI, 0.11-0.74， OR, 0.66；95% CI分别为0.49-0.91)。结论：在标准三联治疗失败后，含甲硝唑的二次根除治疗方案的根除率高于不含甲硝唑的治疗方案。

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引用次数: 0

Ethnic Inequity in the Current Approach to H. pylori Testing and Treatment: Linked Data Cohort Analysis 当前幽门螺杆菌检测和治疗方法中的种族不平等：相关数据队列分析。

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2025-01-10 DOI: 10.1111/hel.70005

Andrea Teng, Erin Hildred, James Stanley, Stephen Inns, Melissa McLeod

Background

As seen globally, there are up to sixfold differences in gastric cancer mortality by ethnicity in Aotearoa New Zealand, and H. pylori is the major modifiable risk factor. This study investigates whether current H. pylori testing and treatment approaches are equitable.

Materials and Methods

The study design was a retrospective cohort analysis of linked administrative health data. Laboratory testing data and pharmacy dispensing were linked to the Northern region health user population dataset (1.9 million) from 2015 to 2018. We investigated an individual's first test for H. pylori. Regression analyses compared ethnic differences in rates of H. pylori testing, infection, treatment, and retesting, adjusted for age, sex, and calendar year.

Results

Ethnic inequities were present across the clinical pathway. Compared to sole-European, testing rates were lowest in Māori (OR 0.69) and Pacific (OR 0.81) and highest in Middle-Eastern/Latin-American/African (MELAA) (OR 2.21) and Asian (OR 2.02). Positivity rates were highest in MELAA (RR 2.96, 39%) and Pacific (RR 2.84, 38%) followed by Asian (RR 1.93, 26%) and Māori (RR 1.71, 23%). Treatment rates were similar for Asian (HR 1.05), MELAA (HR 1.03), and Māori (HR 0.98) compared to sole-European but lower in Pacific (HR 0.90). Māori and Pacific were half as likely to be retested as sole-European.

Conclusions

Despite the higher prevalence of H. pylori and gastric cancer, Māori and Pacific are relatively underserved with lower rates of testing and treatment than sole-European. Improved guidelines and the consistent application of these along with an equity-focused test and treat program are likely to be particularly beneficial for Māori and Pacific in addressing inequities.

背景：从全球范围来看，新西兰Aotearoa地区不同种族的胃癌死亡率差异高达6倍，而幽门螺杆菌是主要的可改变的危险因素。本研究调查当前的幽门螺杆菌检测和治疗方法是否公平。材料和方法：研究设计是对相关行政卫生数据进行回顾性队列分析。2015年至2018年，实验室检测数据和药房配药与北部地区健康用户人口数据集（190万）相关联。我们调查了一个人的第一次幽门螺杆菌检测。回归分析比较了年龄、性别和日历年调整后的幽门螺杆菌检测、感染、治疗和再检测率的种族差异。结果：种族不平等在整个临床途径中都存在。与单一欧洲相比，Māori （OR 0.69）和太平洋（OR 0.81）的检测率最低，中东/拉丁美洲/非洲（MELAA）（OR 2.21）和亚洲（OR 2.02）的检测率最高。阳性率最高的是MELAA （RR 2.96, 39%）和太平洋（RR 2.84, 38%），其次是亚洲（RR 1.93, 26%）和Māori （RR 1.71, 23%）。与单一欧洲患者相比，亚洲患者（HR 1.05）、MELAA患者（HR 1.03）和Māori患者（HR 0.98）的治愈率相似，但太平洋患者较低（HR 0.90）。Māori和太平洋公司重新接受检测的可能性是纯欧洲公司的一半。结论：尽管幽门螺杆菌和胃癌的患病率较高，Māori和太平洋地区相对服务不足，检测和治疗率低于欧洲地区。改进指导方针并始终如一地应用这些指导方针以及侧重于公平的测试和治疗方案，可能特别有利于Māori和太平洋解决不公平问题。

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引用次数: 0

Combatting Helicobacter pylori: A Focus on Nanomaterials 对抗幽门螺杆菌：纳米材料的焦点。

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-12-26 DOI: 10.1111/hel.70004

Xuanping Wang, Xihui Felicia Chan, Yuyo Go, Yishen Wang, Tingyu Li, Gangshi Wang

Developing effective non-antibiotic antimicrobial strategies is essential for combating global antibiotic resistance, including resistance stemming from Helicobacter pylori (H. pylori) treatment. Nanomaterials offer a promising and innovative approach for non-antibiotic anti-H. pylori treatment strategies. This review highlights the progress made in the use of metallic and nonmetallic nanoparticles, as well as nanozymes, to directly inhibit H. pylori growth. Moreover, we summarize advances made in the direct targeting of H. pylori by nanomaterials and the stimuli-responsive release of nanoparticles in the stomach. Additionally, we explore the recent advancements in multifunctional nanoplatforms that integrate physical methods, such as light, heat, ultrasound, and magnetism, with nanomaterials to synergistically treat H. pylori infections. Finally, we briefly address the existing challenges and future directions in this field. In summary, we highlight that with ongoing research, nanomaterials may serve as a promising treatment strategy for H. pylori eradication.

制定有效的非抗生素抗微生物策略对于对抗全球抗生素耐药性至关重要，包括幽门螺杆菌治疗引起的耐药性。纳米材料为非抗生素抗h提供了一种有前途的创新方法。幽门螺杆菌治疗策略。本文综述了利用金属和非金属纳米颗粒以及纳米酶直接抑制幽门螺杆菌生长的进展。此外，我们还总结了纳米材料直接靶向幽门螺杆菌和纳米颗粒在胃中的刺激反应释放方面的进展。此外，我们还探索了多功能纳米平台的最新进展，该平台将光、热、超声和磁性等物理方法与纳米材料结合起来，协同治疗幽门螺杆菌感染。最后，简要介绍了该领域存在的挑战和未来的发展方向。总之，我们强调，随着正在进行的研究，纳米材料可能作为一种有前途的治疗策略根除幽门螺杆菌。

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引用次数: 0

Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis 补充乳酸杆菌根除幽门螺杆菌的功效：一项随机对照试验的系统荟萃分析。

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-12-25 DOI: 10.1111/hel.70006

Vivek Mishra, Debabrata Dash, Aditya K. Panda, Sushil Kumar Pathak

<div> <section> <h3> Background</h3> <p><i>Helicobacter pylori</i> infection is a major global health concern and has been associated with a number of gastrointestinal disorders. Probiotics, especially <i>Lactobacillus</i> spp., have been suggested to have beneficial effect in managing <i>H. pylori</i> infection. This meta-analysis of randomized control trials (RCTs) aimed to evaluate the effect of <i>Lactobacillus</i> spp. supplementation on <i>H. pylori</i> eradication rates and associated side effects when combined with standard therapy.</p> </section> <section> <h3> Materials and Methods</h3> <p>Relevant studies were retrieved from PubMed, Scopus, Google Scholar and the Cochrane Library. Comprehensive Meta-Analysis (CMA) Software 4.0 was used for all the statistical analyses. TSA 0.9.5.10 Beta software was used for the trial sequential analysis (TSA). GRADEpro GDT was used to assess the certainty of evidence.</p> </section> <section> <h3> Results</h3> <p>An analysis of 26 selected studies showed that supplementing with <i>Lactobacillus</i> spp. significantly increased the rates of <i>H. pylori</i> eradication in per-protocol (PP) analysis (Overall risk ratio [RR] = 1.063, <i>p</i> = 0.000, 95% CI of −0.21 to 2.11; adults: RR = 1.050, <i>p</i> = 0.005, 95% CI = −0.55 to 2.03, children: RR = 1.223, <i>p</i> = 0.001, 95% CI = −13.35 to 4.55). In comparison to quadruple therapy, <i>Lactobacillus</i> spp. supplementation to triple therapy showed significant benefit (RR: 1.124; <i>p</i> = 0.000, 95% CI of −0.48 to 2.61). <i>L. reuteri</i> supplementation indicated better efficacy (RR: 1.049; <i>p</i> = 0.055, 95% CI of −0.56 to 3.26) than <i>Lactobacillus</i> GG (RR: 0.980; <i>p</i> = 0.595, 95% CI of −0.69 to 1.21). The 28–30 day (RR: 1.103; <i>p</i> = 0.003, 95% CI of −2.14 to 4.19) and 14-day supplementation periods (RR: 1.102; p = 0.003, 95% CI of −1.69 to 3.51) showed the most improvement. The analysis also revealed that <i>Lactobacillus</i> spp. significantly reduced gastrointestinal side effects: nausea/vomiting (RR: 0.566; <i>p</i> = 0.037, −3.11 to 1.45), diarrhea (RR: 0.324; <i>p</i> = 0.000, −5.46 to 0.48), and abdominal pain (RR: 0.438; <i>p</i> = 0.007, −5.65 to 4.22). The effect on bloating was non-significant (RR: 0.820; <i>p</i> = 0.498, −4.01 to 0.96). TSA graphs validated sufficient evidence for the conclusions.</p> </section> <section> <h3> Conclusion</h3> <p><i>Lactobacillus</i> spp. significantly enhances <i>H. pylori</i> eradication rates and may reduce gastrointestinal side effects when used alongside standard therapy, offering a promising adjunctive treatment option. The evidence was supported by TSA and asse

背景：幽门螺杆菌感染是一个主要的全球健康问题，并与许多胃肠道疾病有关。益生菌，尤其是乳杆菌，被认为对控制幽门螺杆菌感染有有益的作用。这项随机对照试验（rct）的荟萃分析旨在评估补充乳酸杆菌与标准治疗联合使用时对幽门螺杆菌根除率和相关副作用的影响。材料和方法：相关研究检索自PubMed、Scopus、谷歌Scholar和Cochrane Library。采用综合meta分析软件4.0进行统计分析。采用TSA 0.9.5.10 Beta软件进行试验序列分析（TSA）。GRADEpro GDT用于评估证据的确定性。结果：对选定的26项研究的分析显示，在per-protocol （PP）分析中，添加乳酸杆菌可显著提高幽门螺杆菌根除率(总风险比[RR] = 1.063, p = 0.000, 95% CI为-0.21 ~ 2.11；成人:RR = 1.050, p = 0.005, 95% CI = -0.55至2.03,孩子:RR = 1.223, p = 0.001, 95% CI = -13.35 - 4.55)。与四联疗法相比，三联疗法中添加乳酸杆菌具有显著的益处(RR: 1.124；p = 0.000, 95% CI为-0.48 ~ 2.61)。补充罗伊氏乳杆菌效果更好(RR: 1.049；p = 0.055, 95% CI为-0.56 ~ 3.26)比乳酸菌GG (RR: 0.980；p = 0.595, 95% CI为-0.69 ~ 1.21)。28 ~ 30天(RR: 1.103；p = 0.003, 95% CI为-2.14 ~ 4.19)和14天的补充期(RR: 1.102；p = 0.003, 95% CI为-1.69 ~ 3.51)，改善最大。分析还显示，乳杆菌可显著减少胃肠道副作用：恶心/呕吐(RR: 0.566；p = 0.037, -3.11 ~ 1.45)，腹泻(RR: 0.324；p = 0.000, -5.46 ~ 0.48)，腹痛(RR: 0.438；P = 0.007, -5.65至4.22)。对腹胀无显著影响(RR: 0.820；P = 0.498, -4.01至0.96)。运输安全管理局的图表证实了结论的充分证据。结论：乳酸菌可显著提高幽门螺杆菌的根除率，并可减少胃肠道副作用，与标准治疗一起使用，是一种有希望的辅助治疗选择。这些证据得到了TSA的支持，并使用GRADEpro进行了评估，表明研究结果具有很高的确定性。

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引用次数: 0

Effect of Macrolide Exposure on Tailored Helicobacter pylori Eradication Therapy and Antibiotic Resistance Profiles: A Prospective Study Using the Drug Utilization Review System 大环内酯暴露对幽门螺杆菌根除治疗和抗生素耐药性的影响：一项使用药物利用审查系统的前瞻性研究

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-12-04 DOI: 10.1111/hel.70003

Jin Hee Noh, Kee Don Choi, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung

Background/Aims

Determining antibiotic use history accurately is challenging due to its reliance on patient recall. By determining macrolide exposure using the Korean drug utilization review (DUR) system, we analyzed the impact of previous macrolide use on antibiotic resistance profiles and compared the eradication rate between tailored therapy based on macrolide exposure history and empirical therapy.

Methods

Patients with confirmed Helicobacter pylori (H. pylori) infection who agreed to access prescription information using the Health Insurance Review and Assessment Service DUR system were enrolled between 2021 and 2023. Patients received tailored therapy, which was clarithromycin (CLR)-based triple therapy in cases without macrolide exposure and bismuth quadruple (BQ) therapy in cases with macrolide exposure. The empirical therapy group was prospectively recruited at the same time to compare the eradication rate.

Results

A total of 418 patients (tailored therapy group, n = 57; empirical therapy group, n = 361) were analyzed. Among the tailored therapy group, 24.6% took macrolide antibiotics for the past 5 years. CLR resistance rates were higher in patients with previous macrolide use than in those without (66.7% vs. 7.5%, p < 0.001). The tailored therapy group showed a higher eradication rate than the empirical therapy group for intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses (ITT, 86.0% vs. 75.6%; MITT, 94.2% vs. 80.3%; PP, 94.2% vs. 85.1%).

Conclusions

Previous macrolide exposure identified using the DUR system was associated with a higher rate of CLR resistance. Tailored therapy based on macrolide exposure history led to higher eradication rates compared to empirical therapy.

背景/目的由于依赖于患者回忆，准确确定抗生素使用史具有挑战性。通过使用韩国药物利用审查（DUR）系统确定大环内酯暴露情况，我们分析了以前使用大环内酯对抗生素耐药性的影响，并比较了基于大环内酯暴露史的定制治疗和经验治疗的根除率。方法选取2021年至2023年同意通过健康保险审查和评估服务DUR系统获取处方信息的确诊幽门螺杆菌感染患者。患者接受了量身定制的治疗，即在没有大环内酯暴露的病例中采用克拉霉素（CLR）三联治疗，在大环内酯暴露的病例中采用铋四联治疗。同时前瞻性招募经验治疗组，比较根除率。结果共418例患者(定制治疗组，n = 57；经验治疗组（n = 361）。在定制治疗组中，近5年服用大环内酯类抗生素的占24.6%。既往使用大环内酯类药物的患者的CLR耐药率高于未使用大环内酯类药物的患者（66.7% vs. 7.5%, p < 0.001）。在意向治疗（ITT）、改良意向治疗（MITT）和每个方案（PP）分析中，定制治疗组的根除率高于经验治疗组(ITT, 86.0% vs. 75.6%；MITT， 94.2%对80.3%；PP, 94.2% vs. 85.1%)。结论先前使用DUR系统识别的大环内酯暴露与较高的CLR耐药率相关。与经验治疗相比，基于大环内酯暴露史的量身定制治疗导致更高的根除率。

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引用次数: 0

Helicobacter pylori Infection in Children: To Eradicate or Not to Eradicate? 儿童幽门螺杆菌感染：根除还是不根除？

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-11-22 DOI: 10.1111/hel.70002

Marco Manfredi, Madhur Ravikumara

Helicobacter pylori infection is usually acquired during childhood and represents one of the most common infections in humans. It is well known that H. pylori has belonged to humankind for hundreds of thousands of years and it accompanied the human migration from Africa. The adult international guidelines recommend treating all infected patients as H. pylori was classified among the first-class human carcinogens by the WHO in 1994 and it is one of the main factors involved in the development of gastric cancer. Conversely, the pediatric international guidelines are more restrictive in recommending the eradication of the infection in children. Although many studies have shown evidence regarding the pathological role of H. pylori regardless of the age of the infected patients, many others have highlighted its protective/positive role in several extra-gastric diseases in children. In this review, both points of view regarding the eradication in children are critically analyzed.

幽门螺杆菌感染通常发生在儿童时期，是人类最常见的感染之一。众所周知，幽门螺杆菌属于人类已有数十万年的历史，它伴随着人类从非洲迁徙而来。由于幽门螺杆菌在 1994 年被世界卫生组织列为人类一级致癌物，是导致胃癌的主要因素之一，因此成人国际指南建议对所有感染者进行治疗。相反，国际儿科指南则更严格地建议根除儿童感染的幽门螺杆菌。尽管许多研究表明，幽门螺杆菌的病理作用与受感染患者的年龄无关，但也有许多其他研究强调了幽门螺杆菌在儿童多种胃外疾病中的保护/阳性作用。在这篇综述中，我们将对有关根除儿童幽门螺杆菌的两种观点进行批判性分析。

引用次数: 0

Helicobacter pylori Eradication Therapy and the Risk of Colorectal Cancer: A Population-Based Nationwide Cohort Study in Sweden 幽门螺杆菌根除疗法与结直肠癌风险：瑞典基于人口的全国队列研究

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter

Pub Date : 2024-11-20 DOI: 10.1111/hel.70001

Qing Liu, Omid Sadr-Azodi, Lars Engstrand, Katja Fall, Nele Brusselaers

Background

Helicobacter pylori (H. pylori) is an established gastric carcinogen, also associated with an increased risk of colorectal cancer. Therefore, we suspected that H. pylori eradication lowers the risk of colorectal cancer.

Material and Methods

We assessed if H. pylori eradication therapy is associated with a reduced risk of colorectal adenocarcinoma in a population-based nationwide cohort study. This study included all Swedish adults with at least one recorded H. pylori eradication episode between July 2005 and December 2012, based on the high-quality Swedish health registries. Colorectal adenocarcinoma risks were compared to the Swedish background population, presented as standardized incidence ratios (SIRs) and 95% confidence intervals (CIs), accounting for age, sex, calendar period, tumor location (left or right sided), stage, and number of eradication episodes, from 1 year after eradication and onward.

Results

Among 80,381 individuals receiving H. pylori eradication therapy (average follow-up 4.1 years), 282 were diagnosed with colorectal cancer (97.2% adenocarcinoma). Overall, H. pylori eradication was associated with an elevated risk of colorectal adenocarcinoma (SIR 1.27, 95% CI: 1.12–1.43). The colorectal adenocarcinoma risk was increased 1–2 years after eradication (SIR 1.42, 95% CI: 1.17–1.72), then decreased 2–4 years (SIR 0.80, 95% CI: 0.65–0.98) and 4–6 years (SIR 0.76, 95% CI: 0.57–0.99), yet not ≥ 6 years (SIR 1.36, 95% CI: 0.78–2.21) after eradication compared to the general population. Overall, right-sided (SIR 1.47, 95% CI: 1.21–1.76) and left-sided (SIR 1.35, 95% CI: 1.09–1.67) colon adenocarcinomas risks were higher among eradicated individuals than the general population.

Conclusion

H. pylori eradication was not associated with a clear and consistent reduction of colorectal cancer in our Swedish cohort.

背景幽门螺杆菌（H. pylori）是一种公认的胃癌致癌物，也与结直肠癌风险增加有关。因此，我们怀疑根除幽门螺杆菌可降低结直肠癌的风险。材料和方法我们在一项全国性人群队列研究中评估了根除幽门螺杆菌治疗是否与结直肠腺癌风险的降低有关。这项研究纳入了 2005 年 7 月至 2012 年 12 月期间至少有一次幽门螺杆菌根除病例记录的所有瑞典成年人，其依据是高质量的瑞典健康登记。在考虑年龄、性别、日历时间、肿瘤位置（左侧或右侧）、分期和根除次数的情况下，将根除后1年及以后的结直肠腺癌风险与瑞典背景人群进行比较，并以标准化发病率比（SIR）和95%置信区间（CI）表示。结果在接受幽门螺杆菌根除治疗的 80,381 人中（平均随访 4.1 年），有 282 人被确诊为结直肠癌（97.2% 为腺癌）。总体而言，根除幽门螺杆菌与结直肠腺癌风险升高有关（SIR 1.27，95% CI：1.12-1.43）。与普通人群相比，根除幽门螺杆菌后 1-2 年的结直肠腺癌风险增加（SIR 1.42，95% CI：1.17-1.72），2-4 年（SIR 0.80，95% CI：0.65-0.98）和 4-6 年（SIR 0.76，95% CI：0.57-0.99）的风险降低，但根除后≥ 6 年的风险没有增加（SIR 1.36，95% CI：0.78-2.21）。总体而言，根除者患右侧（SIR 1.47，95% CI：1.21-1.76）和左侧（SIR 1.35，95% CI：1.09-1.67）结肠腺癌的风险高于普通人群。结论在我们的瑞典队列中，根除幽门螺杆菌与结直肠癌发病率的明显持续下降无关。

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