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Rudasill J, Peeler C, Grant D, Lazar C, Criswell SL. A comparison of staining methods for Helicobacter pylori in laparoscopic vertical sleeve gastrectomy resections. Lab Med 2024; 55:386-390. [PMID: 38048075 DOI: 10.1093/labmed/lmad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Helicobacter pylori is an important public health concern due to its status as a carcinogenic bacterium. Well adapted to the acidic environment of the human stomach, the variety of strains and virulence factors of the organism when interacting with the host immune system creates an individualistic response. Although estimates suggest that approximately half of the global population is infected with H pylori, the majority of infected persons remain asymptomatic while harboring an increased risk of intestinal metaplasia and gastric cancers. Therefore, appropriate diagnostic testing protocols are imperative. METHODS This study compared labeling methodologies, including Wright stain, alcian yellow toluidine blue (AYTB), and immunohistochemistry (IHC) on formalin-fixed paraffin-embedded stomach resections from sleeve gastrectomy patients, to detect H pylori infection. RESULTS Although all 3 labeling methods evidenced similar specificity in H pylori detection, the IHC method was significantly more sensitive. However, the IHC cost per test was approximately 5-fold higher than that of the Wright or AYTB stains, and the technical time required per test was at least 6-fold that of Wright or AYTB. CONCLUSION Despite the higher cost per test, IHC is the most sensitive and preferred method for determination of H pylori infection.
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Affiliation(s)
- JoAnna Rudasill
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Chelsea Peeler
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Danielle Grant
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Cynthia Lazar
- Department of Pathology, Methodist University Hospital, Memphis, TN, US
| | - Sheila L Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
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2
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Moreels N, Boven A, Gressani O, Andersson FL, Vlieghe E, Callens S, Engstrand L, Simin J, Brusselaers N. The combined effect of systemic antibiotics and proton pump inhibitors on Clostridioides difficile infection and recurrence. J Antimicrob Chemother 2024; 79:608-616. [PMID: 38267263 PMCID: PMC10904719 DOI: 10.1093/jac/dkae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Antibiotics and proton pump inhibitors (PPI) are recognized risk factors for acquisition and recurrence of Clostridioides difficile infection (CDI), yet combined effects remain unclear. OBJECTIVES To assess the short- and long-term effects of antibiotics and PPIs on CDI risk and recurrence. METHODS Population-based study including all 43 152 patients diagnosed with CDI in Sweden (2006-2019), and 355 172 matched population controls without CDI. The impact of antibiotics and PPIs on CDI risk and recurrence was explored for recent (0-30 days) and preceding (31-180 days) use prior to their first CDI diagnosis, using multivariable conditional logistic regression presented as odds ratios (ORs) and 95% confidence interval, adjusted for demographics, comorbidities and other drugs. RESULTS Compared to controls, the combined effect of recent PPIs and antibiotics [ORAB+PPI = 17.51 (17.48-17.53)] on CDI risk was stronger than the individual effects [ORAB = 15.37 (14.83-15.93); ORPPI = 2.65 (2.54-2.76)]. Results were less pronounced for exposure during the preceding months. Dose-response analyses showed increasing exposure correlated with CDI risk [recent use: ORAB = 6.32 (6.15-6.49); ORPPI = 1.65 (1.62-1.68) per prescription increase].Compared to individuals without recurrence (rCDI), recent [ORAB = 1.30 (1.23-1.38)] and preceding [ORAB = 1.23 (1.16-1.31); ORPPI = 1.12 (1.03-1.21)] use also affected the risk of recurrence yet without significant interaction between both. Recent macrolides/lincosamides/streptogramins; other antibacterials including nitroimidazole derivates; non-penicillin beta lactams and quinolones showed the strongest association with CDI risk and recurrence, particularly for recent use. PPI use, both recent and preceding, further increased the CDI risk associated with almost all antibiotic classes. CONCLUSION Recent and less recent use of PPIs and systemic antibiotics was associated with an increased risk of CDI, particularly in combination.
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Affiliation(s)
- Nele Moreels
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Annelies Boven
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Family Medicine and Population Health, Global Health Institute, Antwerp University, Antwerp, Belgium
| | - Oswaldo Gressani
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | | | - Erika Vlieghe
- Department of Family Medicine and Population Health, Global Health Institute, Antwerp University, Antwerp, Belgium
| | - Steven Callens
- Department of Internal Medicine and Pediatrics, General Internal Medicine, Ghent University, Ghent, Belgium
| | - Lars Engstrand
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Simin
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Nele Brusselaers
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Family Medicine and Population Health, Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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3
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Afkhamipour M, Kaviani F, Dalali S, Piri-Gharaghie T, Doosti A. Potential Gastric Cancer Immunotherapy: Stimulating the Immune System with Helicobacter pylori pIRES2-DsRed-Express- ureF DNA Vaccines. Arch Immunol Ther Exp (Warsz) 2024; 72:aite-2024-0004. [PMID: 38346161 DOI: 10.2478/aite-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/20/2023] [Indexed: 02/15/2024]
Abstract
Most gastric cancers (GC) are thought to be caused by Helicobacter pylori (H. pylori) infections. However, there is mounting evidence that GC patients with positive H. pylori status have improved prognoses. The H. pylori-induced cellular immune reaction may inhibit cancer. In this study, BALB/c mice were immunized using recombinant plasmids that encode the ureF gene of H. pylori. Purified functional splenic CD3+ T lymphocytes are used to study the anticancer effects in vitro and in vivo. The immunological state of GC patients with ongoing H. pylori infection is mimicked by the H. pylori DNA vaccines, which cause a change in the reaction from Th1 to Th2. Human GC cells grow more slowly when stimulated CD3+ T lymphocytes are used as adoptive infusions because they reduce GC xenograft development in vivo. The more excellent ratios of infiltrating CD8+/CD4+ T cells, the decreased invasion of regulatory FOXP3+ Treg lymphocytes, and the increased apoptosis brought on by Caspase9/Caspase-3 overexpression and Survivin downregulation may all contribute to the consequences. Our findings suggest that in people with advanced GC, H. pylori pIRES2-DsRed-Express-ureF DNA vaccines may have immunotherapeutic utility.
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Affiliation(s)
- Mahsa Afkhamipour
- Biotechnology Research Center, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Fatemeh Kaviani
- Biotechnology Research Center, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Samaneh Dalali
- Biotechnology Research Center, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Tohid Piri-Gharaghie
- Biotechnology Research Center, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
- Biotechnology Research Center, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Abbas Doosti
- Biotechnology Research Center, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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4
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Shen KP, Chang CD, Hsieh MH, Chaung HC. Efficiency and Mechanism Evaluation of Magnolia officinalis Water Extract in Preventing Gastric Ulcer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:7901734. [PMID: 37064946 PMCID: PMC10101745 DOI: 10.1155/2023/7901734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 04/09/2023]
Abstract
In this study we aimed at demonstrating the ability of Magnolia officinalis water extract to ameliorate gastric ulcers in in vitro and in vivo experiments. The gastric mucosa epithelial cell line, RGM 1, was pretreated with Magnolia officinalis water extract (0, 0.1, 1, 2, 5, or 10 mg/ml) and cultured in DMEM/F12 medium (pH 7.4) for 2 h and then in DMEM/F12 medium (pH 4.0) for 10 min. Magnolia officinalis water extract protected the cell viability and decreased reactive oxygen species formation by the acidic medium. In the in vivo experiment, Magnolia officinalis water extract (100 mg/kg) was administrated daily for 28 days in ICR mice via oral gavage, and then Shay’s ulcer surgical method was performed to induce gastric ulcers. We analyzed the pH value of stomach acid and the pathological section, inflammation, and cannabinoid receptor type 2 (CB2) cDNA levels of the stomach. Magnolia officinalis water extract not only enhanced the pH value of stomach acid but also ameliorated the ulcer index and inflammation and increased CB2 expression effectively. These results suggest that Magnolia officinalis water extract might be used to decrease the incidence of gastric ulcer.
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Affiliation(s)
- Kuo-Ping Shen
- Department of Veterinary Medicine, Research Center for Animal Biologics, National Pingtung University of Science and Technology, Neipu, Pingtung 912, Taiwan
| | - Ching-Dong Chang
- Department of Veterinary Medicine, Research Center for Animal Biologics, National Pingtung University of Science and Technology, Neipu, Pingtung 912, Taiwan
| | - Meng-Hsun Hsieh
- Department of Veterinary Medicine, Research Center for Animal Biologics, National Pingtung University of Science and Technology, Neipu, Pingtung 912, Taiwan
| | - Hso-Chi Chaung
- Department of Veterinary Medicine, Research Center for Animal Biologics, National Pingtung University of Science and Technology, Neipu, Pingtung 912, Taiwan
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5
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Azrad M, Vazana D, On A, Paritski M, Rohana H, Roshrosh H, Agay‐Shay K, Peretz A. Antibiotic resistance patterns of Helicobacter pylori in North Israel - A six-year study. Helicobacter 2022; 27:e12932. [PMID: 36110057 PMCID: PMC9786357 DOI: 10.1111/hel.12932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND One main challenge in Helicobacter pylori (H. pylori) eradication is its increasing antibiotic resistance. Additionally, resistance rates vary between geographic areas and periods. However, data are limited since susceptibility testing is not routinely performed. Thus, it is valuable to gather data regarding H. pylori's resistance rates in Israel that would aid in better adjustment of treatment. MATERIALS AND METHODS The study included 540 H. pylori isolates, recovered from gastric biopsy samples of patients who had undergone endoscopy, during 2015-2020, at the Padeh Poriya Medical Center. Antibiotic susceptibility testing to amoxicillin, clarithromycin, metronidazole, levofloxacin, rifampicin, and tetracycline was performed using the Etest technique. Data regarding participants' sex, age, and ethnic group were collected. For every antibiotic and for multi-resistance, generalized linear models were used to estimate crude and adjusted estimated differences in mean MIC and odds ratios (ORs) for every year, compared with the reference year 2015. RESULTS The highest resistance rates were for clarithromycin and metronidazole (46.3% and 16.3%, respectively). Patients above 18 had higher resistance rate to rifampicin and multi-resistance (3.3% and 14.8%), compared with patients under 18 (0.5% and 8.4%, respectively). Resistance rates for levofloxacin, rifampicin, and multi-resistance were significantly higher among Arab patients, compared with Jewish patients. During the 6-year surveillance, a significant annual trend in MIC for metronidazole and in ORs for metronidazole, levofloxacin, and multi-resistance were observed (after adjustment). During 2020 compared with 2015, significant increased ORs were observed for levofloxacin and metronidazole [5.72 (1.03-31.84); 4.28 (1.30-14.14), respectively]. CONCLUSIONS In light of the remarkable changes in antibiotic resistance of H. pylori during the study's period and the increasing resistance rates to various antibiotics, it is very important to continuously monitor H. pylori antibiotic susceptibly. In order to increase eradication rates of this bacterium, therapy regimes must be based on an updated antibiotic resistance data.
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Affiliation(s)
- Maya Azrad
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Dafna Vazana
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Avi On
- Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael,The Gastroenterological Institute, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Maya Paritski
- Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael,The Pediatric Gastroenterological Unit, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Hanan Rohana
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Halim Roshrosh
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | | | - Avi Peretz
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Tiberias 1528001, affiliated with Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
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6
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Hassan IH, Soliman M, Shirazi-Nejad AR. Ménétrier's Disease and Its Atypical Presentation in Four Siblings. Cureus 2022; 14:e30759. [PMID: 36320788 PMCID: PMC9611642 DOI: 10.7759/cureus.30759] [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] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
Abstract
Ménétrier's disease is a rare, acquired, premalignant disorder of the stomach distinguished by hypertrophic giant mucosal folds in the proximal part of the stomach (body and fundus), diminished acid secretion and excessive mucous production, resulting in hypoalbuminemia. Menetrier's is also known as hypoproteinaemic hypertrophic gastropathy and giant hypertrophic gastritis. We present a case of four siblings who presented between 2010 and 2017 with symptomatic iron deficiency anaemia or upper gastrointestinal symptoms with confirmed Ménétrier's disease. The etiology of Ménétrier's disease is unknown but it has been linked to raised TGF-α (transforming growth factor alpha protein) in the gastric mucosa causing increased signalling of epidermal growth factor. It is also associated with infections such as cytomegalovirus and Helicobacter pylori. Despite these associations, there have been cases without any of these viruses detected. Diagnosis is usually made by barium swallow or endoscopic evaluation, which characteristically shows thickened gastric folds, while the biopsies' hallmark feature is massive foveolar hyperplasia. We present a case series of four siblings who presented between 2010 and 2017 with symptomatic iron deficiency anaemia or upper gastrointestinal symptoms with confirmed Ménétrier's disease.
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Affiliation(s)
- Imran H Hassan
- Gastroenterology, Barnsley Hospital National Health Service (NHS) Foundation Trust, Barnsley, GBR
| | - Mina Soliman
- Gastroenterology, Barnsley Hospital National Health Service (NHS) Foundation Trust, Barnsley, GBR
| | - Ahmad R Shirazi-Nejad
- Gastroenterology, Barnsley Hospital National Health Service (NHS) Foundation Trust, Barnsley, GBR
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7
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Schubert JP, Warner MS, Rayner CK, Roberts-Thomson IC, Mangoni AA, Costello S, Bryant RV. Increasing Helicobacter pylori clarithromycin resistance in Australia over 20 years. Intern Med J 2021; 52:1554-1560. [PMID: 34865299 DOI: 10.1111/imj.15640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/20/2021] [Accepted: 11/28/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Helicobacter pylori infection is responsible for considerable morbidity and mortality worldwide, and eradication rates are falling in many countries, primarily due to clarithromycin and metronidazole resistance. However, there is a paucity of contemporary Australian data, which we sought to address by evaluating local rates of resistance of H. pylori to amoxicillin, clarithromycin, metronidazole, and tetracycline over the past 20 years. DESIGN All gastric biopsy specimens collected at endoscopy to detect H. pylori infection at a single centre underwent routine culture and antibiotic susceptibility testing between 1998-2017. Specimens from 12,842 patients were cultured for H. pylori, of which 1,473 positive cultures were tested for antibiotic susceptibility. RESULTS Antibiotic resistance to clarithromycin increased by 3.7% per year (IRR 1.037, p=0.014) over 20 years, with a corresponding 5.0% annual increase in minimum inhibitory concentration (MIC) (OR 1.050, p<0.001). Since 2010, average clarithromycin resistance has exceeded 20%, with >25% of isolates resistant in the last 2 years of data capture. By contrast, rates of resistance to metronidazole (35.3%), amoxicillin (0.14%) and tetracycline (0.34%) and their MICs have remained stable. Review of a representative sample of these patients (n=120, 8%) revealed that only 5% had documented prior H. pylori eradication therapy. CONCLUSIONS Over the last 20 years there has been a substantial rise in clarithromycin resistance, with stable metronidazole resistance and low rates of resistance to amoxicillin and tetracycline. Current first line H. pylori eradication therapy may fail to achieve adequate eradication rates, and optimal first line therapy in Australia should be revisited. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jonathon P Schubert
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Bedford Park, Australia
| | - Morgyn S Warner
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Microbiology and Infectious Diseases Directorate, SA Pathology, Adelaide, Australia
| | - Christopher K Rayner
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Ian C Roberts-Thomson
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Bedford Park, Australia
| | - Sam Costello
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Robert V Bryant
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville, Australia
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8
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Rodriguez N, Kennedy AG, Tompkins BJ, VanOpdorp J, Heffley J, Ganguly E. Quality improvement opportunities exist for Helicobacter pylori treatment and confirmatory testing. Clin Res Hepatol Gastroenterol 2021; 45:101720. [PMID: 34087425 DOI: 10.1016/j.clinre.2021.101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Natalie Rodriguez
- Pharmacy Services, The University of Vermont Medical Center, 111 Colchester Avenue Main Campus, Burlington, VT 05401, United States.
| | - Amanda G Kennedy
- Department of Medicine, The Larner College of Medicine at The University of Vermont, Quality Program, Given Building C 344, 89 Beaumont Avenue, Burlington, VT 05405, United States.
| | - Bradley J Tompkins
- Department of Medicine, The Larner College of Medicine at The University of Vermont, Quality Program, Given Building C 344, 89 Beaumont Avenue, Burlington, VT 05405, United States.
| | - Jocelyn VanOpdorp
- University of Iowa Healthcare, 200 Hawkins Dr, Iowa City, IA 52242, United States.
| | - Jason Heffley
- Division of Gastroenterology, Department of Medicine, University of Vermont Medical Center and The Larner College of Medicine at The University of Vermont, 111 Colchester Avenue Main Campus, Main Pavilion, Level, 5, Burlington, VT 05401, United States.
| | - Eric Ganguly
- Division of Gastroenterology, Department of Medicine, University of Vermont Medical Center and The Larner College of Medicine at The University of Vermont, 111 Colchester Avenue Main Campus, Main Pavilion, Level, 5, Burlington, VT 05401, United States.
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9
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Schubert JP, Gehlert J, Rayner CK, Roberts-Thomson IC, Costello S, Mangoni AA, Bryant RV. Antibiotic resistance of Helicobacter pylori in Australia and New Zealand: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:1450-1456. [PMID: 33217029 DOI: 10.1111/jgh.15352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/21/2020] [Accepted: 11/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE While the global prevalence of antibiotic-resistant Helicobacter pylori (H. pylori) is increasing, there is much regional variation, and local data are required to guide eradication therapy. We performed a systematic review and meta-analysis to determine rates of H. pylori antibiotic resistance in Australia and New Zealand. STUDY DESIGN Random effects meta-analysis of data from 15 published studies and three published abstracts reporting prevalence of primary or secondary H. pylori antibiotic resistance in Australasia. DATA SOURCES PubMed, EMBASE, MEDLINE, PROSPERO, and the Cochrane Library were searched until August, 2020. DATA SYNTHESIS Fifteen published studies and three published abstracts were identified; one study was excluded due to high risk of bias. Seventeen studies conducted between 1996 and 2013 were included in the final analysis, 12 reporting primary and five reporting secondary antibiotic resistance. Prevalence of primary resistance was clarithromycin 7.4% (95% confidence interval [CI], 5.3-9.7%), metronidazole 50.0% (95%CI, 23.9-56.1%), fluoroquinolones 3.7% (95%CI, 0.004-14.8%), and both amoxicillin and tetracycline <0.5%. Subgroup analysis (last 20 years) showed doubling of clarithromycin resistance to 16.1% (95%CI 11.2-21.7%) with other resistance stable. Prevalence of secondary resistance was high for all antibiotics, particularly clarithromycin 78.7% (95%CI, 64.1-90.1%) and metronidazole 68.3% (95%CI, 59.9-76.1%). CONCLUSIONS The outcomes reveal an increase in primary H. pylori clarithromycin resistance since the year 2000, while metronidazole resistance has remained stable and primary resistance to amoxicillin, tetracycline, and fluoroquinolones is low. Rates of secondary resistance to metronidazole and clarithromycin are high. The results highlight the need for contemporary local data on antibiotic resistance in Australia and New Zealand.
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Affiliation(s)
- Jonathon P Schubert
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Jessica Gehlert
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ian C Roberts-Thomson
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sam Costello
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Robert V Bryant
- Faculty of Health Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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10
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Eslick GD, Tilden D, Arora N, Torres M, Clancy RL. Clinical and economic impact of "triple therapy" for Helicobacter pylori eradication on peptic ulcer disease in Australia. Helicobacter 2020; 25:e12751. [PMID: 32820568 DOI: 10.1111/hel.12751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Helicobacter pylori infection has had a major impact on the global health of billions of people. Triple therapy was extensively used in Australia by 1986 for H pylori eradication after its discovery in 1984 and was critical in reducing the morbidity and mortality associated with this infection. AIMS This study analyzed hospital admission, mortality, and therapeutic data to determine the economic and clinical impact that antibiotic triple therapy had on peptic ulcer disease (PUD) in Australia. METHODS An analysis of indirect and direct cost-savings in Australia between 1990 and 2015 associated with triple therapy and the impact on PUD mortality and hospital admissions. RESULTS The direct and indirect impacts of PUD treated by triple therapy between 1990 and 2015 suggest that triple therapy is likely to have prevented 18 665 deaths, and saved 258 887 life years and 33 776 productive life years. The total savings, over the 26-year period, including direct and indirect costs, are calculated to be $10.03 billion, equating to an average annual saving of $393.419 million. CONCLUSIONS This study highlights the enormous benefits to Australia's health care of the discovery of triple therapy, a relatively low-cost antibiotic regimen which brought considerable savings via the reduction in morbidity (hospital admissions) and mortality related to PUD. It is likely that benefits of similar scale occurred internationally.
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Affiliation(s)
- Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | | | - Nimita Arora
- THEMA Consulting Pty Ltd, Pyrmont, NSW, Australia
| | | | - Robert L Clancy
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, NSW, Australia
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11
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Shypulin V, Chernyavskyi V, Nechypurenko T, Neverovskyi A, Gvozdecka L, Mikhn'ova N. Clinical experience of use of 13C-breath tests in oesophagogastroduodenal diseases: selective questions. PRZEGLAD GASTROENTEROLOGICZNY 2019; 15:126-130. [PMID: 32550944 PMCID: PMC7294975 DOI: 10.5114/pg.2019.90080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/25/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Motility disorders can be an important factor in the occurrence of symptoms of dyspepsia that consequently require evaluation of clinical significance of noninvasive diagnostic approaches when observing patients with functional dyspepsia (FD), gastroesophageal reflux disease (GERD), and Helicobacter pylori-associated diseases of the stomach and duodenum. AIM To determine the relationship between various motility disorders and to improve the diagnostics and treatment with the use of 13C-urea (UBT) and 13C-octanoic breath tests (OBT). MATERIAL AND METHODS A total of 591 patients, aged 18-83 years, who underwent upper gastrointestinal endoscopy at our department were evaluated. Age, sex, and duration of symptoms of dyspepsia were recorded. UBT and OBT were examined in patients with dyspepsia, GERD, and H. pylori-associated diseases. RESULTS Patients with dyspepsia syndrome had H. pylori infection in 70 ±1.3% of cases. The strategy of "test-and-treat" using UBT can be applied in 76.5% of cases of unexplained dyspepsia in the Ukrainian population. In patients with GERD, slowing down of the gastric emptying (GE) prevails (overall 79.7 ±4.4%), which is a reliable predictor of early relapse of GERD symptoms (OR = 4.9, 2.4-7.0). In the case of H. pylori-associated diseases, the slowing down of GE according to OBT data is a prognostic sign of the return of the symptoms of dyspepsia after successful eradication of H. pylori (OR = 2.1, 1.9-2.3). In H. pylori-associated diseases with a slow GE, recurrence of dyspeptic syndrome after H. pylori-eradication therapy is observed in 33.1% of cases; the appointment of prokinetics reduces this probability to 9.2% (p = 0.0074). CONCLUSIONS Investigations into the clinical use of new facilities of 13C-breath tests in gastroenterology are shown. The clinical efficacy of urea and octanoic breath tests in FD, GERD, and H. pylori-associated diseases was proven experimentally among patients of the Ukrainian population. New simplified diagnostic and treatment approaches were proposed for certain groups of patients with gastric dyspepsia syndrome, based on the results of the UBT and the OBT.
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Affiliation(s)
- Vadim Shypulin
- Department of Internal Medicine No. 1, Bogomolets National Medical University, Kyiv, Ukraine
| | - Volodimir Chernyavskyi
- Department of Internal Medicine No. 1, Bogomolets National Medical University, Kyiv, Ukraine
| | - Tetyana Nechypurenko
- Department of Internal Medicine No. 1, Bogomolets National Medical University, Kyiv, Ukraine
| | - Artyom Neverovskyi
- Department of Internal Medicine No. 1, Bogomolets National Medical University, Kyiv, Ukraine
| | - Lesya Gvozdecka
- Department of Internal Medicine No. 1, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natallya Mikhn'ova
- Department of Internal Medicine No. 1, Bogomolets National Medical University, Kyiv, Ukraine
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Kim SY, Choi DJ, Chung JW. Antibiotic treatment for Helicobacter pylori: Is the end coming? World J Gastrointest Pharmacol Ther 2015; 6:183-198. [PMID: 26558152 PMCID: PMC4635158 DOI: 10.4292/wjgpt.v6.i4.183] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/01/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori) has been associated with gastro-duodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Antibiotic resistance to clarithromycin and metronidazole is particularly problematic and several approaches have been proposed to overcome this issue, such as complementary probiotic therapy with Lactobacillus. Other studies have identified novel molecules with an anti-H. pylori effect, as well as tailored therapy and nanotechnology as viable alternative eradication strategies. This review discusses current antibiotic therapy for H. pylori infections, limitations of this type of therapy and predicts the availability of newly developed therapies for H. pylori eradication.
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Buzás GM. [Helicobacter pylori -- 2014]. Orv Hetil 2015; 156:203-10. [PMID: 25639633 DOI: 10.1556/oh.2015.30097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The author reviews the main achievements in Helicobacter pylori research in the past 2 years. Of the more than 1000 microRNAs described thus far, sets of over- and underexpressed samples were identified that are associated with either gastric cancer or precancerous lesions, and some of them could be either markers or therapeutic targets in the near future. Meta-analyses involved 95 new publications: the association between infection and oesophageal, colorectal, pancreatic and liver carcinomas is supported by the increased odds ratios, but the results do not reach the strength seen in gastric carcinoma. Epstein-Barr virus is an emerging pathogen: 10% of gastric cancers are virus-associated; the prevalence of the virus in normal mucosa, chronic gastritis and peptic ulcer are currently being studied. Current Helicobacter pylori eradication regimens frequently achieve suboptimal results: a few optimisation methods are presented, although not all are supported by the meta-analyses. In 2013, the European Helicobacter Study Group proposed the development of a pan-European registry; data from 5792 patients registered so far indicated that many therapeutic regimens resulted in a low eradication rate. In 2013, the Healthy Stomach Initiative was started with the aim of supporting and disseminating research performed in the field of healthy and diseased stomachs.
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Affiliation(s)
- György Miklós Buzás
- Ferencvárosi Egészségügyi Szolgáltató KKNp Kft. Budapest Mester utca 45. 1095
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