Influence of adding vitamin D3 to standard clarithromycin-based triple therapy on the eradication rates of Helicobacter pylori infection

Helicobacter pylori eradication therapy for children

OBJECTIVES

The research aims to investigate the effect of vitamin D supplementation on the efficacy of Helicobacter pylori eradication therapy and to find new drug combinations for the eradication of the bacterium.

METHODS

A total of 128 children participated in the research. They were distributed under the following criteria: group A were children who tested positive for H. pylori and were treated with the standard so-called triple therapy including vitamin D; group B were children who tested positive for H. pylori and received the standard triple therapy without including vitamin D in the treatment; and group C were children who tested negative for H. pylori. After endoscopic examination, additional venous blood samples were taken from the children to determine vitamin D levels. A controlled study was carried out 45 days after the initial treatment.

RESULTS

The overall success rate of eradication therapy was 84.1 %. In group A, the success rate of treatment was 93.5 %, contrary to group B, where the success rate was 75 %. Although there was a difference in the percentage of H. pylori eradication therapy in the main group compared to the control group, there was no significant difference in group B. The success rate of eradication is p=0.082.

CONCLUSIONS

Following the research results, the addition of vitamin D to the standard triple therapy regimen for H. pylori had no effect. It can therefore be concluded that vitamin D does not significantly increase the efficacy of eradication therapy.

Recent Advances in Vitamin D3 Intervention to Eradicate Helicobacter pylori Infection

Helicobacter pylori (HP) infections affect approximately one-third of children worldwide. In China, the incidence of HP infection in children ranges from approximately 30% to 60%. In addition to damaging the gastrointestinal tract mucosa, HP infection in children can negatively affect their growth and development, hematology, respiratory and hepatobiliary system, skin, nutritional metabolism, and autoimmune system. However, the rate of HP eradication also fell considerably from the previous rate due to the presence of drug-resistant HP strains and the limited types of antibiotics that can be used in young patients. Vitamin D3 (VitD3) is a steroid hormone that can reduce inflammation in the stomach mucosa induced by HP and can alleviate and eradicate HP through a variety of pathways and mechanisms, including immune regulation and the stimulation of antimicrobial peptide (AMP) secretion and Ca2+ influx, to reestablish lysosomal acidification; thus, these results provide new strategies and ideas for the eradication of drug-resistant HP strains.

Vitamin D and Its Association with H. pylori Prevalence and Eradication: A Comprehensive Review

Taking into account previous data that sustain a relationship between vitamin D deficiency and higher H. pylori infection positivity rates, this review aims to assess the influence of vitamin D deficiency and/or insufficiency upon the prevalence of H. pylori infection and its eradication success. Three major databases were searched for articles that analyzed a relationship between vitamin D status and H. pylori infection. The literature search retrieved a total of 37 reports, after the article selection process. Hypovitaminosis D emerged as a potential risk factor for H. pylori infection, given the higher prevalence of vitamin D deficiency and/or insufficiency among H. pylori-positive subjects. Furthermore, the same type of micronutrient deficiency has been directly linked to H. pylori eradication failure. An inverse linear relationship between vitamin D status and gastric cancer risk exists, but the additional involvement of H. pylori in this correlation is still in question. The potential benefit of oral supplements in enhancing the success of classical therapeutic regimens of H. pylori still requires future research. Future population-based studies from larger geographical areas are warranted to address this subject in more depth.

25-hydroxyvitamin D levels in children of different ages and with varying degrees of Helicobacter pylori infection and immunological features

Background

Helicobacter pylori (HP) is a major cause of upper digestive tract diseases. However, the relationship between HP infection and 25-hydroxyvitamin D [25(OH)D] levels in children has not been fully elucidated. This study investigated the levels of 25(OH)D in children of different ages and with varying degrees of HP infection and immunological features as well as the correlations between 25(OH)D levels in children infected with HP and their ages and degrees of infection.

Materials and methods

Ninety-four children who underwent upper digestive endoscopy were divided into an HP-positive group without peptic ulcers (Group A), an HP-positive group with peptic ulcers (Group B) and an HP-negative control group (Group C). The serum levels of 25(OH)D and immunoglobulin and the percentages of lymphocyte subsets were determined. HP colonization, the degree of inflammation, and the degree of activity were further evaluated by HE staining and immunohistochemical staining in gastric mucosal biopsy.

Results

The 25(OH)D level of the HP-positive groups (50.93 ± 16.51 nmol/L) was significantly lower than that of the HP-negative group (62.89 ± 19.18 nmol/L). The 25(OH)D level of Group B (47.79 ± 14.79 nmol/L) was lower than that of Group A (51.53 ± 17.05 nmol/L) and was significantly lower than that of Group C (62.89 ± 19.18 nmol/L). The 25(OH)D level decreased with increasing age, and there was a significant difference between Group C subjects who were ≤5 years old and those who were aged 6-9 years and ≥10 years. The 25(OH)D level was negatively correlated with HP colonization (r = -0.411, P < 0.01) and the degree of inflammation (r = -0.456, P < 0.01). The percentages of lymphocyte subsets and immunoglobulin levels among Groups A, B and C were not significantly different.

Conclusions

The 25(OH)D level was negatively correlated with HP colonization and the degree of inflammation. As the age of the children increased, the level of 25(OH)D decreased, and the susceptibility to HP infection increased.

The Crosstalk between Vitamin D and Pediatric Digestive Disorders

Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance H. pylori eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of H. pylori infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis.

Factors Affect the Eradication Rate of Helicobacter pylori by Modified Quadruple Therapy: A Prospective Cohort Study

Objective

This study aimed to investigate related factors affecting the eradication rate of Helicobacter pylori (Hp) by modified quadruple therapy.

Methods

Between September 2020 and March 2021, 341 patients who were diagnosed with Hp infection and whose infections were confirmed by gastroscopy, a histological examination, and a C13-UBT without culturing and antimicrobial susceptibility studies received a two-week anti-Hp treatment, a modified quadruple therapy, in our department. The result of C13-UBT was rechecked 4 weeks after the drug withdrawal, and the patients were divided into two groups-a success group and a failure group-according to the final breath result. The general clinical information and related laboratory indexes of each patient were collected, and the factors affecting the eradication rate were analyzed.

Results

The total clinical eradication rate was 80.06% (273/341), and the failure rate was 19.94% (68/341), correspondingly. Univariate analysis identified statistically significant differences between the two groups in serum 25-hydroxyvitamin D levels, presence of oral diseases, positive cytotoxin-associated gene A (CagA), and medical compliance (P < 0.05). Meanwhile, the use of a proton pump inhibitor (PPIs) and antibiotics was statistically different (P < 0.05). Logistic regression analysis revealed that vitamin D level (<20 ng/mL) [OR = 98.56, 95% CI (29.01-334.83), P < 0.001] and medical compliance [OR = 148.18, 95% CI (37.64-583.33), P < 0.001] were independent effecting factors for eradication rate.

Conclusion

Serum 25-hydroxyvitamin D level lower than 20 ng/mL may affect the success of eradication of Hp and is an independent risk factor for eradication failure.