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}
{"title":"Response to “Re-Evaluating the Adverse Events With the Same-Dosage Regimen in Hemodialysis Patients Undergoing Helicobacter pylori Eradication”","authors":"Mitsushige Sugimoto, Shu Sahara","doi":"10.1111/hel.70080","DOIUrl":"10.1111/hel.70080","url":null,"abstract":"","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258085","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":"Letter to the Editor: “Gastric Cancer Endoscopic Screening in an Intermediate-Risk Country—A Dual-Center Pilot Program”","authors":"Abubakar Afzal, Zaib Un Nisa","doi":"10.1111/hel.70076","DOIUrl":"10.1111/hel.70076","url":null,"abstract":"","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244465","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}
Stephen James Inns, Samantha Sowerbutts, Bibek Yumnam, Kate Payne, Georgina Wheller, Mali Camberis, Thomas Mules
Background
Helicobacter pylori (H. pylori) infection is a major cause of peptic ulcer disease and gastric cancer. Rising clarithromycin resistance has significantly reduced the efficacy of standard triple therapy. In Aotearoa New Zealand, the prevalence and impact of antibiotic resistance remain incompletely defined, limiting the development of effective treatment strategies.
Methods and Aims
This study evaluated the feasibility and clinical utility of detecting clarithromycin resistance genes using droplet digital polymerase chain reaction (ddPCR) on stored Rapid Urease Test (RUT) samples—a relatively novel application of molecular diagnostics. We also assessed the association between resistance status and treatment outcomes following empiric first-line triple therapy. Patients with positive RUT tests during gastroscopy were treated with omeprazole-based triple therapy and followed up with H. pylori stool antigen testing to confirm eradication.
Results
Among 84 patients, clarithromycin resistance genes were detected in 13 (15.5%). Overall eradication was achieved in 74 (88.1%) patients. However, eradication success was significantly lower in those with resistance (38.5%) compared to those without (97.2%, p < 0.001). Infection burden, treatment regimen, and duration were not associated with eradication rates, supporting resistance status as the primary determinant of treatment outcome. Resistance rates were similar between Māori and Pacific patients (18.2%) and other ethnic groups (14.8%), although sample sizes limited definitive conclusions.
Conclusions
ddPCR testing on stored RUT samples is a feasible and effective method for detecting clarithromycin resistance. This study demonstrates that clarithromycin resistance, rather than infection burden, treatment regimen, or duration, drives eradication failure in New Zealand. Tailored therapy based on molecular resistance testing may enhance treatment success and support antibiotic stewardship. These findings justify the development of PCR-guided treatment pathways and provide a strong rationale for extending this approach to non-invasive stool-based testing suitable for use in primary care and screening programs.
{"title":"Droplet Digital PCR-Based Detection of Clarithromycin Resistance on Rapid Urease Test Samples Predicts Helicobacter pylori Eradication Success: A New Zealand Cohort Study","authors":"Stephen James Inns, Samantha Sowerbutts, Bibek Yumnam, Kate Payne, Georgina Wheller, Mali Camberis, Thomas Mules","doi":"10.1111/hel.70075","DOIUrl":"https://doi.org/10.1111/hel.70075","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 a major cause of peptic ulcer disease and gastric cancer. Rising clarithromycin resistance has significantly reduced the efficacy of standard triple therapy. In Aotearoa New Zealand, the prevalence and impact of antibiotic resistance remain incompletely defined, limiting the development of effective treatment strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Aims</h3>\u0000 \u0000 <p>This study evaluated the feasibility and clinical utility of detecting clarithromycin resistance genes using droplet digital polymerase chain reaction (ddPCR) on stored Rapid Urease Test (RUT) samples—a relatively novel application of molecular diagnostics. We also assessed the association between resistance status and treatment outcomes following empiric first-line triple therapy. Patients with positive RUT tests during gastroscopy were treated with omeprazole-based triple therapy and followed up with <i>H. pylori</i> stool antigen testing to confirm eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 84 patients, clarithromycin resistance genes were detected in 13 (15.5%). Overall eradication was achieved in 74 (88.1%) patients. However, eradication success was significantly lower in those with resistance (38.5%) compared to those without (97.2%, <i>p</i> < 0.001). Infection burden, treatment regimen, and duration were not associated with eradication rates, supporting resistance status as the primary determinant of treatment outcome. Resistance rates were similar between Māori and Pacific patients (18.2%) and other ethnic groups (14.8%), although sample sizes limited definitive conclusions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ddPCR testing on stored RUT samples is a feasible and effective method for detecting clarithromycin resistance. This study demonstrates that clarithromycin resistance, rather than infection burden, treatment regimen, or duration, drives eradication failure in New Zealand. Tailored therapy based on molecular resistance testing may enhance treatment success and support antibiotic stewardship. These findings justify the development of PCR-guided treatment pathways and provide a strong rationale for extending this approach to non-invasive stool-based testing suitable for use in primary care and screening programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172044","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}
Stefano Bibbò, Gustav Ahlström, Giovanni Mario Pes, David Y. Graham, Lars Engstrand, Elettra Merola, Maria Pina Dore
Background
Helicobacter pylori eradication therapy typically consists of a combination of antibiotics and an antisecretory drug. Probiotics may be added to reduce side effects and possibly improve outcomes.
Materials and Methods
We conducted a double-blind, randomized trial of pantoprazole plus either Lactobacillus reuteri (Gastrus) (high dose) or a matching placebo to assess the impact on the gut microbiota of H. pylori-positive adults. Fecal samples were collected at baseline and after one and 2 months for shotgun metagenomic sequencing.
Results
A total of 26 patients were recruited and completed therapy. L. reuteri was only detected in the group that received supplemental L. reuteri and only at the 1-month post-treatment interval. L. reuteri failed to colonize for long-term the gut, and challenge with L. reuteri failed to alter alpha-diversity (Shannon index) or beta-diversity (community ordination) metrics at any time point. Machine learning (PLS-DA) analysis identified the presence of L. reuteri as the most distinguishing feature at 1 month. No other taxa showed a significant difference between groups.
Conclusion
Short-term administration of pantoprazole and L. reuteri had no lasting effects on gut microbial composition. While L. reuteri transiently bloomed during supplementation, the overall gut microbiota showed resilience, returning to baseline shortly after therapy.
{"title":"Resilience of the Gut Microbiome to Short Proton Pump Inhibitor Therapy With or Without High-Dosage L. reuteri in H. pylori-Infected Adults","authors":"Stefano Bibbò, Gustav Ahlström, Giovanni Mario Pes, David Y. Graham, Lars Engstrand, Elettra Merola, Maria Pina Dore","doi":"10.1111/hel.70064","DOIUrl":"10.1111/hel.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Helicobacter pylori</i> eradication therapy typically consists of a combination of antibiotics and an antisecretory drug. Probiotics may be added to reduce side effects and possibly improve outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a double-blind, randomized trial of pantoprazole plus either <i>Lactobacillus reuteri</i> (Gastrus) (high dose) or a matching placebo to assess the impact on the gut microbiota of <i>H. pylori</i>-positive adults. Fecal samples were collected at baseline and after one and 2 months for shotgun metagenomic sequencing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 26 patients were recruited and completed therapy. <i>L. reuteri</i> was only detected in the group that received supplemental <i>L. reuteri</i> and only at the 1-month post-treatment interval. <i>L. reuteri</i> failed to colonize for long-term the gut, and challenge with <i>L. reuteri</i> failed to alter alpha-diversity (Shannon index) or beta-diversity (community ordination) metrics at any time point. Machine learning (PLS-DA) analysis identified the presence of <i>L. reuteri</i> as the most distinguishing feature at 1 month. No other taxa showed a significant difference between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Short-term administration of pantoprazole and <i>L. reuteri</i> had no lasting effects on gut microbial composition. While <i>L. reuteri</i> transiently bloomed during supplementation, the overall gut microbiota showed resilience, returning to baseline shortly after therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Identifier: NCT03404440</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"30 5","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137331","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}
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