Low rate of recurrence of Helicobacter Pylori infection in spite of high clarithromycin resistance in Pakistan

Abstract

BackgroundThe aim was to investigate the reinfection rate of H. pylori during a follow-up period of 12 months in adults who had undergone eradication therapy.MethodsOne hundred-twenty patients; 116 with gastritis, 3 with duodenal ulcer and 1 gastric ulcer, were studied. Their mean age was 41 ± 13 years (range 18–77) and male: female ratio of 2:1. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP). 14C urea breath test (14C-UBT) was performed 4 weeks after the eradication therapy. The successfully treated patients were observed for 12 months with 14C-UBT to assess H. pylori status. If 14C-UBT was negative, it was repeated after every 12 weeks. If 14C-UBT was positive, endoscopy was repeated with biopsies.ResultThe eradication therapy was successful in 102(85%) patients. Out of forty-seven H. pylori isolates cultured, clarithromycin sensitivity was present in 30(64%) and amoxicillin in 45(98%), respectively. Follow-up 14C-urea breath tests of all 102 patients who eradicated H. pylori remained negative up to 9 months. However, in 6 patients, the 14C-UBT confirmed recurrence at 12 months. The recurrence rate was 6%.ConclusionA low rate of recurrence of H. pylori infection was found in patients with dyspeptic symptoms. H. pylori isolates demonstrated a high invitro clarithromycin resistance.

Potential Benefit of Curcumin Adjuvant Therapy to the Standard H. Pylori Eradication Therapy in Patients With Peptic Ulcer Disease

“…Female patients had the higher rate of infection with H. pylori microorganism, similar finding was found among Iraqi population in other studies [31,32], inversely, male gender was predominant to females in others [33,34]. Higher percentage of peptic ulcer patients diagnosed endoscopically as duodenal ulcer compared to these with gastric ulcer in the present study.…”

Two Years Follow Up After Eradication Therapy of Peptic Ulcer

“…post-eradication therapy, these results were in agreement with Sekine et al, Metzgen et al, Enderset et al, Cheon et al, Hilddbrand et al, Rollar et al, Kin et al, Lai and Lan, Chey et al, Ryu et al, and Yakoob et al[12][13][14][15][16][17][18][19][20][21][22], who recorded 4.4-20% recurrence rate per a year.…”

Analysis of Clinical Isolates of Helicobacter pylori in Pakistan Reveals High Degrees of Pathogenicity and High Frequencies of Antibiotic Resistance

“…Three previous studies investigating H. pylori resistance have been published from the Southern part of Pakistan (approximately 1400 km from the Northern region). These showed wide variations in the frequencies of antibiotic resistance to MTZ (89.0% and 48% of H. pylori isolates with resistance to MTZ not being analyzed in the third study), CLR resistance in 36.0%, 64.0%, and 33.0% of isolates, and AML resistance in 37.0%, 98.0%, and 2.0% of isolates, respectively [36–38]. Geographic variations in the antibiotic resistance of H. pylori are related to the consumption of antibiotics in different communities [39].…”

“…Given that nucleotide substitutions in other antibiotic resistance-associated genes, such as rdxA associated with MTZ resistance, may not in fact be responsible for the drug resistance, clearly further experiments (mutagenic analysis by transformation) are required to substantiate any direct association of this novel nucleotide variation in the 23S rRNA gene to CLR resistance. It is also worth noting that despite the high CLR resistance rates seen in H. pylori isolates from Pakistan, a recent study has reported a low incidence of recurrence of H. pylori infection in patients [38]. …”