Efficacy of Helicobacter pylori eradication followed by the administration of a proton pump inhibitor (PPI) or PPI plus a prokinetic in H. pylori-positive patients with dyspepsia

As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H pylori infection; recurrent abdominal pain of childhood is not an indication to test for H pylori infection; H pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H pylori infection; serological antibody tests are not recommended as diagnostic tools for H pylori infection in children; first-line therapy for H pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics (clarithromycin plus amoxicillin or metronidazole); the optimal treatment period for H pylori infection in children is 14 days; and H pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures.

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European Registry on Helicobacter pylori Management: single-capsule bismuth quadruple therapy is effective in real-world clinical practice

United European Gastroenterology Journal ◽

10.1177/2050640620972615 ◽

2020 ◽

pp. 205064062097261

Author(s):

Olga P Nyssen ◽

Angeles Perez-Aisa ◽

Manuel Castro-Fernandez ◽

Rinaldo Pellicano ◽

Jose M. Huguet ◽

...

Keyword(s):

Helicobacter Pylori ◽

Clinical Practice ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Real World ◽

Case Report Form ◽

First Line ◽

Quadruple Therapy ◽

Intention To Treat ◽

H Pylori

Background There has been resurgence in the use of bismuth quadruple therapy (proton pump inhibitor, bismuth, tetracycline and metronidazole) for treating Helicobacter pylori infection thanks to a three-in-one single-capsule formulation. Objective To evaluate the effectiveness and safety of the single-capsule bismuth quadruple therapy. Methods Data were collected in a multicentre, prospective registry of the clinical practice of gastroenterologists on the management of H. pylori infection, where patients were registered at the Asociación Española de Gastroenterología REDCap database on an electronic case report form until January 2020. Effectiveness by modified intention-to-treat and per-protocol as well as multivariable analysis were performed. Independent factors evaluated were: age, gender, indication, compliance, proton pump inhibitor dose and treatment line. Results Finally, 2100 patients were prescribed single-capsule bismuth quadruple therapy following the technical sheet (i.e. three capsules every 6 hours for 10 days). The majority of these patients were naive (64%), with an average age of 50 years, 64% women and 16% with peptic ulcer. An overall modified intention-to-treat effectiveness of 92% was achieved. Eradication was over 90% in first-line treatment (95% modified intention-to-treat, n = 1166), and this was maintained as a rescue therapy, both in second (89% modified intention-to-treat, n = 375) and subsequent lines of therapy (third to sixth line: 92% modified intention-to-treat, n = 236). Compliance was the factor most closely associated with treatment effectiveness. Adverse events were generally mild to moderate, and 3% of patients reported a severe adverse event, leading to discontinuation of treatment in 1.7% of cases. Conclusions Single-capsule bismuth quadruple therapy achieved H. pylori eradication in approximately 90% of patients in real-world clinical practice, both as a first-line and rescue treatment, with good compliance and a favourable safety profile.

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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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The Current Strategy of Helicobacter pylori Eradication

Korean Journal of Medicine ◽

10.3904/kjm.2021.96.1.13 ◽

2021 ◽

Vol 96 (1) ◽

pp. 13-21

Author(s):

Yong Hwan Kwon

Keyword(s):

Helicobacter Pylori ◽

Clinical Practice ◽

Antimicrobial Resistance ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Eradication Rate ◽

Meta Analysis ◽

Cure Rate ◽

Helicobacter Pylori Eradication ◽

H Pylori

Helicobacter pylori (H. pylori) is the main cause of most gastroduodenal diseases. Triple therapy including two antibiotics, amoxicillin and clarithromycin, and a proton pump inhibitor given for a week has been recommended as the treatment of choice since the revision of the Korean H. pylori Clinical Practice Guidelines in 2013. However, antimicrobial resistance significantly decreased the cure rate of H. pylori eradication to 63.9%. Thus, the new H. pylori treatment regimen would be needed to increase the eradication rate in Korea. Recently, the update of clinical practice guideline for treatment of H. pylori was developed by conducting a meta-analysis. In this review, the recommended H. pylori eradication regimen in current 2020 guideline will be discussed.

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Potent inhibitory action of the gastric proton pump inhibitor lansoprazole against urease activity of Helicobacter pylori: unique action selective for H. pylori cells.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.37.4.769 ◽

1993 ◽

Vol 37 (4) ◽

pp. 769-774 ◽

Cited By ~ 105

Author(s):

K Nagata ◽

H Satoh ◽

T Iwahi ◽

T Shimoyama ◽

T Tamura

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Inhibitory Action ◽

Urease Activity ◽

Gastric Proton Pump ◽

H Pylori

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Eradicating Helicobacter pylori reduces hypergastrinaemia during long term omeprazole treatment

Gut ◽

10.1136/gut.42.2.159 ◽

1998 ◽

Vol 42 (2) ◽

pp. 159-165 ◽

Cited By ~ 18

Author(s):

A El-Nujumi ◽

C Williams ◽

J E Ardill ◽

K Oien ◽

K E L McColl

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Serum Gastrin ◽

Symptomatic Treatment ◽

Initial Presentation ◽

Proton Pump Inhibitor Treatment ◽

H Pylori ◽

Inhibitor Treatment

Background—Both proton pump inhibitor drug treatment and Helicobacter pylori infection cause hypergastrinaemia in man.Aims—To determine whether eradicating H pylori is a means of reducing hypergastrinaemia during subsequent proton pump inhibitor treatment.Methods—Patients with H pylori were randomised to treatment with either anti-H pylori or symptomatic treatment. One month later, all received four weeks treatment with omeprazole 40 mg/day for one month followed by 20 mg/day for six months. Serum gastrin concentrations were measured before and following each treatment.Results—In the patients randomised to anti-H pylori treatment, eradication of the infection lowered median fasting gastrin by 48% and meal stimulated gastrin by 46%. When gastrin concentrations one month following anti-H pylori/symptomatic treatment were used as baseline, omeprazole treatment produced a similar percentage increase in serum gastrin in the H pylori infected and H pylorieradicated patients. Consequently, in the patients in which H pylori was not eradicated, median fasting gastrin concentration was 38 ng/l (range 26–86) at initial presentation and increased to 64 ng/l (range 29–271) after seven months omeprazole, representing a median increase of 68% (p<0.005). In contrast, in the patients randomised to H pylori eradication, median fasting gastrin at initial presentation was 54 ng/l (range 17–226) and was unchanged after seven months omeprazole at 38 ng/l (range 17–95).Conclusion—Eradicating H pylori is a means of reducing the rise in gastrin during subsequent long term omeprazole treatment. In view of the potential deleterious effects of hypergastrinaemia it may be appropriate to render patients H pylori negative prior to commencing long term proton pump inhibitor treatment.

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Effect of proton pump inhibitor on the movement of Helicobacter pylori across the mucus layer to the gastric lumen

10.21203/rs.2.15795/v2 ◽

2019 ◽

Author(s):

shanshan Su(Former Corresponding Author) ◽

Guo-qi Zheng(New Corresponding Author) ◽

Ying-ying Liu ◽

Yu-fei Liang ◽

Hui Song ◽

...

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitor ◽

Gastric Juice ◽

Proton Pump ◽

Intervention Group ◽

Control Group ◽

Mucus Layer ◽

Urease Test ◽

Gastric Lumen ◽

H Pylori

Abstract Background: Helicobacter pylori ( H. pylori ) cannot usually be detected in the gastric juice and it is thought that H. pylori may reside under the mucus layer for long term. The mechanisms of action of proton pump inhibitor (PPI)for H. pylori eradication are not entirely clear. Our study aimed to determine the role of PPI on the movement of H. pylori across the mucus layer to the gastric lumen and the mechanism of PPI on H. pylori eradication. Methods: Patients with H. pylori infection were intravenous injected with PPI (intervention group, n=31) or without PPI (control group, n=37). The presence of H. pylori in the gastric juice was evaluated by the rapid urease test (RUT), polymerase chain reaction (PCR), and culture methods. Results: The H. pylori positive detection rates were all significantly higher among patients in the intervention group than among patients in the control group by the RUT ( P < 0.0001), PCR ( P < 0.0001), and culturing ( P = 0.0386). Conclusion: H. pylori can penetrate across the mucus layer to the gastric lumen following PPI intervention, and thus it might represent a novel target in the eradication of H. pylori .

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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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Proton Pump Inhibitor-Associated Large Hyperplastic Polyp in Non-Helicobacter pylori-Infected Stomach

Case Reports in Gastroenterology ◽

10.1159/000514530 ◽

2021 ◽

pp. 539-544

Author(s):

Kimitoshi Kubo ◽

Noriko Kimura ◽

Norishige Maiya ◽

Soichiro Matsuda ◽

Momoko Tsuda ◽

...

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Hyperplastic Polyp ◽

Gastric Body ◽

Tarry Stool ◽

Transnasal Endoscopy ◽

Pedunculated Polyp ◽

Greater Curvature ◽

H Pylori

A proton pump inhibitor (PPI)-associated hyperplastic polyp (HP) in the non-Helicobacter pylori-infected stomach is rare, and its endoscopic features remain poorly described. A 42-year-old man with tarry stool was referred to our hospital for examination and treatment. He had taken PPI for 14 years and was confirmed to be H. pylori-negative. Transnasal endoscopy revealed bleeding from a 20-mm, reddish pedunculated polyp with a nodular surface, located in the greater curvature of the upper gastric body. Endoscopic mucosal resection was performed, and the lesion was diagnosed as an HP. To our knowledge, this report represents a valuable addition to the HP literature describing a rare case of PPI-associated large HP in the non-H. pylori-infected stomach.

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Efficacy of Low Dose Proton Pump Inhibitor-Based Therapy to Eradicate Helicobacter pylori in Patients with Subtotal Gastrectomy

Journal of Clinical Medicine ◽

10.3390/jcm8111933 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1933

Author(s):

Dongwoo Kim ◽

Sung Woo Jung ◽

Dong-won Lee ◽

Chang Min Lee ◽

Seung Young Kim ◽

...

Keyword(s):

Helicobacter Pylori ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Low Dose ◽

Eradication Rate ◽

Bile Reflux ◽

Subtotal Gastrectomy ◽

Double Dose ◽

H Pylori ◽

Triple Regimen

Proton pump inhibitor (PPI)-based therapy is standard to eradicate Helicobacter pylori (H. pylori). Gastric acidity is lowered after gastrectomy because of bile reflux and impaired mechanism of acid secretion. Therefore, low-dose PPI may be effective for H. pylori eradication in the remnant stomach after gastrectomy. In this study, we compared the efficacy of low-dose PPI with standard double-dose PPI to eradicate H. pylori in patients who underwent subtotal gastrectomy. A total of 145 patients who were treated for eradication after gastrectomy was analyzed. They were treated with PPI-based triple regimen (PPI, clarithromycin and amoxicillin) for 14 days. We compared the eradication rate in the low-dose PPI group (lansoprazole 15 mg once daily) with that in the standard double-dose PPI group (lansoprazole 30 mg twice daily). The H. pylori eradication rate was 79.1% in the low-dose PPI group and 85.3% in the standard double-dose group; the difference was not significant statistically (p = 0.357). In the multivariate analysis, low-dose PPI (odds ratio (OR) = 1.79, 95% confidence interval (CI), 0.68–4.69) was not associated with eradication failure, while Billroth II anastomosis (OR = 4.45, 85% CI, 1.23–16.2) was significantly associated with eradication failure. Low-dose PPI-based triple regimen was as effective as standard double-dose PPI-based regimen for H. pylori eradication in patients with subtotal gastrectomy. Further study is needed to confirm the effect of low-dose PPI on H. pylori eradication in patients with gastrectomy.

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