Helicobacter最新文献

{"title":"Vonoprazan-Amoxicillin Dual Therapy Versus Drug Sensitivity-Based Individualized Therapy as a Rescue Regimen for Helicobacter pylori Infection: A Multicenter, Randomized Controlled Trial","authors":"Yu-xiang Liu,&nbsp;Han-ning Liu,&nbsp;Heng-qi Liu,&nbsp;Ying-ying Yang,&nbsp;Hong-li Cui,&nbsp;Li-lin Fan,&nbsp;Wen-jing Sun,&nbsp;Hao Mei,&nbsp;Xing-wei Wang,&nbsp;Guo Yan,&nbsp;Chun-hui Lan","doi":"10.1111/hel.70009","DOIUrl":"https://doi.org/10.1111/hel.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Vonoprazan is a novel potassium-competitive acid blocker (P-CAB) that offers several advantages, such as fast onset time and strong acid inhibition, in the treatment of <i>Helicobacter pylori</i> infection. This study aims to evaluate the efficacy, adverse reactions, and compliance of the 14-day vonoprazan-amoxicillin dual therapy versus drug sensitivity-based individualized therapy in the retreatment of <i>H. pylori</i> infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, open-label, randomized, controlled non-inferiority study enrolled 240 adult patients who previously failed anti-<i>H. pylori</i> treatment. These patients were randomly assigned to receive the 14-day vonoprazan-amoxicillin dual therapy or drug sensitivity-based individualized therapy. The primary outcome was the eradication rate, and the secondary outcomes mainly included adverse events, patient compliance, antibiotic resistance rates, and risk factors that affected the eradication rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intention-to-treat (ITT) and per-protocol (PP) analyses revealed that the eradication rates for the vonoprazan-amoxicillin dual therapy and drug sensitivity-based individualized therapy were comparably high, with rates of 87.50% and 83.33%, respectively. Furthermore, the vonoprazan-amoxicillin dual therapy fulfilled the criteria for the non-inferiority test, when compared to individualized therapy. The incidence of adverse reactions was significantly lower in the vonoprazan-amoxicillin dual therapy group. Both groups showed similarly good compliance and comparable rates of antibiotic resistance. The previous treatment with a clarithromycin-containing regimen was identified as an independent risk factor for clarithromycin resistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 14-day vonoprazan-amoxicillin dual therapy exhibits high eradication rates and low incidence of adverse reactions in retreated patients, indicating its effectiveness and safety as a rescue regimen for patients with <i>H. pylori</i> infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481386","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}

{"title":"The Accuracy of Melting Curve–Based Multiplex Real-Time PCR for Diagnosing Helicobacter pylori Resistance to Clarithromycin and Levofloxacin in Stool Specimens","authors":"Youhua Wang,&nbsp;Xiaoling Gong,&nbsp;Qirui Lai,&nbsp;Hui Fang,&nbsp;Xiyin Yang,&nbsp;Xuan Li,&nbsp;Dong Sheng Liu,&nbsp;Yong Xie","doi":"10.1111/hel.70012","DOIUrl":"https://doi.org/10.1111/hel.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study evaluates the accuracy of melting curve–based multiplex real-time PCR (multiplex rt-PCR) on stool samples for diagnosing antibiotic resistance in <i>Helicobacter pylori</i> (<i>H. pylori</i>) compared to E-test and sequencing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Gastric biopsies and stool samples were collected from 385 <i>H. pylori</i>-infected patients. A total of 325 strains were isolated, and genomic DNA was extracted from all 385 stool samples. E-tests were conducted to detect phenotypic resistance for clarithromycin and levofloxacin. Sanger sequencing and multiplex rt-PCR were employed to identify <i>H. pylori</i> 23S rRNA and GyrA mutations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>E-test results indicated that 203 (62.5%) were susceptible to both clarithromycin and levofloxacin, 33 (10.2%) exhibited mono-resistance to clarithromycin, 48 (14.8%) showed mono-resistance to levofloxacin, and 41 (12.6%) had dual resistance to both antibiotics. Compared to E-test results, the sensitivity and specificity of the multiplex rt-PCR method for detecting clarithromycin resistance mutation were 93.2 (95% CI 84.3–97.5) and 87.1% (95% CI 82.2–90.9), respectively. For levofloxacin resistance mutation, the multiplex rt-PCR method showed a sensitivity of 80.7 (95% CI 70.3–88.3) and a specificity of 93.0% (95% CI 88.7–95.8). Compared to Sanger sequencing, the sensitivity and specificity of the multiplex rt-PCR method for detecting clarithromycin resistance mutation were 95.8 (95% CI 90.0–98.4) and 96.0% (95% CI 92.6–98.0), respectively. For levofloxacin resistance mutation, the multiplex rt-PCR method showed a sensitivity of 91.3% (95% CI, 83.1–95.9) and a specificity of 96.1% (95% CI, 92.7–98.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Genotypic methods, including Sanger sequencing and multiplex rt-PCR, were rapid and reliable for diagnosing clarithromycin and levofloxacin resistance in the stool samples.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388953","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}

{"title":"Interpretation the Results of Eradicating Helicobacter pylori Infection Causing Colorectal Cancer Could Be Cautious","authors":"Lo-Yip Yu,&nbsp;Yang-Che Kuo,&nbsp;Ying-Chun Lin,&nbsp;Kuang-Chun Hu","doi":"10.1111/hel.70017","DOIUrl":"https://doi.org/10.1111/hel.70017","url":null,"abstract":"","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380382","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}

{"title":"Is Tailored Bismuth Quadruple Therapies (With Clarithromycin or Furazolidone) Based on Fecal Molecular Susceptibility Testing in First-Line Helicobacter pylori Eradication Treatment More Effective? A Three-Arm, Multicenter Randomized Clinical Trial","authors":"Zhengchen Yu,&nbsp;Xiaochen Liu,&nbsp;Jincheng Qiao,&nbsp;Wenjuan Shen,&nbsp;Xingwei Mao,&nbsp;Guochun Lou,&nbsp;Yan Li,&nbsp;Ziming Xie,&nbsp;Jun Ye","doi":"10.1111/hel.70018","DOIUrl":"https://doi.org/10.1111/hel.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rising antimicrobial resistance has significantly challenged the eradication rates of <i>Helicobacter pylori</i>. Due to its invasive nature, susceptibility testing based on endoscopic biopsy is controversial, while few studies have focused on the efficacy of tailored bismuth quadruple therapies (BQT) based on fecal susceptibility testing as a first-line treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multicenter study, 598 <i>H. pylori</i>-positive patients without previous eradication treatment were recruited and randomly assigned to three groups: empirical BQT, BQT-tailored based on the history of clarithromycin use and tailored based on fecal molecular susceptibility testing where furazolidone was substituted for clarithromycin when there was clinical or laboratory evidence of clarithromycin resistance. This study defines BQT as regimens comprising rabeprazole, colloidal bismuth, amoxicillin, and one additional antibiotic (furazolidone or clarithromycin). The study assessed eradication rates using intention-to-treat (ITT), modified intention-to-treat (mITT), and per-protocol (PP) analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The eradication rates of three groups were 82.00%, 80.90%, and 87.44% in the ITT analysis; 82.41%, 83.42%, and 89.23% in the mITT analysis; and 85.86%, 87.50%, and 94.57% in the PP analysis, respectively. Tailored BQT based on fecal susceptibility testing was not inferior to empirical BQT (all <i>p</i> values for noninferiority &lt; 0.001) and demonstrated greater efficacy in the PP analysis (difference [95% CI]: 7.07% [0.90%, 13.25%]). The incidence of adverse events and treatment compliance did not differ significantly among the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tailored BQT based on fecal susceptibility testing is an effective regimen for <i>H. pylori</i> eradication, with no increase in adverse events or treatment noncompliance compared with empirical BQT. Therefore, we recommend tailored BQT based on fecal susceptibility testing as a first-line treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>EudraCT number: NCT05718609; ClinicalTrials.gov</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380404","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}

{"title":"Advances in Helicobacter pylori Antimicrobial Resistance Detection: From Culture-Based to Multi-Omics-Based Technologies","authors":"Zupeng Kuang,&nbsp;Yuwei Wu,&nbsp;Xinqiang Xie,&nbsp;Xinyu Zhao,&nbsp;Huiyuan Chen,&nbsp;Lei Wu,&nbsp;He Gao,&nbsp;Hui Zhao,&nbsp;Tingting Liang,&nbsp;Jumei Zhang,&nbsp;Ying Li,&nbsp;Qingping Wu","doi":"10.1111/hel.70007","DOIUrl":"https://doi.org/10.1111/hel.70007","url":null,"abstract":"<div>\u0000 \u0000 <p><i>Helicobacter pylori</i> (<i>H. pylori</i>), a proven carcinogenic microbe, necessitates antimicrobial treatment once infected. However, <i>H. pylori</i> worldwide currently faces serious antibiotic resistance (AMR), requiring infected patients to undergo antibiotic susceptibility testing (AST) to guide therapy. Currently, the recommended ASTs for <i>H. pylori</i> are culture-based methods, which are time-consuming, complicated, and expensive, impeding their widespread application. With in-depth researches on the AMR mechanisms of <i>H. pylori</i>, specific gene mutations and novel proteins have been confirmed as the cause of AMR and can serve as targets of ASTs. Accordingly, molecular biology detection has been developed and tremendously shortened the time and reduced difficulty of AST. However, these assays still struggle to meet the enormous testing demand and need for even faster, simpler, and more accurate methods. In recent years, researchers have developed various new platforms based on biosensors, transcriptomics, proteomics, and single-cell analysis. This review introduces the AMR mechanisms of <i>H. pylori</i> and summarizes the current ASTs from the working principles to application characteristics. Additionally, we draw attention to the potentially applicable techniques for AST of <i>H. pylori</i> from DNA, RNA, protein, and cell perspectives. By systematically recapitulating the past, present, and future of AST for <i>H. pylori</i>, this review provides valuable insights for developing novel assays.</p>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380403","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}

{"title":"Improvement in Helicobacter pylori Eradication Among Adults Receiving Semaglutide: A Population-Based Propensity-Score-Adjusted Analysis","authors":"Asaf Ness,&nbsp;Zohar Levi,&nbsp;Rachel Gingold Belfer,&nbsp;Ram Dickman,&nbsp;Doron Boltin","doi":"10.1111/hel.70014","DOIUrl":"https://doi.org/10.1111/hel.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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 <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection depends upon a precise dosing schedule. We aimed to examine the impact of GLP-1 drugs on antibiotic treatment for <i>H. pylori</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults with a new diagnosis of <i>H. pylori</i> 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p =</i> 0.059 across subgroups). Eradication among those who received semaglutide was 93.8% (OR 2.78, 95% CI 1.32–5.83, <i>p</i> = 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, <i>p</i> = 0.014). Additional independent predictors of successful eradication included male sex, high socioeconomic status, quadruple therapy, and older age (<i>p &lt;</i> 0.001 for all).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Co-administration of semaglutide and antibiotics for <i>H. pylori</i> infection is associated with an increased likelihood of successful eradication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111646","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}

{"title":"Efficacy of Rifabutin-Based Helicobacter pylori Eradication Regimen in Korea With High Prevalence of Tuberculosis Infection","authors":"Yuri Kim,&nbsp;Jeong Hoon Lee,&nbsp;Hee Kyong Na,&nbsp;Kee Wook Jung,&nbsp;Ji Yong Ahn,&nbsp;Do Hoon Kim,&nbsp;Kee Don Choi,&nbsp;Ho June Song,&nbsp;Gin Hyug Lee,&nbsp;Hwoon-Yong Jung","doi":"10.1111/hel.70011","DOIUrl":"https://doi.org/10.1111/hel.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As the antibiotic resistance and treatment failure rates of <i>Helicobacter pylori</i> are rising, the need for rescue therapy with rifabutin for <i>H. pylori</i> eradication (HPE) is also increasing. Therefore, in this study, we investigated the efficacy, resistance status, and adverse events in patients receiving rifabutin-based HPE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Between January 2020 and December 2022, 3006 patients underwent esophagogastroduodenoscopy (EGD) with <i>H. pylori</i> 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 1792 patients, 14 (0.8%) were rifabutin-resistant. A total of 665 (37.1%) patients had multidrug-resistant (MDR) <i>H. pylori</i> infections. Patients with rifabutin-resistant <i>H. pylori</i> infections had a significantly higher rate of tuberculosis treatment history (2.8% vs. 28.6%, <i>p</i> &lt; 0.001) and MDR <i>H. pylori</i> infections (49.6% vs. 85.7%, <i>p</i> &lt; 0.001) than those in the rifabutin-susceptible <i>H. pylori</i> group. Among the 45 patients who received the rifabutin-based HPE regimen, 44 (97.8%) had MDR <i>H. pylori</i> 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111645","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}

{"title":"Managing Helicobacter pylori as an Infectious Disease: Implementation of Antimicrobial Stewardship","authors":"Jen-Yu Hsu,&nbsp;Un-In Wu,&nbsp;Jann-Tay Wang,&nbsp;Wang-Huei Sheng,&nbsp;Yee-Chun Chen,&nbsp;Shan-Chwen Chang","doi":"10.1111/hel.70013","DOIUrl":"10.1111/hel.70013","url":null,"abstract":"<div>\u0000 \u0000 <p><i>Helicobacter pylori</i> is prevalent globally and implicated in various gastric diseases and malignancies. Rising antibiotic resistance has increasingly compromised the effectiveness of standard <i>H. pylori</i> eradication therapies. This review explores the role of antimicrobial stewardship (AMS) as a structured approach to optimizing <i>H. pylori</i> 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 <i>H. pylori</i> 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, <i>H. pylori</i> 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.</p>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079727","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}

{"title":"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","authors":"Hideki Mori,&nbsp;Toshihiro Nishizawa,&nbsp;Kohei Morioka,&nbsp;Motohiko Kato,&nbsp;Takanori Kanai","doi":"10.1111/hel.70010","DOIUrl":"10.1111/hel.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Although standard triple therapy remains the first-line eradication treatment for <i>H. pylori</i> 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>After failure of standard triple therapy, secondary eradication treatment regimens containing metronidazole demonstrate higher eradication rates than those without metronidazole.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046681","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}

{"title":"Ethnic Inequity in the Current Approach to H. pylori Testing and Treatment: Linked Data Cohort Analysis","authors":"Andrea Teng,&nbsp;Erin Hildred,&nbsp;James Stanley,&nbsp;Stephen Inns,&nbsp;Melissa McLeod","doi":"10.1111/hel.70005","DOIUrl":"10.1111/hel.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As seen globally, there are up to sixfold differences in gastric cancer mortality by ethnicity in Aotearoa New Zealand, and <i>H. pylori</i> is the major modifiable risk factor<i>.</i> This study investigates whether current <i>H. pylori</i> testing and treatment approaches are equitable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>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 <i>H. pylori</i>. Regression analyses compared ethnic differences in rates of <i>H. pylori</i> testing, infection, treatment, and retesting, adjusted for age, sex, and calendar year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the higher prevalence of <i>H. pylori</i> 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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948082","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}