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Huang XP, Liu YJ, Lin SW, Shao YF, Qiu F, Qiu QW, Xu ZK, Chen JX, Chen LH, Lin ZQ, Dai WH, Zhang MQ, Jiang Q, Xiao ZQ, Cheng XX, Zhang XF, You WB, Chen W, Li LQ, Lin WX, Wang YF, Lai FJ, Chen LQ, Huang ZH, Zheng WQ, Wei JQ, Lin ZH. Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication in Chinese population: A prospective, multicenter, randomized, two-stage study. World J Gastroenterol 2024; 30:3304-3313. [DOI: 10.3748/wjg.v30.i27.3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The efficacy of Vonoprazan-amoxicillin dual therapy (VAT) in the treatment of Helicobacter pylori (H. pylori) is controversial.
AIM To evaluate the efficacy of VAT in the Chinese population.
METHODS This prospective, multicenter, randomized, open-label, and two-stage study was conducted at 23 centers in Fujian, China (May 2021-April 2022). H. pylori-infected patients were randomized to bismuth quadruple therapy (BQT), BQT-Vonoprazan (BQT-V), seven-day VAT (VAT-7), ten-day VAT (VAT-10), and fourteen-day VAT (VAT-14) groups. The primary endpoint was the H. pylori eradication rate. The secondary endpoint was the frequency of adverse events. This study was registered with the Chinese Clinical Trial Registry, ChiCTR2100045778.
RESULTS In the first stage, VAT-7 and BQT-V groups were selected for early termination because less than 23 among 28 cases were eradicated. In the second stage, the eradication rates for BQT, VAT-10, and VA-14 were 80.2% [95% confidence interval (95%CI): 71.4%-86.8%], 93.2% (86.6%-96.7%), 92.2% (85.3%-96.0%) in the intention-to-treat (ITT) analysis, and 80.9% (95%CI: 71.7%-87.5%), 94.0% (87.5%-97.2%), and 93.9% (87.4%-97.2%) in the per-protocol analysis. The ITT analysis showed a higher eradication rate in the VAT-10 and VAT-14 groups than in the BQT group (P = 0.022 and P = 0.046, respectively). The incidence of adverse events in the VAT-10 and VAT-14 groups was lower than in the BQT group (25.27% and 13.73% vs 37.62%, respectively; P < 0.001).
CONCLUSION VAT with a duration of 10 or 14 days achieves a higher eradication rate than the BQT, with a more tolerable safety profile in H. pylori-infected patients in Fujian.
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Affiliation(s)
- Xue-Ping Huang
- Department of Gastroenterology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastroenterology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Yi-Juan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Shao-Wei Lin
- School of Public Health, Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Yan-Feng Shao
- Department of Gastroenterology, The Third People’s Hospital of Fujian Province, Fuzhou 350000, Fujian Province, China
| | - Feng Qiu
- Department of Gastroenterology, Fujian Provincial Hospital North Brance Fujian Provincial Geriatric Hospital, Fuzhou 350000, Fujian Province, China
| | - Qing-Wu Qiu
- Department of Gastroenterology, Xiaoao Hospital, Fuzhou 350000, Fujian Province, China
| | - Zhang-Kun Xu
- Department of Gastroenterology, The General Hospital of Fujian Energy Group, Fuzhou 350000, Fujian Province, China
| | - Jin-Xian Chen
- Department of Gastroenterology, The Second Hospital of Zhangzhou, Zhangzhou 363000, Fujian Province, China
| | - Liang-Huo Chen
- Department of Gastroenterology, Anxi Country Hospital, Quanzhou 362000, Fujian Province, China
| | - Zhen-Qun Lin
- Department of Gastroenterology, Zhangzhou Municipal Hospital of TCM, Zhangzhou 363000, Fujian Province, China
| | - Wen-Hua Dai
- Department of Gastroenterology, Zhangpu Hospital, Zhangzhou 363000, Fujian Province, China
| | - Ming-Qing Zhang
- Department of Gastroenterology, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Qi Jiang
- Department of Gastroenterology, First Hospital of Nanping City, Nanping 353000, Fujian Province, China
| | - Zhong-Qin Xiao
- Department of Gastroenterology, Fujian Nanping Second Hospital, Nanping 353000, Fujian Province, China
| | - Xian-Xing Cheng
- Department of Gastroenterology, Wuyishan Municipal Hospital, Nanping 353000, Fujian Province, China
| | - Xiang-Fei Zhang
- Department of Gastroenterology, Fuzhou Changle District Hospital, Fuzhou 350000, Fujian Province, China
| | - Wen-Bin You
- Department of Gastroenterology, Changle City Second Hospital, Fuzhou 350000, Fujian Province, China
| | - Wei Chen
- Department of Gastroenterology, Changle City Second Hospital, Fuzhou 350000, Fujian Province, China
| | - Long-Qin Li
- Department of Gastroenterology, Jinjiang Municipal Hospital, Quanzhou 362000, Fujian Province, China
| | - Wei-Xing Lin
- Department of Gastroenterology, Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Ningde 352000, Fujian Province, China
| | - Yong-Fu Wang
- Department of Gastroenterology, Liancheng Hospital, Longyan 364000, Fujian Province, China
| | - Fu-Jin Lai
- Department of Gastroenterology, Xiapu County Hospital, Ningde 352000, Fujian Province, China
| | - Long-Qun Chen
- Department of Gastroenterology, Jinjiang Second Hospital, Quanzhou 362000, Fujian Province, China
| | - Zhong-Hua Huang
- Department of Gastroenterology, The First Hospital of Putian City, Putian 351100, Fujian Province, China
| | - Wen-Qi Zheng
- Department of Gastroenterology, Putian Fude Hospital, Putian 351100, Fujian Province, China
| | - Jin-Qi Wei
- Department of Gastroenterology, The 5th Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
| | - Zhi-Hui Lin
- Department of Gastroenterology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastroenterology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
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Wang JY, Zhou XZ, Wang CJ, Xu SH, Zhu HY, Du YQ. Helicobacter pylori antibiotic resistance in different regions of China: A systematic review and meta-analysis. Shijie Huaren Xiaohua Zazhi 2024; 32:71-87. [DOI: 10.11569/wcjd.v32.i1.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/06/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Increasing drug resistance of Helicobacter pylori (H. pylori) in China has become one of the major obstacles to the efficacy of empirical eradication therapy. Resistance profiles vary from region to region, which poses an additional challenge to the expansion of empirical eradication therapy.
AIM To evaluate H. pylori antibiotic resistance in various regions of China systematically.
METHODS A thorough computerized search of various databases, including PubMed, EMBASE, Web of Science, Sinomed, CNKI, Wanfang Data, and VIP, was conducted to identify cross-sectional studies on H. pylori resistance in various regions of China. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the literature. R 4.3.1 software was used for Meta-analysis of the resistance rate to each antibiotic and their combinations.
RESULTS A total of 46 eligible articles were included. Clarithromycin (CLA), levofloxacin (LEV), amoxicillin (AMX), tetracycline (TET), metronidazole (MNZ), and furazolidone (FZD) resistance rates in China were 27.72% (95% confidence interval [CI]: 23.80%-31.82%), 31.23% (95%CI: 26.62%-36.02%), 3.97% (95%CI: 1.96%-6.65%), 4.01% (95%CI: 1.36%-7.98%), 75.30% (95%CI: 70.31%-79.97%), and 0.64% (95%CI: 0.13%-1.53%), respectively. The rate of AMX resistance varied significantly among different regions of China, being the highest in South China (7.15%, 95%CI: 6.16%-76.10%) and the lowest in North China (1.86%, 95%CI: 0.67%-3.64%). CLA resistance in East and Central China, LEV resistance in East and Northwest China, and MNZ resistance in North and Southwest China all increased significantly over time, while AMX and TET resistance in East China notably decreased. CLA + MNZ, LEV + MNZ, and CLA + LEV dual resistance rates in China reached 14.05% (95%CI: 10.70%-17.77%), 15.12% (95%CI: 11.53%-19.10%), and 5.16% (95%CI: 2.87%-8.06%), respectively. CLA + LEV + MNZ, LEV + MNZ + AMX, and CLA + MNZ + AMX triple resistance rates were 10.36% (95%CI: 7.45%-13.69%), 0.92% (95%CI: 0.12%-2.44%), and 0.85% (95%CI: 0.20%-1.92%), respectively.
CONCLUSION H. pylori resistance is serious in China, with MNZ resistance rate being the highest, followed by CLA and LEV resistance rates. The detection rate of some multi-resistant organisms has also reached a high level. Antibiotic resistance rates vary slightly across different regions of China, and most of them show an increasing trend over time.
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Affiliation(s)
- Jia-Yue Wang
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Xian-Zhu Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Chan-Juan Wang
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Shi-Han Xu
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Hui-Yun Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Yi-Qi Du
- Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
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Jearth V, Rath MM, Chatterjee A, Kale A, Panigrahi MK. Drug-Resistant Helicobacter pylori: Diagnosis and Evidence-Based Approach. Diagnostics (Basel) 2023; 13:2944. [PMID: 37761310 PMCID: PMC10528400 DOI: 10.3390/diagnostics13182944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Helicobacter pylori (H. pylori) is the most common chronic bacterial infection, affecting approximately half of the world's population. H. pylori is a Class I carcinogen according to the World Health Organization, and the International Agency for Research on Cancer (IARC) has linked it to 90% of stomach cancer cases worldwide. The overall pattern points to a yearly reduction in eradication rates of H. pylori with the likelihood of success further decreasing after each unsuccessful therapeutic effort. Antimicrobial resistance in Helicobacter pylori is a major public health concern and is a predominant cause attributed to eradication failure. As a result, determining H. pylori's antibiotic susceptibility prior to the administration of eradication regimens becomes increasingly critical. Detecting H. pylori and its antimicrobial resistance has traditionally been accomplished by time-consuming culture and phenotypic drug susceptibility testing. The resistance of H. pylori to different antibiotics is caused by various molecular mechanisms, and advances in sequencing technology have greatly facilitated the testing of antibiotic susceptibility to H. pylori. This review will summarize H. pylori antibiotic resistance patterns, mechanisms, and clinical implications. We will also review the pros and cons of current antibiotic susceptibility testing methods. Along with a comparison of tailored susceptibility-guided regimens and empirical therapy based on the latest evidence, an evidence-based approach to such situations will be explored.
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Affiliation(s)
- Vaneet Jearth
- Post Graduate Institute Medical Education and Research, Chandigarh 160012, India; (V.J.); (A.C.)
| | | | - Abhirup Chatterjee
- Post Graduate Institute Medical Education and Research, Chandigarh 160012, India; (V.J.); (A.C.)
| | - Aditya Kale
- Tata Memorial Hospital, Mumbai 400012, India;
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Maghrabia AE, Elshebrawy HA, Mahros MA, Elgazzar MM, Sallam KI. Clarithromycin-, and metronidazole-resistant Helicobacter pylori isolated from raw and ready-to-eat meat in Mansoura, Egypt. Int J Food Microbiol 2023; 387:110052. [PMID: 36512933 DOI: 10.1016/j.ijfoodmicro.2022.110052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Helicobacter pylori (H. pylori), classified as a class-I carcinogen, is one of the leading medical pathogens of global concern associated mainly with the development of gastric adenocarcinomas and gastric mucosa-associated lymphoid tissue lymphomas; nevertheless, its prevalence in food especially meat and meat products is not fully covered. Additionally, the resistance of H. pylori towards clarithromycin is increasing worldwide and consider the leading cause of H. pylori treatment failure. Thus, the present study was designed to determine the prevalence, molecular characterization, and antimicrobial resistance profiles of clarithromycin-, and metronidazole-resistant H. pylori isolated from raw and ready-to-eat meat samples retailed in Mansoura city, Egypt. Among the 250 samples tested, H. pylori were molecularly confirmed in 40.8 % (49/120) of raw meat products and in 29.2 % (38/130) of ready-to-eat meat products. Precisely, 53.3 % (32/60), 56.7 % (17/30), 40 % (8/20), 55 % (11/20), 60 % (12/20), 13.3 % (4/30), and 15 % (3/20) of raw ground beef, beef burger, beef burger sandwiches, beef shawarma sandwiches, beef kofta sandwiches, beef luncheon, and beef sausage sandwiches, respectively were positive for H. pylori. Of the 204 biochemically-identified H. pylori isolates, 53.9 % (110/204) were molecularly confirmed by PCR through the detection of glmM, cagA, or vacA genes, which were detected at an incidence of 95.5 % (105/110), 77.3 % (85/110), and 20.9 % (23/110) among the isolates, respectively. The antimicrobial sensitivity testing revealed that all of the 110 (100 %) molecularly-confirmed H. pylori isolates were multidrug-resistant (MDR; resistant to four or more antibiotics). Interestingly, 100 % and 61.8 % of H. pylori isolated from raw and ready-to-eat meat were resistant to metronidazole and clarithromycin, respectively which consider alarming results as metronidazole and clarithromycin are the mainstay antibiotics in the treatment of H. pylori infections. Additionally, 94.5 %, 94.5 %, 24.5 %, 23.6 %, and 13.6 % of isolates were resistant to vancomycin, sulphamethoxazole-trimethoprim, imipenem, levofloxacin, and nitrofurantoin, respectively. The widespread contamination of examined raw and ready-to-eat meat product samples with MDR H. pylori isolates could constitute a tremendous public health hazard. Further studies concerning the prevalence and possible methods of elimination of H. pylori in different food categories distributed in the various provinces in Egypt as well as in other countries is required for a better understanding the H. pylori as an emerging foodborne pathogen.
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Affiliation(s)
- Aya Elsayed Maghrabia
- Medical Experimental Research Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Hend Ali Elshebrawy
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mahmoud Ahmed Mahros
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mohammed Mohammed Elgazzar
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Khalid Ibrahim Sallam
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt.
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Ansari S, Yamaoka Y. Helicobacter pylori Infection, Its Laboratory Diagnosis, and Antimicrobial Resistance: a Perspective of Clinical Relevance. Clin Microbiol Rev 2022; 35:e0025821. [PMID: 35404105 PMCID: PMC9491184 DOI: 10.1128/cmr.00258-21] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite the recent decrease in overall prevalence of Helicobacter pylori infection, morbidity and mortality rates associated with gastric cancer remain high. The antimicrobial resistance developments and treatment failure are fueling the global burden of H. pylori-associated gastric complications. Accurate diagnosis remains the opening move for treatment and eradication of infections caused by microorganisms. Although several reports have been published on diagnostic approaches for H. pylori infection, most lack the data regarding diagnosis from a clinical perspective. Therefore, we provide an intensive, comprehensive, and updated description of the currently available diagnostic methods that can help clinicians, infection diagnosis professionals, and H. pylori researchers working on infection epidemiology to broaden their understanding and to select appropriate diagnostic methods. We also emphasize appropriate diagnostic approaches based on clinical settings (either clinical diagnosis or mass screening), patient factors (either age or other predisposing factors), and clinical factors (either upper gastrointestinal bleeding or partial gastrectomy) and appropriate methods to be considered for evaluating eradication efficacy. Furthermore, to cope with the increasing trend of antimicrobial resistance, a better understanding of its emergence and current diagnostic approaches for resistance detection remain inevitable.
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Affiliation(s)
- Shamshul Ansari
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu City, Oita, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu City, Oita, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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