Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil:A national survey

AIM To evaluate bacterial resistance to clarithromycin and fluoroquinolones in Brazil using molecular methods.METHODS The primary antibiotic resistance rates of Helicobacter pylori(H. pylori) were determined from November 2012 to March 2015 in the Southern,South-Eastern,Northern,North-Eastern,and Central-Western regions of Brazil. Four hundred ninety H. pylori patients [66% female,mean age 43 years(range: 18-79)] who had never been previously treated for this infection were enrolled. All patients underwent gastroscopy with antrum and corpus biopsies and molecular testing using Geno Type Helico DR(Hain Life Science,Germany). This test was performed to detect the presence of H. pylori and to identify point mutations in the genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from the biopsies,multiplex amplification,and reverse hybridization. RESULTS Clarithromycin resistance was found in 83(16.9%) patients,and fluoroquinolone resistance was found in 66(13.5%) patients. There was no statistical difference in resistance to either clarithromycin or fluoroquinolones(P = 0.55 and P = 0.06,respectively) among the different regions of Brazil. Dual resistance to clarithromycin and fluoroquinolones was found in 4.3%(21/490) of patients. The A2147 G mutation was present in 90.4%(75/83),A2146 G in 16.9%(14/83) and A2146 C in 3.6%(3/83) of clarithromycin-resistant patients. In 10.8%(9/83) of clarithromycin-resistant samples,more than 01 mutation in the 23 S r RNA gene was noticed. In fluoroquinolone-resistant samples,37.9%(25/66) showed mutations not specified by the Geno Type Helico DR test. D91 N mutation was observed in 34.8%(23/66),D91 G in 18.1%(12/66),N87 K in 16.6%(11/66) and D91 Y in 13.6%(9/66) of cases. Among fluoroquinolone-resistant samples,37.9%(25/66) showed mutations not specified by the Geno Type Helico DR test. CONCLUSION The H. pylori clarithromycin resistance rate in Brazil is at the borderline(15%-20%) for applying the standard triple therapy. The fluoroquinolone resistance rate(13.5%) is equally concerning.

Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents:a twelve-year experience

Background:There are few data regarding endoscopic retrograde cholangiopancreatography(ERCP)usefulness in children and adolescents.We reviewed the long-term experience with diagnostic and therapeutic ERCP in a tertiary single center in Southern Brazil.Methods:A retrospective chart review of patients aged 0-18 years who had undergone ERCPs from January 2000 to June 2012 was done.Data on demographics,indications,diagnosis,treatments,and complications were collected.Results:Seventy-five ERCPs were performed in 60 patients.The median age of the patients at the procedure was 13.9 years(range:1.2-17.9).Of the 60 patients,47(78.3%)were girls.Of all ERCPs,48(64.0%)were performed in patients above 10 years and 35(72.9%)of them were in girls.ERCP was indicated for patients with bile duct obstruction(49.3%),sclerosing cholangitis(18.7%),post-surgery complication(12%),biliary stent(10.7%),choledochal cyst(5.3%),and pancreatitis(4%).The complication rate of ERCP was 9.7%involving mild bleeding,pancreatitis and cholangitis.Patients who had therapeutic procedures were older(13.7±3.9 vs.9.9±4.9 years;P=0.001)and had more extrahepatic biliary abnormalities(82%vs.50%;P=0.015)than those who had diagnostic ERCPs.A marked change in the indications of ERCPs was found,i.e.,from 2001 to 2004,indications were more diagnostic and from 2005 therapeutic procedures were predominant.Conclusions:Diagnostic ERCPs are being replaced by magnetic resonance cholangiopancreatography and also by endoscopic ultrasound.All these procedures are complementary and ERCP still has a role for therapeutic purposes.