The Effect of Helicobacter pylori on the Presentation and Clinical Course of Coronavirus Disease 2019 Infection

The interplay of co-infections in shaping COVID-19 severity: Expanding the scope beyond SARS-CoV-2

High mortality has been reported in severe cases of COVID-19. Emerging reports suggested that the severity is not only due to SARS-CoV-2 infection, but also due to coinfections by other pathogens exhibiting symptoms like COVID-19. During the COVID-19 pandemic, simultaneous respiratory coinfections with various viral (Retroviridae, Flaviviridae, Orthomyxoviridae, and Picoviridae) and bacterial (Mycobacteriaceae, Mycoplasmataceae, Enterobacteriaceae and Helicobacteraceae) families have been observed. These pathogens intensify disease severity by potentially augmenting SARSCoV-2 replication, inflammation, and modulation of signaling pathways. Coinfection emerges as a critical determinant of COVID-19 severity, principally instigated by heightened pro-inflammatory cytokine levels, as cytokine storm. Thereby, in co-infection scenario, the severity is also driven by the modulation of inflammatory signaling pathways by both pathogens possibly associated with interleukin, interferon, and cell death exacerbating the severity. In the current review, we attempt to understand the role of co- infections by other pathogens and their involvement in the severity of COVID-19.

Addressing Challenges in Standardizing Helicobacter pylori Treatment Protocols: Importance and Review

Helicobacter pylori, one of the top carcinogens, is associated with most cases of gastric cancer-related deaths worldwide. Over the past two decades, the rising rates of antibiotic resistance in the bacterium have reduced the efficacy of conventional antibiotic-based treatments. This underscores the urgency for continued research and novel treatment approaches. Establishing a worldwide accepted physician guideline for antibiotic prescription is crucial to combat antibiotic resistance and improve H. pylori infection management. Therefore, it is important to address the challenges that complicate the establishment of a universally accepted treatment protocol to prescribe an antibiotic regimen to eradicate H. pylori. The answers to the questions of why conventional standard triple therapy remains a first-line treatment choice despite its low efficacy, and how different factors affect therapy choice, are needed to identify these challenges. Hence, this review addresses concerns related to H. pylori treatment choice, role of antibiotic resistance and patient compliance in treatment outcomes, first-line vs. second-line therapy options, and methods for enhancing existing treatment methods. We also present a chart to aid antibiotic treatment prescription, which may support physician guidelines in this aspect. Eradication of H. pylori and patient adherence is paramount in overcoming antibiotic resistance in the bacterium, and our chart summarizes key considerations and suggests novel approaches to achieve this goal.

H. Pylori Treatment in the COVID-19 Era. What Have We Learned So Far?

PURPOSE OF REVIEW

CoronaVirus Disease of 2019 (COVID-19) has negatively influenced the management of multiple conditions in regards to the gastroenterology patient. An equivalent change in the management of Helicobacter pylori (H. pylori)-related diseases was reported, as practically no eradication treatment was offered during most of the pandemic. Given the scarcity of published data, we performed a literature review trying to elucidate the effect of COVID-19 on H. pylori treatment.

RECENT FINDINGS

COVID-19 has produced more questions than answers as to the outcome of COVID-19 in H. Pylori infected patients, post-COVID-19 patients treated for H. pylori, acid suppression and COVID-19 incidence and outcomes, and H. pylori eradication treatment in patients having recovered from COVID-19. We strongly believe that this scientific uncertainty produced by the COVID-19 pandemic has set up the stage for an incremental change in H. pylori treatment as COVID-19 has offered us the chance to speed up how we will, in the near future, approach patients with a possible Η. pylori infection.

Mixed (multiple-genotype) Helicobacter pylori infections in Bulgarian patients

The aim of the study was to evaluate the frequency and characteristics of mixed (multiple-genotype) Helicobacter pylori infections (MGIs) in 155 Bulgarian symptomatic patients (21 children and 134 adults). MGIs were common (36.1%), including double-strain (34.8%) and triple-strain infections (1.3%). None of the 8 ulcer patients harbored multiple subtypes. We detected 18 multiple allelic combinations, of which the most frequent subtypes (17.4%) were vacA s1as2 and vacA s1cs2. The 2 patients with triple-strain infections had vacA s1bs1cs2i1i2/iceA1A2 and vacA s1as1cs2 subtypes. They were both adult men with chronic gastritis and both were examined in 2022. The prevalence of MGIs (51.7%) was 2-fold higher in 2020 to 2022 than in 2015 to 2019 (26.3%). Putative factors for the increase may be the patient's characteristics and COVID-19 pandemic-associated factors. MGI rates corresponded to the high infection seroprevalence (72.4% in 2011) in Bulgaria. The evolution and clinical importance of mixed H. pylori infections merit extensive evaluation.

An Evaluation of Gastroscopy Findings During the COVID-19 Pandemic: A Public Hospital-Based Study From Turkey

Background and objective Emotional factors can affect stomach secretions, acid expression, and stomach motor functions. The coronavirus disease 2019 (COVID-19) pandemic was an emotionally difficult time for many individuals as the whole world faced a life-threatening disease for which definitive treatment is still not fully established. In light of this, the aim of this study was to compare the results of gastroscopies performed among individuals before and after the pandemic. Methods The study included patients who underwent gastroscopy at Bursa Çekirge State Hospital in the following four different time frames: March-June 2019 (Group 1), March-June 2020 (Group 2), March-June 2021 (Group 3), and March-June 2022 (Group 4). All gastroscopy procedures were performed under anesthesia in the endoscopy unit. During the COVID-19 pandemic, all patients underwent a polymerase chain reaction (PCR) test, and gastroscopy was performed on those with negative results. Biopsies were taken from the antrum in all cases. Patient data were collected retrospectively and the groups were examined and compared in terms of age, gender, COVID-19 history, histopathology examination results, and diagnoses. Results A total of 803 patients were evaluated: 201 in Group 1, 200 in Group 2, 201 in Group 3, and 201 in Group 4. Group 1 comprised 66 (32.8%) males and 135 (67.2%) females, Group 2 consisted of 76 (38%) males and 124 (62%) females, Group 3 had 76 (37.8%) males and 125 (62.2%) females, and Group 4 comprised 86 (42.8%) males and 115 (57.2%) females. The mean age was 52.77 ±14.92 years in Group 1, 52.5 ±14.49 years in Group 2, 50.08 ±15.71 years in Group 3, and 52.83 ±13.20 years in Group 4. Helicobacter pylori (HP) positivity was found in 84 (41.8%) patients in Group 1, 146 (73%) in Group 2, 107 (53.2%) in Group 3, and 70 (34.8%) in Group 4. The HP infection was mild in 47 (23.4%) patients in Group 1, 26 (13%) in Group 2, 49 (24.4%) in Group 3, and 72 (35.8%) in Group 4. Moderate severity of HP infection was found in 16 (8%) patients in Group 1, 18 (9%) in Group 2, 25 (12.4%) in Group 3, and 25 (12.4%) in Group 4. Very severe HP infection was noted in 21 (10.4%) patients in Group 1, nine (4.5%) in Group 2, 20 (10%) in Group 3, and 34 (16.9%) in Group 4. With regard to mild HP infection, the highest rate was seen in Group 4 (35.8%). As for patients with very severe HP infection, a statistically significant difference was found between Group 2 and Group 4. In 2020 (Group 2), the rate was 4.5%, increasing to 16.9% in 2022 (Group 4). Regarding the comparison among groups based on histopathological examination findings, the frequency of chronic antral gastritis was determined to be highest in Group 4, at a statistically significant level (p<0.001). Conclusion The COVID-19 pandemic has caused physical and emotional hardships for several people worldwide. The possibility of transmission of the disease, unknown facts about the disease, and anxiety due to the condition being potentially fatal have had a drastic impact on the emotional states of many people. It is a condition that affects the lives of many people in the short term, and we believe that its effects reflected in the chronic period can be better evaluated through further studies conducted over the long term.

COVID-19 and Gastrointestinal Tract: From Pathophysiology to Clinical Manifestations

Background: Since its first report in Wuhan, China, in December 2019, COVID-19 has become a pandemic, affecting millions of people worldwide. Although the virus primarily affects the respiratory tract, gastrointestinal symptoms are also common. The aim of this narrative review is to provide an overview of the pathophysiology and clinical manifestations of gastrointestinal COVID-19. Methods: We conducted a systematic electronic search of English literature up to January 2023 using Medline, Scopus, and the Cochrane Library, focusing on papers that analyzed the role of SARS-CoV-2 in the gastrointestinal tract. Results: Our review highlights that SARS-CoV-2 directly infects the gastrointestinal tract and can cause symptoms such as diarrhea, nausea/vomiting, abdominal pain, anorexia, loss of taste, and increased liver enzymes. These symptoms result from mucosal barrier damage, inflammation, and changes in the microbiota composition. The exact mechanism of how the virus overcomes the acid gastric environment and leads to the intestinal damage is still being studied. Conclusions: Although vaccination has increased the prevalence of less severe symptoms, the long-term interaction with SARS-CoV-2 remains a concern. Understanding the interplay between SARS-CoV-2 and the gastrointestinal tract is essential for future management of the virus.

The Impact of COVID-19 Infection on Miscellaneous Inflammatory Disorders of the Gastrointestinal Tract

The novel coronavirus pandemic of COVID-19 has emerged as a highly significant recent threat to global health with about 600,000,000 known infections and more than 6,450,000 deaths worldwide since its emergence in late 2019. COVID-19 symptoms are predominantly respiratory, with mortality largely related to pulmonary manifestations, but the virus also potentially infects all parts of the gastrointestinal tract with related symptoms and manifestations that affect patient treatment and outcome. COVID-19 can directly infect the gastrointestinal tract because of the presence of widespread angiotensin-converting enzyme 2 receptors in the stomach and small intestine that can cause local COVID-19 infection and associated inflammation. This work reviews the pathopysiology, clinical manifestations, workup, and treatment of miscellaneous inflammatory disorders of the gastrointestinal tract other than inflammatory bowel disease.

Helicobacter pylori and unignorable extragastric diseases: Mechanism and implications

Considered as the most popular pathogen worldwide, Helicobacter pylori is intensively associated with diverse gastric diseases, including gastric ulcers, chronic progressive gastritis, and gastric cancer. Aside from its pathogenic effect on gastric diseases, growing evidences reveal that H. pylori may be related to numerous extragastric diseases. In this article, we reviewed recent studies and systematically elucidated that H. pylori may interfere with many biological processes outside the stomach and influence the occurrence of various extragastric diseases. Many epidemiological studies have indicated that H. pylori plays a pathogenic role in COVID-19, atherosclerosis, hyperemesis gravidarum and several other extragastric diseases, while the effect of H. pylori is currently under investigation in gastroesophageal reflux disease, asthma, and inflammatory bowel disease. Moreover, we also summarized the possible pathogenic mechanisms of H. pylori that may be related to chronic systemic inflammation and molecular mimicker. Taken together, this review provides a new perspective on the role of H. pylori in extragastric diseases and explores the possible mechanisms, which may help guide clinical treatment.

The Potential Use of Antibiotics Against Helicobacter pylori Infection: Biopharmaceutical Implications

Helicobacter pylori (H. pylori) is a notorious, recalcitrant and silent germ, which can cause a variety of debilitating stomach diseases, including gastric and duodenal ulcers and gastric cancer. This microbe predominantly colonizes the mucosal layer of the human stomach and survives in the inhospitable gastric microenvironment, by adapting to this hostile milieu. In this review, we first discuss H. pylori colonization and invasion. Thereafter, we provide a survey of current curative options based on polypharmacy, looking at pharmacokinetics, pharmacodynamics and pharmaceutical microbiology concepts, in the battle against H. pylori infection.

Interrelation: gastric microbiota - acid-dependent diseases, and more…

Introduction

The relationship between gastric microbiota and acid-dependent diseases is currently not fully studied. The study is based on a review of the literature to analyze and reflect the available data on the interaction of gastric microbiota and acid-dependent diseases, as well as brain-gut diseases.

Methods

The survey was performed by analyzing data from Medscape, PubMed, Elsevier. The articles analyzed are in English, Romanian, Russian, published in the last 10 years. Data on the composition (landscape) of the gastric microbiota and their influence on acid-dependent diseases and digestive diseases in general were reflected.

Results

The research reflected that in addition to Helicobacter pylori infection, the landscape of the gastric microbiota in the acid stomach (with low pH) is not sterile and includes other types such as: Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, Fusobacteria. At the same time, current methods document a bacterial load of 1010-1012 CFU/mL in the colon, which is much higher than in the stomach, where it reaches 102-104 CFU/mL. H. pylori influences the diversification of the non-H.pylori gastric microbiota; Decreased diversification increases the risk of carcinogenesis. The aspects of the role of H. pylori in functional dyspepsia, named after the Maastricht Consensus V - H. pylori dyspepsia, were also demonstrated. The taxonomic profiles (Philum-level, Genus-level) of the gastric microbiota require the study of the interrelationships with acid-dependent diseases, as well as the feedback.

Conclusions

The study shows that the stomach is not a sterile organ and in addition to H. pylori there are 5 other types of gastric microbiota, which are interrelated with acid-dependent diseases and digestive disorders and vice versa. This issue requires a comprehensive approach.

Chromatographic estimation of a novel triple-therapy combination targeting Helicobacter pylori eradication in different matrices

Aim: Helicobacter pylori infection is a prevalent global bacterial infection that can potentially exaggerate symptoms of other serious infections like SARS-CoV-2 (COVID-19). Methodology: Herein, an efficient, accurate and cost-effective high-performance liquid chromatography-diode array detector method was developed and validated for determination of the novel triple therapy combination of tinidazole (TD), clarithromycin (CLR) and lansoprazole (LAN) in different analytical matrices (pharmaceutical formulation, dissolution media and spiked human plasma). Results: Successful chromatographic separation was achieved using Agilent Microsorb-MV 100-5 CN column (250 × 4.6 mm, 5 μm) and a mobile phase consisted of acetonitrile and 10.0 mM phosphate buffer, pH 7.5 ± 0.1 at flow rate of 1 ml/min via gradient elution. UV-detection was accomplished at 210.0 nm for CLR and 290.0 nm for TD and LAN. Conclusion: The developed method clearly provides a reliable, beneficial and cost-effective tool for quality control, dissolution testing and biological applications of the mentioned drugs.

Does COVID-19 Vaccination Warrant the Classical Principle "ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic.