With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment reg...With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.展开更多
The bacterial pathogen Helicobacter pylori (H. pylori) colonizes in over half of the world’s population. H. pylori that establishes life-long infection in the stomach is definitely associated with gastro-d...The bacterial pathogen Helicobacter pylori (H. pylori) colonizes in over half of the world’s population. H. pylori that establishes life-long infection in the stomach is definitely associated with gastro-duodenal diseases and a wide variety of non-gastrointestinal tract conditions such as immune thrombocytopenia. Triple therapy which consists of a proton pump inhibitor and combinations of two antibiotics (amoxicillin, clarithromycin or amoxicillin, metronidazol) is commonly used for H. pylori eradication. Recently, the occurrence of drug-resistant H. pylori and the adverse effect of antibiotics have severely weakened eradication therapy. Generally antibiotics induce the disturbance of human gastrointestinal microflora. Furthermore, there are inappropriate cases of triple therapy such as allergy to antibiotics, severe complications (liver and/or kidney dysfunction), the aged and people who reject the triple therapy. These prompt us to seek alterative agents instead of antibiotics and to develop more effective and safe therapy with these agents. The combination of these agents actually may result in lower a dose of antibiotics. There are many reports world-wide that non-antibiotic substances from natural products potentially have an anti-H. pylori agent. We briefly review the constituents derived from nature that fight against H. pylori in the literature with our studies.展开更多
AIM： To develop a serum or histological marker for early discovery of gastric atrophy or intestinal metaplasia. METHODS： This study enrolled 44 patients with gastric adenocarcinoma, 52 patients with duodenal ulcer, ...AIM： To develop a serum or histological marker for early discovery of gastric atrophy or intestinal metaplasia. METHODS： This study enrolled 44 patients with gastric adenocarcinoma, 52 patients with duodenal ulcer, 14 patients with gastric ulcer and 42 consecutive healthy adults as controls. Each patient received an endoscopy and five biopsy samples were obtained. The degrees of histological parameters of gastritis were categorized following the Updated Sydney System. Anti-parietal cell antibodies （APCA） and anti- Helicobacter pylori （ H pylori） antibodies （AHPA） were analyzed by immunoassays. Hpyloriinfection was diagnosed by rapid unease test and histological examination. RESULTS： Patients with gastric cancer and gastric ulcer are significantly older than healthy subjects, while also displaying higher frequency of APCA than healthy controls. Patients with positive APCA showed higher scores in gastric atrophy and intestinal metaplasia of corpus than patients with negative APCA. Patients with positive AHPA had higher scores in gastric atrophy, intestinal metaplasia, and gastric inflammation of antrum than those patients with negative AHPA. Elderly patients had greater prevalence rates of APCA. Following multivariant logistic regression analysis, the only significant risk factor for antral atrophy is positive AHPA, while that for corpus atrophy is positive APCA. CONCLUSION： The existence of positive APCA correlates with glandular atrophy in corpus and the presence of positive AHPA correlates with glandular atrophy in antrum. The existence of serum APCA and AHPA betokens glandular atrophy and requires further examination for gastric cancer.展开更多
Infection with Helicobacter pylori (H. pylori) is an important known risk factor for gastric disease. At least half the world’s population is under the influence of this bacterium type. So many therapeutic studies fo...Infection with Helicobacter pylori (H. pylori) is an important known risk factor for gastric disease. At least half the world’s population is under the influence of this bacterium type. So many therapeutic studies focus on treat gastric disease. But these treatments could be interrupted due to metabolic toxic and show the drug resistance. The objective of this study was to investigate the effecting degree of H. pylori with different type of honey samples from Turkey. The study was supported by bioactivity results of total phenolic (TPC) and flavonoid content (TFC). The agar-well diffusion assay was carried out on H. pylori strain J99 and the inhibition zones were measured and compared with standards. Inhibition of H. pylori urease as IC50 ranged from 2.67-18.12 mg/mL. These results were supported by TPC and TFC had range from 22.10-79.00 mg Gallic Acid Equivalent (GAE)/100 honey and 0.88-7.08 mg Quercetin Equivalent (QE)/100 g honey, respectively. These results indicate that honey extracts may be appropriate agents to treat H. pylori by inhibition effect.展开更多
Therapeutic management of Helicobacter pylori(H.pylori)remains an unsolved issue.Indeed,no therapeutic regimen is able to cure the infection in all treated patients,and in many the infection persists despite the admin...Therapeutic management of Helicobacter pylori(H.pylori)remains an unsolved issue.Indeed,no therapeutic regimen is able to cure the infection in all treated patients,and in many the infection persists despite the administration of several consecutive standard therapies.Although antibiotic resistance reports describe alarming results,the outcome of therapeutic regimens does not seem to parallel this scenario in most cases,since a successful performance is often reached in more than 80%of cases.However,the phenomenon of increasing antibiotic resistance is being closely studied,and the results show controversial aspects even in the same geographic area.For the continents of Europe,America,Asia,Africa,and Oceania,minimal and maximal values of resistance to the main antibiotics(clarithromycin,amoxicillin,metronidazole,and levofloxacin)feature wide ranges in different countries.The real enigma is therefore linked to the several different therapeutic regimens,which show results that often do not parallel the in vitro findings even in the same areas.A first aspect to be emphasized is that some regimens are limited by their use in very small geographic districts.Moreover,not all therapeutic trials have considered bacterial and host factors affecting the therapeutic outcome.The additional use of probiotics may help to reduce adverse events,but their therapeutic impact is doubtful.In conclusion,the"ideal therapy",paradoxically,appears to be a"utopia",despite the unprecedented volume of studies in the field and the real breakthrough in medical practice made by the discovery and treatment of H.pylori.The ample discrepancies observed in the different areas do not encourage the development of therapeutic guidelines that could be valid worldwide.On these bases,one of the main challenges for the future might be identifying a successful solution to overcome antibiotic resistances.In this context,geography must be considered a relevant matter.展开更多
AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pyl...AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy(January 2015 to December 2015) who received the ^(13)C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTS Of the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval(CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0%(95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3%(95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144(17%) reported treatment-related adverse events including 24(3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio(AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments(AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy(AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy(AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication. CONCLUSION Furazolidone-and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.展开更多
Helicobacter pylori(H.pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide.H.pylori treatment sti...Helicobacter pylori(H.pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide.H.pylori treatment still remains a challenge,since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance,mucosal drug concentration,patient compliance,side-effect profile and cost.While no new drug has been developed,current therapy still relies on different mixture of known antibiotics and anti-secretory agents.A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen.Bismuthcontaining quadruple treatment,sequential treatment or a non-bismuth quadruple treatment(concomitant) are also an alternative therapy.Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H.pylori after defeat of first-line therapy.The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies.Therefore,adding probiotic to the medications,developing anti-H.pylori photodynamic or phytomedicine therapy,and achieving a successful H.pylori vaccine may have the promising to present synergistic or additive consequence against H.pylori,because each of them exert different effects.展开更多
Worldwide prevalence of Helicobacter pylori(H.pylori) infection is approximately 50%,with the highest being in developing countries.We compared cure rates and tolerability(SE) of second-line anti-H.pylori levofloxacin...Worldwide prevalence of Helicobacter pylori(H.pylori) infection is approximately 50%,with the highest being in developing countries.We compared cure rates and tolerability(SE) of second-line anti-H.pylori levofloxacin/amoxicillin(LA)-based triple regimens vs standard quadruple therapy(QT).An English language literature search was performed up to October 2010.A meta-analysis was performed including randomized clinical trials comparing 7-or 10-d LA with 7-d QT.In total,10 articles and four abstracts were identified.Overall eradication rate in LA was 76.5%(95% CI:64.4%-97.6%).When only 7-d regimens were included,cure rate was 70.6%(95% CI:40.2%-99.1%),whereas for 10-d combinations,cure rate was significantly higher(88.7%;95% CI:56.1%-109.9%;P < 0.05).Main eradication rate for QT was 67.4%(95% CI:49.7%-67.9%).The 7-d LA and QT showed comparable efficacy [odds ratio(OR):1.09;95% CI:0.63-1.87],whereas the 10-d LA regimen was significantly more effective than QT(OR:5.05;95% CI:2.74-9.31;P < 0.001;I 2 = 75%).No differences were reported in QT eradication rates among Asian and European studies,whereas LA regimens were more effective in European populations(78.3% vs 67.7%;P = 0.05).Incidence of SE was lower in LA therapy than QT(OR:0.39;95% CI:0.18-0.85;P = 0.02).A higher rate of side effects was reported in Asian patients who received QT.Our findings support the use of 10-d LA as a simple second-line treatment for H.pylori eradication with an excellent eradication rate and tolerability.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.展开更多
Mastic gum is derived from the tree named Pistacia lentiscus that is grown only in Island Hios of Greek.Since Mastic was first reported to kill Helicobacter pylori(H.pylori)in 1998,there has been no further study to e...Mastic gum is derived from the tree named Pistacia lentiscus that is grown only in Island Hios of Greek.Since Mastic was first reported to kill Helicobacter pylori(H.pylori)in 1998,there has been no further study to elucidate which component of mastic specifically shows the antimicrobial activity against H.pylori.In this study,we examined which component of mastic gum was responsible for anti-H.pylori activity.We prepared the essential oil of mastic gum and identified 20 constituents by GC–MS analysis.Ten standard components were assayed for anti-H.pylori activity,and it clarified that a-terpineol and(E)-methyl isoeugenol showed the anti-H.pylori activity against four different H.pylori strains that were established from patients with gastritis,gastric ulcer and gastric cancer.These components could be useful to overcome the drug-resistance H.pylori growth in stomach.展开更多
BACKGROUND Helicobacter pylori(H.pylori)is the most important infectious agent and plays an important role in the progression of chronic gastritis and the development of gastric cancer.AIM To identify efficient therap...BACKGROUND Helicobacter pylori(H.pylori)is the most important infectious agent and plays an important role in the progression of chronic gastritis and the development of gastric cancer.AIM To identify efficient therapeutic agents or strategies that can treat H.pylori infection.METHODS We performed literature analysis,experimental validation,and network pharmacology.First,traditional Chinese medicine(TCM)prescriptions for the treatment of H.pylori infection were obtained from the China National Knowledge Infrastructure,China Biology Medicine,China Science and Technology Journal Database,and WanFang databases.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).Next,we used TCM Inheritance Support System V2.5 to identify core drug combinations in the TCM prescriptions.Then,an H.pylori-associated chronic mouse model of gastritis was established.The antibacterial properties and antiinflammatory potential of the core drug combination were evaluated by the rapid urease test,modified Warthin-Starry silver staining,histopathological analysis,and enzyme linked immunosorbent assay.Finally,the active compounds,hub targets,and potential signaling pathways associated with the core drug combination were analyzed by network pharmacology.RESULTS The TCM treatment of H.pylori was mainly based on reinforcing the healthy Qi and eliminating pathogenic factors by simultaneously applying pungent dispersing,bitter descending,cold and warm drugs.The combination of Coptis,Pinellia,and Scutellaria(CPS)was identified as the core drug combination from 207 prescriptions and 168 herbs.This drug combination eradicated H.pylori,alleviated the gastric pathology induced by H.pylori infection,and reduced the expression levels of tumor necrosis factor-α(P=0.024)and interleukin-1β(P=0.001).Moreover,a total of 35 compounds and 2807 targets of CPS were identified using online databases.Nine key compounds(tenaxin I,neobaicalein,norwogonin,skullcapflavone II,baicalein,5,8,2'-trihydroxy-7-methoxyflavone,acacetin,panicolin,and wogonin)and nine hub target proteins(EGFR,PTGS2,STAT3,MAPK3,MAPK8,HSP90AA1,MAPK1,MMP9,and MTOR)were further explored.Seventy-seven signaling pathways were correlated with H.pylori-induced inflammation and carcinogenesis.CONCLUSION In summary,we showed that CPS is the core drug combination for treating H.pylori infection.Animal experiments demonstrated that CPS has bacteriostatic properties and can reduce the release of inflammatory cytokines in the gastric mucosa.Network pharmacology predictions further revealed that CPS showed complex chemical compositions with multi-target and multipathway regulatory mechanisms.Although the results derived from network pharmacology are not necessarily comprehensive,they still expand our understanding of CPS for treating H.pylori infection.展开更多
BACKGROUND Antibiotic resistance to Helicobacter pylori(H.pylori)infection,which ultimately results in eradication failure,has been an emerging issue in the clinical field.Recently,to overcome this problem,an antibiot...BACKGROUND Antibiotic resistance to Helicobacter pylori(H.pylori)infection,which ultimately results in eradication failure,has been an emerging issue in the clinical field.Recently,to overcome this problem,an antibiotic sensitivity-based tailored therapy(TT)for H.pylori infection has received attention.AIM To investigate the efficacy and safety profiles of TT for H.pylori infection treatment compared to a non-bismuth quadruple therapy,concomitant therapy(CT)regimen.METHODS We included patients(>18 years)with an H.pylori infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October 2020.After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner,patient compliance,eradication success rate(ESR),and patient-reported side effects profiles were assessed and compared between the two groups.H.pylori infection was diagnosed using a rapid urease test,Giemsa stain,or dual priming oligonucleotide polymerase chain reaction(DPO-PCR).Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation.For the TT group,a DPO-PCR test,which detected A2142G and/or A2143G point mutations,and a clarithromycin resistance test were performed.Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy,while those with sensitive results were treated with the standard triple regimen.RESULTS Of the 217 patients with a treatment naive H.pylori infection,110 patients[mean age:58.66±13.03,men,n=55(50%)]were treated with TT,and 107 patients[mean age:56.67±10.88,men,n=52(48.60%)]were treated with CT.The compliance(TT vs CT,100%vs 98.13%,P=0.30),and follow-up loss rates(8.18%vs 9.35%,P=0.95)were not significantly different between the groups.The ESR after treatment was also not statistically different between the groups(TT vs CT,82.73%vs 82.24%,P=0.95).However,the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group(22.77%vs 50.52%,P<0.001).CONCLUSION The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea,especially when physicians are confronted with increased antibiotic resistance rates.展开更多
Helicobacter pylori （H. pylori ） is a very common bacterium that infects about 50% of the world population in urban areas and over 90% of people living in rural and developing countries. Fluoroquinolones, a class o...Helicobacter pylori （H. pylori ） is a very common bacterium that infects about 50% of the world population in urban areas and over 90% of people living in rural and developing countries. Fluoroquinolones, a class of antimicrobials, have been extensively used in eradic-ation regimens for H. pylori . Levofloxacin is the most commonly used, and in second-line regimens, is one of the most effective options. However, an increasing resistance rate of H. pylori to fuoroquinolones is being observed, that will likely affect their effectiveness in the near future. Other novel fluoroquinolone molecules, such as moxifoxacin, sitafoxacin, gatifoxacin and gemif-loxacin, have been proposed and showed encouraging results in vitro, although data on their clinical use are still limited. Further studies in large sample trials are needed to confirm their safety and efficacy profile in clinical practice.展开更多
文摘With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.
基金Supported by JSPS KAKENHI Grant,No.24590697 and No.24590698the Vietnam National Foundation for Science and Technology Development(NAFOSTED,106.99-2011.22)
文摘The bacterial pathogen Helicobacter pylori (H. pylori) colonizes in over half of the world’s population. H. pylori that establishes life-long infection in the stomach is definitely associated with gastro-duodenal diseases and a wide variety of non-gastrointestinal tract conditions such as immune thrombocytopenia. Triple therapy which consists of a proton pump inhibitor and combinations of two antibiotics (amoxicillin, clarithromycin or amoxicillin, metronidazol) is commonly used for H. pylori eradication. Recently, the occurrence of drug-resistant H. pylori and the adverse effect of antibiotics have severely weakened eradication therapy. Generally antibiotics induce the disturbance of human gastrointestinal microflora. Furthermore, there are inappropriate cases of triple therapy such as allergy to antibiotics, severe complications (liver and/or kidney dysfunction), the aged and people who reject the triple therapy. These prompt us to seek alterative agents instead of antibiotics and to develop more effective and safe therapy with these agents. The combination of these agents actually may result in lower a dose of antibiotics. There are many reports world-wide that non-antibiotic substances from natural products potentially have an anti-H. pylori agent. We briefly review the constituents derived from nature that fight against H. pylori in the literature with our studies.
基金Supported by Research Grant VGHKS-92-20 and VGHKS-93-28from Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, China
文摘AIM： To develop a serum or histological marker for early discovery of gastric atrophy or intestinal metaplasia. METHODS： This study enrolled 44 patients with gastric adenocarcinoma, 52 patients with duodenal ulcer, 14 patients with gastric ulcer and 42 consecutive healthy adults as controls. Each patient received an endoscopy and five biopsy samples were obtained. The degrees of histological parameters of gastritis were categorized following the Updated Sydney System. Anti-parietal cell antibodies （APCA） and anti- Helicobacter pylori （ H pylori） antibodies （AHPA） were analyzed by immunoassays. Hpyloriinfection was diagnosed by rapid unease test and histological examination. RESULTS： Patients with gastric cancer and gastric ulcer are significantly older than healthy subjects, while also displaying higher frequency of APCA than healthy controls. Patients with positive APCA showed higher scores in gastric atrophy and intestinal metaplasia of corpus than patients with negative APCA. Patients with positive AHPA had higher scores in gastric atrophy, intestinal metaplasia, and gastric inflammation of antrum than those patients with negative AHPA. Elderly patients had greater prevalence rates of APCA. Following multivariant logistic regression analysis, the only significant risk factor for antral atrophy is positive AHPA, while that for corpus atrophy is positive APCA. CONCLUSION： The existence of positive APCA correlates with glandular atrophy in corpus and the presence of positive AHPA correlates with glandular atrophy in antrum. The existence of serum APCA and AHPA betokens glandular atrophy and requires further examination for gastric cancer.
文摘Infection with Helicobacter pylori (H. pylori) is an important known risk factor for gastric disease. At least half the world’s population is under the influence of this bacterium type. So many therapeutic studies focus on treat gastric disease. But these treatments could be interrupted due to metabolic toxic and show the drug resistance. The objective of this study was to investigate the effecting degree of H. pylori with different type of honey samples from Turkey. The study was supported by bioactivity results of total phenolic (TPC) and flavonoid content (TFC). The agar-well diffusion assay was carried out on H. pylori strain J99 and the inhibition zones were measured and compared with standards. Inhibition of H. pylori urease as IC50 ranged from 2.67-18.12 mg/mL. These results were supported by TPC and TFC had range from 22.10-79.00 mg Gallic Acid Equivalent (GAE)/100 honey and 0.88-7.08 mg Quercetin Equivalent (QE)/100 g honey, respectively. These results indicate that honey extracts may be appropriate agents to treat H. pylori by inhibition effect.
文摘Therapeutic management of Helicobacter pylori(H.pylori)remains an unsolved issue.Indeed,no therapeutic regimen is able to cure the infection in all treated patients,and in many the infection persists despite the administration of several consecutive standard therapies.Although antibiotic resistance reports describe alarming results,the outcome of therapeutic regimens does not seem to parallel this scenario in most cases,since a successful performance is often reached in more than 80%of cases.However,the phenomenon of increasing antibiotic resistance is being closely studied,and the results show controversial aspects even in the same geographic area.For the continents of Europe,America,Asia,Africa,and Oceania,minimal and maximal values of resistance to the main antibiotics(clarithromycin,amoxicillin,metronidazole,and levofloxacin)feature wide ranges in different countries.The real enigma is therefore linked to the several different therapeutic regimens,which show results that often do not parallel the in vitro findings even in the same areas.A first aspect to be emphasized is that some regimens are limited by their use in very small geographic districts.Moreover,not all therapeutic trials have considered bacterial and host factors affecting the therapeutic outcome.The additional use of probiotics may help to reduce adverse events,but their therapeutic impact is doubtful.In conclusion,the"ideal therapy",paradoxically,appears to be a"utopia",despite the unprecedented volume of studies in the field and the real breakthrough in medical practice made by the discovery and treatment of H.pylori.The ample discrepancies observed in the different areas do not encourage the development of therapeutic guidelines that could be valid worldwide.On these bases,one of the main challenges for the future might be identifying a successful solution to overcome antibiotic resistances.In this context,geography must be considered a relevant matter.
基金Supported by the Zhejiang Science and Technology Project,No.LGF18H160012
文摘AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy(January 2015 to December 2015) who received the ^(13)C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTS Of the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval(CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0%(95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3%(95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144(17%) reported treatment-related adverse events including 24(3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio(AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments(AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy(AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy(AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication. CONCLUSION Furazolidone-and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.
文摘Helicobacter pylori(H.pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide.H.pylori treatment still remains a challenge,since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance,mucosal drug concentration,patient compliance,side-effect profile and cost.While no new drug has been developed,current therapy still relies on different mixture of known antibiotics and anti-secretory agents.A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen.Bismuthcontaining quadruple treatment,sequential treatment or a non-bismuth quadruple treatment(concomitant) are also an alternative therapy.Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H.pylori after defeat of first-line therapy.The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies.Therefore,adding probiotic to the medications,developing anti-H.pylori photodynamic or phytomedicine therapy,and achieving a successful H.pylori vaccine may have the promising to present synergistic or additive consequence against H.pylori,because each of them exert different effects.
文摘Worldwide prevalence of Helicobacter pylori(H.pylori) infection is approximately 50%,with the highest being in developing countries.We compared cure rates and tolerability(SE) of second-line anti-H.pylori levofloxacin/amoxicillin(LA)-based triple regimens vs standard quadruple therapy(QT).An English language literature search was performed up to October 2010.A meta-analysis was performed including randomized clinical trials comparing 7-or 10-d LA with 7-d QT.In total,10 articles and four abstracts were identified.Overall eradication rate in LA was 76.5%(95% CI:64.4%-97.6%).When only 7-d regimens were included,cure rate was 70.6%(95% CI:40.2%-99.1%),whereas for 10-d combinations,cure rate was significantly higher(88.7%;95% CI:56.1%-109.9%;P < 0.05).Main eradication rate for QT was 67.4%(95% CI:49.7%-67.9%).The 7-d LA and QT showed comparable efficacy [odds ratio(OR):1.09;95% CI:0.63-1.87],whereas the 10-d LA regimen was significantly more effective than QT(OR:5.05;95% CI:2.74-9.31;P < 0.001;I 2 = 75%).No differences were reported in QT eradication rates among Asian and European studies,whereas LA regimens were more effective in European populations(78.3% vs 67.7%;P = 0.05).Incidence of SE was lower in LA therapy than QT(OR:0.39;95% CI:0.18-0.85;P = 0.02).A higher rate of side effects was reported in Asian patients who received QT.Our findings support the use of 10-d LA as a simple second-line treatment for H.pylori eradication with an excellent eradication rate and tolerability.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
文摘Mastic gum is derived from the tree named Pistacia lentiscus that is grown only in Island Hios of Greek.Since Mastic was first reported to kill Helicobacter pylori(H.pylori)in 1998,there has been no further study to elucidate which component of mastic specifically shows the antimicrobial activity against H.pylori.In this study,we examined which component of mastic gum was responsible for anti-H.pylori activity.We prepared the essential oil of mastic gum and identified 20 constituents by GC–MS analysis.Ten standard components were assayed for anti-H.pylori activity,and it clarified that a-terpineol and(E)-methyl isoeugenol showed the anti-H.pylori activity against four different H.pylori strains that were established from patients with gastritis,gastric ulcer and gastric cancer.These components could be useful to overcome the drug-resistance H.pylori growth in stomach.
基金Supported by the Domestic First-class Construction Disciplines of the Hunan University of Chinese Medicine,No. 2018[03]the Key Scientific Research Project of Hunan Provincial Education Board,No. 20A371the Key Programs of Administration of Traditional Chinese Medicine of Hunan Province,No. C2022016
文摘BACKGROUND Helicobacter pylori(H.pylori)is the most important infectious agent and plays an important role in the progression of chronic gastritis and the development of gastric cancer.AIM To identify efficient therapeutic agents or strategies that can treat H.pylori infection.METHODS We performed literature analysis,experimental validation,and network pharmacology.First,traditional Chinese medicine(TCM)prescriptions for the treatment of H.pylori infection were obtained from the China National Knowledge Infrastructure,China Biology Medicine,China Science and Technology Journal Database,and WanFang databases.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).Next,we used TCM Inheritance Support System V2.5 to identify core drug combinations in the TCM prescriptions.Then,an H.pylori-associated chronic mouse model of gastritis was established.The antibacterial properties and antiinflammatory potential of the core drug combination were evaluated by the rapid urease test,modified Warthin-Starry silver staining,histopathological analysis,and enzyme linked immunosorbent assay.Finally,the active compounds,hub targets,and potential signaling pathways associated with the core drug combination were analyzed by network pharmacology.RESULTS The TCM treatment of H.pylori was mainly based on reinforcing the healthy Qi and eliminating pathogenic factors by simultaneously applying pungent dispersing,bitter descending,cold and warm drugs.The combination of Coptis,Pinellia,and Scutellaria(CPS)was identified as the core drug combination from 207 prescriptions and 168 herbs.This drug combination eradicated H.pylori,alleviated the gastric pathology induced by H.pylori infection,and reduced the expression levels of tumor necrosis factor-α(P=0.024)and interleukin-1β(P=0.001).Moreover,a total of 35 compounds and 2807 targets of CPS were identified using online databases.Nine key compounds(tenaxin I,neobaicalein,norwogonin,skullcapflavone II,baicalein,5,8,2'-trihydroxy-7-methoxyflavone,acacetin,panicolin,and wogonin)and nine hub target proteins(EGFR,PTGS2,STAT3,MAPK3,MAPK8,HSP90AA1,MAPK1,MMP9,and MTOR)were further explored.Seventy-seven signaling pathways were correlated with H.pylori-induced inflammation and carcinogenesis.CONCLUSION In summary,we showed that CPS is the core drug combination for treating H.pylori infection.Animal experiments demonstrated that CPS has bacteriostatic properties and can reduce the release of inflammatory cytokines in the gastric mucosa.Network pharmacology predictions further revealed that CPS showed complex chemical compositions with multi-target and multipathway regulatory mechanisms.Although the results derived from network pharmacology are not necessarily comprehensive,they still expand our understanding of CPS for treating H.pylori infection.
基金National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-2020R1F1A1076839。
文摘BACKGROUND Antibiotic resistance to Helicobacter pylori(H.pylori)infection,which ultimately results in eradication failure,has been an emerging issue in the clinical field.Recently,to overcome this problem,an antibiotic sensitivity-based tailored therapy(TT)for H.pylori infection has received attention.AIM To investigate the efficacy and safety profiles of TT for H.pylori infection treatment compared to a non-bismuth quadruple therapy,concomitant therapy(CT)regimen.METHODS We included patients(>18 years)with an H.pylori infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October 2020.After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner,patient compliance,eradication success rate(ESR),and patient-reported side effects profiles were assessed and compared between the two groups.H.pylori infection was diagnosed using a rapid urease test,Giemsa stain,or dual priming oligonucleotide polymerase chain reaction(DPO-PCR).Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation.For the TT group,a DPO-PCR test,which detected A2142G and/or A2143G point mutations,and a clarithromycin resistance test were performed.Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy,while those with sensitive results were treated with the standard triple regimen.RESULTS Of the 217 patients with a treatment naive H.pylori infection,110 patients[mean age:58.66±13.03,men,n=55(50%)]were treated with TT,and 107 patients[mean age:56.67±10.88,men,n=52(48.60%)]were treated with CT.The compliance(TT vs CT,100%vs 98.13%,P=0.30),and follow-up loss rates(8.18%vs 9.35%,P=0.95)were not significantly different between the groups.The ESR after treatment was also not statistically different between the groups(TT vs CT,82.73%vs 82.24%,P=0.95).However,the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group(22.77%vs 50.52%,P<0.001).CONCLUSION The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea,especially when physicians are confronted with increased antibiotic resistance rates.
文摘Helicobacter pylori （H. pylori ） is a very common bacterium that infects about 50% of the world population in urban areas and over 90% of people living in rural and developing countries. Fluoroquinolones, a class of antimicrobials, have been extensively used in eradic-ation regimens for H. pylori . Levofloxacin is the most commonly used, and in second-line regimens, is one of the most effective options. However, an increasing resistance rate of H. pylori to fuoroquinolones is being observed, that will likely affect their effectiveness in the near future. Other novel fluoroquinolone molecules, such as moxifoxacin, sitafoxacin, gatifoxacin and gemif-loxacin, have been proposed and showed encouraging results in vitro, although data on their clinical use are still limited. Further studies in large sample trials are needed to confirm their safety and efficacy profile in clinical practice.
