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

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.

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

Gastroenterology Research and Practice ◽

10.1155/2015/818043 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

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.

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An evaluation of the usefulness of invasive and non-invasive methods used to diagnose Helicobacter spp. infections in dogs

Polish Journal of Veterinary Sciences ◽

10.1515/pjvs-2017-0059 ◽

2017 ◽

Vol 20 (3) ◽

pp. 491-499 ◽

Cited By ~ 2

Author(s):

M. Jankowski ◽

J. Spużak ◽

K. Kubiak ◽

K. Glińska-Suchocka ◽

M. Biernat

Keyword(s):

Nested Pcr ◽

Gastric Biopsy ◽

Diagnostic Methods ◽

Rapid Urease Test ◽

Pcr Assay ◽

Non Invasive ◽

Biopsy Specimens ◽

Urease Test ◽

Invasive Method ◽

Pcr Method

AbstractThe aim of this study was to assess the suitability of invasive and non-invasive methods used to diagnose Helicobacter spp. in the stomachs of dogs. The study was carried out on 30 dogs of both sexes and different breeds, between one and 15 years old. A histopathologic examination, a microbiological culture, a rapid urease test, a direct bacteriological preparation and a nested PCR assay were carried out. Gastric Helicobacter spp. was identified in gastric biopsy specimens from 16 (53.3%) dogs using direct bacteriological preparation, in four (13.3%) dogs based on a culture, in 23 (76.6%) dogs using the rapid urease test and in 21 (70,0%) dogs based on a histopathological assessment of the biopsy specimens. The nested PCR of the gastric biopsy specimens revealed gastric Helicobacter spp. in all the dogs (100%). A saliva PCR assay revealed gastric Helicobacter spp. in 23 (76.6%) dogs, while stool PCR revealed the bacterium in seven (23.3%) dogs. We found that invasive methods were more accurate than non-invasive methods in detecting a Helicobacter spp. infection in dogs. In addition, the nested PCR method used to evaluate the gastric mucosal biopsy specimens was the most accurate test for detecting Helicobacter spp. It was further found that the PCR-based saliva assay was the best non-invasive method for detecting Helicobacter spp. However, taking into consideration that most of the diagnostic methods used to detect this bacterium have drawbacks, at least two diagnostic methods should be used to detect Helicobacter spp. as is done in human medicine.

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

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.08.000758 ◽

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.

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Prospective study to evaluate the number and the location of biopsies in rapid urease test for diagnosis of Helicobacter Pylori

Gastroenterology Insights ◽

10.4081/gi.2017.7223 ◽

2017 ◽

Vol 8 (1) ◽

Author(s):

Antoine Abou Rached ◽

Jowana Saba ◽

Cesar Yaghi ◽

Joyce Sanyour ◽

Ahmad El Hajjar ◽

...

Keyword(s):

Helicobacter Pylori ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Rapid Test ◽

Rapid Urease Test ◽

Ulcer Disease ◽

Urease Test ◽

Gastric Biopsies ◽

H Pylori ◽

Antral Biopsy

Helicobacter pylori (H. pylori) can cause a wide variety of illnesses such as peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. The diagnosis and eradication of H. pylori are crucial. The diagnosis of H. pylori is usually based on the rapid urease test (RUT) and gastric antral biopsy for histology. The aim of this study is to evaluate the numbers of needed biopsies and their location (antrum/fundus) to obtain optimal result for the diagnosis of H. pylori. Three hundred fifty consecutive patients were recruited, 210 fulfill the inclusion criteria and had nine gastric biopsies for the detection of H. pylori infection: two antral for the first RUT (RUT1), one antral and one fundic for the second (RUT2), one antral for the third (RUT3) and two antral with two fundic for histology (HES, Giemsa, PAS). The reading of the 3 types of RUT was performed at 1 hour, 3 hours and 24 hours and biopsies were read by two experienced pathologists not informed about the result of RUT. Results of RUT were considered positive if H. pylori was found on histology of at least one biopsy. The RUT1 at 1h, 3h and 24h has a sensitivity of 72%, 82% and 89% and a specificity of 100%, 99% and 87% respectively. The positive predictive value (PPV) was 100%, 99% and 85% respectively and the negative predictive value (NPV) of 81%, 87% and 90%. The RUT2 at 1h, 3h and 24h, respectively, had a sensitivity of 86%, 87% and 91% and a specificity of 99%, 97% and 90%. The PPV was 99%, 96% and 88% and NPV of 89%, 90%, 94%. The RUT3 at 1h, 3h and 24h, respectively, had a sensitivity of 70%, 74% and 84% and a specificity of 99%, 99% and 94%. The PPV was 99%, 99% and 92% and NPV of 79%, 81% and 87%. The best sensitivity and specificity were obtained for RUT1 read at 3h, for RUT2 read 1h and 3h, and the RUT3 read at 24h.This study demonstrates that the best sensitivity and specificity of rapid test for urease is obtained when fundic plus antral biopsy specimens are used with a reading time at 3 hours.

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Antimicrobial resistance of Helicobacter pylori in Smolensk

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2018.1.42-48 ◽

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.

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Genotyping and Association of the Presence of Helicobacter Pylori in Dental Plaque and Gastric Biopsy Specimens in Dyspeptic Patients by PCR-RFLP Technique in Southwest of Iran

10.21203/rs.3.rs-1164630/v1 ◽

2021 ◽

Author(s):

Mojtaba Moosavian ◽

Elyas Kushki ◽

Tahereh Navidifar ◽

Eskandar Hajiani ◽

Mahdi Mandegari

Keyword(s):

Oral Cavity ◽

Dental Plaque ◽

Gastric Biopsy ◽

Rapid Urease Test ◽

Biopsy Specimens ◽

Urease Test ◽

Pcr Rflp ◽

Dental Plaques ◽

H Pylori ◽

Southwest Of Iran

Abstract The oral cavity can act as an extra gastric reservoir for H pylori, and also the presence of the bacteria in the oral cavity is associated with a higher risk of dental caries development. The aim of this study was to determine the genotype and evaluate the association of the presence of H. pylori in dental plaque and gastric biopsy specimens in dyspeptic patients in Ahvaz, Southwest of Iran. In this study, 106 patients with recruited dyspeptic complaints were selected and from each patient, two gastric antral biopsy specimens and two dental plagues were examined. The presence of H. pylori was identified by the Rapid Urease Test (RUT) and the amplification of ureAB and 16S rRNA genes. Also, to verify a hypothetical mouth-to-stomach infection route, the enzymatic digestions of three genes of cagA, vacA, and ureAB in H. pylori strains isolated from dental plaques and stomach samples were compared for each same case. H. pylori was found in the stomach of 52.8% (56 /106) and the dental plaques of 17.9% (19/106) of the studied cases. On the other hand, H. pylori was recognized in the stomach of all 19 cases with oral colonization. Following a combination of restriction fragment length polymorphism (RFLP) patterns of these three known genes on stomach and dental plague samples, 14 and 11 unique patterns were seen, respectively. However, for all H. pylori-positive cases (19), the comparison of RLFP patterns of these genes in the dental plaque and gastric biopsy specimens was different for the same case. This study showed, no significant association was observed between the presence of H. pylori in dental plaque and the stomach of the same case.

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

Terapevticheskii arkhiv ◽

10.26442/terarkh201890235-42 ◽

2018 ◽

Vol 90 (2) ◽

pp. 35-42 ◽

Cited By ~ 4

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.

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Performance of RoutineHelicobacter pyloriInvasive Tests in Patients with Dyspepsia

Gastroenterology Research and Practice ◽

10.1155/2013/184806 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Hsi-Chang Lee ◽

Ting-Chang Huang ◽

Chin-Lin Lin ◽

Kuan-Yang Chen ◽

Chung-Kwe Wang ◽

...

Keyword(s):

Predictive Value ◽

Gastrointestinal Endoscopy ◽

Positive Culture ◽

Upper Gastrointestinal Endoscopy ◽

Rapid Urease Test ◽

Urease Test ◽

H Pylori ◽

Sensitivity Specificity ◽

Upper Gastrointestinal ◽

Antral Biopsy

Background. This study was designed to compare the accuracy of three different invasive methods for the detection ofHelicobacter pylori (H. pylori)infection in patients with dyspepsia. These tests included culture, histology, and the rapid urease test (CLO test).Methods.H. pyloriinfection was diagnosed prospectively in 246 untreated dyspeptic patients who underwent upper gastrointestinal endoscopy. The gold standard forH. pyloriinfection was based on a positive culture or both a positive histological examination and a CLO test.Results.H. pyloriwas diagnosed in 33.3% of the patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were as follows: histology from the antrum (95.12; 95.12; 90.7; 97.5; 95.12%); histology from the antrum and corpus (95.12; 95.12; 90.7; 97.5; 95.12%); histology from the corpus (76.83; 96.95; 92.65; 89.33; 90.24%); culture (91.46; 100; 100; 95.91; 97.15%); a CLO test from the antrum and corpus (85.59; 100; 100; 93.71; 95.52%); a CLO test from the antrum (64.63; 100; 100; 84.97; 88.21%); a CLO test from the corpus (69.51; 100; 100; 96.77; 89.83%), respectively.Conclusions. Antral biopsy histology and culture are the best methods for the diagnosis ofH. pyloriinfection in our cohort of patients with dyspepsia.

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Mutational Analysis of Clarithromycin and Levofloxacin Resistance in Helicobacter pylori from Gastric Biopsy Specimens in a Tertiary Care Hospital in Dhaka, Bangladesh

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v13i1.51780 ◽

2019 ◽

Vol 13 (1) ◽

pp. 12-19

Author(s):

Nusrat Noor Tanni ◽

Shaheda Anwar ◽

Sharmeen Ahmed ◽

Kakali Halder ◽

Maherun Nesa ◽

...

Keyword(s):

Gene Mutations ◽

Gastric Biopsy ◽

23S Rrna ◽

Rapid Urease Test ◽

Care Hospital ◽

Gyra Gene ◽

Biopsy Specimens ◽

Urease Test ◽

Gastric Biopsies ◽

H Pylori

Background: Clarithromycin and Levofloxacin are most frequently included in the standard triple therapies for H. pylori eradication in our country. Resistance to clarithromycin and fluoroquinolones are particularly related with treatment failure. Objectives: The objective of this study was to detect, clarithromycin and levofloxacin resistance associated with gene mutations in H. pylori directly from gastric biopsies using an allele specific primer-PCR (ASP-PCR) assay. Materials and Methods: Gastric biopsy specimens were collected from 143 adult dyspeptic patients, from Department of Gastroenterology, BSMMU and Dhaka Medical College Hospital (DMCH), during the period of March, 2018 to February, 2019. H. pylori was identified by rapid urease test, ureC gene by PCR, histological staining and culture. ASP-PCR was used to identify 23S rRNA gene and gyrA gene mutation predictive of clarithromycin and levofloxacin resistant H. pylori respectively. Results: H. pylori positive cases were 32.9% based on the case definition used in the study. Among 42 ureC positive H. pylori cases, point mutations in 23Sr RNA gene for clarithromycin resistance were detected only at A2142G position in 9 (21.4%) cases and gyrA gene mutations for levofloxacin resistance were detected in 16 (38.1%) cases. Only 1 (2.4%) case had mutation both in 23Sr RNA and gyrA gene. Conclusion: Those findings may guide toward the therapeutic choices in our country. PCR based diagnostic assays can be the alternative approach for rapid detection of antibiotic resistances of H. pylori directly from gastric biopsies, where culture and susceptibility tests are not routinely performed. Bangladesh J Med Microbiol 2019; 13 (1): 12-19

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

Epidemiology and Infection ◽

10.1017/s0950268810001226 ◽

2010 ◽

Vol 139 (4) ◽

pp. 581-590 ◽

Cited By ~ 11

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.

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