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Ji YH, Shi YM, Hei QW, Sun JM, Yang XF, Wu T, Sun DL, Qi YX. Evaluation of guidelines for diagnosis and treatment of Helicobacter pylori infection. Helicobacter 2023; 28:e12937. [PMID: 36408808 DOI: 10.1111/hel.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND To systematically evaluate the quality of the guidelines for the diagnosis and treatment of Helicobacter pylori infection and to analyze the differences and reasons for the key recommendations in the guidelines. METHODS Databases and websites were systematically searched to obtain guidelines for the diagnosis and treatment of Helicobacter pylori infection. Four independent reviewers used the Guideline Evaluation Tool (AGREE II) to evaluate the included guidelines. The intraclass correlation coefficient (ICC) and Fleiss' kappa coefficient were used to measure the consistency of evaluation guidelines between guide reviewers. Differences between guidelines and the reasons for the differences were analyzed by comparing the recommendations of different guidelines and the evidence supporting the recommendations. RESULTS A total of 17 guidelines for Helicobacter pylori infection were included in this study. The AGREE II scores of these guidelines were low overall, with 4 of them had a score of over 60%, which indicates that the guidelines are recommended, and 13 of them having a score ranging from 30 to 60%, which indicates that the guidelines are recommended but need to be revised, while no guideline had a score of 30% or less, which indicates that they were not recommended. The analysis of these guidelines found that there were some differences in the main recommendations. Not all guidelines recommend sequential therapy as the recommended therapy. Whether bismuth quadruple therapy should be used as the recommended first-line therapy is unclear. The antibiotic resistance rate is different in different regions. Combined with the local antibiotic sensitivity test, the eradication rate of Helicobacter pylori can be improved. CONCLUSION There are significant differences in the quality of Helicobacter pylori infection guidelines and the key recommendations. Improving the deficiencies of existing guidelines is an effective way to develop high-quality guidelines and make reasonable recommendations for the treatment of Helicobacter pylori infection in the future.
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Affiliation(s)
- Yan-Hong Ji
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Yan-Mei Shi
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Qian-Wen Hei
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Jin-Min Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Xiao-Feng Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Tao Wu
- Department of infectious diseases, The First People's Hospital of Kunming, Kunming, China
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Yu-Xing Qi
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
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Sholeh M, Khoshnood S, Azimi T, Mohamadi J, Kaviar VH, Hashemian M, Karamollahi S, Sadeghifard N, Heidarizadeh H, Heidary M, Saki M. The prevalence of clarithromycin-resistant Helicobacter pylori isolates: a systematic review and meta-analysis. PeerJ 2023; 11:e15121. [PMID: 37016679 PMCID: PMC10066884 DOI: 10.7717/peerj.15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/03/2023] [Indexed: 04/06/2023] Open
Abstract
Background Knowledge of global clarithromycin (CLA)-resistant rates of Helicobacter pylori (H. pylori) is crucial for decision of the most appropriate eradication therapies with good clinical outcomes. Therefore, this review and meta-analysis aimed to evaluate the global prevalence of the CLA resistance in H. pylori to provide some guidance for selecting the first-line antibiotics. Method A comprehensive search was performed for relevant literature until April 2021 in PubMed, Embase, and Web of Science databases. Freeman-Tukey double arcsine transformation was performed to estimate the weighted pooled prevalence of resistance. Results The meta-analysis included 248 articles. The prevalence of CLA-resistant H. pylori was 27.53% (95% CI [25.41-29.69]). The heterogeneity between reports was significant (I2 = 97.80%, P < 0.01). The resistance rate increased from 24.28% in 2010-2017 to 32.14% in 2018-2021 (P < 0.01). Iran, with 38 articles, has the most report. Nevertheless, Switzerland, Portugal, and Israel had the highest resistance rates (67.16%, 48.11%, and 46.12%, respectively). The heterogeneity between the continents and the antimicrobial susceptibility methods also interpreted standard guidelines and breakpoints was insignificant (P > 0.05). Conclusion Overall CLA resistance rate was 27.53%, worldwide. The difference in CLA resistance rate among the included studies can be due to several reasons such as differences in antibiotic prescription rates in various geographic areas, use of different breakpoints or inaccurate criteria in performed studies, and the emergence of multidrug-resistant (MDR) strains.
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Affiliation(s)
- Mohammad Sholeh
- Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Taher Azimi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jasem Mohamadi
- Department of Pediatrics, School of Medicine, Emam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Vahab Hassan Kaviar
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Marzieh Hashemian
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Somayeh Karamollahi
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Hedayat Heidarizadeh
- Department of Pediatrics, School of Medicine, Emam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Pichon M, Cremniter J, Burucoa C. How Did We End Up Using a Quadruple Guided Therapy Combining At Least Two Antibiotics with a PPI to Eradicate Helicobacter pylori? J Clin Med 2022; 11:jcm11175216. [PMID: 36079146 PMCID: PMC9457093 DOI: 10.3390/jcm11175216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Maxime Pichon
- CHU Poitiers, Infectious Agents Department, Bacteriology Laboratory, 86021 Poitiers, France
- INSERM U1070 Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- Correspondence: (M.P.); (C.B.); Tel.: +33-(0)5-49-44-41-43 (M.P.); +33-(0)5-49-44-64-68 (C.B.)
| | - Julie Cremniter
- CHU Poitiers, Infectious Agents Department, Bacteriology Laboratory, 86021 Poitiers, France
- INSERM U1070 Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Christophe Burucoa
- CHU Poitiers, Infectious Agents Department, Bacteriology Laboratory, 86021 Poitiers, France
- INSERM U1070 Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- Correspondence: (M.P.); (C.B.); Tel.: +33-(0)5-49-44-41-43 (M.P.); +33-(0)5-49-44-64-68 (C.B.)
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Keikha M, Karbalaei M. Prevalence of antibiotic heteroresistance associated with Helicobacter pylori infection: A systematic review and meta-analysis. Microb Pathog 2022; 170:105720. [PMID: 35964816 DOI: 10.1016/j.micpath.2022.105720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Heteroresistance is a general term to describe diverse responses to specific antibiotics that can occur due to infection with either multiple bacterial strains or microevolution of a single strain during chronic infection. Due to limited information regarding heteroresistance Helicobacter pylori (H. pylori) infection, the current study was carried out to evaluate the prevalence of this phenomenon. METHODS For this study, all potential relevant studies were collected by searching international databases such as ISI Web of Science, PubMed, Scopus, ScienceDirect, ProQuest, Embase, DOAJ, China National Knowledge Infrastructure (CNKI), and Google Scholar. Finally, the frequency of heteroresistance H. pylori infection was measured using the event rate corresponding to 95% confidence intervals. RESULTS A total of 26 studies met our criteria; the eligible studies were related to the years 2001-2022. Our results showed that the prevalence of heteroresistance H. pylori strains was 60.1% to clarithromycin, 61.1% to metronidazole, 46.1% to levofloxacin, 3.8% to amoxicillin, and 21.1% to tetracycline. Our literature review also showed discrepancy of antimicrobial susceptibility test in strains isolated from different anatomical sites of the stomach. Heteroresistance H. pylori infection in developing countries is mostly due to infection with multiple H. pylori strains, while in developed countries it is due to microevolution of a single H. pylori strain in response to antibiotic pressure. CONCLUSIONS Heteroresistance H. pylori infection interferes with successful therapy and eventually can lead to the treatment failure. If a biopsy is taken from only one gastric site, resistant strains of H. pylori may be underestimated. Considering the role of heteroresistance H. pylori infection in treatment failure, it is very important for gastroenterologists to improve their knowledge about this fact. Regardingly, new guidelines should be developed and designed for the management and treatment of heteroresistance H. pylori infection.
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Affiliation(s)
- Masoud Keikha
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Karbalaei
- Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran.
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Guided Treatment of Helicobacter pylori Infections with Non-Invasive PCR Tests-The Glory Days of Primary Care? J Clin Med 2022; 11:jcm11154320. [PMID: 35893411 PMCID: PMC9331569 DOI: 10.3390/jcm11154320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
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Mutations Associated to Antibiotic-Resistant Helicobacter pylori: It Is Time to Validate Sequencing Observations. J Clin Med 2022; 11:jcm11154293. [PMID: 35893384 PMCID: PMC9329754 DOI: 10.3390/jcm11154293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 02/07/2023] Open
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Pichon M, Freche B, Burucoa C. New Strategy for the Detection and Treatment of Helicobacter pylori Infections in Primary Care Guided by a Non-Invasive PCR in Stool: Protocol of the French HepyPrim Study. J Clin Med 2022; 11:jcm11051151. [PMID: 35268242 PMCID: PMC8911369 DOI: 10.3390/jcm11051151] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (Hp) infects half of the world population and is responsible for gastric, duodenal ulcers and gastric cancer. The eradication of Hp cures ulcers and prevents ulcer recurrences and gastric cancer. Antibiotic resistance of Hp, and particularly clarithromycin resistance, is the primary cause of treatment failure and is a major concern identified by the WHO as a high priority requiring research into new strategies. Treatments guided by the detection of antibiotic resistance have proven their medical and economical superiority. However, this strategy is severely hampered by the invasive nature of the fibroscopy, since antibiotic resistance detection requires gastric biopsies. The eradication of Hp involves primary care physicians. The objective of this study will be to evaluate the feasibility of a strategy for the management of Hp infection in primary care by a recently developed non-invasive procedure and its non-inferiority in eradication rates compared with the strategy recommended by the French National Authority of Health. The non-invasive procedure is a PCR on stool to detect Hp infection and mutations conferring resistance to clarithromycin allowing a treatment guided by the results of the PCR. We present the protocol of a prospective, multicenter, randomized, controlled interventional study in two arms.
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Affiliation(s)
- Maxime Pichon
- Bacteriology Laboratory, Infectious Agents Department, CHU Poitiers, 86021 Poitiers, France
- INSERM U1070 Pharmacology of Antimicrobial Agents and Resistances, University of Poitiers, 86073 Poitiers, France;
- Correspondence: (M.P.); (C.B.); Tel.: +33-(0)5-49-44-41-43 (M.P.); +33-(0)5-49-44-64-68 (C.B.)
| | - Bernard Freche
- INSERM U1070 Pharmacology of Antimicrobial Agents and Resistances, University of Poitiers, 86073 Poitiers, France;
- Department of General Medicine, Faculty of Medicine and Pharmacy, University of Poitiers, 86073 Poitiers, France
| | - Christophe Burucoa
- Bacteriology Laboratory, Infectious Agents Department, CHU Poitiers, 86021 Poitiers, France
- INSERM U1070 Pharmacology of Antimicrobial Agents and Resistances, University of Poitiers, 86073 Poitiers, France;
- Correspondence: (M.P.); (C.B.); Tel.: +33-(0)5-49-44-41-43 (M.P.); +33-(0)5-49-44-64-68 (C.B.)
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Skrebinska S, Megraud F, Daugule I, Santare D, Isajevs S, Liepniece-Karele I, Bogdanova I, Rudzite D, Vangravs R, Kikuste I, Vanags A, Tolmanis I, Savcenko S, Alix C, Herrero R, Park JY, Leja M. Who Could Be Blamed in the Case of Discrepant Histology and Serology Results for Helicobacter pylori Detection? Diagnostics (Basel) 2022; 12:133. [PMID: 35054298 PMCID: PMC8774513 DOI: 10.3390/diagnostics12010133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Discrepancies between histology and serology results for Helicobacter pylori detection could be caused by a variety of factors, including a biopsy sampling error, expertise of the pathologist, natural loss of infection due to advanced atrophy, or a false-positive serology in the case of a previous infection, since antibodies may be present in blood following recovery from the infection. AIMS To identify true H. pylori-positive individuals in discrepant cases by serology and histology using real time polymerase chain reaction (RT-PCR) as a gold standard. METHODS Study subjects with discrepant histology and serology results were selected from the GISTAR pilot study data base in Latvia. Subjects having received previous H. pylori eradication therapy or reporting use of proton pump inhibitors, antibacterial medications, or bismuth containing drugs one month prior to upper endoscopy were excluded. We compared the discrepant cases to the corresponding results of RT-PCR performed on gastric biopsies. RESULTS In total, 97 individuals with discrepant results were identified: 81 subjects were serology-positive/histology-negative, while 16 were serology-negative/histology-positive. Among the serology-positive/histology-negative cases, 64/81 (79.0%) were false-positives by serology and, for the majority, inflammation was absent in all biopsies, while, in the serology-negative/histology-positive group, only 6.2% were proven false-positives by histology. CONCLUSIONS Among this high H. pylori prevalent, middle-aged population, the majority of discrepant cases between serology and histology were due to false positive-serology, rather than false-negative histology. This confirms the available evidence that the choice of treatment should not be based solely on the serological results, but also after excluding previous, self-reported eradication therapy.
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Affiliation(s)
- Sabine Skrebinska
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Faculty of Residency, Riga Stradins University, LV-1007 Riga, Latvia
| | - Francis Megraud
- French National Reference Centre for Campylobacters and Helicobacters, Bacteriology Laboratory, Bordeaux University Hospital, 33076 Bordeaux, France; (F.M.); (C.A.)
- Campus of Carreire, INSERM U1053 BaRITOn, University of Bordeaux, 33000 Bordeaux, France
| | - Ilva Daugule
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
| | - Daiga Santare
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Riga East University Hospital, LV-1038 Riga, Latvia
| | - Sergejs Isajevs
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Academic Histology Laboratory, LV-1073 Riga, Latvia
| | - Inta Liepniece-Karele
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Academic Histology Laboratory, LV-1073 Riga, Latvia
| | - Inga Bogdanova
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Academic Histology Laboratory, LV-1073 Riga, Latvia
| | - Dace Rudzite
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Riga East University Hospital, LV-1038 Riga, Latvia
| | - Reinis Vangravs
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
| | - Ilze Kikuste
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Digestive Diseases Centre “GASTRO”, LV-1079 Riga, Latvia;
| | - Aigars Vanags
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Digestive Diseases Centre “GASTRO”, LV-1079 Riga, Latvia;
| | - Ivars Tolmanis
- Digestive Diseases Centre “GASTRO”, LV-1079 Riga, Latvia;
| | - Selga Savcenko
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Riga East University Hospital, LV-1038 Riga, Latvia
| | - Chloé Alix
- French National Reference Centre for Campylobacters and Helicobacters, Bacteriology Laboratory, Bordeaux University Hospital, 33076 Bordeaux, France; (F.M.); (C.A.)
- Campus of Carreire, INSERM U1053 BaRITOn, University of Bordeaux, 33000 Bordeaux, France
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomedicas, Fundación INCIENSA, San Jose 2250, Costa Rica;
- International Agency for Research on Cancer, Early Detection, Prevention and Infections Branch, 69372 Lyon, France;
| | - Jin Young Park
- International Agency for Research on Cancer, Early Detection, Prevention and Infections Branch, 69372 Lyon, France;
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.D.); (D.S.); (S.I.); (I.L.-K.); (I.B.); (D.R.); (R.V.); (I.K.); (A.V.); (S.S.); (M.L.)
- Digestive Diseases Centre “GASTRO”, LV-1079 Riga, Latvia;
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Binmaeil H, Hanafiah A, Mohamed Rose I, Raja Ali RA. Development and Validation of Multiplex Quantitative PCR Assay for Detection of Helicobacter pylori and Mutations Conferring Resistance to Clarithromycin and Levofloxacin in Gastric Biopsy. Infect Drug Resist 2021; 14:4129-4145. [PMID: 34675558 PMCID: PMC8502538 DOI: 10.2147/idr.s325056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022] Open
Abstract
Aims and Objectives More than half of the world's population is infected with Helicobacter pylori, which can cause chronic gastritis. WHO has regarded clarithromycin-resistant H. pylori as a high priority pathogen. Hence, accurate diagnosis and detection of clarithromycin- and levofloxacin-resistant H. pylori strains is essential for proper management of infection. The objective of this study was to develop and optimize multiplex quantitative PCR assay for detection of mutations associated with clarithromycin and levofloxacin resistance in H. pylori directly from the gastric biopsies. Materials and Methods Specific primers and probes were designed to amplify ureA and mutations in 23S rRNA and gyrA genes. Singleplex and triplex qPCR assays were optimized and the assay's sensitivities and specificities were determined. The optimized multiplex qPCR assay was performed on 571 gastric biopsies. Results In this study, 14.7% (84/571) of the gastric biopsies were positive for H. pylori by conventional methods and 23.8% (136/571) were positive by the ureA-qPCR with 96.4% sensitivity and 88.5% specificity, while the +LR and -LR were 8.72 and 0.04, respectively. The ureA-positive samples (n=136) were subjected to multiplex qPCR which detected A2142G and A2143G mutations in the 23S rRNA gene (20.6%, 28/136) conferring clarithromycin resistance and gyrA mutations N87K, N87I, D91N, and D91Y (11.8%, 16/136) leading to levofloxacin resistance. The sensitivity and specificity of qPCR of 23S rRNA gene were 100% and 98.7%, respectively, while 100% and 99.8% for qPCR of gyrA, respectively. Conclusion The effectiveness of this qPCR is that it is sensitive in detecting low bacterial load and will help in timely detection of clarithromycin- and levofloxacin-resistant strains, especially in case of mixed infections. Since it is culture independent, it can inform clinicians about antibiotics to be included in the first-line therapy, thereby improving the management of H. pylori infection at a much greater pace.
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Affiliation(s)
- Hasyanee Binmaeil
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Alfizah Hanafiah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia.,GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Isa Mohamed Rose
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Raja Affendi Raja Ali
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia.,Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
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Gong L, El-Omar EM. Application of molecular techniques in Helicobacter pylori detection: limitations and improvements. Helicobacter 2021; 26:e12841. [PMID: 34333819 DOI: 10.1111/hel.12841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Lan Gong
- Microbiome Research Centre, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Emad M El-Omar
- Microbiome Research Centre, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
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Rajabnia M, Sadeghi A, Abdi S, Găman MA, Zali MR, Salehi N, Yadegar A, Rahmani K. Effect of Statins on <b><i>Helicobacter pylori</i></b> Eradication Rate: A Systematic Review and Meta-Analysis. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:322-330. [PMID: 36159198 PMCID: PMC9485919 DOI: 10.1159/000518597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
Statins have been used as adjuvants to standard treatment in order to increase the eradication rates of Helicobacter pylori infection. This study aimed to summarize the results of the efficacy of adding statins to standard treatments used for the eradication of H. pylori infection. We conducted a systematic search using a comprehensive combination of keywords in PubMed/MEDLINE, Web of Science, and Scopus to retrieve relevant studies from 1990 to 2020. The estimate of pooled relative risk (RR), as the effect measure, was calculated using random effects meta-analyses in Stata 14. We finally included 5 studies (all of them were randomized controlled trials). The meta-analysis of all studies showed that the pooled RR (95% confidence interval) was 1.03 (0.64–1.68) in the random effects model, which was not statistically significant. In other words, based on our meta-analysis, the addition of statins as an adjuvant therapy to the standard treatment regimens does not increase the rate of H. pylori eradication. However, further evidence is needed to confirm this result as the number of available studies was small.
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Affiliation(s)
- Mohsen Rajabnia
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Abdi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mihnea-Alexandru Găman
- Carol Davila University of Medicine and Pharmacy, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Niloufar Salehi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- * Khaled Rahmani,
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Ribaldone DG, Zurlo C, Fagoonee S, Rosso C, Armandi A, Caviglia GP, Saracco GM, Pellicano R. A Retrospective Experience of Helicobacter pylori Histology in a Large Sample of Subjects in Northern Italy. Life (Basel) 2021; 11:life11070650. [PMID: 34357021 PMCID: PMC8303344 DOI: 10.3390/life11070650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Updated data about the prevalence of Helicobacter pylori (H. pylori) and its correlation with histological results are scarce. The aim of our study was to provide current data on the impact of H. pylori in a third-level endoscopy service. We performed a large, retrospective study analyzing the results of all histological samples of gastroscopy from the year 2019. In total, 1512 subjects were included. The prevalence of H. pylori was 16.8%. A significant difference between the prevalence in subjects born in Italy and those from eastern Europe, south America, or Africa was found (p < 0.0001, p = 0.006, and p = 0.0006, respectively). An association was found between H. pylori and active superficial gastritis (p < 0.0001). Current H. pylori and/or a previous finding of H. pylori was related to antral atrophy (p < 0.0001). Fifteen patients had low-grade dysplasia. There were no statistically significant associations with current or past H. pylori infection. One patient presented gastric cardia adenocarcinoma with regular gastric mucosa. One patient, H. pylori positive, was diagnosed with gastric signet ring cell adenocarcinoma in a setting of diffuse atrophy, without metaplasia.. Our study provides updated, solid (biopsy diagnosis and large population) data on the prevalence of H. pylori infection in a representative region of southern Europe.
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Affiliation(s)
- Davide Giuseppe Ribaldone
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, 10124 Torino, Italy; (C.Z.); (C.R.); (A.A.); (G.M.S.)
- Correspondence: (D.G.R.); (G.P.C.)
| | - Carlo Zurlo
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, 10124 Torino, Italy; (C.Z.); (C.R.); (A.A.); (G.M.S.)
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging (CNR), Molecular Biotechnology Center, 10126 Turin, Italy;
| | - Chiara Rosso
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, 10124 Torino, Italy; (C.Z.); (C.R.); (A.A.); (G.M.S.)
| | - Angelo Armandi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, 10124 Torino, Italy; (C.Z.); (C.R.); (A.A.); (G.M.S.)
| | - Gian Paolo Caviglia
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, 10124 Torino, Italy; (C.Z.); (C.R.); (A.A.); (G.M.S.)
- Correspondence: (D.G.R.); (G.P.C.)
| | - Giorgio Maria Saracco
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, 10124 Torino, Italy; (C.Z.); (C.R.); (A.A.); (G.M.S.)
| | - Rinaldo Pellicano
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy;
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Ajayi A, Jolaiya T, Smith SI. Direct detection of Helicobacter pylori from biopsies of patients in Lagos, Nigeria using real-time PCR-a pilot study. BMC Res Notes 2021; 14:90. [PMID: 33750448 PMCID: PMC7941902 DOI: 10.1186/s13104-021-05505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/27/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Prompt diagnosis of Helicobacter pylori infection is essential for proper treatment and eradication of the pathogen because prolonged infection could lead to gastric cancer. Sensitive and cost effective diagnostic methods are key to guiding treatment options that will reduce mortality. This study was aimed at detecting H. pylori from biopsies of peptic ulcer patients. Real-time PCR using TaqMan and EvaGreen assays targeting 16S rRNA and ureA genes were used to detect H. pylori DNA extracted from 40 biopsy samples comprising 20 biopsies obtained from the antrum and 20 from the corpus of 20 patients undergoing endoscopy for duodenal ulcer investigation in Lagos, Nigeria. Results H. pylori was detected in 80% of the biopsy samples by combined cycle threshold (Ct) and melting temperature (Tm) values. Mean Ct value for ureA gene ranged from 21.40 to 37.53 and 22.71 to 35.44 for 16SrRNA gene. Average melting temperatures (Tm) of 81.57 and 82.90 °C among amplicons of ureA and 16S rRNA were observed respectively. H. pylori DNA was generally detected in biopsies collected from antrum and corpus. Real-time PCR in the diagnosis of H. pylori can be considered a simple, low cost and efficient alternative or addition to the gold standard. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05505-y.
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Affiliation(s)
- A Ajayi
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - T Jolaiya
- Department of Microbiology, University of Lagos, Lagos, Nigeria
| | - S I Smith
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria. .,Mountain Top University, Makogi Oba, Ogun, Nigeria.
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Liang CM, Tai WC, Hsu PI, Wu DC, Kuo CH, Tsay FW, Lee CL, Chen KY, Chuah SK. Trend of changes in antibiotic resistance in Helicobacter pylori from 2013 to 2019: a multicentre report from Taiwan. Therap Adv Gastroenterol 2020; 13:1756284820976990. [PMID: 33354229 PMCID: PMC7734532 DOI: 10.1177/1756284820976990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/03/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Antibiotic resistance plays a crucial role in the treatment failure of Helicobacter pylori (H. pylori) infection. This study aimed to determine the trend of changes in the primary, secondary and tertiary antibiotic resistance of H. pylori in Taiwan over the last 7 years. METHODS We retrospectively analysed H. pylori-infected isolates from patients with primary resistance (n = 1369), secondary resistance (n = 196) and tertiary resistance (n = 184) from January 2013 to December 2019. The H. pylori strains were tested for susceptibility to amoxicillin, clarithromycin, levofloxacin, metronidazole and tetracycline using the Epsilometer test method. RESULTS A progressively higher primary resistance rate was observed for clarithromycin (11.8-20.4%, p = 0.039 in χ2 test for linear trend), levofloxacin (17.3-38.8%, p < 0.001) and metronidazole (25.6-42.3%, p < 0.001) among naïve patients who received first-line eradication therapy. The dual primary resistance to clarithromycin and metronidazole also progressively increased in a linear trend (2.4-10.4%, p = 0.009). For secondary resistance, an increase was observed for levofloxacin (30.5-64.7%, p = 0.006) and metronidazole (40.5-77.4%, p < 0.001). For tertiary resistance, the observed increase was even more significant for levofloxacin (65.9-100.0%, p = 0.106) and metronidazole (44.4-88.2%, p < 0.001). The resistance to amoxicillin and tetracycline remained very low in Taiwan regardless of primary, secondary and tertiary resistance. CONCLUSION Primary, secondary and tertiary antibiotic resistance to clarithromycin, levofloxacin and metronidazole for H. pylori has been increasing in Taiwan since 2013. Treatment should be targeted for eradication success rates of more than 90%. Third-line treatment should be based on antibiotic susceptibility.
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Affiliation(s)
- Chih-Ming Liang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
- Chang Gung University College of Medicine, Taoyuan City
| | - Pin-I Hsu
- Department of Medicine, An Nan Hospital, China Medical University
| | - Deng-Chyang Wu
- Department of Internal Medicine, Division of Gastroenterology, Kaohsiung Medical University Hospital, Kaohsiung
| | - Chao-Hung Kuo
- Department of Internal Medicine, Division of Gastroenterology, Kaohsiung Medical University Hospital, Kaohsiung
| | - Feng-Woey Tsay
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chia-Long Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Cathay General Hospital, Taipei
| | - Kuan-Yang Chen
- Department of Gastroenterology, Taipei City Hospital, 10, Section 4, Ren’ai Road, Da’an District 106, Taipei
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, 833 Chang Gung University College of Medicine, Taoyuan City
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