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Yang C, You N, Chen Y, Zhang J. Helicobacter pylori infection increases the risk of dyslipidemia in Chinese diabetic Population: a retrospective cross-sectional study. BMC Infect Dis 2024; 24:730. [PMID: 39054452 PMCID: PMC11270938 DOI: 10.1186/s12879-024-09597-2] [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: 04/06/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND In contemporary times, increased prevalence of Helicobacter pylori (H. pylori) infection and elevated dyslipidemia levels present substantial public health challenges. However, the relationship between H. pylori and dyslipidemia remains inconclusive. No studies have yet conducted a population-based classification to investigate the impact of H. pylori infection on dyslipidemia in individuals with diabetes. METHODS A retrospective cohort study was carried out on a total of 60,535 individuals who underwent health check-ups at the Health Examination Center in Taizhou Hospital from 2017 to 2022. Physical measurements, hematological markers and detection of H. pylori were gathered from all patients. The study population was further stratified into diabetic and non-diabetic groups for analysis. RESULTS H. pylori infection was found to be an autonomous risk factor for dyslipidemia based on the results of multivariate logistic regression analysis (OR = 1.13, 95% CI: 1.03-1.24). However, no notable effect on dyslipidemia in the non-diabetic group was observed. Furthermore, at the follow-up, the group with persistent negative showed a significantly lower incidence ratio of dyslipidemia compared to the group with persistent infection (P = 0.006). The persistent negative group exhibited a significantly higher rate of improvement in dyslipidemia compared to the new infection group (P = 0.038). CONCLUSIONS In the diabetic population, the presence of H. pylori infection heightens the propensity for developing dyslipidemia. Therefore, the implementation of efficient eradication strategies for H. pylori infection could potentially lead to a decrease in the occurrence of dyslipidemia among individuals with diabetes.
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Affiliation(s)
- Chaoyu Yang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Ningning You
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Yi Chen
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Jinshun Zhang
- Health Management Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China.
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Umar Z, Tang JW, Marshall BJ, Tay ACY, Wang L. Rapid diagnosis and precision treatment of Helicobacter pylori infection in clinical settings. Crit Rev Microbiol 2024:1-30. [PMID: 38910506 DOI: 10.1080/1040841x.2024.2364194] [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: 02/28/2024] [Accepted: 05/25/2024] [Indexed: 06/25/2024]
Abstract
Helicobacter pylori is a gram-negative bacterium that colonizes the stomach of approximately half of the worldwide population, with higher prevalence in densely populated areas like Asia, the Caribbean, Latin America, and Africa. H. pylori infections range from asymptomatic cases to potentially fatal diseases, including peptic ulcers, chronic gastritis, and stomach adenocarcinoma. The management of these conditions has become more difficult due to the rising prevalence of drug-resistant H. pylori infections, which ultimately lead to gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. In 1994, the International Agency for Research on Cancer (IARC) categorized H. pylori as a Group I carcinogen, contributing to approximately 780,000 cancer cases annually. Antibiotic resistance against drugs used to treat H. pylori infections ranges between 15% and 50% worldwide, with Asian countries having exceptionally high rates. This review systematically examines the impacts of H. pylori infection, the increasing prevalence of antibiotic resistance, and the urgent need for accurate diagnosis and precision treatment. The present status of precision treatment strategies and prospective approaches for eradicating infections caused by antibiotic-resistant H. pylori will also be evaluated.
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Affiliation(s)
- Zeeshan Umar
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jia-Wei Tang
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
| | - Barry J Marshall
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
- Marshall International Digestive Diseases Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Alfred Chin Yen Tay
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
- Marshall International Digestive Diseases Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liang Wang
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- Division of Microbiology and Immunology, School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia, China
- Center for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, China
- School of Agriculture and Food Sustainability, University of Queensland, Brisbane, Queensland, Australia
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Moreno Trigos Y, Tortajada-Girbés M, Simó-Jordá R, Hernández Pérez M, Hortelano I, García-Ferrús M, Ferrús Pérez MA. Use of Deep-Amplicon Sequencing (DAS), Real-Time PCR and In Situ Hybridization to Detect H. pylori and Other Pathogenic Helicobacter Species in Feces from Children. Diagnostics (Basel) 2024; 14:1216. [PMID: 38928632 PMCID: PMC11203337 DOI: 10.3390/diagnostics14121216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Detecting Helicobacter pylori in fecal samples is easier and more comfortable than invasive techniques, especially in children. Thus, the objective of the present work was to detect H. pylori in feces from children by molecular methods as an alternative for diagnostic and epidemiological studies. METHODS Forty-five fecal samples were taken from pediatric patients who presented symptoms compatible with H. pylori infection. HpSA test, culture, real-time quantitative PCR (qPCR), fluorescence in situ hybridization (FISH), direct viable count associated with FISH (DVC-FISH), and Illumina-based deep-amplicon sequencing (DAS) were applied. RESULTS No H. pylori colonies were isolated from the samples. qPCR analysis detected H. pylori in the feces of 24.4% of the patients. In comparison, DVC-FISH analysis showed the presence of viable H. pylori cells in 53.3% of the samples, 37% of which carried 23S rRNA mutations that confer resistance to clarithromycin. After DAS, H. pylori-specific 16S rDNA sequences were detected in 26 samples. In addition, DNA from H. hepaticus was identified in 10 samples, and H. pullorum DNA was detected in one sample. CONCLUSION The results of this study show the presence of H. pylori, H. hepaticus, and H. pullorum in children's stools, demonstrating the coexistence of more than one Helicobacter species in the same patient. The DVC-FISH method showed the presence of viable, potentially infective H. pylori cells in a high percentage of the children's stools. These results support the idea that fecal-oral transmission is probably a common route for H. pylori and suggest possible fecal-oral transmission of other pathogenic Helicobacter species.
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Affiliation(s)
- Yolanda Moreno Trigos
- Research Institute of Water and Environmental Engineering (IIAMA), Universitat Politècnica de València, 46022 Valencia, Spain; (Y.M.T.); (I.H.)
| | - Miguel Tortajada-Girbés
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain;
- Department of Pediatrics, La Fe Polytechnique and University Hospital, 46026 Valencia, Spain
- Foundation for Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
| | - Raquel Simó-Jordá
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain;
- Foundation for Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
- Department of Pediatrics, University Hospital Doctor Peset, 46017 Valencia, Spain
| | - Manuel Hernández Pérez
- Biotechnology Department, Universitat Politècnica de València, 46022 Valencia, Spain; (M.H.P.); (M.A.F.P.)
| | - Irene Hortelano
- Research Institute of Water and Environmental Engineering (IIAMA), Universitat Politècnica de València, 46022 Valencia, Spain; (Y.M.T.); (I.H.)
| | - Miguel García-Ferrús
- Biotechnology Department, Universitat Politècnica de València, 46022 Valencia, Spain; (M.H.P.); (M.A.F.P.)
| | - María Antonia Ferrús Pérez
- Biotechnology Department, Universitat Politècnica de València, 46022 Valencia, Spain; (M.H.P.); (M.A.F.P.)
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Moalla M, Chtourou L, Mnif B, Charfi S, Smaoui H, Boudabous M, Mnif L, Amouri A, Gdoura H, Hammami A, Boudawara T, Tahri N. Assessment of histology's performance compared with PCR in the diagnosis of Helicobacter pylori infection. Future Sci OA 2024; 10:FSO976. [PMID: 38817388 PMCID: PMC11137788 DOI: 10.2144/fsoa-2023-0217] [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: 09/28/2023] [Accepted: 02/14/2024] [Indexed: 06/01/2024] Open
Abstract
Aim: Histology is the most widely used test to detect H. pylori. PCR is less used but allows the detection of both infection and antibiotics' resistance. Methods: We conducted a monocentric cross-sectional study, collecting 97 symptomatic patients to assess the diagnostic performance of histology in the detection of H. pylori infection compared with PCR. Results: Sensitivity of histology in comparison with PCR was 81.5% and specificity was 56.3%. A history of anti-H. pylori therapy intake, as well as the density of the bacterium on the gastric sample and the presence of gastric atrophy, were significantly correlated to the PCR's result in terms of H. pylori detection. Conclusion: Thus, histology can be considered as an efficient test compared with PCR in H. pylori detection.
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Affiliation(s)
- Manel Moalla
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Lassaad Chtourou
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Basma Mnif
- Microbiology department, Habib Bourguiba hospital, Sfax, Tunisia
| | - Slim Charfi
- Pathology department, Habib Bourguiba hospital, Sfax, Tunisia
| | - Hend Smaoui
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Mon Boudabous
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Leila Mnif
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Ali Amouri
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Hela Gdoura
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
| | - Adnene Hammami
- Microbiology department, Habib Bourguiba hospital, Sfax, Tunisia
| | - Tahya Boudawara
- Pathology department, Habib Bourguiba hospital, Sfax, Tunisia
| | - Nabil Tahri
- Gastroenterology department, Hedi Chaker hospital, Sfax, Tunisia
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Kim I, Shin YR, Kim JS, Kim BW, Maeng LS, Kim JM. Detection of Clarithromycin Resistance in Helicobacter pylori Using MmaxSure™ H. pylori & ClaR Assay. Dig Dis 2024; 42:292-298. [PMID: 38599188 PMCID: PMC11250404 DOI: 10.1159/000538655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Clarithromycin resistance is a crucial factor in the eradication of Helicobacter pylori. This study aimed to evaluate the performance of MmaxSure™ H. pylori & ClaR Assay (MmaxSure™) in the diagnosis and detection of clarithromycin resistance in H. pylori. METHODS Subjects who underwent esophagogastroduodenoscopy between April 2020 and October 2022 were enrolled. The diagnostic performances of MmaxSure™ and dual priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) were compared with the rapid urease test and culture. Secondary gene sequencing analysis was performed in discordant cases of PCR tests. RESULTS A total of 156 gastric biopsy samples were analyzed. In H. pylori detection, MmaxSure™ showed a 95.9% sensitivity (95% CI: 90.6-98.6), a 42.7% specificity (95% CI: 26.3-60.7), and a kappa value of 0.457. For the detection of A2143G mutation samples, MmaxSure™ showed a 91.2% sensitivity (95% CI: 76.3-98.1), a 93.4% specificity (95% CI: 87.5-97.1), and a kappa value of 0.804. There were a total of 10 discordant cases compared to gene sequencing in A2143G mutation detection for MmaxSure™. CONCLUSION In this study, MmaxSure™ showed comparable diagnostic performance to DPO-PCR in the detection of the H. pylori and A2143G mutation. Further research is needed to confirm the clinical effectiveness of the MmaxSure™ assay in H. pylori eradication.
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Affiliation(s)
- Ilsoo Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Lee-So Maeng
- Department of Hospital Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Min Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Rovaris GZ, Back JV, Ronchi-Colombo MP, Rosa VS, Cardoso MCB, Berger EC. ASSESSMENT OF THE ACCURACY OF THE RAPID TEST FOR THE DIAGNOSIS OF HELICOBACTER PYLORI IN PATIENTS THAT DIDN'T UNDERGO PREVIOUS ERADICATION THERAPY AND WHO WENT THROUGH ENDOSCOPY. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23136. [PMID: 38451669 DOI: 10.1590/s0004-2803.24612023-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Helicobacter pylori infection is widely spread globally and is known to cause potentially serious diseases. Several diagnostic methods exist to identify and treat carriers of this bacterium. Serological tests for the diagnosis of infection are based on the detection of antibodies immunoglobulin G against H. pylori, a non-invasive, inexpensive, and easy-to-perform option. OBJECTIVE This research aims to ascertain the accuracy of an immunochromatographic serological test to verify the feasibility of using this method in patients who have not undergone previous eradication therapy. METHODS Rapid tests and questionnaires were applied to 53 patients that underwent upper digestive endoscopy with research for H. pylori between the period of September and October 2021. The results were compared with histopathology. RESULTS In the rapid tests, seven positive and 46 negative results were obtained. When compared with the gold stan-dard, the following values were described: sensitivity 54.5%, specificity 97.6%, positive predictive value 85.7%, and negative predictive value 89.1%. CONCLUSION In the present study, the immunochromatographic serological tests had an accuracy close to the values found in other similar studies. Therefore, it may be concluded that the rapid serological test remains a reasonable choice for screening large populations due to its low cost and ease of application, especially in those individuals who have not undergone previous treatment. BACKGROUND • Helicobacter pylori infection can cause potentially serious diseases. BACKGROUND • Serological tests are based on the detection of antibodies immunoglobulin G against Helicobacter pylori. BACKGROUND • Serological tests for the diagnosis of Helicobacter pylori infection are low cost tools and have easy application. BACKGROUND • Rapid serological test is a reasonable choice for screening large populations.
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Affiliation(s)
- Gianluca Z Rovaris
- Curso de Medicina Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - João V Back
- Curso de Medicina Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | | | - Vitória S Rosa
- Curso de Medicina Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Manoel C B Cardoso
- Universidade da Região de Joinville, Joinville, SC, Brasil
- Hospital Dia Clinigastro, Criciúma, SC, Brasil
| | - Emilio C Berger
- Programa de Pós-Graduação em Ciências da Saúde, Criciúma, SC, Brasil
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Nguyen TC, Robert A, Pham THA, Vo KH, Le LD, Ma HT, Le MHT, Che TH, Nguyen HT, Truong DQ, Bontems P, Nguyen PNV. Helicobacter pylori Eradication Rate Using Stool Antigen Test in Vietnamese Children: A Prospective Multicenter Study. JPGN REPORTS 2023; 4:e374. [PMID: 38034459 PMCID: PMC10684207 DOI: 10.1097/pg9.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 12/02/2023]
Abstract
Objectives This study assessed the diagnostic value of a monoclonal immunoassay stool antigen test (HpSA) for Helicobacter pylori (H. pylori) infection and the eradication outcomes. Methods Children undergoing digestive endoscopy at 2 Children's Hospitals in Ho Chi Minh City were recruited. Treatment was offered to H. pylori-infected children. Stool samples were collected on the same day as the endoscopy procedure and after 6 weeks post-treatment for HpSA. Diagnostic value and optimal cutoff of HpSA were assessed using biopsy-based tests as the gold standard. Eradication was defined as a negative HpSA post-treatment. Ethical approval was obtained, and informed consent was signed by the participants. Results In total, 394 patients participated in the study. The most common symptoms were epigastric pain (74.6%) and vomiting (37.3%). H. pylori status was positive in 78% of patients (306/394), doubtful in 10.1%, and negative in 12.2%. HpSA was positive in 73.2% (142/194). Excluding doubtful infections, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of HpSA were 87.4%, 95.2%, 99.2%, 51.3%, and 88.4%, respectively. The optimal cutoff value of 0.148 provided similar accuracy to the recommended cutoff. The eradication rate was 56.1% in per-protocol analysis and 27.9% in intention-to-treat analysis. Treatment success was higher in boys, but lower among malnourished children and those infected with cagA+ strains. Conclusions The HpSA is reliable for identifying H. pylori infection in epidemiological studies and assessing eradication outcomes. The low eradication rate highlights the need for an appropriate intervention strategy in Vietnamese children.
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Affiliation(s)
- Tu Cam Nguyen
- From the Department of Gastroenterology, City Children’s Hospital, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique, Pôle D’Épidémiologie et Biostatistique, Université Catholique de Louvain, Brussels, Belgium
| | - Thu Hien Anh Pham
- Department of Microbiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Khoa Hoang Vo
- Department of Gastroenterology, Children’s Hospital 2, Ho Chi Minh City, Vietnam
| | - Loc Duc Le
- From the Department of Gastroenterology, City Children’s Hospital, Ho Chi Minh City, Vietnam
| | - Ha Tu Ma
- Department of Microbiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - My Huynh Thao Le
- Department of Biostatistics and Informatics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thai Hoang Che
- Institut de Recherche Expérimentale et Clinique, Pôle D’Épidémiologie et Biostatistique, Université Catholique de Louvain, Brussels, Belgium
- Department of Biostatistics and Informatics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hiep Thanh Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Dinh Quang Truong
- Department of Surgery, City Children’s Hospital, Ho Chi Minh City, Vietnam
| | - Patrick Bontems
- Department of Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Phuong Ngoc Van Nguyen
- Department of Biostatistics and Informatics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Sousa C, Ferreira R, Santos SB, Azevedo NF, Melo LDR. Advances on diagnosis of Helicobacter pylori infections. Crit Rev Microbiol 2023; 49:671-692. [PMID: 36264672 DOI: 10.1080/1040841x.2022.2125287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
The association of Helicobacter pylori to several gastric diseases, such as chronic gastritis, peptic ulcer disease, and gastric cancer, and its high prevalence worldwide, raised the necessity to use methods for a proper and fast diagnosis and monitoring the pathogen eradication. Available diagnostic methods can be classified as invasive or non-invasive, and the selection of the best relies on the clinical condition of the patient, as well as on the sensitivity, specificity, and accessibility of the diagnostic test. This review summarises all diagnostic methods currently available, including the invasive methods: endoscopy, histology, culture, and molecular methods, and the rapid urease test (RUT), as well as the non-invasive methods urea breath test (UBT), serological assays, biosensors, and microfluidic devices and the stool antigen test (SAT). Moreover, it lists the diagnostic advantages and limitations, as well as the main advances for each methodology. In the end, research on the development of new diagnostic methods, such as bacteriophage-based H. pylori diagnostic tools, is also discussed.
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Affiliation(s)
- Cláudia Sousa
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
| | - Rute Ferreira
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Sílvio B Santos
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno F Azevedo
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Luís D R Melo
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga/Guimarães, Portugal
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Ishibashi F, Suzuki S, Nagai M, Mochida K, Morishita T. Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments. Gut Liver 2023; 17:684-697. [PMID: 36843419 PMCID: PMC10502504 DOI: 10.5009/gnl220429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 02/28/2023] Open
Abstract
As the rate of discovery of drug-resistant Helicobacter pylori cases increases worldwide, the relevant societies have updated their guidelines for primary eradication regimens. A promising strategy against drug-resistant H. pylori is tailored therapy based on the results of an antibiotic susceptibility test; however, it is difficult to apply this strategy to all cases. Although culture-based antibiotic susceptibility tests can assess resistance to any antimicrobial agent, their greatest disadvantage is the time required to draw a conclusion. In contrast, molecular-based methods, such as polymerase chain reaction, can rapidly determine the presence of resistance, although a single test can only test for one type of antimicrobial agent. Additionally, the limited availability of facilities for molecular-based methods has hindered their widespread use. Therefore, low-cost, minimally invasive, simple, and effective primary regimens are needed. Several studies have compared the efficacy of the latest primary eradication regimens against that of tailored therapies, and their results have shaped guidelines. This article reviews the latest research on empirical and tailored treatments for H. pylori infections. Evidence for the superiority of tailored therapy over empirical therapy is still limited and varies by region and treatment regimen. A network meta-analysis comparing different empirical treatment regimens showed that vonoprazan triple therapy provides a superior eradication effect. Recently, favorable results towards vonoprazan dual therapy have been reported, as it reached eradication levels similar to those of vonoprazan triple therapy. Both vonoprazan dual therapy and tailored therapy based on antibiotic susceptibility tests could contribute to future treatment strategies.
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Affiliation(s)
- Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
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Li M, Wang X, Meng W, Dai Y, Wang W. Empirical versus tailored therapy based on genotypic resistance detection for Helicobacter pylori eradication: a systematic review and meta-analysis. Therap Adv Gastroenterol 2023; 16:17562848231196357. [PMID: 37667805 PMCID: PMC10475236 DOI: 10.1177/17562848231196357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Background The eradication rate of Helicobacter pylori infection with empirical therapy has decreased due to increased drug resistance. The latest guidelines recommend genotypic resistance-guided therapy, but its clinical efficacy remains unclear. Objectives The purpose of our study was to evaluate whether tailored therapy based on genotypic resistance is superior to empirical therapy for H. pylori infection. Design A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing tailored therapy based on genotypic resistance with empirical therapy was performed. Sources and methods We retrieved relevant studies from PubMed, Embase, and the Cochrane Library. The primary outcome was H. pylori eradication rate and the adverse events (AEs) was the secondary outcome. A random-effect model was applied to compare pooled risk ratios (RRs) with related 95% confidence intervals (CIs). Results A total of 12 qualified RCTs containing 3940 patients were identified in our systematic review and meta-analysis. The pooled eradication rates of tailored therapy based on the detection of genotypic resistance were consistently higher than those in the empirical treatment group, with no statistical significance. In triple therapy, the eradication rate was significantly higher in the tailored group than in the empirical group by intention-to-treat analysis (ITT) and per-protocol analysis (PP) analysis (p < 0.0001, RR: 1.20; 95% CI: 1.12-1.29; p < 0.0001, RR: 1.20; 95% CI: 1.15-1.25). In quadruple therapy, the eradication rate was higher in the empirical group (p = 0.001, RR: 0.93; 95% CI: 0.89-0.97; p = 0.009, RR: 0.95; 95% CI: 0.92-0.99). And this result was true for both bismuth quadruple therapy (BQT) and non-BQT. Regarding total AEs, the pooled rate was 34% in the tailored group and 37% in the empirical group, and no difference between the two groups was found (p = 0.17, RR: 0.88; 95% CI: 0.74-1.06). Conclusion In conclusion, tailored therapy based on molecular methods may offer better efficacy than empirical triple therapy, but it may not be superior to empirical quadruple therapy in eradicating H. pylori infection. Larger and more individualized RCTs are needed to aid clinical decision-making. Registration PROSPERO CRD42023408688.
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Affiliation(s)
- Meng Li
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Xiaolei Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Wenting Meng
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Yun Dai
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Weihong Wang
- Department of Gastroenterology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China
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11
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Ng HY, Leung WK, Cheung KS. Antibiotic Resistance, Susceptibility Testing and Stewardship in Helicobacter pylori Infection. Int J Mol Sci 2023; 24:11708. [PMID: 37511471 PMCID: PMC10380565 DOI: 10.3390/ijms241411708] [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: 06/21/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the declining trend of Helicobacter pylori (H. pylori) prevalence around the globe, ongoing efforts are still needed to optimize current and future regimens in view of the increasing antibiotic resistance. The resistance of H. pylori to different antibiotics is caused by different molecular mechanisms, and advancements in sequencing technology have come a far way in broadening our understanding and in facilitating the testing of antibiotic susceptibility to H. pylori. In this literature review, we give an overview of the molecular mechanisms behind resistance, as well as discuss and compare different antibiotic susceptibility tests based on the latest research. We also discuss the principles of antibiotic stewardship and compare the performance of empirical therapies based on up-to-date resistance patterns and susceptibility-guided therapies in providing effective H. pylori treatment. Studies and clinical guidelines should ensure that the treatment being tested or recommended can reliably achieve a pre-agreed acceptable level of eradication rate and take into account the variations in antibiotic resistance across populations. Local, regional and international organizations must work together to establish routine antibiotic susceptibility surveillance programs and enforce antibiotic stewardship in the treatment of H. pylori, so that it can be managed in a sustainable and efficient manner.
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Affiliation(s)
- Ho-Yu Ng
- School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Wai K Leung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Ka-Shing Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
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12
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Jiang X, Deng B, Gao X, Zhang Y, Li G, Li G, She Q, Ding Y. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen - An open-label, randomized trial. Open Med (Wars) 2023; 18:20230722. [PMID: 37465346 PMCID: PMC10350889 DOI: 10.1515/med-2023-0722] [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: 12/05/2022] [Revised: 04/23/2023] [Accepted: 05/12/2023] [Indexed: 07/20/2023] Open
Abstract
This research aimed to evaluate the eradication efficacy, safety, and gastrointestinal symptom relief rates of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy in primary eradication patients in Yangzhou, China. It also investigated the possible factors influencing the success of different Helicobacter pylori eradication regimens. A single-center, prospective, open-label, randomized controlled study was performed from December 2020 and October 2021, in which 255 patients with H. pylori infection were assigned in a 1:1:1 ratio to the three different groups. Our results showed that high-dose dual therapy (91.0%, 71/78) and resistance gene-based triple therapy (94.9%, 75/79) achieved eradication rates and compliance equivalent to those of empirical bismuth quadruple therapy (85.3%, 64/75) in the per-protocol analysis, while high-dose dual therapy had lower rates of adverse events (11.5%, 9/78, P < 0.05), fewer side effects, and greater safety. Most patients' gastrointestinal discomfort symptoms improved after eradication of H. pylori. Poor compliance (P < 0.05) and antibiotic resistance (P < 0.05) were risk factors for the efficacy of H. pylori eradication. Therefore, the appropriate regimen can be individualized for eradication therapy in clinical practice according to the patient's resistance and tolerance to the drug.
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Affiliation(s)
- Xin Jiang
- Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Bin Deng
- Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Xuefeng Gao
- Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Yun Zhang
- Department of Emergency Medicine, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, China
| | - Guangyao Li
- Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Guiqing Li
- Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Qiang She
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yanbing Ding
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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13
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Kim I, Maeng LS, Kim JS, Kim BW, Cheung DY, Kim JI, Park SH. Quantitative multiplex real-time polymerase chain reaction assay for the detection of Helicobacter pylori and clarithromycin resistance. BMC Microbiol 2023; 23:155. [PMID: 37237357 DOI: 10.1186/s12866-023-02868-z] [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: 12/14/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Identifying clarithromycin resistance is essential for eradicating Helicobacter pylori (HP). Therefore, we evaluated the performance of Allplex™ H.pylori & ClariR Assay (Allplex™) for diagnosing and detecting clarithromycin resistance in HP. METHODS Subjects who underwent esophagogastroduodenoscopy between April 2020 and August 2021 at Incheon St. Mary's hospital were enrolled in this study. The diagnostic performances of Allplex™ and dual priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) were compared with sequencing as the gold standard. RESULTS A total of 142 gastric biopsy samples were analyzed. Gene sequencing revealed 124 HP infections, 42 A2143G mutations, 2 A2142G mutations, one dual mutation, and no A2142C mutation. DPO-PCR showed 96.0% sensitivity and 100.0% specificity for HP detection; the corresponding rates for Allplex™ were 99.2% and 100.0%. DPO-PCR showed 88.3% sensitivity and 82.0% specificity for A2143G mutation, and Allplex™ showed 97.6% and 96.0%. The Cohen's Kappa coefficient for overall test results was 0.56 for DPO-PCR and 0.95 for Allplex™. CONCLUSION Allplex™ showed comparable diagnostic performance with direct gene sequencing and non-inferior diagnostic performance to DPO-PCR. Further research is required to confirm whether Allplex™ is an effective diagnostic tool for the eradication of HP.
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Affiliation(s)
- Ilsoo Kim
- Divison of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Lee-So Maeng
- Department of Hospital Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Divison of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
| | - Byung-Wook Kim
- Divison of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dae Young Cheung
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Heon Park
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Caserta S, Genovese C, Cicero N, Gangemi S, Allegra A. The Anti-Cancer Effect of Cinnamon Aqueous Extract: A Focus on Hematological Malignancies. Life (Basel) 2023; 13:life13051176. [PMID: 37240821 DOI: 10.3390/life13051176] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Cinnamon is an evergreen and tropical plant of the family Lauraceae, growing particularly in Sri Lanka, whose aqueous extract has been tested in different studies to evaluate its possible use as an anti-cancer compound. Both in vitro and in vivo experiments seem to confirm that it acts on various cellular pathways, contributing to down-regulating the activity of molecules that stimulate the proliferation and survival of cells such as the transcription factors NF-KB and AP-1, COX-2, dihydrofolate reductase and pro-angiogenic substances such as VEGF, while up-regulating the function of immune cells against tumors, such as cytotoxic CD8+ T cells. In hematological malignancies, aqueous cinnamon extract has been studied in order to understand if it is possible to count on its help, alone or in combination with traditional drugs such as doxorubicin, to treat patients. The aim of our work is to investigate results from in vitro and in vivo studies about the possible anti-cancer effect of aqueous cinnamon extract in hematological malignancies and the different pathways involved in its action. The possibility of using cinnamon extract in clinical practice is discussed; even if its use could appear very interesting, more studies are necessary to clear the real potentiality of this substance in cancer.
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Affiliation(s)
- Santino Caserta
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Claudia Genovese
- National Research Council, Institute for Agricultural and Forest Systems in the Mediterranean, Via Empedocle 58, 95128 Catania, Italy
| | - Nicola Cicero
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Sebastiano Gangemi
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 98125 Messina, Italy
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15
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Lyu T, Cheung KS, Deng Z, Ni L, Chen C, Wu J, Leung WK, Seto WK. Whole genome sequencing reveals novel genetic mutations of Helicobacter pylori associating with resistance to clarithromycin and levofloxacin. Helicobacter 2023:e12972. [PMID: 36965192 DOI: 10.1111/hel.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Detection of mutations in one or a couple of genes may not provide enough data or cover all the genomic DNA variance related to antibiotic resistance of Helicobacter pylori to clarithromycin (CLA) and levofloxacin (LVX). We aimed to perform whole genome sequencing to explore novel antibiotic resistance-related genes to increase predictive accuracy for future targeted sequencing tests. METHODS Gastric mucosal biopsies were taken during upper endoscopy in 27 H. pylori-infected patients. According to culture-based antibacterial susceptibility test, H. pylori strains were divided into three groups, with nine strains in each group: CLA single-drug resistance (group C), LVX single-drug resistance (group L), and strains sensitive to all antibacterial drugs (group S). Based on whole genome sequencing with group S being the control, group C and group L group-specific single nucleotide variants and amino acid mutations were screened, and potential candidate genes related to CLA and LVX resistance were identified. RESULTS The median age of study subjects was 35 years (IQR: 31-40), and 17 (63.0%) were male. All nine CLA-resistant strains had A2143G mutations in 23S rRNA, while none of nine sensitive strains had the mutation. Six of nine strains in group L and six of nine strains in group S had 87th or 91st mutation in gyrA. After comparing sequencing data of strains among the three groups, we identified five mutated positions belonging to four genes related to CLA resistance, and 31 mutated positions belonging to 20 genes related to LVX resistance. Novel genetic mutations were detected for CLA resistance (including fliJ and clpX) and LVX resistance (including fliJ, cheA, hemE, Val360Ile, and HP0568). Missense mutations in fliJ and cheA gene were mainly involved in chemotaxis and flagellar motility to facilitate bacterial escape of antibiotics, while the functions of other novel gene mutations underpinning antibiotic resistance remain to be investigated. CONCLUSION Whole genome sequencing detected potential novel genetic mutations conferring resistance of H. pylori to CLA and LVX including fliJ and cheA. Further studies to correlate these findings with treatment outcome should be performed.
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Affiliation(s)
- Tao Lyu
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ka Shing Cheung
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Zijie Deng
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Li Ni
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chuan Chen
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Juan Wu
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wai K Leung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wai Kay Seto
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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16
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Vasapolli R, Ailloud F, Suerbaum S, Neumann J, Koch N, Macke L, Schirra J, Mayerle J, Malfertheiner P, Schulz C. Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of Helicobacter pylori. World J Gastroenterol 2023; 29:1638-1647. [PMID: 36970593 PMCID: PMC10037247 DOI: 10.3748/wjg.v29.i10.1638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/15/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Endofaster is an innovative technology that can be combined with upper gastrointestinal endoscopy (UGE) to perform gastric juice analysis and real-time detection of Helicobacter pylori (H. pylori).
AIM To assess the diagnostic performance of this technology and its impact on the management of H. pylori in the real-life clinical setting.
METHODS Patients undergoing routine UGE were prospectively recruited. Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test (RUT). Gastric juice sampling and analysis was performed using the Endofaster, and the diagnosis of H. pylori was based on real-time ammonium measurements. Histological detection of H. pylori served as the diagnostic gold standard for comparing Endofaster-based H. pylori diagnosis with RUT-based H. pylori detection.
RESULTS A total of 198 patients were prospectively enrolled in an H. pylori diagnostic study by Endofaster-based gastric juice analysis (EGJA) during the UGE. Biopsies for RUT and histological assessment were performed on 161 patients (82 men and 79 women, mean age 54.8 ± 19.2 years). H. pylori infection was detected by histology in 47 (29.2%) patients. Overall, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) for H. pylori diagnosis by EGJA were 91.5%, 93.0%, 92.6%, 84.3%, and 96.4%, respectively. In patients on treatment with proton pump inhibitors, diagnostic sensitivity was reduced by 27.3%, while specificity and NPV were unaffected. EGJA and RUT were comparable in diagnostic performance and highly concordant in H. pylori detection (κ-value = 0.85).
CONCLUSION Endofaster allows for rapid and highly accurate detection of H. pylori during gastroscopy. This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.
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Affiliation(s)
- Riccardo Vasapolli
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
- Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
| | - Florent Ailloud
- Max von Pettenkofer Institute, Faculty of Medicine, Ludwig-Maximilians University of Munich, Munich 80336, Germany
- National Reference Center for Helicobacter pylori, Munich 81377, Germany
| | - Sebastian Suerbaum
- Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
- Max von Pettenkofer Institute, Faculty of Medicine, Ludwig-Maximilians University of Munich, Munich 80336, Germany
- National Reference Center for Helicobacter pylori, Munich 81377, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich, Munich 81377, Germany
| | - Nadine Koch
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Lukas Macke
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
- Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
| | - Jörg Schirra
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Julia Mayerle
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Peter Malfertheiner
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Christian Schulz
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
- Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
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17
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Vasapolli R, Ailloud F, Suerbaum S, Neumann J, Koch N, Macke L, Schirra J, Mayerle J, Malfertheiner P, Schulz C. Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of Helicobacter pylori. World J Gastroenterol 2023; 29:1494-1503. [DOI: 10.3748/wjg.v29.i10.1494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Endofaster is an innovative technology that can be combined with upper gastrointestinal endoscopy (UGE) to perform gastric juice analysis and real-time detection of Helicobacter pylori (H. pylori).
AIM To assess the diagnostic performance of this technology and its impact on the management of H. pylori in the real-life clinical setting.
METHODS Patients undergoing routine UGE were prospectively recruited. Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test (RUT). Gastric juice sampling and analysis was performed using the Endofaster, and the diagnosis of H. pylori was based on real-time ammonium measurements. Histological detection of H. pylori served as the diagnostic gold standard for comparing Endofaster-based H. pylori diagnosis with RUT-based H. pylori detection.
RESULTS A total of 198 patients were prospectively enrolled in an H. pylori diagnostic study by Endofaster-based gastric juice analysis (EGJA) during the UGE. Biopsies for RUT and histological assessment were performed on 161 patients (82 men and 79 women, mean age 54.8 ± 19.2 years). H. pylori infection was detected by histology in 47 (29.2%) patients. Overall, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) for H. pylori diagnosis by EGJA were 91.5%, 93.0%, 92.6%, 84.3%, and 96.4%, respectively. In patients on treatment with proton pump inhibitors, diagnostic sensitivity was reduced by 27.3%, while specificity and NPV were unaffected. EGJA and RUT were comparable in diagnostic performance and highly concordant in H. pylori detection (κ-value = 0.85).
CONCLUSION Endofaster allows for rapid and highly accurate detection of H. pylori during gastroscopy. This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.
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Affiliation(s)
- Riccardo Vasapolli
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany,Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
| | - Florent Ailloud
- Max von Pettenkofer Institute, Faculty of Medicine, Ludwig-Maximilians University of Munich, Munich 80336, Germany,National Reference Center for Helicobacter pylori, Munich 81377, Germany
| | - Sebastian Suerbaum
- Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany,Max von Pettenkofer Institute, Faculty of Medicine, Ludwig-Maximilians University of Munich, Munich 80336, Germany,National Reference Center for Helicobacter pylori, Munich 81377, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich, Munich 81377, Germany
| | - Nadine Koch
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Lukas Macke
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany,Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
| | - Jörg Schirra
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Julia Mayerle
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Peter Malfertheiner
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany
| | - Christian Schulz
- Medical Department ІІ, University Hospital LMU Munich, Munich 81377, Germany,Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich 81377, Germany
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Godavarthy PK, Puli C. From Antibiotic Resistance to Antibiotic Renaissance: A New Era in Helicobacter pylori Treatment. Cureus 2023; 15:e36041. [PMID: 36919111 PMCID: PMC10008461 DOI: 10.7759/cureus.36041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
Helicobacter pylori (H. pylori) is a common bacterial infection that can cause gastric diseases, including gastric cancer. The standard treatment for H. pylori infection is a combination of antibiotics and acid suppressants, but antibiotic resistance has become a significant problem that can reduce treatment efficacy. The development of novel treatment strategies for H. pylori is necessary to reduce the burden of this infection on public health. This review article examines H. pylori antibiotic resistance and future treatment possibilities. We discuss transitioning from trial and error to antimicrobial stewardship and using multi-strain probiotics as an adjunct therapy for H. pylori eradication. This review article provides an extensive overview of H. pylori antibiotic resistance and future treatment possibilities. It begins with an introduction and background of the topic, followed by a literature review. The review of the literature covers the transition from trial and error to antimicrobial stewardship, the diagnosis and treatment of H. pylori, the comparative effectiveness of multiple first-line treatment regimens, the ideal H. pylori treatment for the present and future, the use of probiotics to reduce adverse events and improve eradication rates, and the use of novel and effective therapeutic regimens in an era of increasing antibiotic resistance. The conclusion summarizes the review's findings and provides recommendations for future research. The terms Helicobacter pylori, infection, antibiotic resistance, clarithromycin, macrolide resistance, proton pump inhibitors, vonoprazan, triple regimen, susceptibility, and stewardship were used in a PubMed literature search. Finally, the article highlights the urgent need for a global collaborative approach toward tackling antibiotic resistance in H. pylori infections.
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Affiliation(s)
| | - Chandra Puli
- Gastroenterology and Hepatology, London Gastro Care, Hyderabad, IND
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19
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Helicobacter pylori Infection: Current Status and Future Prospects on Diagnostic, Therapeutic and Control Challenges. Antibiotics (Basel) 2023; 12:antibiotics12020191. [PMID: 36830102 PMCID: PMC9952126 DOI: 10.3390/antibiotics12020191] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection, which affects approximately half of the world's population, remains a serious public health problem. As H. pylori infection leads to a number of gastric pathologies, including inflammation, gastroduodenal ulcers, and malignancies, early detection and treatment are crucial to preventing the spread of the infection. Multiple extragastric complications, such as iron deficiency anaemia, immune thrombocytopenic purpura, vitamin B12 deficiency, diabetes mellitus, cardiovascular diseases, and certain neurological disorders, have also been linked to H. pylori infection. An awareness of H. pylori and associated health hazards is necessary to minimize or even eradicate the infection. Therefore, there is an urgent need to raise the standards for the currently employed diagnostic, eradication, alternative treatment strategies. In addition, a brief overview of traditional and cutting-edge approaches that have proven effective in identifying and managing H. pylori is needed. Based on the test and laboratory equipment available and patient clinical characteristics, the optimal diagnostic approach requires weighing several factors. The pathophysiology and pathogenic mechanisms of H. pylori should also be studied, focusing more on the infection-causing virulence factors of this bacterium. Accordingly, this review aims to demonstrate the various diagnostic, pathophysiological, therapeutic, and eradication tactics available for H. pylori, emphasizing both their advantages and disadvantages. Invasive methods (such as quick urease testing, biopsy, or culture) or noninvasive methods (such as breath tests, stool investigations, or serological tests) can be used. We also present the most recent worldwide recommendations along with scientific evidence for treating H. pylori. In addition to the current antibiotic regimens, alternative therapies may also be considered. It is imperative to eradicate the infections caused by H. pylori as soon as possible to prevent problems and the development of stomach cancer. In conclusion, significant advances have been made in identifying and treating H. pylori. To improve eradication rates, peptide mass fingerprinting can be used as a diagnostic tool, and vaccines can also eliminate the infection.
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Abula A, Yang T, Zhang Y, Li T, Ji X. Enhancement of Escherichia coli Ribonuclease R Cytosine-Sensitive Activity by Single Amino Acid Substitution. Mol Biotechnol 2023; 65:108-115. [PMID: 35838865 DOI: 10.1007/s12033-022-00533-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/30/2022] [Indexed: 02/07/2023]
Abstract
Exoribonucleases are frequently used as nuclei acids detection tools for their sequences, modifications, and structures. Escherichia coli ribonuclease R (EcR) is the prototypical exoribonuclease of the RNase II/RNB family degrading RNA in the 3'-5' direction. Different from RNase II, EcR is capable of degrading structured RNA efficiently, which makes it a potential analysis tool for various RNA species. In this work, we examined the nuclease activity of EcR degrading a series of RNA substrates with various sequences. Our biochemical work reveals that EcR is significantly sensitive to cytosine compared with other bases when catalyzing RNA degradation. EcR shows higher cytosine sensitivity compared to its homolog RNase II when degrading RNAs, and the hydrolysis process of EcR is transiently halted and produces apparent intermediate product when the 1-nt upstream of C is A or U, or G. Furthermore, the substitution of glycine with proline (G273P) in EcR enhances its cytosine sensitivity. These findings expand our understanding of EcR enzymatic activities. The EcR G273P mutant bearing higher cytosine sensitivity could help enrich cytosine trails in RNAs and will have potential implications in the detection and analysis of various RNA species especially small RNAs in biological and clinical samples.
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Affiliation(s)
- Abudureyimu Abula
- The State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, Jiangsu, People's Republic of China.,School of Basic Medical Sciences, Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Tingting Yang
- The State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, Jiangsu, People's Republic of China
| | - Yingxin Zhang
- The State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, Jiangsu, People's Republic of China
| | - Tinghan Li
- The State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, Jiangsu, People's Republic of China
| | - Xiaoyun Ji
- The State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, Jiangsu, People's Republic of China. .,Institute of Artificial Intelligence Biomedicine, Nanjing University, Nanjing, China. .,Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China. .,Ministry of Education, Engineering Research Center of Protein and Peptide Medicine, Nanjing, China.
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The Importance of Accurate Early Diagnosis and Eradication in Helicobacter pylori Infection: Pictorial Summary Review in Children and Adults. Antibiotics (Basel) 2022; 12:antibiotics12010060. [PMID: 36671261 PMCID: PMC9854763 DOI: 10.3390/antibiotics12010060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
Among the most widespread childhood infections, Helicobacter pylori (H. pylori) develops potentially life-threatening conditions in adults if not appropriately treated. Helicobacter pylori is a common human pathogen that was first described in the stomach many years ago. The discovery of H. pylori was crucial in gastroenterology; this bacterium is associated with chronic gastritis, peptic ulcers, gastric cancer, and lymphoid tissue lymphoma related to the gastric mucosa. Studies published so far estimate that approximately 10% of subjects infected with H. pylori develop a peptic ulcer, and 1-3% of subjects develop gastric cancer. The clinical manifestations are variable and characteristically depend on the individual factors of the host. Various methods of detection and diagnosis of H. pylori infection have been developed, each with advantages, disadvantages, and/or limitations. Available diagnostic tests are usually performed using invasive (endoscopy, biopsy, rapid urease test, cultures, and molecular tests) and noninvasive methods (urea breath test, stool antigen examination, and serological and molecular tests). Although there is extensive accessibility for diagnosing and treating H. pylori infection, the prevalence of antibiotic resistance is not negligible. Thus, numerous studies and meta-analyses are focused on a new orientation of gastroenterologists in diagnosing and treating H. pylori infections. A fascinating perspective hypothesis is the administration of probiotics to reduce H. pylori adhesion to gastric epithelial cells, preventing H. pylori colonization, especially in children, or reinfection with H. pylori in high-risk adult patients.
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Usefulness of Molecular Methods for Helicobacter pylori Detection in Pediatric Patients and Their Correlation with Histopathological Sydney Classification. Int J Mol Sci 2022; 24:ijms24010179. [PMID: 36613620 PMCID: PMC9820059 DOI: 10.3390/ijms24010179] [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: 10/23/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Helicobacter pylori infections, as one of the most prevalent among humans, are generally acquired during childhood, and are one of the main causes of chronic gastritis and peptic ulcer disease. A bacterial culture from a gastric biopsy is the gold standard and is the only method that has 100% specificity. However, its sensitivity varies, depending on experience of the laboratory staff, applied culture media, specimen transport conditions, biopsy site, and quality of the sample. The same factors compromise all invasive methods and a culture-based H. pylori infection diagnostic, as well as a recent intake of antibiotics, bismuth-containing compounds, and proton pump inhibitors. Molecular methods have been used for clinical microbiology investigation since the beginning of the 21st century. However, their usefulness for H. pylori infections diagnosis remains unclear, especially in pediatric patients. The aim of the study was to assess the incidence of H. pylori infections in a group of 104 pediatric patients and to compare the results of the PCR test with the corresponding histopathological investigation effects. Among the biopsy samples collected from 104 children, 44 (42.3%) were positive in PCR, while 43 (41.3%) and 39 (37.5%) presented histologically-confirmed signs of inflammation and H. pylori colonization, respectively. Moreover, the mean grades of the parameters of the histopathological examination were higher in the group of PCR-positive samples. The compatibility of both research methods was confirmed, emphasizing the usefulness of molecular methods for detecting H. pylori infections in pediatric patients. Considering that the PCR-based method gives reliable results and is less time-consuming and costly, it is worth discussing this method as a new standard in the diagnosis of H. pylori infections, at least among pediatric patients, for which culture-based diagnostics is not sufficient or histopathological examination is negative, while inflammation signs are observed macroscopically.
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Mestrovic A, Perkovic N, Tonkic A, Sundov Z, Kumric M, Bozic J. Personalized Approach in Eradication of Helicobacter pylori Infection. Antibiotics (Basel) 2022; 12:antibiotics12010007. [PMID: 36671208 PMCID: PMC9854992 DOI: 10.3390/antibiotics12010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The increase in antibiotic resistance to Helicobacter pylori (H. pylori) is associated with a decrease in the effectiveness of eradication therapy. Although some success has been achieved by adjusting therapeutic regimens according to local data on resistance to certain antibiotics, a new approach is needed to ensure a better therapeutic response. Tailored therapy, based on sensitivity tests to antibiotics, is increasingly proving to be a superior therapeutic option, even as a first-line therapy. Moreover, the recently published Maastricht VI guidelines emphasize utilizing a susceptibility-guided strategy in respect to antibiotic stewardship as the first choice for eradication therapy. In addition, polymerase chain reaction (PCR) technology is becoming a standard tool in the diagnosis of H. pylori infections through non-invasive testing, which further optimizes the eradication process. We provide a review regarding the current position of the individualized approach in eradication therapy and its future prospects. Based on novel understandings, the personalized approach is an effective strategy to increase the successful eradication of H. pylori infections.
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Affiliation(s)
- Antonio Mestrovic
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
- Correspondence:
| | - Nikola Perkovic
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
| | - Ante Tonkic
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
- Department of Internal Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Zeljko Sundov
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
- Department of Internal Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Wang Y, Liu L, Liu X, Wu K, Zhu X, Ma L, Su J. An Ultrasensitive PCR-Based CRISPR-Cas13a Method for the Detection of Helicobacter pylori. J Pers Med 2022; 12:jpm12122082. [PMID: 36556302 PMCID: PMC9784247 DOI: 10.3390/jpm12122082] [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: 10/21/2022] [Revised: 11/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
The rapid and simple detection of Helicobacter pylori (H. pylori) is essential for its clinical eradication. Although various methods for detecting H. pylori have been well established, such as endoscopy in combination with histology or culture, rapid urease test (RUT) and molecular tests using clinical specimens, it is of great importance to develop an ultrasensitive and accurate nucleic acid detection platform and apply it to identify H. pylori. To meet these demands, a novel method based on PCR and CRISPR-Cas13a, called PCR-Cas13a, was developed and validated using the DNA of 84 clinical strains and 71 clinical specimens. PCR primers for the pre-amplification of conservative sequence and CRISPR RNA (crRNA) for the detection of specific sequence were designed according to the principle. The designed primers and crRNA were specific to H. pylori, and the assay showed a high degree of specificity compared with other common pathogens. Our detection system can screen H. pylori with a limit of 2.2 copies/μL within 30 mins after PCR amplification. Using a coincidence analysis with traditional methods, our method exhibited 100% accuracy for the detection of H. pylori. Furthermore, its diagnostic performance was compared, in parallel with a q-PCR. The PCR-Cas13a demonstrates 98% sensitivity and 100% specificity. Moreover, our approach had a lower limit of detection (LOD) than q-PCR. Herein, we present a diagnostic system for the highly sensitive screening of H. pylori and distinguish it from other pathogens. All the results demonstrated that this PCR-based CRISPR assay has wide application prospects for the detection of H. pylori and other slow-growth pathogens.
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Affiliation(s)
- Yaxuan Wang
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Liyang Liu
- Department of Gastroenterology, Jingdong Medical Area, General Hospital of Chinese PLA, Beijing 101149, China
| | - Xiaochuan Liu
- Department of Gastroenterology, Emergency General Hospital, Beijing 100028, China
| | - Kai Wu
- Department of Gastroenterology, The Eighth Medical Center of PLA General Hospital, Beijing 100091, China
| | - Xiaoyan Zhu
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Liyan Ma
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Correspondence:
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Mousavinafchi SB, Rahimi E, Shakerian A. Campylobacter spp. isolated from poultry in Iran: Antibiotic resistance profiles, virulence genes, and molecular mechanisms. Food Sci Nutr 2022; 11:1142-1153. [PMID: 36789060 PMCID: PMC9922131 DOI: 10.1002/fsn3.3152] [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: 09/03/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
Campylobacter spp. genera is one of the most common causes of microbial enteritis worldwide. The objective of this work was to investigate the antimicrobial resistance (AMR) patterns, virulence genes, and genetic variation of thermophilic Campylobacter species collected from chicken meat samples in Iran. A total of 255 meat specimens were taken and transferred to the laboratory. Culture methods were utilized to identify the Campylobacter genus, and PCR and sequencing were performed to confirm the organisms. Antimicrobial susceptibility evaluation was performed using broth microdilution for six antimicrobials [ciprofloxacin (CIP), nalidixic acid (NAL), sitafloxacin (SIT), erythromycin (ERY), tetracycline (TET), and gentamicin (GEN)]. By using PCR, AMR and virulence genes were detected. The detection rate of Campylobacter spp. was 64 (25.09%) out of 255 meat samples, with C. jejuni and C. coli accounting for 41 (64.06%) and 14 (21.87%), respectively. Other Campylobacter isolates accounted for 14.06% of the total (nine samples). The antibiotic susceptibility of all Campylobacter isolates was tested using six antibiotics, and all (100%) were resistant to CIP and NAL. However, TET resistance was observed in 93.9% and 83.3% of C. jejuni and C. coli isolates, respectively. Four (8.2%) C. jejuni isolates were multidrug-resistant (MDR), while none of the C. coli isolates were MDR. Two of the four MDR isolates were resistant to CIP, NAL, TET, and ERY, whereas the other two isolates were resistant to CIP, NAL, TET, and GEN. The values of the Minimum Inhibitory Concentration (MIC) were as follows: CIP, 64-256 μg/ml; NAL, 128-512 μg/ml; TET, 2-1024 μg/ml; SIT, 0.25-1 μg/ml; ERY, 1-32 μg/ml; and GEN, 1-256 μg/ml. recR, dnaJ, cdtC, cdtB, cdtA, flaA, ciaB, cadF, and pidA were discovered in more than 50% of C. jejuni isolates, although wlaN, virbll, cgtB, and ceuE were found in <50%. flaA, cadF, pidA, and ciaB were discovered in more than 50% of the C. coli samples, whereas recR, cdtC, cdtB, cdtA, and cgtB were found in less than half. For C. coli, the percentages for wlaN, dnaJ, virbll, and ceuE were all zero. The results of this study show Campylobacter isolates obtained from poultry have higher resistance to quinolones and TET, pathogenicity potential, and varied genotypes.
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Affiliation(s)
- Seyedeh Bita Mousavinafchi
- Department of Food Hygiene, Faculty of Veterinary Medicine, Shahrekord BranchIslamic Azad UniversityShahrekordIran
| | - Ebrahim Rahimi
- Department of Food Hygiene, Faculty of Veterinary Medicine, Shahrekord BranchIslamic Azad UniversityShahrekordIran
| | - Amir Shakerian
- Research Center of Nutrition and Organic Products, Shahrekord BranchIslamic Azad UniversityShahrekordIran
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Ummarino A, Caputo M, Tucci FA, Pezzicoli G, Piepoli A, Gentile A, Latiano T, Panza A, Calà N, Ceglia AP, Pistoio G, Troiano V, Pucatti M, Latiano A, Andriulli A, Tucci A, Palmieri O. A PCR-based method for the diagnosis of Enterobius vermicularis in stool samples, specifically designed for clinical application. Front Microbiol 2022; 13:1028988. [PMID: 36466657 PMCID: PMC9712443 DOI: 10.3389/fmicb.2022.1028988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/31/2022] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Enterobius vermicularis (E. vermicularis) is a nematode that infects up to 200 million people worldwide, despite effective medications being available. Conventional diagnostic tests are hindered by low sensitivity and poor patient compliance. Furthermore, no biomolecular techniques are available for clinical application. The aim of this study was to develop a procedure specifically designed for clinical application to detect E. vermicularis by means of PCR. MATERIALS AND METHODS Two subject groups were taken into account: a group of 27 infected patients and a control group of 27 healthy subjects. A nested-PCR was performed on fecal samples to detect E. vermicularis. Due to the intrinsic difficulties of the fecal matrix, several countermeasures were adopted to ensure the efficient performance of the method: (a) a large amount of feces for the extraction process (20 g instead of 200 mg); (b) a combination of chemical and physical treatments to grind the fecal matrix; (c) an additional purification process for the negative samples after the first nested-PCR; and (d) the selection of a very specific target region for the PCR. RESULTS Due to the lack of overlap with other organisms, a sequence of the 5S ribosomal DNA (rDNA) spacer region including the tract SL1 was chosen to design appropriate external and internal primers. The first nested-PCR detected E.vermicularis in 19/27 samples from infected patients. After further purification, 5/8 of the negative samples resulted positive at the second PCR. Conversely, all the samples from healthy controls resulted negative to both PCRs. Sensitivity and specificity of the method were, respectively, 88.9% and 100%. CONCLUSION The results prove the high diagnostic accuracy of the proposed method, addressing and overcoming the challenges posed by both conventional tests and PCR-based approaches. Therefore, the method can be proposed for clinical application.
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Affiliation(s)
- Aldo Ummarino
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | - Michele Caputo
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | | | | | - Ada Piepoli
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Annamaria Gentile
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Tiziana Latiano
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Anna Panza
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Nicholas Calà
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | | | | | | | - Michela Pucatti
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | - Anna Latiano
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Angelo Andriulli
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Antonio Tucci
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | - Orazio Palmieri
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
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Negovan A, Szőke AR, Mocan S, Bănescu C. Helicobacter pylori-Positive Gastric Biopsies-Association with Clinical Predictors. Life (Basel) 2022; 12:life12111789. [PMID: 36362946 PMCID: PMC9699335 DOI: 10.3390/life12111789] [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: 10/04/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction: Although Helicobacter pylori’s role in gastric oncogenesis is well-known, only a fraction of infected patients develop cancer. Hence, more factors are supposed to be involved. The objectives of the present study were to investigate the impact of clinicopathological parameters on Helicobacter pylori status. Methods: The study included 1522 patients referred for endoscopy: study group consisted of 557 patients with Helicobacter pylori-positive biopsies confirmed using histochemical stains or immunohistochemistry methods; and the control group consisted of 965 patients with Helicobacter pylori-negative status on histology. Results: Severe endoscopic lesions were more frequent in the Helicobacter pylori group (p < 0.001), with no difference noticed in the distribution of premalignant gastric lesions (p = 0.82). Anemia and dyslipidemia were independent factors associated with Helicobacter pylori-positive biopsies (p < 0.05). Non-steroidal anti-inflammatory therapy was more frequently administered in the study group, while proton-pump inhibitors had an anti-Helicobacter pylori activity on histology (p < 0.0001). Conclusion: In the studied population, patients with Helicobacter pylori-positive biopsies had a more frequent history of gastrotoxic medication, severe endoscopic lesions, and anemia. Helicobacter pylori was unpredictable by gastrointestinal symptoms. The frequency of premalignant gastric lesions was similar irrespective of the actual status of infection, underlining the importance of unintentional clearance of bacteria in old infection and the remaining risk for cancer in this population.
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Affiliation(s)
- Anca Negovan
- Department of Clinical Science-Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Correspondence: (A.N.); (A.-R.S.)
| | - Andreea-Raluca Szőke
- Department of Pathophysiology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Pathology Department, Mureș County Clinical Hospital, 540011 Târgu Mureș, Romania
- Correspondence: (A.N.); (A.-R.S.)
| | - Simona Mocan
- Pathology Department, Emergency County Hospital of Targu Mures, 540136 Târgu Mureș, Romania
| | - Claudia Bănescu
- Genetics Laboratory, Center for Advanced Medical and Pharmaceutical Research, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
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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: 30] [Impact Index Per Article: 15.0] [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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Ma Q, Li H, Liao J, Cai Z, Zhang B. Tailored therapy for Helicobacter pylori eradication: A systematic review and meta-analysis. Front Pharmacol 2022; 13:908202. [PMID: 36160444 PMCID: PMC9495299 DOI: 10.3389/fphar.2022.908202] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Due to an increase in drug resistance, the eradication rate of H. pylori with empirical therapy has declined. Tailored therapy has been proposed as an alternative to standard empirical treatments. The necessity of personalized eradication therapy remains unclear. The aim of this study was to determine whether tailored therapy is superior to empirical therapy for H. pylori infection. Methods: We searched for eligible randomized controlled trials in the PubMed, Embase (Ovid), Wanfang, and Cochrane Central Register of Controlled Trials databases up to 10 December 2021. A random effects model comparing pooled relative risks (RRs) with 95% confidence intervals (CIs) was applied in the meta-analysis. Results: Twenty-one studies were included in the meta-analysis. In the first-line treatment, tailored therapy was more effective than empirical therapy (RR, 1.14 [95% CI, 1.08–1.21], I2 = 72.2%). In the second-line therapy setting, the results did not reveal significant differences between the two treatments (RR, 1.05 [95% CI, 0.84–1.30], I2 = 80.6%). A similar result was observed in mixed second- and third-line treatments (RR, 1.03 [95% CI, 0.96–1.11], I2 = 0.0%). Regarding adverse events, no significant differences were found between the two treatments (RR, 0.90 [95% CI, 0.80–1.01], I2 = 35.7%). Most of the results were highly heterogeneous. Conclusion: A tailored approach might provide a better eradication rate than empirical methods in first-line treatment. There might be no obvious advantage in second-line or mixed second- and third-line treatments third-line treatment. Due to the high heterogeneity, the results should be interpreted with caution. Further clinical studies are needed and justified.
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Affiliation(s)
- Qin Ma
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hancong Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liao
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Bo Zhang, ; Zhaolun Cai,
| | - Bo Zhang
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Bo Zhang, ; Zhaolun Cai,
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Chey WD, Mégraud F, Laine L, López LJ, Hunt BJ, Howden CW. Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the United States and Europe: Randomized Clinical Trial. Gastroenterology 2022; 163:608-619. [PMID: 35679950 DOI: 10.1053/j.gastro.2022.05.055] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Novel, effective treatments for Helicobacter pylori infection are needed. This study evaluated the efficacy of vonoprazan, a potassium-competitive acid blocker, vs standard treatment on H pylori eradication in the United States and Europe. METHODS In a randomized, controlled, phase 3 trial, treatment-naïve adults with H pylori infection were randomized 1:1:1 to open-label vonoprazan dual therapy (20 mg vonoprazan twice daily; 1 g amoxicillin 3 times daily), or double-blind triple therapy twice a day (vonoprazan 20 mg or lansoprazole 30 mg; amoxicillin 1 g; clarithromycin 500 mg) for 14 days. The primary outcome was noninferiority in eradication rates in patients without clarithromycin- and amoxicillin-resistant strains (noninferiority margin = 10%). Secondary outcomes assessed superiority in eradication rates in clarithromycin-resistant infections, and in all patients. RESULTS A total of 1046 patients were randomized. Primary outcome eradication rates (nonresistant strains): vonoprazan triple therapy 84.7%, dual therapy 78.5%, vs lansoprazole triple therapy 78.8% (both noninferior; difference 5.9%; 95% confidence interval [CI], -0.8 to 12.6; P < .001; difference -0.3%; 95% CI, -7.4 to 6.8; P = .007, respectively). Eradication rates in clarithromycin-resistant infections: vonoprazan triple therapy 65.8%, dual therapy 69.6%, vs lansoprazole triple therapy 31.9% (both superior; difference 33.9%; 95% CI, 17.7-48.1; P < .001; difference 37.7%; 95% CI, 20.5-52.6; P < .001, respectively). In all patients, vonoprazan triple and dual therapy were superior to lansoprazole triple therapy (80.8% and 77.2%, respectively, vs 68.5%, difference 12.3%; 95% CI, 5.7-18.8; P < .001; difference 8.7%; 95% CI, 1.9-15.4; P = .013). Overall frequency of treatment-emergent adverse events was similar between vonoprazan and lansoprazole regimens (P > .05). CONCLUSION Both vonoprazan-based regimens were superior to proton pump inhibitor-based triple therapy in clarithromycin-resistant strains and in the overall study population. CLINICALTRIALS gov; NCT04167670.
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Affiliation(s)
- William D Chey
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | | | - Barbara J Hunt
- Research and Development, Phathom Pharmaceuticals, Buffalo Grove, Illinois
| | - Colin W Howden
- Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee
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Ma S, Guo X, Wang C, Yin Y, Xu G, Chen H, Qi X. Association of Barrett's esophagus with Helicobacter pylori infection: a meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221117971. [PMID: 36034104 PMCID: PMC9403448 DOI: 10.1177/20406223221117971] [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: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Barrett’s esophagus (BE) is the only recognized precursor for esophageal
adenocarcinoma. Helicobacter pylori (H.
pylori) infection is a major contributing factor towards upper
gastrointestinal diseases, but its relationship with BE remains
controversial. Some previous studies suggested that H.
pylori infection negatively correlated with BE, while others
did not. This may be attributed to the difference in the selection of
control groups among studies. The present meta-analysis aims to clarify
their association by combining all available data from well-designed
studies. Methods: The PubMed, EMBASE, and Cochrane
Library databases were searched. Odds ratios (ORs) with 95%
confidence intervals (CIs) were pooled by a random-effects model.
Heterogeneity was evaluated using the Cochran’s Q test and
I2 statistics. Meta-regression, subgroup,
and leave-one-out sensitivity analyses were employed to explore the sources
of heterogeneity. Results: Twenty-four studies with 1,354,369 participants were included. Meta-analysis
found that patients with BE had a significantly lower prevalence of
H. pylori infection than those without (OR = 0.53, 95%
CI = 0.45–0.64; p < 0.001). The heterogeneity was
statistically significant (I² = 79%;
p < 0.001). Meta-regression, subgroup, and leave-one-out
sensitivity analyses did not find any source of heterogeneity. Meta-analysis
of 7 studies demonstrated that CagA-positive H. pylori
infection inversely correlated with BE (OR = 0.25, 95% CI = 0.15–0.44;
p = 0.000), but not CagA-negative H.
pylori infection (OR = 1.22, 95% CI = 0.90–1.67;
p = 0.206). Meta-analysis of 4 studies also
demonstrated that H. pylori infection inversely correlated
with LSBE (OR = 0.39, 95% CI = 0.18–0.86; p = 0.019), but
not SSBE (OR = 0.73, 95% CI = 0.30–1.77; p = 0.484). Conclusion: H. pylori infection negatively correlates with BE. More
experimental studies should be necessary to elucidate the potential
mechanisms in future.
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Affiliation(s)
| | | | | | | | - Guangqin Xu
- Department of Gastroenterology, General
Hospital of Northern Theater Command, Shenyang, China
- Graduate School, Dalian Medical University,
Dalian, China
| | - Hongxin Chen
- Department of Gastroenterology, General
Hospital of Northern Theater Command, Shenyang, China
- Graduate School, Liaoning University of
Traditional Chinese Medicine, Shenyang, China
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Yadav R, Sagar M. Comparison of Different Histological Staining Methods for Detection of Helicobacter pylori Infection in Gastric Biopsy. Cureus 2022; 14:e27316. [PMID: 36043000 PMCID: PMC9411074 DOI: 10.7759/cureus.27316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background: Helicobacter pylori gastritis affects two-thirds of the world's human population. Among various invasive and non-invasive tests, histology play a very important role in detecting H. pylori in gastric biopsies. In histology, for detection of H. pylori, we use different histological staining techniques like routine haematoxylin & eosin (H&E) stain, Giemsa stain, Gimenez stain, and periodic acid Schiff - Alcian blue (PAS-AB) stain. Objective: Aim of our study was to evaluate these different histopathological staining techniques for detecting H. pylori in gastric mucosal biopsies and to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H&E stain, Gemenez stain and PAS-AB in the detection of H. pylori in gastric biopsies using Giemsa stain as the reference standard. Materials and Methods: It was a prospective descriptive study design of 45 gastric biopsies of patients having gastritis. This study was conducted at Vivekananda Polyclinic and Institute of Medical Sciences over a period of one year, from March 2021 to February 2022. From each formalin-fixed paraffin-embedded block, four glass slides were prepared and stained with H&E stain, Giemsa stains, Gemenez stain, and PAS-AB stain to detect the presence/absence of H. pylori in gastric biopsies. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were assessed. Results: Various staining techniques for detecting H. pylori in gastric mucosal biopsies were compared. In reference to Giemsa stain results, statistical analysis indicates that the diagnostic accuracy of the Gimenez stain, H&E stain, and PAS-AB stain were 95.6%, 91.1%, and 84.4% respectively. Gimenez stain is confirmed to be better than H&E stain and PAS-AB stain to detect H. pylori in 45 gastric biopsies of patients having gastritis. PAS-AB stain is the worst stain to detect H. pylori in gastric biopsies. Conclusion: Gimenez stain has higher diagnostic accuracy than PAS-AB stain in the detection of H. pylori in gastric biopsy. In fact, Gimenez stain has high sensitivity, specificity and diagnostic accuracy as compared to traditional H&E stain while PAS-AB stain has lower sensitivity, specificity and diagnostic accuracy. Thus, Gimenez stain is also recommended for the detection of H. pylori in gastric biopsy.
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Empiric treatment vs susceptibility-guided treatment for eradicating H. pylori: Is it possible to change that paradigm using modern molecular methods? REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:330-341. [DOI: 10.1016/j.rgmxen.2022.06.003] [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: 07/27/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
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Mărginean CO, Meliț LE, Săsăran MO. Traditional and Modern Diagnostic Approaches in Diagnosing Pediatric Helicobacter pylori Infection. CHILDREN 2022; 9:children9070994. [PMID: 35883980 PMCID: PMC9316053 DOI: 10.3390/children9070994] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 01/10/2023]
Abstract
Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide, is usually acquired during childhood and is related to gastric carcinogenesis during adulthood. Therefore, its early proper diagnosis and subsequent successful eradication represent the cornerstones of gastric cancer prevention. The aim of this narrative review was to assess traditional and modern diagnostic methods in terms of H. pylori diagnosis. Several invasive and non-invasive methods were described, each with its pros and cons. The invasive diagnostic methods comprise endoscopy with biopsy, rapid urease tests, histopathological exams, cultures and biopsy-based molecular tests. Among these, probably the most available, accurate and cost-effective test remains histology, albeit molecular tests definitely remain the most accurate despite their high costs. The non-invasive tests consist of urea breath tests, serology, stool antigens and non-invasive molecular tests. Urea breath tests and stool antigens are the most useful in clinical practice both for the diagnosis of H. pylori infection and for monitoring the eradication of this infection after therapy. The challenges related to accurate diagnosis lead to a choice that must be based on H. pylori virulence, environmental factors and host peculiarities.
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Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Targu Mures, Romania;
| | - Lorena Elena Meliț
- Department of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Targu Mures, Romania;
- Correspondence:
| | - Maria Oana Săsăran
- Department of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Targu Mures, Romania;
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Sharif Z, Mubashir M, Naqvi M, Atique H, Mahmood S, Ullah M. Randomized Clinical Trial on the Efficacy of Triple Therapy Versus Sequential Therapy in Helicobacter pylori Eradication. Cureus 2022; 14:e24897. [PMID: 35706754 PMCID: PMC9187159 DOI: 10.7759/cureus.24897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Helicobacter pylori (H. pylori) colonization is prevalent all over the world, and it is associated with low socioeconomic status, poor hygiene, and overcrowding. Its eradication is important since it is an etiologic agent for gastritis, peptic ulcer, gastric carcinoma, and mucosa-associated lymphoid tissue lymphoma. Different regimens are available for the eradication of H. pylori and include triple therapy and sequential therapy. Our study aims to compare the efficacy of triple therapy versus sequential therapy in the eradication of H. pylori. Material and methods: This randomized clinical trial was conducted at the Pakistan Institute of Medical Sciences Hospital, Islamabad, from September 2016 to September 2017 after the approval of the institutional review board. A total of 160 patients were enrolled and equally divided into two, group A and group B. A twice-daily dose of amoxicillin 1,000 mg, rabeprazole 20 mg, and clarithromycin 500 mg was given to group A for 10 days, while group B was initially given rabeprazole 20 mg and amoxicillin 1,000 mg two times daily for the first five days (i.e., induction phase), followed by triple therapy that included rabeprazole 20 mg, clarithromycin 500 mg, and metronidazole/tinidazole 500 mg twice daily for the next five days. A negative stool antigen test performed four weeks after the completion of therapy was considered an effective eradication. A proforma was used to collect data that included age, gender, city or province of residence, family income, group (group A or group B), and eradication efficacy. Analysis of the data was performed using the Statistical Package for the Social Sciences version 17 (SPSS Inc., Chicago, USA). Results: A total of 160 patients were included, with mean age and standard deviation of 40.02±24.4 years. The male/female ratio was 1.8:1. Successful eradication of H. pylori achieved in group A was 67.5% (N=54) in comparison to group B, which was 95% (N=76) (p=0.001). Conclusion: Sequential therapy was superior to triple therapy in H. pylori eradication.
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Dai B, Xiang A, Qu D, Chen G, Wang L, Wang W, Zhai D, Wang L, Lu Z. Rapid and Sensitive Assay of Helicobacter pylori With One-Tube RPA-CRISPR/Cas12 by Portable Array Detector for Visible Analysis of Thermostatic Nucleic Acid Amplification. Front Microbiol 2022; 13:858247. [PMID: 35586866 PMCID: PMC9108776 DOI: 10.3389/fmicb.2022.858247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
Helicobacter pylori (H. pylori) has infected more than half of the world’s population and is still a threat to human health. The urea breath test, despite being widely used in clinical diagnosis, still faces huge challenges in the immediate detection of H. pylori. Thus, a rapid, sensitive, and highly specific point of care diagnosis is particularly important for preventing the further transmission of H. pylori and for real-time monitoring of the disease in a given population. Recently, the clustered regularly interspaced short palindromic repeats (CRISPR)-based diagnostics have been applied to various types of nucleic acid testing; however, there are often shortcomings of complex operation and high signal transmission background. In this study, we proposed a new platform for the assay of H. pylori using one-tube-based CRISPR/Cas12a diagnostic methods and designed a detector for this platform, which is a portable array detector for visible analysis of thermostatic nucleic acid amplification (Pad-VATA). By incorporating isothermal recombinase polymerase amplification, our platform could detect the conserved gene fragments of H. pylori with a constant low as 2 copies/μl. The assay process can be performed at a single temperature in about 30 min and integrated into the reactor in the palm-sized Pad-VATA to facilitate rapid diagnosis of H. pylori. We also verified the accuracy of our platform using 10 clinical samples and found that the platform can quickly detect H. pylori infection in a given population. We believe that this fast, convenient, efficient, and inexpensive screening and diagnostic platform can be widely used in various settings, including homes and clinics.
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Affiliation(s)
- Bing Dai
- The College of Life Sciences, Northwest University, Xi’an, China
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - An Xiang
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - Di Qu
- The College of Life Sciences, Northwest University, Xi’an, China
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - Guo Chen
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - Li Wang
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - Wenwen Wang
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - Dongsheng Zhai
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
| | - Lei Wang
- Department of Gastrointestinal Surgery, General Hospital of Ningxia Medical University, Ningxia, China
- *Correspondence: Lei Wang,
| | - Zifan Lu
- Department of Biopharmaceutics, State Key Laboratory of Cancer Biology, Air Force Medical University, Xi’an, China
- Zifan Lu,
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37
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Tian L, Yao Y, Yin L, Wang L, An Z, Kang L, Ru C, Li J. Direct Detection of Antibiotic Resistance in Chinese Helicobacter pylori Clinical Isolates by Sequencing-Based Approach. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6436256. [PMID: 35463681 PMCID: PMC9033385 DOI: 10.1155/2022/6436256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
Objective The detection of Helicobacter pylori mutations that result in antimicrobial resistance can serve as a guideline of antimicrobial therapeutics and probably prevent the failure of clinical treatments. Evaluating the potential of Sanger sequencing to identify genetically resistant determinants in Helicobacter pylori clinical isolates will be important. Methods 180 cultured strains have been tested using agar dilution for antibiotic susceptibility. NCBI BLAST was used to perform genotypic analysis on the sequencing data. Sanger sequencing was evaluated as an alternative method to detect resistant genotypes and susceptibility. Results By the conventional E-test, resistance to levofloxacin, amoxicillin, metronidazole, and clarithromycin was 67.3%, 15.1%, 96.4%, and 25.5%, respectively. In contrast, tetracycline had no resistance. Resistance to multiple drugs was observed in 8.12% of the strains. The genetic determinants of resistance to CLA was 23s rRNA, the determinants of resistance to amoxicillin was Pbp1, the determinants of resistance to metronidazole was rdxA, and the determinants of resistance to levofloxacin were GyrA and GyrB. However, there was no association of resistance in tetracycline. Conclusion We found increased rates of metronidazole antibiotic resistance, highlighting the necessity for alternative therapies and periodic evaluation. Sanger sequencing has proved to be highly effective and holds the potential to be implemented in policies catering to local treatments.
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Affiliation(s)
- Lixia Tian
- Department of Emergency Medicine, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Yao
- Department of Gastroenterology, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li Yin
- Western Medical District of Chinese PLA General Hospital, Beijing, China
| | - Lanxiang Wang
- Department of Xiangshan Road Clinic, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ze An
- Department of Xiangshan Road Clinic, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin Kang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Chenglin Ru
- Department of Ultrasound, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jinping Li
- Department of Xiangshan Road Clinic, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Carretero-Barrio I, Rodajo-Fernandez T, Romio E, Sanchez-Rodriguez E, Vázquez-Sequeiros E, Perna C, Caminoa-Lizarralde A. Comparison Between Real-time Ammonium and pH Measurement, Immunohistochemistry, and Histochemistry for the Diagnosis of Helicobacter pylori. J Clin Gastroenterol 2022; 56:e263-e267. [PMID: 34028395 DOI: 10.1097/mcg.0000000000001569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/20/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Helicobacter pylori (HP) infection has been implicated in several malignant and nonmalignant conditions. The confirmatory diagnosis of HP requires an endoscopic biopsy, followed by a rapid urease test, culture, and/or histopathologic examination using hemotoxylin and eosin, histochemical stains, or immunohistochemistry against HP. EndoFaster is a novel device that can perform real-time ammonium and pH measurements in gastric juice, allowing a diagnosis of HP during gastroduodenal endoscopy. GOAL This study aimed to validate the accuracy of EndoFaster and to compare different histochemical and immunohistochemical techniques for the diagnosis of HP infection. STUDY Consecutive patients who underwent upper endoscopy at our center were prospectively enrolled. During the endoscopy procedure, gastric juice was aspirated to perform an automatic analysis by EndoFaster and gastric biopsies were taken. Histologic sections were reviewed to assess the histopathologic features. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the EndoFaster test, Diff-Quick (DQ), and immunohistochemistry against HP (anti-HP) using Warthin-Starry as the gold standard for HP detection. RESULTS Overall, 80 patients were enrolled. In 19 cases (23,75%), histology was normal. In the remaining cases, varying degrees of inflammation were found. The sensitivity, specificity, positive predictive value, and negative predictive value were 73.33%, 86.00%, 75.86%, and 84.31% for the EndoFaster test using 67 ppm/mL as the positive threshold; 73.33%, 100%, 100%, and 86.21% for DQ; and 79.31%, 88.00%, 79.31%, and 88.00% for anti-HP, respectively. CONCLUSIONS The EndoFaster test has good sensitivity and specificity for the diagnosis of HP during the gastroscopy procedure. DQ and anti-HP are excellent alternatives to Warthin-Starry for the detection of HP.
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Luo W, Wang Q, Zhang X, Gu D, Zhang W, Yuan C. Evaluation of the diagnostic value of FliD, a Helicobacter pylori flagellar protein. Jpn J Infect Dis 2022; 75:454-460. [PMID: 35354706 DOI: 10.7883/yoken.jjid.2021.795] [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: 11/17/2022]
Abstract
Novel immunodominant antigens are urgently required for diagnosis and vaccine of Helicobacter pylori(HP). FliD, an important colonization factor was cloned and expressed(rFliD) to evaluate the levels of specific-IgG, IgM and IgA antibodies in the serum of patients by ELISA. Rabbit anti-rFliD polyclonal antibody (pAb) was obtained by subcutaneous injections of rFliD. The rFliD-specific IFN-γ and IL-4 of peripheral blood mononuclear cells and CD4+ T cells from human were analyzed by enzyme-linked immunospot and flow cytometry. We found that the levels of rFliD-specific IgG, IgM and IgA were significantly higher in HP-infected-patients compared with healthy controls. IgG, IgM and IgA had diagnostic sensitivities of 92.6, 89.8 and 83.2%; specificities of 91.1, 88.7 and 64.6%; and areas under the receiver operating curves of 0.97, 0.96 and 0.92, respectively. Furthermore, rFliD-pAb was used in the immunohistochemical analysis of gastritis and gastric cancer tissues from patients infected with HP. The levels of rFliD-specific IFN-γ and IL-4 were significantly elevated in HP-infected patients and exhibited a T helper type 1-dominant subtype. These findings indicate that rFliD exhibits high validity as a biomarker in HP diagnosis and may also be a potent antigen for vaccine design due to its high cellular and humoral immune response.
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Affiliation(s)
- Wei Luo
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, China
| | - Qian Wang
- Department of Pathology, Tianjin Haihe Hospital, Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, China
| | - Xiaofang Zhang
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, China
| | - Dongmei Gu
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, China
| | - Weifeng Zhang
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, China
| | - Chunhui Yuan
- Department of Laboratory Medicine, Wuhan Children's Hospital, Huazhong University of Science and Technology, China
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Zhang R, Zhuang Y, Xiao ZH, Li CY, Zhang F, Huang WQ, Zhang M, Peng XM, Liu C. Diagnosis and Surveillance of Neonatal Infections by Metagenomic Next-Generation Sequencing. Front Microbiol 2022; 13:855988. [PMID: 35401464 PMCID: PMC8989347 DOI: 10.3389/fmicb.2022.855988] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Microbial infections cause significant morbidity and mortality in neonates. Metagenomic next-generation sequencing is a hypothesis-free and culture-free test that enables broad identification of pathogens and antimicrobial resistance genes directly from clinical samples within 24 h. In this study, we used mNGS for etiological diagnosis and monitoring the efficacy of antibiotic treatment in a cohort of neonatal patients with severe infections. The median age was 19.5 (3–52) days, median gestational age was 37.96 (31–40+3) weeks, and the median birth weight was 3,261 (1,300–4,300) g. The types of infectious diseases included pneumonia, sepsis, and meningitis. mNGS reported microbial findings in all cases, which led to changes in antibiotic treatment. These included cases of Mycobacterium tuberculosis, Legionella pneumophila, and Bacillus cereus. Eight of ten infants recovered after antibiotic adjustment and showed normal development during follow-up. On the other hand, neurological retardation was seen in two infants with meningitis. mNGS enabled etiological diagnosis and guided antibiotic therapy when all conventional methods failed to discover the culprit. It has the potential to cut down the overall cost and burden of disease management in neonatal infections.
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Affiliation(s)
- Rong Zhang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Yan Zhuang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Zheng-hui Xiao
- Department of Emergency, Hunan Children’s Hospital, Changsha, China
| | - Cai-yun Li
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
| | - Fan Zhang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Wei-qing Huang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Min Zhang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Xiao-Ming Peng
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
- *Correspondence: Xiao-Ming Peng,
| | - Chao Liu
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
- Chao Liu,
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41
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Ouyang Y, Zhang W, He C, Zhu Y, Lu N, Hu Y. Susceptibility-Guided Therapy vs. Bismuth-Containing Quadruple Therapy as the First-Line Treatment for Helicobacter pylori Infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:844915. [PMID: 35402425 PMCID: PMC8987208 DOI: 10.3389/fmed.2022.844915] [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: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background The increased antibiotic resistance of Helicobacter pylori (H. pylori) has led to the decreased efficacy of H. pylori regimens. Aim To evaluate the efficacy, safety, and compliance of susceptibility-guided therapy (SGT) vs. bismuth-containing quadruple therapy (BQT) as the first-line treatment for H. pylori infection. Materials and Methods This meta-analysis was performed in accordance with the PRISMA 2009 guidelines. A systematic search in PubMed, Embase, and Cochrane databases was conducted using the combination of “H. pylori or H. pylori or Hp,” “bismuth quadruple,” and “tailored eradication OR tailored therapy OR susceptibility-guided therapy OR personalized therapy OR antibiotic susceptibility testing.” Results Five studies with 2,110 H. pylori-infected patients were enrolled. The pooled eradication rates of SGT and BQT were 86 vs. 78% (p < 0.05) and 92 vs. 86% (p > 0.05) by intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. SGT has a significantly superior efficacy than BQT [pooled risk ratio (RR) = 1.14, p < 0.05] in a subgroup of cultures with the susceptibility test. The pooled side effect rate was 20% in SGT and 22% in BQT, which showed no significant difference (p > 0.05). The compliances of SGT and BQT were 95 and 92%, respectively. Conclusion Compared with BQT, SGT showed a higher efficacy and similar safety as the first-line treatment of H. pylori infection in areas with high antibiotic resistance. The decision-making of first-line regimens for H. pylori infection should depend on the availability and cost-effectiveness of susceptibility tests and bismuth in local areas.
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Affiliation(s)
- Yaobin Ouyang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenjing Zhang
- Medical College of Nanchang University, Nanchang, China
| | - Chen He
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Hu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Dai J, Zhao J, Mao L, Hu Y, Lv B. Study on the value of antibiotic-resistant gene detection in Helicobacter pylori in China. Exp Ther Med 2022; 23:228. [PMID: 35222705 PMCID: PMC8815056 DOI: 10.3892/etm.2022.11153] [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: 01/07/2021] [Accepted: 11/03/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to explore the value of detecting antibiotic-resistant genes in Helicobacter pylori (H. pylori) and the association between genotype and antibiotic resistance. Two gastric mucosa samples from each H. pylori-positive patient were collected. Each patient's H. pylori sample was cultured in vitro, and the agar plate dilution method was conducted. In addition, all patient samples were analyzed for the detection of antibiotic resistance-related mutant genes and VacA gene genotypes. The association between VacA genotypes and antibiotic resistance was also determined and the value of mutant gene detection in predicting H. pylori resistance to antibiotics was evaluated. In total, 133 H. pylori-positive patients were enrolled. A total of 22 strains of H. pylori failed to grow in in vitro culture and 25 strains were negative in a H. pylori gene test. Among 108 strains detected by PCR, a total of 39 VacA s1m1 strains, 69 VacA s1m2 strains and no VacA s2 strain were identified. There was no significant association between VacA genotypes and antibiotic resistance. The mutation rates of G616A in the rdxA gene, T87A, G91A, A91G and G91T in the gyrA gene and A2143G and A2142G in the 23S rRNA gene were 32.1, 32.3, 22.6, 12.9, 6.5, 81.8 and 0.0%, respectively. Among these mutant sites, the mutation coincidence rates were as follows, according to the agar plate dilution method: rdxA G616A (81.8%), gyrA G91T (66.7%), gyrA G91A (54.5%), 23 S rRNA A2143G (49.1%), gyrA T87A (45.5%), gyrA A91G (33.3%), penicillin-binding protein 1 (PBP1) C556G (0.0%), PBP1 A562T (0.0%), PBP1 A562G (0.0%) and 16 S rRNA 926-927 (AT-GT) (0.0%). VacA m subtypes were not associated with H. pylori antibiotic resistance. In conclusion, the present findings suggested that the detection of related mutant genes had a clinical application value in predicting the antibiotic resistance of H. pylori, particularly resistance to clarithromycin and levofloxacin.
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Affiliation(s)
- Jinfeng Dai
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Jing Zhao
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Liqi Mao
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yue Hu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
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Evolution of Diagnostic Methods for Helicobacter pylori Infections: From Traditional Tests to High Technology, Advanced Sensitivity and Discrimination Tools. Diagnostics (Basel) 2022; 12:diagnostics12020508. [PMID: 35204598 PMCID: PMC8871415 DOI: 10.3390/diagnostics12020508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 01/10/2023] Open
Abstract
Rapid diagnosis and treatment application in the early stages of H. pylori infection plays an important part in inhibiting the transmission of this infection as this bacterium is involved in various gastric pathologies such as gastritis, gastro-duodenal ulcer, and even gastric neoplasia. This review is devoted to a quick overview of conventional and advanced detection techniques successfully applied to the detection of H. pylori in the context of a compelling need to upgrade the standards of the diagnostic methods which are currently being used. Selecting the best diagnostic method implies evaluating different features, the use of one or another test depending on accessibility, laboratories equipment, and the clinical conditions of patients. This paper aims to expose the diagnosis methods for H. pylori that are currently available, highlighting their assets and limitations. The perspectives and the advantages of nanotechnology along with the concept of nano(bio)sensors and the development of lab-on-chip devices as advanced tools for H. pylori detection, differentiation, and discrimination is also presented, by emphasizing multiple advantages: simple, fast, cost-effective, portable, miniaturized, small volume of samples required, highly sensitive, and selective. It is generally accepted that the development of intelligent sensors will completely revolutionize the acquisition procedure and medical decision in the framework of smart healthcare monitoring systems.
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Fatemi Khader M, Pourmahdi Borujeni M, Moori Bakhtiari N, Avizeh R. An exploratory study on the presence of
Helicobacter heilmannii
and
Helicobacter billis
in the faces of companion dogs. Vet Med Sci 2022; 8:537-545. [PMID: 35152551 PMCID: PMC8959293 DOI: 10.1002/vms3.765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Companion animals like dogs play an important role in the lives of many people and are often considered to be members of families, but definitely, any contact with them poses an inherent risk of transmitting zoonotic pathogens. One of these pathogens is the genus Helicobacter which is linked to many disorders in human and animal. Objectives The aim of this study was to investigate the presence of some zoonotic species of genus Helicobacter in companion dogs. Results Through culturing in a special medium, nine samples (9%) were detected as infected (two pure and seven mixed culture). Based on multiplex‐PCR, 13 samples (13%) were infected by Helicobacter spp. although none of them were infected by H. pylori. Species‐specific PCR indicated that 38.5% or 5/13 of the samples were infected with H. heilmannii, while 15.45% or 2/13 of the samples were infected by H. billis. Multivariate logistic regression analysis showed that the age factor had a significant effect on Helicobacter spp. infection (odds ratio [OR] = 2.42, p = 0.01). Conclusion This study revealed the negligible faecal transmission of H. pylori. Moreover, due to the detection of H. Heilmannii and H. billis in feces and their association with human gastric diseases, dog owners should be educated about the risks and transmission modes of zoonotic bacterial infections of dogs.
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Affiliation(s)
- Mahdi Fatemi Khader
- Department of Food Hygiene, Faculty of Veterinary Medicine Shahid Chamran University of Ahvaz Ahvaz Iran
| | - Mahdi Pourmahdi Borujeni
- Department of Food Hygiene, Faculty of Veterinary Medicine Shahid Chamran University of Ahvaz Ahvaz Iran
| | - Naghmeh Moori Bakhtiari
- Department of Pathobiology, Faculty of Veterinary Medicine Shahid Chamran University of Ahvaz Ahvaz Iran
| | - Reza Avizeh
- Department of Clinical Sciences, Faculty of Veterinary Medicine Shahid Chamran University of Ahvaz Ahvaz Iran
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Clinical Factors Implicated in Antibiotic Resistance in Helicobacter pylori Patients. Microorganisms 2022; 10:microorganisms10020322. [PMID: 35208776 PMCID: PMC8876575 DOI: 10.3390/microorganisms10020322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. pylori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strategies. Consensus guidelines recommend use of proven locally effective regimens; however, eradication data are inconsistently generated in several regions of the world. In this review, we describe several clinical factors associated with increased rates of antibiotic resistant H. pylori, including history of previous antibiotic exposure, increasing age, female gender, ethnicity/race, extent of alcohol use, and non-ulcer dyspepsia. Assessment of these factors may aid the clinician in choosing the most appropriate empiric treatment strategy for each patient. Future study should aim to identify locally effective therapies and further explore the clinical factors associated with antibiotic resistance.
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Abstract
The last 5 years have seen major shifts in defining whom to test and how to treat Helicobacter pylori infection. Peptic ulcer has changed from a chronic disease to a one-off condition, and countries with a high incidence of gastric cancer have begun implementing population-wide screening and treatment. A proactive approach to testing and treatment of H. pylori is now recommended, including outreach to family members of individuals diagnosed with active infection as well as high-risk local populations such as immigrants from high-risk countries. Increasing antimicrobial resistance has resulted in an overall decline in treatment success, causing a rethinking of the approach to development of treatment guidelines as well as the need to adopt the principles of antibiotic usage and antimicrobial stewardship. Required changes include abandoning empiric use of clarithromycin, metronidazole, and levofloxacin triple therapies. Here, we discuss these transformations and give guidance regarding testing and use of therapies that are effective when given empirically.
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Affiliation(s)
- Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei 10015, Taiwan; .,Department of Medical Research, National Taiwan University Hospital, Taipei 10015, Taiwan
| | - Maria Pina Dore
- Dipartimento di Medicina Clinica e Sperimentale and Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, University of Sassari, 07100 Sassari, Italy;
| | - David Y Graham
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA; .,Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas 77030, USA
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47
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Dore MP, Graham DY. Modern approach to the diagnosis of Helicobacter pylori infection. Aliment Pharmacol Ther 2022; 55 Suppl 1:S14-S21. [PMID: 34989431 DOI: 10.1111/apt.16566] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/29/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Maria Pina Dore
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, University of Sassari, Sassari, Italy
| | - David Y Graham
- Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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49
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Shiotani A, Roy P, Lu H, Graham DY. Helicobacter pylori diagnosis and therapy in the era of antimicrobial stewardship. Therap Adv Gastroenterol 2021; 14:17562848211064080. [PMID: 34987609 PMCID: PMC8721397 DOI: 10.1177/17562848211064080] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/15/2021] [Indexed: 02/04/2023] Open
Abstract
The diagnosis and therapy of Helicobacter pylori infection have undergone major changes based on the use the principles of antimicrobial stewardship and increased availability of susceptibility profiling. H. pylori gastritis now recognized as an infectious disease, as such there is no placebo response allowing outcome to be assessed in relation to the theoretically obtainable cure rate of 100%. The recent recognition of H. pylori as an infectious disease has changed the focus to therapies optimized to reliably achieve high cure rates. Increasing antimicrobial resistance has also led to restriction of clarithromycin, levofloxacin, or metronidazole to susceptibility-based therapies. Covid-19 resulted in the almost universal availability of polymerase chain reaction testing in hospitals which can be repurposed to utilize readily available kits to provide rapid and inexpensive detection of clarithromycin resistance. In the United States, major diagnostic laboratories now offer H. pylori culture and susceptibility testing and American Molecular Laboratories offers next-generation sequencing susceptibility profiling of gastric biopsies or stools for the six commonly used antibiotics without need for endoscopy. Current treatment recommendations include (a) only use therapies that are reliably highly effective locally, (b) always perform a test-of-cure, and (c) use that data to confirm local effectiveness and share the results to inform the community regarding which therapies are effective and which are not. Empiric therapy should be restricted to those proven highly effective locally. The most common choices are 14-day bismuth quadruple therapy and rifabutin triple therapy. Prior guidelines and treatment recommendations should only be used if proven locally highly effective.
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Affiliation(s)
- Akiko Shiotani
- Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Priya Roy
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hong Lu
- GI Division, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - David Y. Graham
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA
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50
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Zurita J, Sevillano G, Paz Y Miño A, Zurita-Salinas C, Peñaherrera V, Echeverría M, Navarrete H. Mutations associated with Helicobacter pylori antimicrobial resistance in the Ecuadorian population. J Appl Microbiol 2021; 132:2694-2704. [PMID: 34856035 DOI: 10.1111/jam.15396] [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: 04/15/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022]
Abstract
AIMS We described the presence of Helicobacter pylori (HP) and estimated the prevalence of primary and secondary resistance using molecular detection in gastric biopsies of Ecuadorian patients. METHODS AND RESULTS 66.7% (238/357) of the patients demonstrated the presence of HP using CerTest qPCR. Of these, 69.79% (104/149) were without previous HP eradication treatment and 64.42% (134/208) with prior HP eradication treatment. The mutation-associated resistance rate for clarithromycin was 33.64% (primary resistance) and 32.82% (secondary resistance), whereas that in levofloxacin the primary and secondary resistance was 37.38% and 42%, respectively. For tetracycline and rifabutin, primary and secondary resistance was 0%. Primary and secondary resistance for metronidazole and amoxicillin could not be evaluated by genotypic methods (PCR and sequencing). CONCLUSIONS The analysis of mutations in gyrA, 23S rRNA and 16S rRNA is useful to detect bacterial resistance as a guide for eradication therapy following failure of the first-line regimen. SIGNIFICANCE AND IMPACT OF THE STUDY This study carried out in an Ecuadorian population indicates that the resistance of HP to first-line antibiotics is high, which may contribute to the high rates of treatment failure, and other treatment alternatives should be considered.
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Affiliation(s)
- Jeannete Zurita
- Servicio de Microbiologia y Tuberculosis, Hospital Vozandes, Quito, Ecuador.,Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.,Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Gabriela Sevillano
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Ariane Paz Y Miño
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Camilo Zurita-Salinas
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
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- Servicio de Gastroenterología, Hospital Vozandes, Quito, Ecuador
| | - Hugo Navarrete
- Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
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