Helicobacter最新文献

Helicobacter pylori infection in children and adults differs in several aspects such as the natural history, prevalence, the clinical presentations and complications, antibiotic resistance rates, treatment options, and the success rates of treatment. Due to all the abovementioned differences, management guidelines and recommendations are different between children and adults. In parallel to the steady decrease in the rate of H. pylori infection in the Western world in recent years, both in children and adults, antibiotic resistance rates have risen to alarming rates. The risk and benefits of eradication treatment, especially in children, must be considered when deciding “to treat or not.” The risks include the negative effects of antibiotics, treatment failure, and reinfection as well as the possibility of losing the “protective effect” of H. pylori on atopy, allergy, and possibly on other gastrointestinal diseases. On the other hand, there are also many benefits of eradication therapy such as prevention of gastric complication and associated non-gastric complications as well as reduction of parental anxiety of nontreatment. This review summarizes the differences related to H. pylori in children versus adults and the risks and benefits of treatment in children.

Background: The current first-line treatment for Helicobacter pylori (H. pylori) infection is bismuth-based quadruple therapy. However, the widespread use of antibiotics has contributed to the emergence of antibiotic-resistant strains, thereby increasing the likelihood of treatment failure. This study aimed to develop a multi-epitope H. pylori vaccine, designated P22-C3, based on P22 Virus-like Particles, with the objective of reducing infection rates and preventing transmission.

Materials and methods: The structural characteristics of P22-C3 were analyzed using transmission electron microscopy (TEM) and dynamic light scattering (DLS). The safety profile of P22-C3 was evaluated through a series of in vitro and in vivo assays. In vitro assessments included cytotoxicity and proinflammatory factor testing. In vivo evaluations, conducted in immunized mice, involved monitoring changes in body weight, biochemical marker fluctuations, and histopathological examinations. The antibody response and T cell-mediated immunity elicited by P22-C3 were quantified using enzyme-linked immunosorbent assay (ELISA) and flow cytometry, respectively. Immune protection efficacy was assessed through a challenge experiment.

Results: P22-C3 successfully self-assembled into T = 7 icosahedral structures with an average diameter of 58 nm. Both in vitro and in vivo experiments confirmed that P22-C3 was safe and well-tolerated. Furthermore, P22-C3 elicited a dose-dependent IgG response and a mixed Th1/Th17 immune profile. In challenge experiments, mice immunized with P22-C3 demonstrated reduced bacterial loads and urease levels in the stomach.

Conclusion: P22-C3 was well-tolerated and successfully induced a strong immune response, offering protection against H. pylori infection. These properties make P22-C3 a promising H. pylori vaccine. It is important to note that this study was conducted solely in mice and did not involve human participants; therefore, a clinical trial registration number is not applicable.

Background: To determine the clinical effects, efficacy, adverse events, tolerance, and antibiotic resistance of Helicobacter pylori (H. pylori) eradication therapy in the elderly.

Materials and methods: We searched Medline, Embase, CINAHL, Cochrane Library, clinical trial registry, conference proceedings portal, and citation screening. We selected randomized controlled trials (RCTs) or cohort designs including participants aged 60 years or older and reported their clinical effects or efficacy as quantitative indices. Meta-analyses were performed using a random effects model.

Results: A total of 5172 studies were identified, of which 64 were selected for review. The pooled eradication rate of the 10-day sequential therapy was 91% (95% confidence interval [CI], 86%-93%) and that of the 7-day standard triple therapy was 81% (95% CI, 77%-85%). In addition, 7-day levofloxacin-based TT, 14-day hybrid, 14-day bismuth-based QT, 7-day vonoprazan-based TT, and 14-day TT-PAC regimen in RCTs, and non-bismuth-based QT and susceptibility-based therapy in cohort studies showed eradication rates ≥ 95%. The most prevalent gastrointestinal adverse event varied by regimens, with compliance ranging from 87% to 100%. When populations with a history of eradication were included, antibiotic resistance rates exceeded the national prevalence. Three cohorts (the United States, South Korea, and China) reported a protective effect against gastric cancer, although this varied by index and age subgroup.

Conclusions: In the eradication therapy of H. pylori in individuals aged 60 years or older, the 7-day standard triple therapy was unacceptable, and the 10-day sequential therapy was borderline acceptable. The eradication history should be assessed as it may contribute to antibiotic resistance. Although positive reports have emerged regarding the protective effects of gastric cancer on that population, country-specific and conditional recommendations are necessary. Future researchers should report more rigorously on adverse events, tolerance, and antibiotic resistance.

Protocol registration: CRD42024617327.