Factors Affecting the Intraluminal Therapy for Helicobacter pylori Infection

Abstract

Helicobacter pylori (H. pylori) can be eradicated immediately while conducting an endoscopic examination. The eradication rate of intraluminal therapy for H. pylori infection (ILTHPI) is 53.7% (51/95) via local application of single-dose medicament containing amoxicillin, metronidazole, and clarithromycin. We aimed to evaluate factors affecting ILTHPI and to assess the efficacy among single antibiotics, and compared our results with combined antibiotics. We enrolled H. pylori-infected treatment-naïve symptomatic patients; 95 completed triple-antibiotic ILTHPI were evaluated for risk factors, along with 60 completed mono-antibiotic ILTHPI containing amoxicillin, clarithromycin, or metronidazole in each of the 20 patients. Univariate analysis revealed the significant influence of BMI (OR: 1.15; 95% CI: 1.03–1.27, p = 0.011) and gastric juice pH (OR: 1.35; 95% CI: 1.16–1.58, p = 0.0001). Logistic regression analysis also showed significant influence of gastric juice pH (OR: 1.30; 95% CI: 1.10–1.54, p = 0.002). The eradication rate of mono-antibiotic ILTHPI is significantly lower than triple-antibiotic ILTHPI (11.7% vs. 53.7%; p < 0.0001; α = 0.05, power = 1.0). The efficacy was 20% (4/20) for metronidazole, 10% (2/20) for amoxicillin, and 5% (1/20) for clarithromycin. In conclusion, the level of gastric juice pH is a crucial factor affecting the ILTHPI. The detection of gastric juice pH and selection of optimal intraluminal medicaments are important. Further studies with combined antibiotics for ILTHPI, perhaps metronidazole-containing medicaments, are recommended.

Intraluminal Therapy for Helicobacter pylori Infection—Comparison of Medicament Containing Tetracycline, Metronidazole, and Bismuth versus Amoxicillin, Metronidazole, and Clarithromycin: A Randomized Controlled Study

“…One patient in Group A (1.9%; 95% CI: <0.01% to 11.1%) and two patients in Group B (3.8%; 95% CI: 0.3% to 13.7%) had watery diarrhea 3–5 times in 1 or 2 days following the ILTHPI; there is no significant difference for the incidence rate of the adverse event between Group A and Group B ( p = 1.0). The overall incidence rate of adverse events was 2.9% (3/104; 95% CI: 0.6% to 8.5%) and the severity of adverse events after ILTHPI was mild as those of our previous reports [ 12 , 14 ]. We must mention that the potential side effects of sedated endoscopy (nausea and dizziness) were overcome in this study after we provided a more comfortable recovery room (quiet and dark place) and a longer wait time for the sedation to wear off.…”

“…All the 286 patients, aged between 20 and 75, were positive for 13 C-UBT. Patients with any of the following were excluded from the study, with the same criteria as our previous studies [ 12 , 14 ]. “(1) contraindication of endoscopic examination; (2) previous gastric surgery; (3) gastroduodenal deformity, stenosis, or obstruction; (4) gastroduodenal malignancy; (5) previous eradication therapy for H. pylori ; (6) use of antibiotics or bismuth salts in the previous 4 weeks; (7) use of PPI or H 2 -blocker in the previous 2 weeks; (8) previous allergic history to medications used for the ILTHPI; (9) pregnant or lactating women; (10) severe concurrent diseases (such as advanced renal disease or decompensated liver cirrhosis) or malignancy; and (11) inability to give written informed consent or refused ILTHPI”.…”

“…Patients in Group A or Group B were further randomized to receive either dexlansoprazole (60 mg delayed release capsule) one capsule twice a day or vonoprazan (20 mg film-coated tablet) one tablet per day. According to our previous study designs [ 12 , 14 ], “the clinical characteristics, endoscopic findings, and levels of gastric juice pH were recorded. All the procedures of ILTHPI were performed by a single, experienced senior gastroenterologist, and were strictly followed as detailed in our previous report [ 12 ].…”

“…The procedures of ILTHPI and the post-ILTHPI follow-ups of the patients were strictly followed as our previous designs [ 12 , 14 ]. “Patients took two orally disintegrating lansoprazole tablets (30 mg each) before ILTHPI and 8 to 10 h after ILTHPI”.…”

Detection and Treatment of Helicobacter pylori: Problems and Advances

“…Patient nonadherence, duration of therapies, dosage of PPIs (the level of gastric juice pH), body mass index, optimal dosage of antibiotics, and number of drugs are associated with the efficacy of eradication treatment. For example, overweight and low level of gastric juice pH are found to reduce the eradication rate [ 59 , 60 ]. Prolonged duration may be able to increase the eradication rate [ 61 ].…”