The effect of virulence genotypes of Helicobacter pylori on eradication therapy in children

Usefulness of Molecular Methods for Helicobacter pylori Detection in Pediatric Patients and Their Correlation with Histopathological Sydney Classification

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.

Prevalence of Primary Multidrug-resistant Helicobacter pylori in Children: A Systematic Review and Meta-analysis

BACKGROUND

The emergence and global spread of multidrug-resistant Helicobacter pylori (MDR H. pylori) is a major health problem in children, which can increase the risk of serious complications such as gastric cancer. The aim of this study was to determine the prevalence of primary MDR H. pylori in children via a comprehensive systematic literature review and meta-analysis.

METHODS

All potential studies were collected from international databases like: ISI Web of Science, Embase, PubMed, Google Scholar, and Scopus from 2011-July 24, 2022. Ultimately, primary MDR H. pylori in children was measured as an event rate with corresponding 95% confidence intervals.

RESULTS

A total of 19 studies met the inclusion criteria. The overall prevalence of primary MDR H. pylori in children was measured at 6.0% (95% CI: 3.1-11.6); There was a significant difference in primary MDR H. pylori resistance rates between Asian populations and Western countries.

CONCLUSIONS

The global spread of MDR H. pylori strains could significantly limit the options of anti-H. pylori treatment regimens. The frequency of primary MDR H. pylori infection differs between various geographical regions. Thus, drug susceptibility testing and the eradication of H. pylori infection can effectively reduce and control the spread of H. pylori antibiotic resistance throughout the world.

Antimicrobial Resistance and the Successful Eradication of Helicobacter pylori-Induced Gastroduodenal Ulcers in Vietnamese Children

Background

Helicobacter pylori infections induce chronic gastric mucosal inflammation and peptic ulcer disease, and eradication is recommended.

Objective

To investigate antibiotic resistance and H. pylori eradication rates in children with gastroduodenal ulcers in Vietnam.

Methods

We performed gastroduodenal endoscopies, H. pylori cultures, and antimicrobial susceptibility testing (clarithromycin, amoxicillin, metronidazole, tetracycline, and levofloxacin) In children with gastroduodenal ulcers at Children's Hospital 2 from November 1, 2019, to June 30, 2020.

Results

A total of 76 participants were studied, with an average age of 9.3 ± 2.8 years (range: 4-15 years), including 52.6% males and 47.4% females. The antibiotic resistance rates were clarithromycin, 92.1%; amoxicillin, 50%; levofloxacin, 31.6%; metronidazole, 14.5%; and tetracycline, 0%. The successful eradication rate was 44.7%. Bismuth increased the eradication rate by 3.69-fold that without bismuth (p = 0.030). The eradication rate of levofloxacin was high (100%, p = 0.038) compared with other antibiotics. The effectiveness of high-dose amoxicillin in cases with >50% H. pylori amoxicillin resistance was only 32.6% (p = 0.015).

Conclusion

Increased antibiotic resistance among H. pylori resulted in decreased eradication efficacy, which was 44.7% in this study. Drug combinations, such as levofloxacin and bismuth, can increase the H. pylori eradication efficacy in children.

Review: Helicobacter pylori in pediatrics

Despite a decrease in the prevalence of Helicobacter pylori infection, it still poses a significant health burden worldwide. This review summarizes important pediatric studies on H pylori published from April 2018 to March 2019. Epidemiologic studies have reported different prevalences in different parts of the world and have mainly confirmed traditional risk factors. Several studies on pathophysiology attempted to identify risk markers in childhood for gastric cancer development later in life. One of the most interesting studies evaluated the relationship between eosinophilic esophagitis and H pylori infection; however, an inverse relationship was not confirmed. The high resistance of H pylori and, consequently, low eradication rates, is still a major concern and susceptibility testing before treatment has again been highlighted. Potassium-competitive acid blockers are promising new acid-suppressant drugs but their role in H pylori eradication schemes is still to be determined.

Erratum: Nonalcoholic fatty liver disease burden - Saudi Arabia and United Arab Emirates, 2017-2030

[This corrects the article DOI: 10.4103/sjg.SJG_122_18].