Risk factors associated withHelicobacter pyloriinfection treatment failure in a high prevalence area

2010 ◽  
Vol 139 (4) ◽  
pp. 581-590 ◽  
Author(s):  
J. YAKOOB ◽  
W. JAFRI ◽  
Z. ABBAS ◽  
S. ABID ◽  
S. NAZ ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Triple Therapy ◽  
Point Mutations ◽  
23S Rrna ◽  
Rapid Urease Test ◽  
Factors Associated ◽  
Urease Test ◽  
High Prevalence ◽  
H Pylori

SUMMARYTriple therapy is commonly used for the treatment ofHelicobacter pyloriinfection. We determined risk factors associated with its failure in compliant patients focusing onH. pyloridensity, virulence marker and 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance.H. pyloriinfection was diagnosed by14C urea breath test (14C UBT) and rapid urease test or histology. Triple therapy with esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. was prescribed for 10 days.14C UBT was repeated 4 weeks after treatment. In total, 111 patients [69 (62%) males] with a mean age of 46±16 years were enrolled. The mean age of treatment failure was 39±14 years compared to 48±16 years with eradication (P=0·002). Treatment failure was associated with younger mean age, point mutations in the23S rRNAgene ofH. pyloriandvacA s1aandm1when associated withcagAnegativity.

scholarly journals Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jaime Natan Eisig ◽  
Tomás Navarro-Rodriguez ◽  
Ana Cristina Sá Teixeira ◽  
Fernando Marcuz Silva ◽  
Rejane Mattar ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Controlled Trial ◽  
Sequential Therapy ◽  
Rapid Urease Test ◽  
Double Blind ◽  
Intention To Treat ◽  
Standard Triple Therapy ◽  
Urease Test ◽  
H Pylori ◽  
Triple Treatment

Aim. To compare 10-day standard triple therapy versus sequential therapy as first-line treatment in patients infected withH. pylori.Methods. One hundredH. pyloripositive patients (diagnosed by rapid urease test and histology), with average age of 47.2, M/F = 28/72, were randomized to receive either standard triple treatment (TT) as follows: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 g, b.i.d. for ten days, or sequential treatment (ST) as follows: lansoprazole 30 mg, amoxicillin and placebo 1.0 g b.i.d for the first five days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg b.i.d, for the remaining five days. Eradication rates were determined 60 days after treatment by urease, histology, or13C-urea breath test.Results. In intention to treat (ITT) analysis, the rate ofH. pylorieradication in the TT and ST groups was the same for both regimens as follows: 86% (43/50), 95% CI 93,3 to 73.4%. In Per protocol (PP) analysis, the rate ofH. pylorieradication in the TT and ST groups was 87.8% (43/49), 95% CI 94,5 to 75.3% and 89.6% (43/48), 95% CI 95,8 to 77.3%, respectively.Conclusions. In Brazil, standard triple therapy is as equally effective as sequential therapy in eradicatingHelicobacter pyloripatients. This study was registered under Clinical Trials with numberISRCTN62400496.

scholarly journals Genotypic Resistance inHelicobacter pyloriStrains Correlates with Susceptibility Test and Treatment Outcomes after Levofloxacin- and Clarithromycin-Based Therapies

2010 ◽  
Vol 55 (3) ◽  
pp. 1123-1129 ◽  
Author(s):  
Jyh-Ming Liou ◽  
Chi-Yang Chang ◽  
Wang-Huei Sheng ◽  
Yu-Chi Wang ◽  
Mei-Jyh Chen ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Triple Therapy ◽  
Direct Sequencing ◽  
Point Mutations ◽  
Kappa Coefficient ◽  
23S Rrna ◽  
Genotypic Resistance ◽  
Phenotypic Resistance ◽  
Therapeutic Outcomes ◽  
H Pylori

ABSTRACTThe accuracy of genotypic resistance to levofloxacin (gyrAmutations) and its agreement with treatment outcomes after levofloxacin-based therapy have not been reported. We aimed to assess the correlation.Helicobacter pyloristrains isolated from patients who received levofloxacin-based and clarithromycin-based triple therapies in a previous randomized trial were analyzed for point mutations ingyrAand 23S rRNA. PCR followed by direct sequencing was used to assess thegyrAand 23S rRNA mutations. An agar dilution test was used to determine the MICs of clarithromycin and levofloxacin. We found that the agreement between genotypic and phenotypic resistance to levofloxacin was best when the MIC breakpoint was >1 μg/ml (kappa coefficient, 0.754). The eradication rates in patients with and withoutgyrAmutations were 41.7% and 82.7%, respectively (P= 0.003). The agreement between genotypic and phenotypic resistance to clarithromycin was best when the MIC breakpoint was >2 μg/ml (kappa, 0.694). The eradication rates in patients with and without 23S rRNA mutations were 7.7% and 93.5%, respectively (P< 0.001). The agreements (kappa coefficient) between therapeutic outcomes after clarithromycin-based triple therapy and genotypic and phenotypic resistance were 0.671 and 0.356, respectively. The agreements (kappa coefficient) between therapeutic outcomes after levofloxacin-based triple therapy and genotypic and phenotypic resistance were 0.244 and 0.190, respectively. In conclusion,gyrAand 23S rRNA mutations inH. pyloristrains appeared to be better markers than phenotypic resistance in the prediction of treatment outcomes. The optimal breakpoints for levofloxacin and clarithromycin resistance appeared to be >1 μg/ml and >2 μg/ml, respectively.

scholarly journals European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan

2020 ◽  
Vol 92 (8) ◽  
pp. 52-59
Author(s):  
S. R. Abdulkhakov ◽  
D. S. Bordin ◽  
R. A. Abdulkhakov ◽  
D. D. Safina ◽  
A. R. Gizdatullina ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Proton Pump Inhibitor ◽  
Triple Therapy ◽  
Proton Pump ◽  
Eradication Therapy ◽  
Helicobacter Pylori Infection ◽  
Rapid Urease Test ◽  
Standard Triple Therapy ◽  
Urease Test ◽  
H Pylori

Background. As part of an observational multicenter prospective study European Registry on the management of Helicobacter pylori infection, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed. Materials and methods. The data of 437 patients included into the register by clinical sites in Kazan in 20132019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients. Results. The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%. Conclusion. The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesnt reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.

scholarly journals Helicobacter pyloriIs Not Eradicated after Triple Therapy: A Nested PCR Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Saurabh Kumar Patel ◽  
Girish Narayan Mishra ◽  
Chandra Bhan Pratap ◽  
Ashok Kumar Jain ◽  
Gopal Nath
Keyword(s):  
Triple Therapy ◽  
Nested Pcr ◽  
Restriction Pattern ◽  
Rapid Urease Test ◽  
Serological Tests ◽  
Biopsy Specimens ◽  
Urease Test ◽  
Before And After ◽  
H Pylori ◽  
Antral Biopsy

Detection ofHelicobacter pyloriafter triple therapy is usually carried out by either rapid urease test (RUT), urea breath test (UBT), histology, bacterial isolation, and single round PCR or serological tests. In this study, antral biopsy specimens from 25 patients were tested forH. pyloriby RUT, culture, histology, and nested PCR in their antral biopsy specimens before and after treatment. Three genes, namely, heat shock protein (hsp60), phosphoglucosamine mutase (ureC), and flagellar export ATP synthase (fliI) ofH. pyloriwere targeted. Of the 25 antral biopsy specimens, the RUT, culture, histology, and nested PCR positivity dropped from 81.8% to 12%, 31% to 0%, 100 to 84%, and 100% to 92%, respectively, before and after therapy. Further,hsp60specific amplicons from 23 out of 25 patients gave identical restriction pattern, while 6fliIand 1ureCspecific amplicon produced different restriction pattern. Furthermore, variations infliIgene sequences inH. pyloriafter treatment were also confirmed by sequencing and comparedin silico. Nested PCR based detection ofH. pyloriis more sensitive method to detectH. pyloriafter therapy than culture, RUT, and histology. Further, this study suggests thatH. pyloriis not eradicated completely after triple therapy.

scholarly journals Antimicrobial resistance of Helicobacter pylori in Smolensk

2018 ◽  
Vol 20 (1) ◽  
pp. 42-48
Author(s):  
Natalya N. Dekhnich ◽  
Nataly V. Ivanchik ◽  
Roman S. Kozlov ◽  
A.V. Alimov ◽  
A.S. Steshits ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Triple Therapy ◽  
Empirical Therapy ◽  
Adult Patients ◽  
Dilution Method ◽  
Agar Dilution Method ◽  
Rapid Urease Test ◽  
Quadruple Therapy ◽  
Urease Test ◽  
H Pylori

Objective. To study the antimicrobial resistance of H. pylori to clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline in adult patients in the Smolensk region. Materials and Methods. Overall, 573 adult patients were included in 2015-2017 and 210 – in 20092010 with positive rapid urease test at the time of gastroscopy for dyspeptic complaints. Antimicrobial susceptibility testing of H. pylori isolates to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline was performed by the agar dilution method. Results. 143 and 133 strains of H. pylori isolated in 2015-2017 and in 2009-2010 were tested. The rates of resistance of H. pylori strains in 2015-2017 were 6.3% for clarithromycin, 1.4% – for amoxicillin, 23.8% – for metronidazole, 24.5% – for levofloxacin, 0.7% – for tetracycline. In 2009-2010 the corresponding numbers were: 5.3% – for clarithromycin, 4.5% – for amoxicillin, 3.8% – for metronidazole, 8.3% – for levofloxacin, 0% – for tetracycline. When assessing the dynamics of antimicrobial resistance of H. pylori in the Smolensk region over the past 9 years, there has been no noticeable increase in the resistance to clarithromycin, amoxicillin and tetracycline (p>0.05), with a significant increase in H. pylori resistance to metronidazole and levofloxacin (p<0,01). The resistance of H. pylori to metronidazole did not exceed the critical value of 40%. Conclusions. The prevalence of H. pylori resistance to clarithromycin and metronidazole in the Smolensk region was low throughout the study period, therefore standard triple therapy is recommended as a first line empirical therapy for H. pylori infection in adults. Preference in choosing a second-line empirical therapy between quadruple therapy with bismuth and triple therapy with levofloxacin should be stated in favor of quadruple therapy with bismuth because of the high rates of H. pylori resistance to levofloxacin.

scholarly journals Evaluation of Clinicopathological and Risk Factors for Nonma-lignant H. Pylori Associated Gastroduodenal Disorders in Iraqi Patients

2015 ◽  
Vol 3 (4) ◽  
pp. 645-654
Author(s):  
Ali Ibrahim Ali AL-Ezzy
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Tap Water ◽  
Endoscopic Diagnosis ◽  
Clinicopathological Parameters ◽  
Rapid Urease Test ◽  
Urease Test ◽  
Animal Contact ◽  
H Pylori ◽  
Cag A

AIM: To determine the risk factors associated with H. pylori infection and possible correlation with clinicopathological parameters.MATERIAL AND METHODS: Gastroduodenal biopsies were examined by rapid urease test and Gram staining. Cag A cytotoxin was detected by in situ hybridization.RESULTS: Risk of H. pylori acquisition reported as following: Males have 1.38 fold, rural residents have 0.63 fold, Nonsmokers have 0.39 fold, mild smokers have 18 fold, and moderate smokers have 1.4 fold while heavy smokers have 1 fold. A person who’s in contact with animals has 1.52 fold risks. Illiterates and patients with primary education have 5.36 & 3 fold risk respectively. Patients under proton pump inhibitor (PPI) therapy have 1.02 fold. Patients under NSAID therapy have 3.48 fold while nonalcoholic Patients have 0.75 fold. Patients using tap water have 0.45 fold risk. H. pylori infection positively correlated with age, weight loss, and heartburn. H. pylori inversely correlated with endoscopic diagnosis, Cag A positivity, and education level. Cag A positivity correlated with animal contact and NSAID usage.CONCLUSIONS: Several life style factors, education, animal contact, using of PPI, and NSAIDs increase the risk of H. pylori infection. Weight loss and heartburn cardinal signs for H. pylori infection. Endoscopic diagnosis and clinicopathological parameters not strictly associated with Cag A positivity.

scholarly journals Evropeyskiy registr Helicobacter pylori (Hp-EuReg): analiz dannykh 2360 bol'nykh, poluchavshikh terapiyu pervoy linii v Rossii

2018 ◽  
Vol 90 (2) ◽  
pp. 35-42 ◽  
Author(s):  
D S Bordin ◽  
Yu V Embutnieks ◽  
L G Vologzhanina ◽  
T A Il'chishina ◽  
I N Voinovan ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Clinical Practice ◽  
Triple Therapy ◽  
Day Treatment ◽  
Eradication Therapy ◽  
Primary Diagnosis ◽  
Rapid Urease Test ◽  
Urease Test ◽  
Multicenter Prospective Observational Study ◽  
H Pylori

On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

PCR-RFLP DETECTION OF POINT MUTATIONS CONFERRING RESISTANCE TO CLARITHROMYCIN OF HELICOBACTER PYLORI IN QUANG NGAI

2015 ◽  
pp. 54-61
Author(s):  
Ngoc Doanh Pham ◽  
Van Huy Tran ◽  
Thi Minh Thi Ha
Keyword(s):  
Helicobacter Pylori ◽  
General Hospital ◽  
Chronic Gastritis ◽  
Point Mutations ◽  
23S Rrna ◽  
Rrna Gene ◽  
Clarithromycin Resistance ◽  
Urease Test ◽  
Pcr Rflp ◽  
H Pylori

Background: Clarithromycin resistance of H-pylori is the main cause leading to treatment failure. Aim: The purpose of this study was to determine the rate of clarithromycin resistance mutation on gene 23S ribosomal popular robonucleotide acid (rRNA) of H-pylori in patients with chronic gastritis in Quang Ngai General Hospital PCR-RFLP. Method: This is a cross-sectional study in 64 patients infected with H-pylori was determined by 3 methods and chronic gastritis proven by histology. Sample collection conducted in Quang Ngai general hospital and molecular biology tests were conducted in the medical genetics department Hue of Medical and Pharmaceutical University. Urease test, histopathological examination and perform HE staining PCR 23S rRNA gene fragment of H-pylori to determine H-pylori infection. Analysis of genetic mutations in the 23S rRNA point is performed by PCR-RFLP technique. Results: Of the 64 biopsies qualify included in the study, 41 samples with clarithromycin resistance point mutations (64%), of which 40 (62.5%) had mutations A2143A, one sample with A2142A (2%). No samples had mutations A2142C and no more than one mutation.Conclusion: This is the first time we report mutations related to clarithromycin of H-pylori in Quang Ngai province. Mutations rate is high (64%), among the common mutations, the most common mutantation is A2143G. Key words: Helicobacter pylori, clarithromycin resistance, PCR-RFLP, point mutations

DETECTING POINT MUTATIONS A2142G AND A2143G IN THE 23S RRNA GENE CAUSING HELICOBACTER PYLORI RESISTANCE TO CLARITHROMYCIN BY PCR RFLP

2013 ◽  
pp. 56-63
Author(s):  
Thi Minh Thi Ha ◽  
Van Huy Tran
Keyword(s):  
Helicobacter Pylori ◽  
Point Mutations ◽  
23S Rrna ◽  
Rapid Urease Test ◽  
Rrna Gene ◽  
Peptic Ulcers ◽  
Urease Test ◽  
Pcr Rflp ◽  
Pcr Products ◽  
23S Rrna Gene

Background: Clarithromycine-resistance of H.pylori is one important cause of decreasing eradication rate of H.pylori. This study is aimed at: (1): evaluating the application of PCR RFLP in detecting point mutations A2142G and A 2143G in the 23SrRNA gene resulting Clarithromycine-resistant H.pylori. (2) determining the rate of these point mutations by PCR RFLP in patients with gastroduodenitis or peptic ulcers. Patients and methods: 38 patients with gastroduodenitis or peptic ulcer were enrolled. H.pylori infection was confirmed by rapid Urease test and PCR. PCR was performed in two phases: amplification of gene 23S rRNA containing A2143 and A2142, followed by digestion of PCR products by enzymes BbsI and BsaI in order to detecting point mutations A2143G and A2142G. Different quantities of enzyme of digestion were evaluated (5U; 7,5U; 10U; 15U and 20U) in order to determine an optimal quantity. Results: The components of digesting reaction were optimized as followings: performed in a solution volume of 20 µl, including 5 µl PCR products (to amplify gene 23S rRNA containing 2142 and 2143), 10 U enzyme (BsaI to detect A2143G, BbsI to detect A2142G), 2 µl buffer G 2X, and water for a sufficient volume. 17 point mutations A2143G were found (44.7%). Conclusion: PCR RFLP could be routinely applied to detect point mutations A2143G and A2142G in the 23S rRNA gene causing clarithromycine-resistant H.pylori. The rate of these point mutations in this group of patients was relatively high. Key words: Clarithromycin resistance, gene 23S rRNA, Helicobacter pylori

scholarly journals Clarithromycin versus levofloxacin-based regimens for Helicobacter pylori eradication in the Kurdistan Region of Iraq: A randomized clinical trial

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Shinah A. Mohammed ◽  
Omer Q. B. Al-lela ◽  
Nawfal R. Hussein ◽  
Ramadhan S. Hajany ◽  
Laween S. Alduhoky
Keyword(s):  
Clinical Trial ◽  
Helicobacter Pylori ◽  
Randomized Clinical Trial ◽  
Rapid Urease Test ◽  
Predisposing Factor ◽  
Helicobacter Pylori Eradication ◽  
Factors Associated ◽  
Urease Test ◽  
H Pylori ◽  
Resistance Rates

Helicobacter pylori infection is a predisposing factor for gastric cancer. This prospective, randomized clinical trial aimed to compare H. pylori eradication rates associated with a clarithromycin-based regimen and levofloxacin-based regimen. H. pylori infection was confirmed by a rapid urease test during endoscopy and its eradication by a urea breath test. In this study, 192 patients were recruited; 93 patients received a clarithromycin- based regimen and 99 a levofloxacin- based regimen. Sixty-four patients completed the clarithromycinbased regimen and 60 the levofloxacinbased regimen. The eradication success rate of the clarithromycin-based regimen was 52/64 (81.25%), while that of the levofloxacin- based regimen was 49/60 (81.6%) (P=0.9524; odds ratio [OR]=1.0280; confidence interval [CI]=0.4153-2.5447). Investigation of the risk factors associated with treatment failure showed that the overall efficacy of the regimens was influenced by body mass index (BMI), with a high failure rate observed in patients with a high BMI (P=0.0174; OR=1.1116; CI=1.0187- 1.2129). Age, sex, endoscopic diagnosis and smoking did not influence treatment outcomes. Further studies are needed to monitor H. pylori antibiotic resistance rates.

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