Kirsten Alexandra Eberhardt, Stefanie Schoppen, Carola Bindt, Stephan Ehrhardt, Yasmin Mohammed, Daniel Fordjour, Doris Kra-Yao, Carine Esther Bony Kotchi, Ekissi Jean Koffi Armel, Bernardin Ahouty Ahouty, Rebecca Hinz, John Appiah-Poku, Mathurin Koffi, Samuel Blay Nguah, Harry Tagbor, Eliezer N'Goran, Richard Odame Phillips, Tom Luedde, Dana Barthel, Torsten Feldt
Background
Helicobacter pylori (H. pylori) infection is highly prevalent in low-resource settings and has been implicated in adverse health outcomes beyond the gastrointestinal tract, including potential effects on early neurodevelopment. However, data from sub-Saharan Africa is limited.
Methods
We conducted a prospective cohort study among 229 mother–child dyads from Ghana and Côte d'Ivoire to assess the association between H. pylori infection and early child development at 12 months of age. Child development was evaluated using the Developmental Milestones Checklist (DMC), encompassing locomotor, fine motor, language, and personal–social domains. H. pylori infection status was determined by stool antigen testing. Quantile regression models, adjusted for socioeconomic status and sex, were applied to analyze associations between H. pylori infection and DMC scores.
Results
Among 229 children, 38 (16.6%) tested positive for H. pylori. The median total motor score was higher in H. pylori-negative children (45, IQR 41–50) compared to positive children (43, IQR 40–45; p = 0.031). At the 75th percentile, H. pylori infection was significantly associated with a 7-point reduction in the motor domain score (estimate = −7; 95% CI: −11.1 to −2.9; p = 0.001; FDR-adjusted p = 0.003) and a 10-point reduction in total DMC score (estimate = −10; 95% CI: −17.5 to −2.6; p = 0.009; FDR-adjusted p = 0.027) after multivariable adjustment. No significant associations were observed at lower or median quantiles, nor in language or personal-social domains.
Conclusion
H. pylori infection at 12 months of age is significantly associated with impaired motor development among children performing in the upper range of developmental achievement. These findings underscore the potential neurodevelopmental impact of early-life H. pylori infection in high-prevalence, resource-limited settings and highlight the importance of integrating infection control strategies into early childhood development programs. Further research is warranted to elucidate infection-related neurodevelopmental risks in early childhood.
{"title":"Helicobacter pylori and Impaired Early Childhood Development—Evidence From a Birth Cohort Study From Ghana and Côte d'Ivoire","authors":"Kirsten Alexandra Eberhardt, Stefanie Schoppen, Carola Bindt, Stephan Ehrhardt, Yasmin Mohammed, Daniel Fordjour, Doris Kra-Yao, Carine Esther Bony Kotchi, Ekissi Jean Koffi Armel, Bernardin Ahouty Ahouty, Rebecca Hinz, John Appiah-Poku, Mathurin Koffi, Samuel Blay Nguah, Harry Tagbor, Eliezer N'Goran, Richard Odame Phillips, Tom Luedde, Dana Barthel, Torsten Feldt","doi":"10.1111/hel.70087","DOIUrl":"https://doi.org/10.1111/hel.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Helicobacter pylori</i> (<i>H. pylori</i>) infection is highly prevalent in low-resource settings and has been implicated in adverse health outcomes beyond the gastrointestinal tract, including potential effects on early neurodevelopment. However, data from sub-Saharan Africa is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study among 229 mother–child dyads from Ghana and Côte d'Ivoire to assess the association between <i>H. pylori</i> infection and early child development at 12 months of age. Child development was evaluated using the Developmental Milestones Checklist (DMC), encompassing locomotor, fine motor, language, and personal–social domains. <i>H. pylori</i> infection status was determined by stool antigen testing. Quantile regression models, adjusted for socioeconomic status and sex, were applied to analyze associations between <i>H. pylori</i> infection and DMC scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 229 children, 38 (16.6%) tested positive for <i>H. pylori</i>. The median total motor score was higher in <i>H. pylori</i>-negative children (45, IQR 41–50) compared to positive children (43, IQR 40–45; <i>p</i> = 0.031). At the 75th percentile, <i>H. pylori</i> infection was significantly associated with a 7-point reduction in the motor domain score (estimate = −7; 95% CI: −11.1 to −2.9; <i>p</i> = 0.001; FDR-adjusted <i>p</i> = 0.003) and a 10-point reduction in total DMC score (estimate = −10; 95% CI: −17.5 to −2.6; <i>p</i> = 0.009; FDR-adjusted <i>p</i> = 0.027) after multivariable adjustment. No significant associations were observed at lower or median quantiles, nor in language or personal-social domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p><i>H. pylori</i> infection at 12 months of age is significantly associated with impaired motor development among children performing in the upper range of developmental achievement. These findings underscore the potential neurodevelopmental impact of early-life <i>H. pylori</i> infection in high-prevalence, resource-limited settings and highlight the importance of integrating infection control strategies into early childhood development programs. Further research is warranted to elucidate infection-related neurodevelopmental risks in early childhood.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407449","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}
Bojan Tepes, Maja Denkovski, Nataša Brglez Jurecic, Katja Tepes, Anna Cano-Català, Pablo Parra, Leticia Moreira, Olga P. Nyssen, Francis Mégraud, Colm O'Morain, Javier P. Gisbert
Background
The best approach for H. pylori second- and third-line management remains unclear. The aim of this study was to evaluate the effectiveness and safety of second- and third-line H. pylori eradication regimens in Slovenia using a centralized registration database.
Methods
Patients second- and third-line eradication data from Slovenia registered in the European Registry on H. pylori Management (Hp-EuReg) from 2013 to 2024 were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analyzed. The effectiveness was assessed by modified intention to treat (mITT).
Results
We have included 402 s-line and 81 third-line eradication regimens. By mITT analysis > 90% eradication rate for second-line regimens were achieved with 14 day quadruple regimen proton pump inhibitor (PPI) amoxicillin (A) levofloxacin (L) bismuth oxide (B) (95.7%; 95% CI 78.1%–99.9%),10 day and 14 day regimen with a PPI + A + L (90.9%, 95% CI 75.7%–98.1% and 90.2%, 95% CI 85.5%–94.9% respectively) and a 10-day regimen with a PPI combined with bismuth quadruple therapy as single capsule (100%, 95% CI 80.5%–100%). The overall eradication rate for second-line empirical treatments was 86% (95% CI 81.9%–90%), while for culture-guided treatments, it was 89.2% (95% CI 74.6%–97%; p > 0.05). In third-line treatment, the PPI and single-capsule combination therapy was the only regimen to achieve an optimal cure rate of 94.1% (95% CI 71.3%–99.9%). The eradication rate for empirical treatment was 84.4% (95% CI 72.7%–96.1%), while for culture-guided treatment it was 84.6% (95% CI 54.6%–98.1%; p > 0.05). Adverse effects were reported by 52 patients in second-line regimens (12.9%), and treatment was discontinued in 0.7% of cases, and by 12 patients (14.8%) in third-line regimens with no need for treatment discontinuation.
Conclusions
In Slovenia, H. pylori eradication therapy appears to be effective and safe in real-world clinical practice.
Trial Registration
Registered at ClinicalTrials. Gov (NCT02328131)
背景幽门螺杆菌二线和三线治疗的最佳方法尚不清楚。本研究的目的是利用集中登记数据库评估斯洛文尼亚二线和三线幽门螺杆菌根除方案的有效性和安全性。方法纳入2013年至2024年在欧洲幽门螺杆菌管理登记处（Hp-EuReg）登记的斯洛文尼亚患者的二线和三线根除数据。分析了处方方案、根除次数、有效性、依从性和安全性。采用改良治疗意向（mITT）评价疗效。结果纳入402个s线和81个三线根除方案。采用质子泵抑制剂（PPI）、阿莫西林(A)、左氧氟沙星(L)、氧化铋(B)的14天四联方案（95.7%,95% CI 78.1%-99.9%）、PPI + A + L的10天和14天方案（分别为90.9%,95% CI 75.7%-98.1%和90.2%,95% CI 85.5%-94.9%）和PPI联合铋四联单胶囊治疗的10天方案（100%,95% CI 80.5%-100%），二线方案的根除率达到90%。二线经验处理的总根除率为86% (95% CI 81.9%-90%)，而培养引导处理的总根除率为89.2% （95% CI 74.6%-97%; p > 0.05）。在三线治疗中，PPI和单胶囊联合治疗是唯一达到94.1%最佳治愈率的方案（95% CI 71.3%-99.9%）。经验处理的根除率为84.4% (95% CI 72.7% ~ 96.1%)，而培养引导处理的根除率为84.6% （95% CI 54.6% ~ 98.1%; p > 0.05）。二线方案中有52例（12.9%）患者报告了不良反应，0.7%的病例停止治疗，三线方案中有12例（14.8%）患者报告了不需要停药的不良反应。结论在斯洛文尼亚，幽门螺杆菌根除治疗在现实世界的临床实践中似乎是有效和安全的。在ClinicalTrials注册。政府(NCT02328131)
{"title":"Second- and Third-Line Therapies for Helicobacter pylori Eradication in Slovenia: Data From 2013–2023 of the European Registry on H. pylori Management","authors":"Bojan Tepes, Maja Denkovski, Nataša Brglez Jurecic, Katja Tepes, Anna Cano-Català, Pablo Parra, Leticia Moreira, Olga P. Nyssen, Francis Mégraud, Colm O'Morain, Javier P. Gisbert","doi":"10.1111/hel.70085","DOIUrl":"https://doi.org/10.1111/hel.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The best approach for <i>H. pylori</i> second- and third-line management remains unclear. The aim of this study was to evaluate the effectiveness and safety of second- and third-line <i>H. pylori</i> eradication regimens in Slovenia using a centralized registration database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients second- and third-line eradication data from Slovenia registered in the European Registry on <i>H. pylori</i> Management (Hp-EuReg) from 2013 to 2024 were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analyzed. The effectiveness was assessed by modified intention to treat (mITT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We have included 402 s-line and 81 third-line eradication regimens. By mITT analysis > 90% eradication rate for second-line regimens were achieved with 14 day quadruple regimen proton pump inhibitor (PPI) amoxicillin (A) levofloxacin (L) bismuth oxide (B) (95.7%; 95% CI 78.1%–99.9%),10 day and 14 day regimen with a PPI + A + L (90.9%, 95% CI 75.7%–98.1% and 90.2%, 95% CI 85.5%–94.9% respectively) and a 10-day regimen with a PPI combined with bismuth quadruple therapy as single capsule (100%, 95% CI 80.5%–100%). The overall eradication rate for second-line empirical treatments was 86% (95% CI 81.9%–90%), while for culture-guided treatments, it was 89.2% (95% CI 74.6%–97%; <i>p</i> > 0.05). In third-line treatment, the PPI and single-capsule combination therapy was the only regimen to achieve an optimal cure rate of 94.1% (95% CI 71.3%–99.9%). The eradication rate for empirical treatment was 84.4% (95% CI 72.7%–96.1%), while for culture-guided treatment it was 84.6% (95% CI 54.6%–98.1%; <i>p</i> > 0.05). Adverse effects were reported by 52 patients in second-line regimens (12.9%), and treatment was discontinued in 0.7% of cases, and by 12 patients (14.8%) in third-line regimens with no need for treatment discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In Slovenia, <i>H. pylori</i> eradication therapy appears to be effective and safe in real-world clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Registered at ClinicalTrials. Gov (NCT02328131)</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407152","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}
Wuyinxiao Zheng, Zijian Zheng, Jingyu Yang, Ruili Nie, Xin Luo, Long Yang, Haiping Li, Chunling Hu, Xiaochuan Ye, Pengtao You, Dan Liu
Background
Excessive inflammatory response represents the primary pathological hallmark of Helicobacter pylori (H. pylori) gastritis. Toll-like receptor 2 (TLR2) has emerged as a promising therapeutic target because of its crucial role in regulating inflammatory responses and tissue damage caused by H. pylori. Galangin (Gal), a naturally occurring flavone, possesses a variety of pharmacological activities, including anti-inflammatory and antibacterial effects. This study systematically evaluates the therapeutic potential of Gal in H. pylori gastritis, with specific emphasis on elucidating its TLR2-targeting mechanism.
Materials and Methods
An H. pylori-induced mouse gastritis model was established to evaluate the therapeutic effects of Gal at dosages of 50 and 100 mg/kg/day over a two-week administration period. The H. pylori-infected GES-1 human gastric epithelial cells were utilized for mechanistic exploration. Molecular docking and siRNA transient transfection techniques were integrated to elucidate the specific interactions between Gal and TLR2.
Results
Gal inhibited the proliferation of H. pylori and alleviated the inflammation caused by H. pylori in both in vitro and in vivo. Furthermore, Gal inhibited the activation of the TLR2/MyD88 signaling pathway, which suppressed the downstream phosphorylation of MAPK (p38/JNK/ERK) and NF-κB nuclear translocation. Notably, the knockdown of TLR2 diminished the inhibitory effects of Gal on MyD88 expression.
Conclusion
Gal demonstrated effectiveness in ameliorating H. pylori gastritis through the therapeutic inhibition of TLR2. Further investigation is warranted to explore the combination of Gal with other H. pylori eradication treatments.
{"title":"Galangin Alleviates Helicobacter pylori Gastritis Through TLR2 Inhibition and Modulation of the MyD88-Dependent Inflammatory Cascades","authors":"Wuyinxiao Zheng, Zijian Zheng, Jingyu Yang, Ruili Nie, Xin Luo, Long Yang, Haiping Li, Chunling Hu, Xiaochuan Ye, Pengtao You, Dan Liu","doi":"10.1111/hel.70084","DOIUrl":"10.1111/hel.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Excessive inflammatory response represents the primary pathological hallmark of <i>Helicobacter pylori</i> (<i>H. pylori</i>) gastritis. Toll-like receptor 2 (TLR2) has emerged as a promising therapeutic target because of its crucial role in regulating inflammatory responses and tissue damage caused by <i>H. pylori</i>. Galangin (Gal), a naturally occurring flavone, possesses a variety of pharmacological activities, including anti-inflammatory and antibacterial effects. This study systematically evaluates the therapeutic potential of Gal in <i>H. pylori</i> gastritis, with specific emphasis on elucidating its TLR2-targeting mechanism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>An <i>H. pylori</i>-induced mouse gastritis model was established to evaluate the therapeutic effects of Gal at dosages of 50 and 100 mg/kg/day over a two-week administration period. The <i>H. pylori-</i>infected GES-1 human gastric epithelial cells were utilized for mechanistic exploration. Molecular docking and siRNA transient transfection techniques were integrated to elucidate the specific interactions between Gal and TLR2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Gal inhibited the proliferation of <i>H. pylori</i> and alleviated the inflammation caused by <i>H. pylori</i> in both in vitro and in vivo. Furthermore, Gal inhibited the activation of the TLR2/MyD88 signaling pathway, which suppressed the downstream phosphorylation of MAPK (p38/JNK/ERK) and NF-κB nuclear translocation. Notably, the knockdown of <i>TLR2</i> diminished the inhibitory effects of Gal on MyD88 expression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gal demonstrated effectiveness in ameliorating <i>H. pylori</i> gastritis through the therapeutic inhibition of TLR2. Further investigation is warranted to explore the combination of Gal with other <i>H. pylori</i> eradication treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372642","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}
Sameh A. Lashen, Mohammed M. Shamseyea, Rasha H. Metwally, Galal Abou-Farrag, Engy S. Elkaragy
Background and Aim
While H. pylori infection is more commonly associated with adults, it can affect children with an impact on their well-being. Vonoprazan is effective in the eradication of H. pylori infection in adults. However, its effectiveness in adolescents and children is still being studied. The study aimed to investigate the efficacy of Vonoprazan-based triple therapy (VTT) compared to Esomeprazole-based triple therapy (ETT) for H. pylori eradication in adolescents and children.
Patients and Methods
In a multicenter, double-blind, randomized controlled design, we included 242 participants with H. pylori infection in the age group 10–18 years. They were randomly assigned to either weight-based Esomeprazole/Amoxicillin/Clarithromycin twice daily for 14 days (ETT) or to Vonoprazan 20 mg/weight-based Amoxicillin/Clarithromycin twice daily for 14 days (VTT). The H. pylori eradication was evaluated 8 weeks after therapy. Treatment-related adverse events were reported.
Results
In intention-to-treat analysis, eradication of H. pylori was achieved in 93 (76.9%) of the ETT arm and in 106 (87.6%) of the VTT arm (p = 0.029). In per-protocol analysis, eradication rates were 83% and 92.2% for ETT and VTT, respectively (p = 0.036). There was no difference between the two study arms in terms of overall adverse events (p = 0.46). In the VTT arm, the most frequent adverse events were diarrhea (5.8%) and nausea (6.6%).
Conclusion
Fourteen days of VTT is superior to ETT for H. pylori eradication and is well tolerated in children and adolescents aged between 10 and 18 years.
{"title":"Vonoprazan-Based Triple Therapy Versus Esomeprazole-Based Triple Therapy for H. pylori Eradication in Adolescents (VONTAPE): A Randomized, Double-Blind Controlled Trial","authors":"Sameh A. Lashen, Mohammed M. Shamseyea, Rasha H. Metwally, Galal Abou-Farrag, Engy S. Elkaragy","doi":"10.1111/hel.70083","DOIUrl":"10.1111/hel.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>While <i>H. pylori</i> infection is more commonly associated with adults, it can affect children with an impact on their well-being. Vonoprazan is effective in the eradication of <i>H. pylori</i> infection in adults. However, its effectiveness in adolescents and children is still being studied. The study aimed to investigate the efficacy of Vonoprazan-based triple therapy (VTT) compared to Esomeprazole-based triple therapy (ETT) for <i>H. pylori</i> eradication in adolescents and children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In a multicenter, double-blind, randomized controlled design, we included 242 participants with <i>H. pylori</i> infection in the age group 10–18 years. They were randomly assigned to either weight-based Esomeprazole/Amoxicillin/Clarithromycin twice daily for 14 days (ETT) or to Vonoprazan 20 mg/weight-based Amoxicillin/Clarithromycin twice daily for 14 days (VTT). The <i>H. pylori</i> eradication was evaluated 8 weeks after therapy. Treatment-related adverse events were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In intention-to-treat analysis, eradication of <i>H. pylori</i> was achieved in 93 (76.9%) of the ETT arm and in 106 (87.6%) of the VTT arm (<i>p</i> = 0.029). In per-protocol analysis, eradication rates were 83% and 92.2% for ETT and VTT, respectively (<i>p</i> = 0.036). There was no difference between the two study arms in terms of overall adverse events (<i>p</i> = 0.46). In the VTT arm, the most frequent adverse events were diarrhea (5.8%) and nausea (6.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fourteen days of VTT is superior to ETT for <i>H. pylori</i> eradication and is well tolerated in children and adolescents aged between 10 and 18 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Registry</h3>\u0000 \u0000 <p>NCT06162949; https://clinicaltrials.gov/study/NCT06162949.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354660","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}
Joon Sung Kim, Hankil Lee, Yuri Jeong, Byung-Wook Kim
Background
In Korea, tailored therapy for H. pylori based on clarithromycin resistance has been shown to be more effective than empirical therapy. However, the cost-effectiveness of tailored therapy has not yet been fully established.
Aim
This study evaluated the cost-effectiveness of tailored therapy guided by genotypic resistance compared to empirical clarithromycin-based triple therapy.
Methods
A decision-tree model was developed to compare two treatment strategies: empirical therapy and tailored therapy. In the empirical therapy group, patients received clarithromycin-based triple therapy. In the tailored therapy group, patients susceptible to clarithromycin received clarithromycin-based triple therapy, while those with clarithromycin resistance were treated with bismuth-based quadruple therapy. A cost-effectiveness analysis was conducted, and the incremental cost-effectiveness ratio (ICER) was calculated to compare the two strategies.
Results
The estimated costs for empirical and tailored therapies were $173.93 and $249.48, respectively. Compared to empirical therapy, the ICER for tailored therapy was $4.66 per 1% increase in eradication rate, representing the additional cost required to achieve a 1% improvement in eradication. In subgroup analyses, the estimated costs of 7-day empirical and tailored therapies were $157.46 and $233.88, respectively, while the costs for 14-day empirical and tailored therapies were $190.40 and $265.08, respectively. The ICERs for the 7- and 14-day regimens were $3.53 and $7.12, respectively.
Discussion
Tailored therapy guided by genotypic resistance is a cost-effective strategy for H. pylori eradication in Korea, particularly in the context of high clarithromycin resistance rates.
{"title":"Cost-Effectiveness of Tailored vs. Empirical Therapy for H. pylori: A Decision-Tree Analysis","authors":"Joon Sung Kim, Hankil Lee, Yuri Jeong, Byung-Wook Kim","doi":"10.1111/hel.70081","DOIUrl":"10.1111/hel.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In Korea, tailored therapy for <i>H. pylori</i> based on clarithromycin resistance has been shown to be more effective than empirical therapy. However, the cost-effectiveness of tailored therapy has not yet been fully established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study evaluated the cost-effectiveness of tailored therapy guided by genotypic resistance compared to empirical clarithromycin-based triple therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A decision-tree model was developed to compare two treatment strategies: empirical therapy and tailored therapy. In the empirical therapy group, patients received clarithromycin-based triple therapy. In the tailored therapy group, patients susceptible to clarithromycin received clarithromycin-based triple therapy, while those with clarithromycin resistance were treated with bismuth-based quadruple therapy. A cost-effectiveness analysis was conducted, and the incremental cost-effectiveness ratio (ICER) was calculated to compare the two strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The estimated costs for empirical and tailored therapies were $173.93 and $249.48, respectively. Compared to empirical therapy, the ICER for tailored therapy was $4.66 per 1% increase in eradication rate, representing the additional cost required to achieve a 1% improvement in eradication. In subgroup analyses, the estimated costs of 7-day empirical and tailored therapies were $157.46 and $233.88, respectively, while the costs for 14-day empirical and tailored therapies were $190.40 and $265.08, respectively. The ICERs for the 7- and 14-day regimens were $3.53 and $7.12, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Tailored therapy guided by genotypic resistance is a cost-effective strategy for <i>H. pylori</i> eradication in Korea, particularly in the context of high clarithromycin resistance rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336946","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}
Baojun Suo, Xinlu Ren, Cailing Li, Yanyan Shi, Xueli Tian, Kai Zhou, Liya Zhou, Zhiqiang Song
Background
Tailored therapy based on genetic testing of fecal samples is a promising method for Helicobacter pylori eradication, but relevant research is still lacking, and the effectiveness remains unclear.
Objective
This study conducted a randomized controlled trial to evaluate the efficacy, safety, and compliance of triple plus bismuth therapy (TBT) guided by clarithromycin and levofloxacin genotypic resistances and CYP2C19 polymorphisms from stool samples. A preliminary health economics analysis was also conducted.
Design
Six hundred and sixteen treatment-naïve patients were randomly divided into tailored (individualized drug selection based on genetic testing for 7 or 14 days) and empiric (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 220 mg, all twice daily for 14 days) TBT groups. Safety and compliance were assessed within 1–3 days after eradication. 13C-urea breath test was performed within 4–8 weeks after eradication to evaluate the therapeutic outcome.
Results
The eradication rates of the tailored TBT group were non-inferior to those of the empiric TBT group [intention-to-treat analysis 87.7% vs. 80.8%, rate difference 6.8% (95% confidence interval 0.8%–12.9%); modified intention-to-treat analysis 93.4% vs. 86.8%, rate difference 6.7% (95% confidence interval 1.5%–11.9%); per-protocol analysis 95.7% vs. 88.7%, rate difference 7.0% (95% confidence interval 2.2%–11.8%)]. The tailored TBT group achieved satisfactory efficacies (acceptable in intention-to-treat and excellent in per-protocol analyses). Safety and compliance were similar between the two groups. The average cost of each successful eradication case in the tailored TBT group is lower than that in the empiric TBT group.
Conclusion
The tailored TBT guided by antibiotic genotypic resistances and CYP2C19 polymorphisms detected from fecal specimens achieved satisfactory efficacy, safety, and compliance in the first-line Helicobacter pylori eradication with less expenses (ChiCTR2300068620).
Trial Registration
Chinese Clinical Trials Registration: ChiCTR2300068620
背景：基于粪便样本基因检测的定制治疗是一种很有前景的根除幽门螺杆菌的方法，但相关研究尚缺乏，有效性尚不清楚。目的：本研究通过随机对照试验，评价由克拉霉素和左氧氟沙星基因型耐药和粪便样本CYP2C19多态性引导的三联加铋治疗（TBT）的疗效、安全性和依从性。还进行了初步的卫生经济学分析。设计：616名treatment-naïve患者随机分为量身定制（基于基因检测的个性化药物选择）和经验（埃索美拉唑20毫克，阿莫西林1000毫克，克拉霉素500毫克，柠檬酸铋钾220毫克，每天两次，持续14天）TBT组。根除后1-3天内评估安全性和依从性。根除后4 ~ 8周进行13c -尿素呼气试验，评价治疗效果。结果：定制TBT组的根除率不低于经验TBT组[意向治疗分析87.7%对80.8%，率差6.8%(95%可信区间为0.8% ~ 12.9%)；改良意向治疗分析93.4% vs. 86.8%，率差6.7%(95%置信区间1.5% ~ 11.9%)；每个方案分析95.7% vs. 88.7%，率差7.0%(95%可信区间2.2%-11.8%)]。量身定制的TBT组取得了令人满意的疗效（治疗意向可接受，每个方案分析优秀）。两组之间的安全性和依从性相似。定制型TBT组每个成功根除病例的平均成本低于经验型TBT组。结论：以抗生素基因型耐药和粪便标本检测CYP2C19多态性为指导的定制TBT在一线根除幽门螺杆菌（ChiCTR2300068620）中获得了满意的疗效、安全性和依从性，且费用较少。试验注册：中国临床试验注册：ChiCTR2300068620。
{"title":"Tailored Therapy Guided by Antibiotic Genotypic Resistances and CYP2C19 Polymorphisms Detected From Fecal Specimens for the First-Line Helicobacter pylori Eradication: A Randomized Controlled Trial","authors":"Baojun Suo, Xinlu Ren, Cailing Li, Yanyan Shi, Xueli Tian, Kai Zhou, Liya Zhou, Zhiqiang Song","doi":"10.1111/hel.70082","DOIUrl":"10.1111/hel.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tailored therapy based on genetic testing of fecal samples is a promising method for <i>Helicobacter pylori</i> eradication, but relevant research is still lacking, and the effectiveness remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study conducted a randomized controlled trial to evaluate the efficacy, safety, and compliance of triple plus bismuth therapy (TBT) guided by clarithromycin and levofloxacin genotypic resistances and CYP2C19 polymorphisms from stool samples. A preliminary health economics analysis was also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Six hundred and sixteen treatment-naïve patients were randomly divided into tailored (individualized drug selection based on genetic testing for 7 or 14 days) and empiric (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 220 mg, all twice daily for 14 days) TBT groups. Safety and compliance were assessed within 1–3 days after eradication. <sup>13</sup>C-urea breath test was performed within 4–8 weeks after eradication to evaluate the therapeutic outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The eradication rates of the tailored TBT group were non-inferior to those of the empiric TBT group [intention-to-treat analysis 87.7% vs. 80.8%, rate difference 6.8% (95% confidence interval 0.8%–12.9%); modified intention-to-treat analysis 93.4% vs. 86.8%, rate difference 6.7% (95% confidence interval 1.5%–11.9%); per-protocol analysis 95.7% vs. 88.7%, rate difference 7.0% (95% confidence interval 2.2%–11.8%)]. The tailored TBT group achieved satisfactory efficacies (acceptable in intention-to-treat and excellent in per-protocol analyses). Safety and compliance were similar between the two groups. The average cost of each successful eradication case in the tailored TBT group is lower than that in the empiric TBT group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The tailored TBT guided by antibiotic genotypic resistances and CYP2C19 polymorphisms detected from fecal specimens achieved satisfactory efficacy, safety, and compliance in the first-line <i>Helicobacter pylori</i> eradication with less expenses (ChiCTR2300068620).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Chinese Clinical Trials Registration: ChiCTR2300068620</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336876","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":"Reevaluating the Adverse Events With the Same-Dosage Regimen in Hemodialysis Patients Undergoing Helicobacter pylori Eradication","authors":"Keigo Misawa, Jun Watanabe, Takeshi Kanno","doi":"10.1111/hel.70073","DOIUrl":"10.1111/hel.70073","url":null,"abstract":"","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307876","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}
B. S. F. Sanches, O. P. Nyssen, S. R. Chaves, J. S. Veloso, L. S. Silva, J. R. Marinho, H. Okamoto, G. C. Couto, H. P. Breyer, C. S. Alencar, E. Comelli, L. S. Sousa, M. Horn, M. G. Massote, M. T. R. Loures, M. P. Vidal, R. V. Paula, L. T. Ribeiro, H. O. Galizzi, D. A. A. Terra, G. G. L. Cançado, B. P. Burmann, J. S. Caetano, L. F. Pena, M. A. Decanio, H. S. Souza, A. S. O. Kuniyoshi, L. R. Guedes, M. C. F. Passos, F. P. Marinho, I. Z. Bombassaro, A. G. Domingues, J. G. Barbosa, I. M. Nogueira, A. F. P. Ramos, D. R. Korman, T. B. Souza, M. C. Barbosa, D. Chinzon, L. L. Silva, A. Mantovani, A. H. A. Freitas, C. S. Poncinelli, M. A. Francato, J. N. Goncalves, P. Parra, A. Cano-Català, L. Moreira, J. P. Gisbert, Luiz Gonzaga Vaz Coelho, the Hp-BrazilReg
<div> <section> <h3> Background</h3> <p>The effectiveness of anti<i>-H. pylori</i> treatment diminishes with therapy failure, making regional performance understanding crucial.</p> </section> <section> <h3> Objective</h3> <p>To evaluate the effectiveness of empirical therapy in second-line and subsequent treatments in Brazil.</p> </section> <section> <h3> Methods</h3> <p>A multicenter, prospective, noninterventional registry assessed <i>H. pylori</i> management outcomes by Brazilian gastroenterologists (Hp-BrazilRe, Hp-WorldReg's partner). Data were registered at e-CRF AEG-ReCap from March 2022 to October 2024 and analyzed via modified intention-to-treat (mITT) methodology. Data were subject to quality review.</p> </section> <section> <h3> Results</h3> <p>572 patients (mean age 52 years, 64% women) were included. The primary treatment indications were dyspepsia (64%) and gastroduodenal ulcer (9.2%). Among them, 67% underwent second-line therapy, while 33% received third-line or subsequent treatments. Proton-pump inhibitors (PPIs) were administered at low (40%), standard (10%), and high doses (24%), with vonoprazan used in 26% of cases. The overall eradication rate for second-line treatment was 74%, with the most common regimen being triple therapy (PPI + amoxicillin + levofloxacin), achieving 73% eradication for 14 days and 57% for 10 days. Adding bismuth to the 14-day regimen increased effectiveness to 100% (<i>p</i> = 0.016). In third-line therapy, a regimen of PPI-bismuth-tetracycline-metronidazole yielded an 87% cure rate. The fourth-line dual therapy with amoxicillin-vonoprazan achieved 100% eradication, while bismuth-quadruple therapy showed similar results. Dual therapy with vonoprazan and amoxicillin was also effective in fifth-line treatments, achieving 100% effectiveness. Mild adverse events occurred in 23% of patients, with nausea being the most common (14%), and compliance was 99%.</p> </section> <section> <h3> Conclusion</h3> <p>In Brazil, the overall effectiveness of second-line therapy was suboptimal (< 90%); however, the combination of bismuth-amoxicillin-levofloxacin prescribed for 14 days reported successful cure rates. In the third-line, the classical bismuth-quadruple therapy with metronidazole-tetracycline provided acceptable results (87%). Alternatively, dual therapy with vonoprazan and amoxicillin and rifabutin-based bismuth-quadruple therapy showed promising results in third- and fifth-line rescue treatment.</p>
{"title":"Empirical Rescue Eradication Therapy for Helicobacter pylori Infection in Second and Subsequent Treatment Lines: Experience From 500 Cases of the Brazilian Registry on H. pylori Management (Hp-BrazilReg)","authors":"B. S. F. Sanches, O. P. Nyssen, S. R. Chaves, J. S. Veloso, L. S. Silva, J. R. Marinho, H. Okamoto, G. C. Couto, H. P. Breyer, C. S. Alencar, E. Comelli, L. S. Sousa, M. Horn, M. G. Massote, M. T. R. Loures, M. P. Vidal, R. V. Paula, L. T. Ribeiro, H. O. Galizzi, D. A. A. Terra, G. G. L. Cançado, B. P. Burmann, J. S. Caetano, L. F. Pena, M. A. Decanio, H. S. Souza, A. S. O. Kuniyoshi, L. R. Guedes, M. C. F. Passos, F. P. Marinho, I. Z. Bombassaro, A. G. Domingues, J. G. Barbosa, I. M. Nogueira, A. F. P. Ramos, D. R. Korman, T. B. Souza, M. C. Barbosa, D. Chinzon, L. L. Silva, A. Mantovani, A. H. A. Freitas, C. S. Poncinelli, M. A. Francato, J. N. Goncalves, P. Parra, A. Cano-Català, L. Moreira, J. P. Gisbert, Luiz Gonzaga Vaz Coelho, the Hp-BrazilReg","doi":"10.1111/hel.70077","DOIUrl":"10.1111/hel.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The effectiveness of anti<i>-H. pylori</i> treatment diminishes with therapy failure, making regional performance understanding crucial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effectiveness of empirical therapy in second-line and subsequent treatments in Brazil.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter, prospective, noninterventional registry assessed <i>H. pylori</i> management outcomes by Brazilian gastroenterologists (Hp-BrazilRe, Hp-WorldReg's partner). Data were registered at e-CRF AEG-ReCap from March 2022 to October 2024 and analyzed via modified intention-to-treat (mITT) methodology. Data were subject to quality review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>572 patients (mean age 52 years, 64% women) were included. The primary treatment indications were dyspepsia (64%) and gastroduodenal ulcer (9.2%). Among them, 67% underwent second-line therapy, while 33% received third-line or subsequent treatments. Proton-pump inhibitors (PPIs) were administered at low (40%), standard (10%), and high doses (24%), with vonoprazan used in 26% of cases. The overall eradication rate for second-line treatment was 74%, with the most common regimen being triple therapy (PPI + amoxicillin + levofloxacin), achieving 73% eradication for 14 days and 57% for 10 days. Adding bismuth to the 14-day regimen increased effectiveness to 100% (<i>p</i> = 0.016). In third-line therapy, a regimen of PPI-bismuth-tetracycline-metronidazole yielded an 87% cure rate. The fourth-line dual therapy with amoxicillin-vonoprazan achieved 100% eradication, while bismuth-quadruple therapy showed similar results. Dual therapy with vonoprazan and amoxicillin was also effective in fifth-line treatments, achieving 100% effectiveness. Mild adverse events occurred in 23% of patients, with nausea being the most common (14%), and compliance was 99%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Brazil, the overall effectiveness of second-line therapy was suboptimal (< 90%); however, the combination of bismuth-amoxicillin-levofloxacin prescribed for 14 days reported successful cure rates. In the third-line, the classical bismuth-quadruple therapy with metronidazole-tetracycline provided acceptable results (87%). Alternatively, dual therapy with vonoprazan and amoxicillin and rifabutin-based bismuth-quadruple therapy showed promising results in third- and fifth-line rescue treatment.</p>\u0000 ","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292066","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}
Nodular gastritis associated with Helicobacter pylori infection (HPi-NG) has long been recognized. Recently, similar mucosal changes have been reported with non-H. pylori Helicobacter (NHPH), including NHPH-induced gastric mucosa-associated lymphoid tissue lymphoma with a nodular gastritis-like appearance (NHPHi-MNG) and NHPH-induced nodular gastritis (NHPHi-NG). However, how bacterial species differences and the presence or absence of malignancy are reflected in endoscopic appearance has not been sufficiently investigated. This study aimed to clarify these relationships and to identify key endoscopic features that differentiate among the three clinically distinct entities.
Methods
We retrospectively analyzed 69 patients diagnosed at Hiroshima University Hospital between 2013 and 2024: 11 with NHPHi-MNG, 12 with NHPHi-NG, and 46 with HPi-NG. Endoscopic findings were compared, focusing on three morphological features of the nodules (maximum diameter, size heterogeneity, and shape) and three distributional features (extent of nodularity, extension to the lower gastric body, and predominant site of nodularity), along with patient sex. Diagnostic accuracy was calculated based on combinations of these features.
Results
NHPHi-MNG was differentiated from NHPHi-NG with 91.3% accuracy when two or more of the three morphological criteria were satisfied. NHPHi-MNG was distinguished from HPi-NG with 93.0% accuracy when four or more of seven criteria were fulfilled: the three morphological features, three distributional features, and patient sex. NHPHi-NG was differentiated from HPi-NG with 91.4% accuracy when all three distributional features were present.
Conclusion
Among the three nodular gastric conditions, the morphological features of nodules reflected the presence or absence of malignancy, whereas the distributional features were associated with the underlying bacterial species. These findings suggest that specific endoscopic features can aid in distinguishing between benign and malignant forms of nodular gastric lesions and between infections with different Helicobacter species, providing important diagnostic guidance.
{"title":"A Three-Way Comparison of Nodular Lesions in H. pylori-Induced Gastritis, Non-Helicobacter pylori Helicobacter (NHPH)-Induced Gastritis, and NHPH-Induced MALT Lymphoma Reveals Their Distinct Endoscopic Predictors: Distribution for Bacterial Etiology and Morphology for Malignancy","authors":"Yuki Kitadai, Hidehiko Takigawa, Akinori Nagao, Daisuke Shimizu, Misa Ariyoshi, Takeshi Takasago, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama, Yoshihiro Kishida, Yuji Urabe, Akira Ishikawa, Toshio Kuwai, Shiro Oka","doi":"10.1111/hel.70079","DOIUrl":"10.1111/hel.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nodular gastritis associated with <i>Helicobacter pylori</i> infection (HPi-NG) has long been recognized. Recently, similar mucosal changes have been reported with non-<i>H. pylori Helicobacter</i> (NHPH), including NHPH-induced gastric mucosa-associated lymphoid tissue lymphoma with a nodular gastritis-like appearance (NHPHi-MNG) and NHPH-induced nodular gastritis (NHPHi-NG). However, how bacterial species differences and the presence or absence of malignancy are reflected in endoscopic appearance has not been sufficiently investigated. This study aimed to clarify these relationships and to identify key endoscopic features that differentiate among the three clinically distinct entities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 69 patients diagnosed at Hiroshima University Hospital between 2013 and 2024: 11 with NHPHi-MNG, 12 with NHPHi-NG, and 46 with HPi-NG. Endoscopic findings were compared, focusing on three morphological features of the nodules (maximum diameter, size heterogeneity, and shape) and three distributional features (extent of nodularity, extension to the lower gastric body, and predominant site of nodularity), along with patient sex. Diagnostic accuracy was calculated based on combinations of these features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NHPHi-MNG was differentiated from NHPHi-NG with 91.3% accuracy when two or more of the three morphological criteria were satisfied. NHPHi-MNG was distinguished from HPi-NG with 93.0% accuracy when four or more of seven criteria were fulfilled: the three morphological features, three distributional features, and patient sex. NHPHi-NG was differentiated from HPi-NG with 91.4% accuracy when all three distributional features were present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among the three nodular gastric conditions, the morphological features of nodules reflected the presence or absence of malignancy, whereas the distributional features were associated with the underlying bacterial species. These findings suggest that specific endoscopic features can aid in distinguishing between benign and malignant forms of nodular gastric lesions and between infections with different <i>Helicobacter</i> species, providing important diagnostic guidance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292099","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}
Li Yan-Dong, Wang Huo-Gen, Yan Xue-Hui, Lv Xiao-Jin, Zhu Shu-Wen, Li Yue-Wen, Yu Jiang-Ping, Zhao Yuan-Han, Wang Shi
Background
Real-time assessment of Helicobacter pylori infection during esophagogastroduodenoscopy (EGD) is clinically valuable but remains technically challenging. We developed a deep learning-based system to predict H. pylori infection directly from EGD videos.
Methods
This prospective multicenter diagnostic study enrolled patients undergoing EGD at three hospitals between September and December 2024. All patients underwent the 14C-urea breath test as the reference standard. The model integrated deep learning-based video analysis to predict gastric regions with H. pylori infection in real time. The primary outcomes were diagnostic accuracy, sensitivity, and specificity. Secondary outcomes included the positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC). Logistic regression was used to explore factors associated with diagnostic performance.
Results
Among the cohort of 701 patients, 42.4% were positive for H. pylori infection. The model achieved an AUC of 0.918 (95% CI: 0.895–0.937), with an accuracy of 86.3% (95% CI: 83.5%–88.8%), sensitivity of 86.9% (95% CI: 82.5%–90.5%), and specificity of 85.9% (95% CI: 82.1%–89.1%). By multivariate analysis, mucosal atrophy was independently associated with an increased diagnostic error (OR = 1.788, p = 0.014), while a higher examination quality score was protective (OR = 0.600, p < 0.001).
Conclusions
This deep learning model demonstrated high diagnostic performance for real-time H. pylori detection during EGD across multiple centers and should be considered to improve diagnostic efficiency and consistency of clinical endoscopy.
Trial Registration
Chinese Clinical Trial Registry registration number: ChiCTR2400088612
{"title":"Real-Time Prediction of Helicobacter pylori Infection Using a Deep Learning Model During Esophagogastroduodenoscopy: A Prospective Multicenter Study","authors":"Li Yan-Dong, Wang Huo-Gen, Yan Xue-Hui, Lv Xiao-Jin, Zhu Shu-Wen, Li Yue-Wen, Yu Jiang-Ping, Zhao Yuan-Han, Wang Shi","doi":"10.1111/hel.70078","DOIUrl":"10.1111/hel.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Real-time assessment of <i>Helicobacter pylori</i> infection during esophagogastroduodenoscopy (EGD) is clinically valuable but remains technically challenging. We developed a deep learning-based system to predict <i>H. pylori</i> infection directly from EGD videos.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective multicenter diagnostic study enrolled patients undergoing EGD at three hospitals between September and December 2024. All patients underwent the 14C-urea breath test as the reference standard. The model integrated deep learning-based video analysis to predict gastric regions with <i>H. pylori</i> infection in real time. The primary outcomes were diagnostic accuracy, sensitivity, and specificity. Secondary outcomes included the positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC). Logistic regression was used to explore factors associated with diagnostic performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the cohort of 701 patients, 42.4% were positive for <i>H. pylori</i> infection. The model achieved an AUC of 0.918 (95% CI: 0.895–0.937), with an accuracy of 86.3% (95% CI: 83.5%–88.8%), sensitivity of 86.9% (95% CI: 82.5%–90.5%), and specificity of 85.9% (95% CI: 82.1%–89.1%). By multivariate analysis, mucosal atrophy was independently associated with an increased diagnostic error (OR = 1.788, <i>p</i> = 0.014), while a higher examination quality score was protective (OR = 0.600, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This deep learning model demonstrated high diagnostic performance for real-time <i>H. pylori</i> detection during EGD across multiple centers and should be considered to improve diagnostic efficiency and consistency of clinical endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Chinese Clinical Trial Registry registration number: ChiCTR2400088612</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279987","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号