Specific Therapeutic Schemes of Omeprazole Affect the Orientation of Helicobacter pylori

ABSTRACT Until now, it has been unclear how proton pump inhibitors (PPIs) support Helicobacter pylori therapy. We tested whether the PPI omeprazole acts on the spatial orientation of H. pylori in the gastric mucus of infected Mongolian gerbils. Following repetitive PPI administration once daily but not following single doses or administration every 8 h, the bacterial spatial distribution changed, indicating a loss of orientation. Therefore, the therapeutic scheme of PPI administration may affect efficiency of treatment.

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Different dose of new generation proton pump inhibitors for the treatment of Helicobacter pylori infection: A meta-analysis

International Journal of Immunopathology and Pharmacology ◽

10.1177/20587384211030397 ◽

2021 ◽

Vol 35 ◽

pp. 205873842110303

Author(s):

Wenwen Gao ◽

Xiang Zhang ◽

Yanhui Yin ◽

Shuwen Yu ◽

Lu Wang

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Eradication Rate ◽

Standard Dose ◽

Statistical Significance ◽

High Dose ◽

Clarithromycin Resistance ◽

H Pylori ◽

New Generation

The evidence on whether high-dose new generation proton pump inhibitors (PPIs) including rabeprazole and esomeprazole achieve a higher eradication rate of Helicobacter pylori has not been assessed. The primary comparison was eradication and adverse events (AEs) rate of standard (esomeprazole 20 mg bid, rabeprazole 10 mg bid) versus high-dose (esomeprazole 40 mg bid, rabeprazole 20 mg bid) PPIs. Sub-analyses were performed to evaluate the eradication rate between Asians and Caucasians, clarithromycin-resistance (CAM-R) strains, and clarithromycin-sensitivity (CAM-S) strains of different dose PPIs. We conducted a literature search for randomized controlled trials comparing high-with standard-dose esomeprazole and rabeprazole for H. pylori eradication and AEs. A total of 12 trials with 2237 patients were included. The eradication rate of high-dose PPIs was not significantly superior to standard-dose PPIs regimens: 85.3% versus 84.2%, OR 1.09 (0.86–1.37), P = 0.47. The high dose induced more AEs than those of the standard dose, but didn’t reach statistical significance (OR 1.25, 95% CI: 0.99–1.56, P = 0.06). Subgroup analysis showed that the difference in eradication rate of PPIs between high- and standard-dose groups were not statistically significant both in Asians (OR 0.99, 95% CI 0.75–1.32, P = 0.97) and Caucasians (OR 1.27, 95% CI 0.84–1.92, P = 0.26). Furthermore, there were similar eradication rates in CAM-S (OR 1.2; 95% CI 0.58–2.5; P = 0.63) and CAM-R strains (OR 1.08; 95% CI 0.45–2.56; P = 0.87) between the standard-and high-dose groups. High and standard dosages of new generation of the PPIs showed similar H. pylori eradication rates and AEs as well as between Asian versus Caucasian populations, with or without clarithromycin-resistance. However, further studies are needed to confirm.

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Comparative Effect of Proton-Pump Inhibitors on the Success of Triple and Quadruple Therapy for Helicobacter pylori Infection

Digestive Diseases ◽

10.1159/000504909 ◽

2020 ◽

Vol 38 (5) ◽

pp. 408-414 ◽

Cited By ~ 1

Author(s):

Doron Boltin ◽

Zohar Levi ◽

Rachel Gingold-Belfer ◽

Hemda Schmilovitz-Weiss ◽

Tzippy Shochat ◽

...

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Treatment Success ◽

Helicobacter Pylori Infection ◽

Comparative Effect ◽

Quadruple Therapy ◽

13C Urea Breath Test ◽

H Pylori ◽

Current Guidelines

Introduction: Suppression of gastric acid secretion with proton-pump inhibitors (PPI) is an integral part of the treatment of Helicobacter pylori infection. Esomeprazole has been shown to be superior to other PPIs when used in the context of triple therapy; however, comparative data for PPI efficacy in quadruple therapy are lacking. Current guidelines recommend H. pylori eradication with quadruple therapy in areas with high clarithromycin resistance. Objective: To determine whether esomeprazole is more effective than other PPIs in the context of quadruple therapy for H. pylori eradication. Methods: We retrospectively identified 25- to 60-year-old subjects with a positive 13C-urea breath test and no prior laboratory or endoscopic test for H. pylori infection. Pharmacy dispensation data were retrieved. Results: A total of 7,896 subjects including 2,856 (36.2%) males, aged 40.4 ± 10.6 years, were identified. Of those, 78.1% received omeprazole, 20.1% received lansoprazole, 1.5% received esomeprazole, and 0.34% received pantoprazole together with antibiotics for H. pylori eradication. Esomeprazole was associated with a greater proportion of successful eradication (85.0 vs. 77.5%, esomeprazole vs. omeprazole, OR 1.64; 95% CI 0.99–2.72; p = 0.05). A nonsignificant trend favored esomeprazole over omeprazole among subjects receiving quadruple therapy (90.0 vs. 82.0%, respectively, OR 1.98; 95% CI 0.68–5.72; p = 0.16). Independent predictors of treatment success included older age and quadruple therapy. Conclusion: Esomeprazole is more beneficial than other PPIs for H. pylori eradication. Studies with larger subgroups are necessary to confirm our findings among subjects receiving quadruple therapy.

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Effect of omeprazole, rabeprazole, and rebamipide on the accuracy of urea breath test in patients with Helicobacter pylori infection

Asian Biomedicine ◽

10.2478/abm-2010-0042 ◽

2010 ◽

Vol 4 (2) ◽

pp. 337-342

Author(s):

Duangporn Thong-Ngam ◽

Maneerat Chayanupatkul ◽

Thirada Thongbai

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Breath Test ◽

False Negative ◽

False Negative Rate ◽

Urea Breath Test ◽

Once Daily ◽

Negative Results ◽

Negative Rate ◽

H Pylori

Abstract Background: The urea breath test (UBT) has been widely used for H. pylori eradication after treatment. The breath test could be adversely affected by various factors including proton pump inhibitors (PPIs) that are also used in the therapy for H. pylori infection. Objective: Determine the effect of omeprazole, rabeprazole and the mucoprotective agent rebamipide, on the UBT. Methods: Fifty-six patients with dyspepsia and positive for H. pylori by rapid urease test were enrolled. They were classified into three groups: Group 1 (n=25) received omeprazole 20 mg once daily, group 2 (n=13) received rabeprazole 20 mg once daily, and group 3 (n=18) received rebamipide 100 mg three times a day. All patients received a 14-day course of their medications. UBT was performed on day 0 as a baseline and on day 14 in all patients. In patient with negative results of UBT on day 14, the UBT was performed in consecutive week until the test became positive. Results: Fifty-six patients (20 men and 36 women) participated in the study. Their mean age was 46.77±14.3 years. False negative rate after 14-day treatment in omeprazole, rabeprazole and rebamipide group were 20.0%, 30.8%, and 0% respectively. There was a significant difference between 13C level in patients with negative and positive UBT results (2.7±0.7 vs.22.9±3.7/mL, p=0.025). The reversal of false negative to true positive tests occurred within two weeks after discontinuation of omeprazole and rabeprazole. Conclusion: Proton pump inhibitors had an effect on the accuracy of H. pylori detection using UBT. Rabeprazole revealed a higher false negative rate in the UBT than omeprazole. The mucoprotective drug, rebamipide, did not influence negative results in the UBT.

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Oxygen concentration influences proton pump inhibitor activity against Helicobacter pylori in vitro.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.6.1531 ◽

1996 ◽

Vol 40 (6) ◽

pp. 1531-1533 ◽

Cited By ~ 13

Author(s):

P D Midolo ◽

J D Turnidge ◽

J R Lambert ◽

J M Bell

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitor ◽

Oxygen Concentration ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Atmospheric Conditions ◽

Inhibitor Activity ◽

Agar Dilution ◽

H Pylori

Omeprazole and lansoprazole are proton pump inhibitors that have shown activity against Helicobacter pylori and other Helicobacter species when tested by agar dilution. Lansoprazole was more active against H. pylori than was omeprazole, and the activity was independent of urease production. Disk susceptibility tests and agar dilution MIC determinations were performed to investigate the effects of incubation under different sets of atmospheric conditions on H. pylori inhibition. Oxygen concentration was found to influence proton pump inhibitor activity in vitro, with higher concentrations leading to greater susceptibility. The method of testing is important in determining the anti-Helicobacter activity of proton pump inhibitors.

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Rapid Loss of Motility of Helicobacter pylori in the Gastric Lumen In Vivo

Infection and Immunity ◽

10.1128/iai.73.3.1584-1589.2005 ◽

2005 ◽

Vol 73 (3) ◽

pp. 1584-1589 ◽

Cited By ~ 42

Author(s):

Sören Schreiber ◽

Roland Bücker ◽

Claudia Groll ◽

Marina Azevedo-Vethacke ◽

Désirée Garten ◽

...

Keyword(s):

Helicobacter Pylori ◽

Gastric Juice ◽

Mongolian Gerbils ◽

Gastric Mucus ◽

Ph Values ◽

Short Period ◽

Gastric Lumen ◽

H Pylori

ABSTRACT The human pathogen Helicobacter pylori has infected more than half of the world's population. Nevertheless, the first step of infection, the acute colonization of the gastric mucus, is poorly understood. For successful colonization, H. pylori must retain active motility in the gastric lumen until it reaches the safety of the mucus layer. To identify the factors determining the acute colonization, we inserted bacteria into the stomach of anesthetized Mongolian gerbils. We adjusted the gastric juice to defined pH values of between 2.0 and 6.0 by using an autotitrator. Despite the fact that Helicobacter spp. are known to survive low pH values for a certain time in vitro, the length of time that H. pylori persisted under the assay conditions within the gastric juice in vivo was remarkably shorter. In the anesthetized animal we found H. pylori to be irreversibly immotile in less than 1 min at lumen pH values of 2 and 3. At pH 4 motility was lost after 2 min. However, the period of motility increased to more than 15 min at pH 6. Blocking pepsins in the gastric lumen in vivo by using pepstatin significantly increased the period of motility. It was possible to simulate the rapid in vivo immotilization in vitro by adding pepsins. We conclude that pepsin limits the persistence of H. pylori in the gastric chymus to only a few minutes by rapidly inhibiting active motility. It is therefore likely that this short period of resistance in the gastric lumen is one of the most critical phases of Helicobacter infection.

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The effect of CYP2C19 gene polymorphism on the eradication rate of Helicobacter pylori by proton pump inhibitors-containing regimens in Asian populations: a meta-analysis

Pharmacogenomics ◽

10.2217/pgs-2020-0127 ◽

2021 ◽

Vol 22 (13) ◽

pp. 859-879

Author(s):

Juan Fu ◽

Chang-Feng Sun ◽

Hong-Yan He ◽

Suvash Chandra Ojha ◽

Han Shi ◽

...

Keyword(s):

Helicobacter Pylori ◽

Gene Polymorphism ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Eradication Rate ◽

Meta Analysis ◽

Cochrane Library ◽

Asian Populations ◽

Cyp2c19 Polymorphism ◽

H Pylori

Premise: The effects of proton pump inhibitors (PPI) depend on metabolic enzyme CYP2C19 that has different activity due to gene polymorphism. The purpose of this meta-analysis is to determine the potential effects of CYP2C19 polymorphism on the efficiency of PPI-based treatment. Materials & methods: The PubMed, EMBASE, Cochrane Library, etc. were searched for relevant articles published in English or Chinese from inception to 31 May 2020. Finally, 26 randomized controlled trials and 15 cohort studies met the inclusion criteria and used for the meta-analysis via STATA version 15. Results: Poor metabolizer (PM) genotype Helicobacter pylori eradication rates were highest for Asian individuals receiving triple or quadruple first-line therapy based on PPIs (p < 0.05). CYP2C19 polymorphism could influence H. pylori eradication rate only in Mainland China and Japan (p < 0.05). Conclusion: PM genotype facilitates the elimination of H. pylori in Asian populations. Rabeprazole-, esomeprazole- and pantoprazole-based eradication program was less affected by the CYP2C19 polymorphism.

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Infeksi Helicobacter Pylori pada Anak

Sari Pediatri ◽

10.14238/sp2.2.2000.82-9 ◽

2016 ◽

Vol 2 (2) ◽

pp. 82

Author(s):

Badriul Hegar

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Vacuolating Cytotoxin ◽

H Pylori ◽

Vacuolating Cytotoxin A

Helicobacter pylori (H. pylori) berkolonisasi di dalam lambung manusia, terutama padaanak. Infeksi H. pylori pada umumnya asimtomatis. Vacuolating cytotoxin A (Vac A) dancytotoxic-associated gene A (CagA) merupakan faktor virulensi yang dihubungkan denganmanifestasi klinis yang berbeda. Kejadian infeksi ini sangat tinggi di negara berkembangyang dihubungkan dengan kondisi sosial ekonomi dan kebersihan lingkungan. Biakanbiopsi jaringan lambung merupakan uji diagnostik baku emas terhadap infeksi H. pylori.Uji urea napas sangat berguna untuk mengevaluasi eradikasi. Tingkat sensitivitas danspesifisitas pada uji serologi rendah pada masa anak-anak, sedangkan terapi eradikasiyang direkomendasi saat ini terdiri dari proton pump inhibitors (PPI) yang dikombinasidengan 2 jenis antibiotik (klaritromisin, amoksisilin atau metronidazol).

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Helicobacter pylori eradication does not influence gastroesophageal reflux disease: a prospective, parallel, randomized, open-label, controlled trial

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032012000100010 ◽

2012 ◽

Vol 49 (1) ◽

pp. 56-63 ◽

Cited By ~ 4

Author(s):

Lino Rodrigues Jr. ◽

Cintya Miler de Faria ◽

Stephan Geocze ◽

Luiz Chehter

Keyword(s):

Helicobacter Pylori ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Treatment Period ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Reflux Disease ◽

Controlled Trial ◽

Post Treatment ◽

H Pylori

CONTEXT: Helicobacter pylori has been associated with worsening of gastroesophageal reflux disease (GERD). OBJECTIVE: To evaluate the effect of H. pylori eradication in GERD patients. METHODS: We conducted a prospective, randomized, controlled trial performing symptom evaluation, endoscopy, histology, manometry and esophageal pH testing on GERD patients. Patients infected with H. pylori were randomized to: 1) eradication treatment plus proton pump inhibitors treatment, or 2) proton pump inhibitors alone. Patients not infected constituted a negative control group. After 3 months, patients were re-evaluated by symptom assessment, endoscopy, histology and manometry. RESULTS: GERD treatment resulted in significantly higher lower esophageal sphincter pressure, as measured by mean expiratory pressure, in H. pylori negative patients. There was significantly lower proportion of hypotensive waves and significantly higher proportion of normotensive waves in non-eradicated patients. All symptom scores were significantly reduced in the post-treatment period compared to baseline, to values that were similar among the three groups, in the post-treatment period. In the post-treatment period, erosive esophagitis was significantly less frequent on those not eradicated. CONCLUSION: Manometric, clinical and endoscopic data showed no benefit in eradicating H. pylori in GERD. Our data supports the hypothesis that H. pylori eradication does not influence GERD.

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Comparison of Immunohistochemistry and Conventional Stains for Helicobacter Pylori Detection in Gastric Biopsies of Patients Receiving Proton Pump Inhibitors

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2020752 ◽

2020 ◽

Author(s):

Kongsak Loharamtaweethong ◽

Napaporn Puripat

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Giemsa Staining ◽

P Value ◽

Predictive Values ◽

Staining Methods ◽

Gastric Biopsies ◽

H Pylori ◽

Sensitivity Specificity

Objective: To evaluate the diagnostic performance of different staining methods for Helicobacter pylori (H. pylori) in patients treated with proton pump inhibitors (PPI) Material and Methods: This is a retrospective study involving 75 gastric biopsies from patients with and without PPI therapy between October 2018 and September 2019. Slides were stained with hematoxylin and eosin (H&E); Giemsa and immunohistochemical staining (IHC) was done using polyclonal anti-H. pylori antibodies. Statistical analysis was performed to determine any association between the results of different staining methods and PPI consumption. Sensitivity, specificity and positive-negative predictive values of H&E and Giemsa stains were calculated. Results: Overall, H. pylori infection was detected in 33.3% of patients using IHC, 26.7% using H&E, and 28.0% via Giemsa staining. A strong correlation was found between PPI consumption and low H. pylori density detected via IHC (p-value=0.015) but not using H&E and Giemsa staining. The sensitivity of H&E and Giemsa was markedly reduced as a result of PPI consumption (57.1% to 18.2% vs. 85.7% to 27.3%, respectively). Conclusion: Identification of H. pylori using IHC in patients treated with PPI was superior to H&E and Giemsa stains. Both H&E and Giemsa stains showed a marked decrease in sensitivity in patients receiving PPI. The results indicate that IHC should be performed in patients with PPI therapy instead of H&E or Giemsa stains, and PPI should be discontinued for at least 14 days before the performance of endoscopy.

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