A new look at anti-Helicobacter pylori therapy

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.

Implications of anti-parietal cell antibodies and anti-Helicobacter pylori antibodies in histological gastritis and patient outcome

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.

Natural products and food components with anti-Helicobacter pylori activities

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.

Evaluation of Anti-Helicobacter Pylori Activity and Urease Inhibition by Some Turkish Authentic Honeys

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.

根除幽门螺杆菌5种治疗方案的药物经济学评价

目的 探讨不同的方案根除幽门螺杆菌 (Hp)所产生的经济效果。方法 15 1例幽门螺杆菌阳性感染的消化性溃疡和胃炎患者 ,随机分为 5组 ,给予不同的短程三联治疗方案 :A组 (胶体次枸橼酸铋 +阿莫西林 +甲硝唑 )、B组 (胶体次枸橼酸铋 +克拉霉素 +甲硝唑 )、C组 (奥美拉唑 +阿莫西林 +克拉霉素 )、D组 (奥美拉唑 +阿莫西林 +甲硝唑 )、E组 (奥美拉唑 +克拉霉素 +甲硝唑 ) ,运用药物经济学的成本 -效果分析方法进行评价。结果 A、B、C、D、E 5组治疗胃炎Hp根除率分别为 6 3 2 %、 70 9%、 89 1%、 77 6 %、 86 8% ,治疗消化性溃疡Hp根除率分别为 6 5 1%、 73 0 %、 96 2 %、 80 4 %、 93 2 % ,5组方案对胃炎 /消化性溃疡的成本 -效果比 (C/E)分别为 3 14 / 3 0 5、 4 10 / 3 98、 4 2 5 / 3 94、 2 91/ 2 81、 2 78/ 2 5 9,增长的成本 -效果比 (△C/△E)分别为 - / -、12 0 0 / 11 70、 6 96 / 5 80、 1 93/ 1 81、 1 83/ 1 5 3。结论 E方案为根除Hp的最佳方案。

Chemical Composition of the Essential Oil of Mastic Gum and their Antibacterial Activity Against Drug-Resistant Helicobacter pylori

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.

Coptis,Pinellia,and Scutellaria as a promising new drug combination for treatment of Helicobacter pylori infection

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.

In vitro anti-Helicobacter pylori activity of aqueous extract from Persian Oak testa

Objective:Growing problem of antibiotic resistance in Helicobacter pylori,as a common cause of chronic gastritis and even stomach cancer,demands searching for novel candidates of herbal sources.This study is aimed at assessing the antimicrobial activity of aqueous extract obtained from Quercus brantii var.persica seed coat(Testa)on H.pylori isolated from gastric biopsy specimens.Methods:Such specimens were collected from 100 patients presenting with endoscopic gastroduodenal findings.Testa extracts were prepared from Persian Oak forests in the province of Kohgiluyeh and BoyerAhmad,IRAN.H.pylori isolates were obtained by a series of standard bacteriology tests and cell culture,then were confirmed by PCR.The activity of testa extracts towards 25 H.pylori isolates was assessed by well diffusion method,microdilution assay,and a disk diffusion assay in vitro.Results were analyzed statistically by one-way ANOVA analysis.Results:Aqueous extract of testa demonstrated an antimicrobial activity with zone diameters of inhibition ranged from 0 mm to 40 mm.Its inhibitory activity increased simultaneously with increasing extract concentration.The lowest MIC and MBC were both recorded as 2μg/m L.Anti-H.pylori activity of testa extract was approximately close to tetracycline and metronidazole and less than amoxicillin.A potent extract of testa possessed significant inhibitory activity(P<0.05).Conclusion:Testa extract is suggested as a natural therapeutic source against the gastric H.pylori infection.However,evaluating the in vivo activity of this extract is necessary too.

抗幽门螺杆菌药物联合甲硫霜治疗酒渣鼻疗效观察

目的探讨抗幽门螺杆菌(Hp)药物联合甲硫霜治疗酒渣鼻的疗效。方法 78例酒渣鼻患者随机分为两组,两组均外涂甲硫霜,3次/d。在此基础上,治疗组口服奥美拉唑、克拉霉素、替硝唑,两组疗程均为14 d,疗程结束判定疗效。结果治疗组有效率为82.50%,对照组有效率为32.84%,两组有效率比较差异有统计学意义(χ2=16.96,P<0.01)。结论抗Hp药物能显著提高治疗酒渣鼻的疗效。

用蛋白芯片技术检测幽门螺杆菌抗体在临床上的应用

目的:通过检测幽门螺杆菌(HP)患者血清中细胞毒素相关蛋白(CagA)、尿素酶(UreC)、热休克蛋白(HSP60)的抗体谱,探讨HP感染的消化道疾病患者在不同年龄组的分布及种类的差异。方法:采用蛋白芯片方法对457例临床患者HP血清进行检测。结果:检测出HP阳性率为89.72%,高于广州地区(63.1%),其中老年组检测率最高为91.59%。老年组UreC抗体阳性率为74.30%,高于儿童组和青年组,差异有统计学意义。CagA、UreC感染的毒力株以青年组为主,高于儿童组和老年组。结论:提示HP感染的青年组以UreC、Ca-gA为主,老年组以UreC和UreC、HSP60为主。通过筛查不同的抗体类型,可为临床诊断治疗消化道疾病提供重要的指导意义。