OC.08.2 EFFECTIVENESS OF EMPIRICAL FIRST-LINE H. PYLORI ERADICATION THERAPY IN ITALY: RESULTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Introduction: Helicobacter pylori is a bacteria which infects half the world population and is an important cause of gastric cancer. The eradication therapy is not always effective because resistance to antimicrobials may occur. The aim of this study was to determine the susceptibility profile of H. pylori to amoxicillin, clarithromycin and ciprofloxacin in the population of Southern Brazil. Material and methods: Fifty four samples of H. pylori were evaluated. The antibiotics susceptibility was determined according to the guidelines of the British Society for Antimicrobial Chemotherapy and the Comité de l'Antibiogramme de la Société Française de Microbiologie. Results: Six (11.1%) H. pylori isolates were resistant to clarithromycin, one (1.9%) to amoxicillin and three (5.5%) to ciprofloxacin. These indices of resistance are considered satisfactory and show that all of these antibiotics can be used in the empirical therapy. Conclusion: The antibiotics amoxicillin and clarithromycin are still a good option for first line anti-H. pylori treatment in the population of Southern Brazil.

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Clinical Features and Effects of Eradication on Helicobacter Pylori Positive 207 ITP Cases in Japan.

Blood ◽

10.1182/blood.v104.11.2071.2071 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2071-2071

Author(s):

Kingo Fujimura ◽

Masataka Kuwana ◽

Yoshiyuki Kurata ◽

Masahiro Imamura ◽

Hiroshi Harada ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Eradication Therapy ◽

The Other ◽

First Line ◽

Platelet Counts ◽

Count Response ◽

Successful Group ◽

H Pylori ◽

Over 40 Years

Abstract In 1998, Gasbarrini et al reported that in ITP cases with Helicobacter pylori (H.pylori) infection, elevation of platelet counts was observed by eradication of this bacterium. Since then, several reports from Italy and Japan confirmed the elevation of platelet counts after eradication. However, the characteristic background in the H.pylori positive ITP and eradication effects on platelet counts is unclear. On the other hand, reports from Spain, North Europe and USA could not show the evidence that eradication is effective on elevating platelet counts in H.pylori positive ITP. Therefore, we designed a nationwide retrospective study in Japan to evaluate the incidence of H.pylori positive ITP cases and the effects of eradication on platelet counts and to clear above problems. Four hundred and thirty-five ITP cases were enrolled over a period of one and half years (2002. 7~2003.12) from 12 hospitals. H. pylori infection was found in 300 cases(65%), who were significantly (P<0.005) older and showed hyperplastic megakaryocyte in bone marrow (P=0.011) comparison with negative cases. Eradication to H. pylori was performed in 207 H. pylori positive ITP cases and as a whole, the platelet count response was observed in 63% of eradication succeeded group. In the successful group, CR and PR rate were 23% and 42% respectively at 12 months after eradication. The platelet count response was significant in the successfully eradicated group (P<0.005) and the increased platelet count was maintained without ITP treatment for over 12 months. In conclusion, H. pylori infection was involved in most ITP patients over 40 years old in Japan and eradication therapy proved effective for increasing platelet counts even in splenectomy non-responsive cases and the platelet count response appeared one month after eradication. This evidence suggests that eradication therapy is the first line of treatment in H. pylori positive ITP patients.

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The Relationship between the Sydney Classification and the First-Line Treatment Efficacy in Helicobacter-Associated Gastritis

Medical Principles and Practice ◽

10.1159/000508248 ◽

2020 ◽

Vol 29 (6) ◽

pp. 551-557

Author(s):

Elif Şenocak Taşçı ◽

Türkay Akbaş

Keyword(s):

Success Rate ◽

Triple Therapy ◽

Chronic Inflammation ◽

Precancerous Lesion ◽

Eradication Therapy ◽

Ease Of Use ◽

University Hospital ◽

First Line ◽

Standard Triple Therapy ◽

H Pylori

Objective: Helicobacter pyloriis responsible for a wide spectrum of diseases. Due to ease of use and access, the standard triple therapy is being used as first-line eradication in many areas. Intestinal metaplasia (IM) is a precancerous lesion that requires eradication therapy. Our aim is to investigate the effect of IM on the standard triple therapy success in H. pylori-positive patients. Subjects and Methods: The patients who were referred to Düzce University Hospital and Avrasya Hospital Gastroenterohepatology clinic between January 2014 and December 2016 and diagnosed with H. pylori-positive gastritis and underwent first-line eradication were evaluated retrospectively. Biopsy specimens were evaluated according to the updated Sydney system. All patients diagnosed with H. pylori started treatment with pantoprazole 40 mg b.i.d., amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. for 14 days. Results: The mean age of 181 patients included in the study was 55.5 ± 7.8. The success rate of H. pylori eradication was found to be low in severe chronic inflammation (p = 0.001). The success rate was found to be high among patients with no neutrophil activity (p = 0.009). As the intensity of IM increased, density of H. pylori was found to be decreased (p = 0.019). There was no correlation between glandular atrophy, IM, and H. pylori eradication success rate (p = 0.390 and p = 0.812). Conclusion: The severity of chronic inflammation is the most effective Sydney criteria for success of eradication, while the presence on IM does not have any effect.

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Comparison of Standard, Sequential, and Concomitant First Line Eradication Therapy for H. pylori

The American Journal of Gastroenterology ◽

10.14309/00000434-201710001-01244 ◽

2017 ◽

Vol 112 ◽

pp. S678

Author(s):

Eun hyea Park

Keyword(s):

Eradication Therapy ◽

First Line ◽

H Pylori

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Efficacy of second-line regimens for Helicobacter pylori eradication treatment: a systemic review and network meta-analysis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000472 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000472 ◽

Cited By ~ 1

Author(s):

Yen-Lin Chang ◽

Yu-Chun Tung ◽

Yu-Kang Tu ◽

Hong-Zen Yeh ◽

Jyh-Chin Yang ◽

...

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Subgroup Analysis ◽

Meta Analysis ◽

Eradication Therapy ◽

Second Line ◽

First Line ◽

Quadruple Therapy ◽

Clarithromycin Resistance ◽

H Pylori

BackgroundCurrent guidelines recommend bismuth-containing quadruple therapy (BQT) and quinolone-containing therapy after failure of first-line Helicobacter pylori eradication therapy. However, the optimum regimen of second-line eradication therapy remains elusive. We conducted a network meta-analysis to compare the relative efficacy of 16 second-line H. pylori eradication regimens.MethodsThree major bibliographic databases were reviewed to enrol relevant randomised controlled trials between January 2000 and September 2018. Network meta-analysis was conducted by STATA software and we performed subgroup analysis in countries with high clarithromycin resistance and high levofloxacin resistance, and in patients with documented failure of first-line triple therapy.ResultsFifty-four studies totalling 8752 participants who received 16 regimens were eligible for analysis. Compared with a 7-day BQT, use of probiotic add-on therapy during, before, and after second-line antibiotic regimens, quinolone-based sequential therapy for 10–14 days, quinolone-based bismuth quadruple therapy for 10–14 days, bismuth quadruple therapy for 10–14 days, and quinolone-based triple therapy for 10–14 days were significantly superior to the other regimens. Subgroup analysis of countries with high clarithromycin resistance and high levofloxacin resistance revealed that the ranking of second-line eradication regimens was distributed similarly in each group, as well as in patients with failure of first-line triple therapy.ConclusionWe conducted a detailed comparison of second-line H. pylori regimens according to different antibiotic resistance rates and the results suggest alternative treatment choices with potential benefits beyond those that could be achieved using salvage therapies recommended by guidelines.

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Apparent Intracellular Helicobacter pylori Detected by Immunohistochemistry: The Missing Link in Eradication Failure

Clinical Infectious Diseases ◽

10.1093/cid/ciaa839 ◽

2020 ◽

Author(s):

Andrea Beer ◽

Helmut Hudler ◽

Maria Hader ◽

Michael Kundi ◽

Susanne Hudler ◽

...

Keyword(s):

Helicobacter Pylori ◽

Eradication Therapy ◽

Test Results ◽

First Line ◽

Before And After ◽

Living Bacterium ◽

Gastric Biopsies ◽

Polymerase Chain ◽

H Pylori ◽

The Impact

Abstract Background Helicobacter pylori is primarily an extracellularly living bacterium. However, seemingly intracellular occurrence can often be detected by immunohistochemical stains. Considering antimicrobial resistance, we investigated the impact of the apparent intracellular H. pylori (aiHp) on treatment failure of first-line triple therapies. Methods Gastric biopsies of 814 patients infected with H. pylori naive to treatment were analyzed before and after eradication therapy by immunohistochemistry. Of these, 373 received treatment consisting of amoxicillin, clarithromycin, and proton pump inhibitor (AC/PPI). Availability of polymerase chain reaction-based clarithromycin susceptibility test results from pretreatment gastric biopsies was a precondition for matching 52 aiHp to 52 non-aiHp cases within the AC/PPI group. Results AiHp were detected mostly in low counts predominantly in corpus biopsies, rarely in antrum biopsies (95.2% vs 24.6%); they were found in 497 (61%) of all patients and in 192 of 373 patients (51.5%) in the AC/PPI group. The eradication rate in aiHp versus non-aiHp cases was 44.4% versus 72.9% in the entire sample and 45.3% versus 66.8% in the AC/PPI group. Among the 104 paired patients, respective values were 46.2% versus 78.8%; in clarithromycin-susceptible cases, 60.6% versus 91.9%. Both aiHp and resistance to clarithromycin proved to be highly significant (P ≤ .001) and independent predictors of eradication failure. Twelve of 13 aiHp cases with a clarithromycin-sensitive strain who failed eradication developed resistance to the antibiotic. Conclusions AiHp found by immunohistochemical staining especially in corpus biopsies proved to be a risk factor for failure of first-line triple therapies; occurrence of aiHp should be considered with regard to therapy options.

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Helicobacter pylori and mucosa-associated lymphoid tissue: what's new

Hematology ◽

10.1182/asheducation-2013.1.109 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 109-117 ◽

Cited By ~ 25

Author(s):

Sung-Hsin Kuo ◽

Ann-Lii Cheng

Keyword(s):

Malt Lymphoma ◽

Lymphoid Tissue ◽

Early Stage ◽

Eradication Therapy ◽

Gastric Malt Lymphoma ◽

High Grade ◽

First Line ◽

Histological Evidence ◽

H Pylori

AbstractLow-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach, gastric MALT lymphoma, is associated with Helicobacter pylori infection. The eradication of H pylori using antibiotics is successful in 60% to 80% of affected patients. In contrast to the previous paradigm, we and other investigators have shown that a certain proportion of patients with H pylori–positive early-stage diffuse large B-cell lymphoma (DLBCL) of the stomach with histological evidence of MALT lymphoma, including high-grade transformed gastric MALT lymphoma and gastric DLBCL(MALT), achieved long-term complete pathological remission (pCR) after first-line H pylori eradication therapy, indicating that the loss of H pylori dependence and high-grade transformation are separate events in the progression of gastric lymphoma. In addition, patients with H pylori–positive gastric DLBCL without histological evidence of MALT (gastric pure DLBCL) may also respond to H pylori eradication therapy. A long-term follow-up study showed that patients who achieved pCR remained lymphoma free. Gastric MALT lymphoma is indirectly influenced by H pylori infection through T-cell stimulation, and recent studies have shown that H pylori–triggering chemokines and their receptors, H pylori–associated epigenetic changes, H pylori–regulated miRNA expression, and tumor infiltration by CD4+CD25+ regulatory T cells contribute to lymphomagenesis of gastric MALT lymphoma. Recent studies have also demonstrated that the translocation of CagA into B lymphocytes inhibits apoptosis through p53 accumulation, BAD phosphorylation, and the up-regulation of Bcl-2 and Bcl-XL expression. In gastric MALT lymphoma, CagA may stimulate lymphomagenesis directly, through the regulation of signal transduction, and intracellular CagA is associated with H pylori dependence. These findings represent a substantial paradigm shift compared with the classical theory of H pylori–reactive T cells contributing indirectly to the development of MALT lymphoma. In conclusion, a wide range of H pylori–related gastric lymphomas have been identified. The use of antibiotics as the sole first-line therapy for early-stage gastric pure DLBCL requires validation in a prospective study. The clinical and biological significance of the CagA oncoprotein in the lymphomagenesis of gastric MALT lymphoma warrants further study.

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Evaluation of the Effectiveness of Helicobacter pylori Eradication Regimens in Lithuania during the Years 2013–2020: Data from the European Registry on Helicobacter pylori Management (Hp-EuReg)

Medicina ◽

10.3390/medicina57070642 ◽

2021 ◽

Vol 57 (7) ◽

pp. 642

Author(s):

Paulius Jonaitis ◽

Juozas Kupcinskas ◽

Olga P. Nyssen ◽

Ignasi Puig ◽

Javier P. Gisbert ◽

...

Keyword(s):

Helicobacter Pylori ◽

Triple Therapy ◽

Diagnostic Methods ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Intention To Treat ◽

H Pylori ◽

Cure Rates ◽

European Registry

Background and Objectives: The prevalence of H. pylori in Eastern Europe remains quite high; however, there is insufficient data on the eradication regimens and their effectiveness. Therefore, the objective of the study was to evaluate the diagnostic methods and treatment of H. pylori infection as well as their adherence to Maastricht V/Florence consensus during the years 2013–2020 in Lithuania. Materials and Methods: Sub-study of the “European Registry on H. pylori Management” (Hp-EuReg), international multicenter prospective non-interventional registry of the routine clinical practice. Lithuanian data from the years 2013–2020 were analyzed for effectiveness on a modified intention-to-treat (mITT) basis. 2000 adult patients, diagnosed with H. pylori infection, were included. Data were compared to the European Maastricht V guidelines. Results: Triple-therapy was used in 90% of the cases. In 91% of the first-line prescriptions, standard triple therapy (STT) was used. The most common second-line treatment was a combination of PPI, amoxicillin and levofloxacin (PPI+A+L) (47%). The overall effectiveness in 552 cases valid for analysis was 90% by mITT. In first-line treatment, the STT effectiveness was 90% and second-line treatment with PPI+A+L achieved 92% by mITT. Increasing overall H. pylori eradication rates were observed: from 72% in 2013 to more than 90% in 2018–2020, as well as a shift from 7 to 10–14 days treatments duration throughout 2013–2020. Conclusions: In Lithuania, the prescribed eradication regimens for H. pylori were in accordance with the international guidelines but diagnostic methods and treatment duration only partially met Maastricht V/Florence guidelines. The eradication effectiveness was improved progressively during the years 2018–2020, reaching ≥90% cure rates.

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