Current Status of the Third-Line<i>Helicobacter pylori</i>Eradication

Choi, Jae Ho; Bang, Chang Seok; Lee, Jae Jun; Baik, Gwang Ho

doi:10.1155/2018/6523653

Cited by 16 publications

(23 citation statements)

References 63 publications

(94 reference statements)

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“…In CVID, serological tests are not useful to identify H. pylori positive patients and only direct diagnostic methods for H. pylori detection should be considered ( 23 ). However, follow-up strategies targeted at gastric cancer secondary prevention cannot rely only on H. pylori identification, since the eradication of H. pylori might not abolish the risk for neoplastic progression ( 24 – 26 ). This is supported by our observation in two CVID patients who developed gastric cancer 1–2 years after a H. pylori -negative gastric biopsy.…”

Section: Discussionmentioning

confidence: 99%

Gastric Cancer Is the Leading Cause of Death in Italian Adult Patients With Common Variable Immunodeficiency

et al. 2018

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An increased prevalence of malignant lymphoma and of gastric cancer has been observed in large cohorts of patients with common variable immunodeficiency (CVID), the most frequently symptomatic primary immunodeficiency. Surveillance strategies for cancers in CVID should be defined based on epidemiological data. Risks and mortality for cancers among 455 Italian patients with CVID were compared to cancer incidence data from the Italian Cancer Registry database. CVID patients showed an increased cancer incidence for all sites combined (Obs = 133, SIR = 2.4; 95%CI = 1.7–3.5), due to an excess of non-Hodgkin lymphoma (Obs = 33, SIR = 14.3; 95%CI = 8.4–22.6) and of gastric cancer (Obs = 25; SIR = 6.4; 95%CI = 3.2–12.5). CVID patients with gastric cancer and lymphoma had a worse survival in comparison to cancer-free CVID (HR: 4.8, 95%CI: 4.2–44.4 and HR: 4.2, 95%CI: 2.8–44.4). Similar to what observed in other series, CVID-associated lymphomas were more likely to be of B cell origin and often occurred at extra-nodal sites. We collected the largest case-series of gastric cancers in CVID subjects. In contrast to other reports, gastric cancer was the leading cause of death in CVID. Standardized mortality ratio indicated a 10.1-fold excess mortality among CVID patients with gastric cancer. CVID developed gastric cancer 15 years earlier than the normative population, but they had a similar overall survival. Only CVID diagnosed at early stage gastric cancer survived >24 months. Stomach histology from upper endoscopy performed before cancer onset showed areas of atrophic gastritis, intestinal metaplasia or dysplasia. CVID patients might progress rapidly to an advanced cancer stage as shown by patients developing a III-IV stage gastric cancer within 1 year from an endoscopy without signs of dysplasia. Based on high rate of mortality due to gastric cancer in Italian CVID patients, we hereby suggest a strategy aimed at early diagnosis, based on regular upper endoscopy and on Helicobacter pylori infection treatment, recommending an implementation of national guidelines.

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Section: Discussionmentioning

confidence: 99%

Gastric Cancer Is the Leading Cause of Death in Italian Adult Patients With Common Variable Immunodeficiency

et al. 2018

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“…[28] Moreover, there is no definite 2nd-line or 3rd-line rescue regimen for patients who do not respond to the above therapies. [17] Fluoroquinolone- and rifabutin-containing regimens or a combination of bismuth with different antibiotics is the remaining empirical option. [8,17] However, the antibiotic resistance rates in Korea of ciprofloxacin, levofloxacin, and moxifloxacin are reported to be up to 38.2%, 37.7%, and 34.6%, respectively, which are higher than those previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…[9,16] Moreover, dual clarithromycin and metronidazole resistance undermines the efficacy of concomitant therapy, and there is no definite 2nd-line or 3rd-line rescue regimen for patients who do not respond to the above therapies. [17,18] Therefore, finding an optimal regimen for 1st-line eradication is warranted in Korea.…”

Section: Introductionmentioning

confidence: 99%

Modified quadruple therapy versus bismuth-containing quadruple therapy in first-line treatment of Helicobacter pylori infection in Korea; rationale and design of an open-label, multicenter, randomized controlled trial

Lim¹,

Bang²,

Shin³

et al. 2018

Medicine

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Background:Clarithromycin-containing triple regimen for eradication of Helicobacter pylori is no longer acceptable in Korea due to high clarithromycin resistance. Concomitant therapy or bismuth-containing quadruple therapy is recommended as an alternative regimen. A recent study in Korea has shown that modified quadruple therapy has comparable efficacy and safety to concomitant therapy as a first-line regimen. However, there has been no comparative study of modified quadruple therapy with bismuth-containing quadruple therapy. The aim of this study is to compare the efficacy and safety of modified quadruple therapy with those of bismuth-containing quadruple therapy as a first-line regimen and to present the phenotypic and genotypic antibiotic resistance profile of H pylori.Methods:This study is an open-label, multicenter, randomized controlled trial. We are recruiting subjects endoscopically diagnosed with H pylori infection from 2 hospitals in Korea. Subjects will be randomly allocated either to modified quadruple therapy (proton-pump inhibitor bid, amoxicillin 1 g bid, metronidazole 500 mg tid, bismuth subcitrate 300 mg qid daily) or bismuth-containing quadruple therapy (proton-pump inhibitor bid, tetracycline 500 mg qid, metronidazole 500 mg tid, bismuth subcitrate 300 mg qid daily) for 14 days. The rate of eradication success and adverse events will be checked at least 4 weeks after the treatment. Antibiotic resistance will be established using both a bacterial culture with agar dilutions and DNA sequencing of the clarithromycin resistance point mutations in the 23S rRNA gene of H pylori.Conclusion:The results of this study will provide solid evidence for determining the optimal treatment regimen for first-line H pylori eradication in Korea.

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“…It has been reported that the bacterium is present in almost all patients with active chronic gastritis, duodenal ulcer and gastric ulcer; thus, it may be a significant factor in the etiology of these diseases. Therefore, eradication of H. pylori in infected patients is very important for the treatment of diseases associated with this agent (3). For the treatment and eradication of this infectious agent, the conventional approach relies on using multiple antibiotics such as clarithromycin, amoxicillin, tetracycline, metronidazole in combination with bismuth sulphate or a proton-pump inhibitor (4).…”

Section: Introductionmentioning

confidence: 99%

An experimental in-vitro study to evaluate the anti-helicobacter activity of Glycyrrhetinic acid

Çelik

Duran

2019

Revista Romana De Medicina De Laborator

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Aim: The aim of this study was to investigate the in-vitro efficacy of Glycyrrhetinic acid against Helicobacter pylori (H. pylori) strains, as compared with conventional antibacterial agents. Methods: A total of 41 H. pylori isolates were used, 6 of which were of standard strains (NCTC 1637), 8 of which were drug-sensitive, and 27 were resistant to drugs isolates. Clarithromycin and metronidazole resistance in all strains of H. pylori were determined by the Epsilometer test (E-test) method. MIC study was performed by using microdilution broth method. Results: Glycyrrhetinic acid was found to be effective against H. pylori NCTC 1637 in doses of 12.0±4.38 µg/mL, while the MIC value of clinical H. pylori isolates susceptible to antimicrobials was 20.8±10.11 µg/ml. It was found that the MIC values for antimicrobial-sensitive clinical H. pylori isolates was higher when compared with H. pylori NCTC 1637 strains. The MIC values of the standard antimicrobial agents against drug-resistant H. pylori strains were higher than H. pylori NCTC 1637 strains and drug-sensitive H. pylori strains. The MIC value was found to be 14.22±7.77 µg/ml for metronidazole, 3.89±1.90 µg/ml for clarithromycin, 2.33±1.0 µg/ml for amoxicillin, 2.44±0.88 µg/ml for levofloxacin and 4.89±2.47 µg/ml for tetracycline, whereas the MIC value of Glycyrrhetinic acid was 26.67±8.0 µg/ml in metronidazole-resistant H. pylori isolates. Besides, MIC values of the antimicrobials and 18ß-Glycyrrhetinic acid among the strains resistant to clarithromycin were as follows: 3.25±2.12 µg/ml for metronidazole, 9.71±4.54 µg/ml for clarithromycin, 2.06±1.32 µg/ml for amoxicillin, 3.88±4.22 µg/ml for levofloaxacin and 3.25±1.04 µg/mL for tetracycline and 22.0±11.11 µg/ml for Glycyrrhetinic acid. Conclusion: Glycyrrhetinic acid had significant antimicrobial activity against H. pylori strains. Although further in-vivo studies are needed on antimicrobial activity of Glycyrrhetinic acid, increased resistance to drugs currently used in treatment suggests that Glycyrrhetinic acid may be a potential agent for the treatment of H. pylori.

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Current Status of the Third-LineHelicobacter pyloriEradication

Cited by 16 publications

References 63 publications

Gastric Cancer Is the Leading Cause of Death in Italian Adult Patients With Common Variable Immunodeficiency

Gastric Cancer Is the Leading Cause of Death in Italian Adult Patients With Common Variable Immunodeficiency

Modified quadruple therapy versus bismuth-containing quadruple therapy in first-line treatment of Helicobacter pylori infection in Korea; rationale and design of an open-label, multicenter, randomized controlled trial

An experimental in-vitro study to evaluate the anti-helicobacter activity of Glycyrrhetinic acid

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