Reconciliation of Recent Helicobacter pylori Treatment Guidelines in a Time of Increasing Resistance to Antibiotics

Fallone, Carlo A; Moss, Steven F.; Malfertheiner, Peter

doi:10.1053/j.gastro.2019.04.011

Cited by 208 publications

(252 citation statements)

References 59 publications

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“…In contrast, using the methodology outlined and paying special attention to rapid plating onto culture media, we have shown that successful culture can be achieved almost three quarters of the time. Susceptibility data are crucial, and others have also called for national and regional data availability to guide antibiotic choices . Such data, as we confirm here, while not generally available, can be quite useful when obtained …”

Section: Discussionmentioning

confidence: 57%

“…We also do not have a control group where empirical HP rescue therapy is prescribed, to compare the value of culture to empirical treatment. The majority of our referral period is prior to the suggestion of quadruple therapy as first line eradication . There were seven patients who were not able to be cultured, this may have been due to prior antibiotic exposure, but given the retrospective nature of our study, we were not able to confirm this.…”

Section: Discussionmentioning

confidence: 85%

“…We also add to a growing experience that rifabutin‐containing regimens may be effective for resistant HP infections . Studies in the Netherlands, Italy and Germany have demonstrated that rifabutin resistance is rare, and it is overall considered a third or fourth line agent . Rifabutin based therapies are not without side effects, however, as a reversible myelotoxicity has been described, though its reversibility and lack of association with increased infections is notable .…”

Section: Discussionmentioning

confidence: 92%

“…The falling cure rates have prompted changes in guidelines, which are currently recommending quadruple therapy as first line . Guidelines suggest evaluating local resistance patterns in order to provide appropriate eradication regimens, yet resistance patterns in the US are poorly studied and largely unknown, with few recent studies identifying patterns of resistance, and two of the most prominent being over 15 years old . Moreover, reimbursement, procedural risk and patient preference prohibit feasibility of uniform culture guided treatment of patients …”

Section: Introductionmentioning

confidence: 99%

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Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

et al. 2020

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Summary Introduction Helicobacter pylori (HP) resistance is increasing in the US. Guidelines suggest treatment based on local resistance patterns, yet are poorly studied. Here, we describe resistance patterns of the Delaware Valley. Methods Retrospective study of patients referred to the Hospital of the University of Pennsylvania, between 2009 and 2019 who underwent endoscopy for culture. Chart review identified demographics, history, endoscopic and culture results, treatment and follow‐up. Results Of 109 patients referred for refractory HP, 90 had identified HP. Median age was 53.2 years and the majority was female (74%), with a median two previous antibiotic courses for HP. Gastric erythema was the most common endoscopic abnormality. Sixty‐five (72.2%) were culture positive, and 45 (69.2%) were resistant to levofloxacin, 27 (41.5%) to metronidazole and 39 (43.3%) to clarithromycin. Being resistant to any one of the three antibiotics was associated with resistance to either of the other two. There was an association with number of previous antibiotics with resistance (OR 1.74, P < 0.05). We prescribed therapy to 77 patients based on susceptibility profiles, and 34 (37.8%) were cured, 14 (15.6%) underwent endoscopic surveillance, 3 (3.3%) were followed by infectious disease, and 39 (43.3%) were lost to follow up. Conclusions Antibiotic resistance is associated with refractory HP, and continues to rise. Culturing is associated with cure, and its use in clinical practice regarding efficacy, cost‐effectiveness and ability to minimise antibiotic resistance should be further studied. Overall follow‐up is limited by loss to follow‐up, emphasising the need for appropriate treatment.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

et al. 2020

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“…37 Therefore, intervening persistent inflammation induced by H pylori may effectively reduce the damage to the host. And it is noticeable that chronic gastritis generally persists even after successful H pylori eradication therapy.…”

Section: Discussionmentioning

confidence: 99%

Upexpression of BHLHE40 in gastric epithelial cells increases CXCL12 production through interaction with p‐STAT3 in Helicobacter pylori ‐associated gastritis

Teng

Zhao

et al. 2019

FASEB j.

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BHLHE40, a member of the basic helix-loop-helix transcription factor family, has been reported to play an important role in inflammatory diseases. However, the regulation and function of BHLHE40 in Helicobacter pylori (H pylori)-associated gastritis is unknown. We observed that gastric BHLHE40 was significantly elevated in patients and mice with H pylori infection. Then, we demonstrate that H pyloriinfected GECs express BHLHE40 via cagA-ERK pathway. BHLHE40 translocates to cell nucleus, and then binds to cagA protein-activated p-STAT3 (Tyr705). The complex increases chemotactic factor CXCL12 expression (production). Release of CXCL12 from GECs fosters CD4 + T cell infiltration in the gastric mucosa. Our results identify the cagA-BHLHE40-CXCL12 axis that contributes to inflammatory response in gastric mucosa during H pylori infection.

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Gastritis and gastropathy

Washington¹,

Peek²

2022

Yamada's Textbook of Gastroenterology

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Reconciliation of Recent Helicobacter pylori Treatment Guidelines in a Time of Increasing Resistance to Antibiotics

Cited by 208 publications

References 59 publications

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

Upexpression of BHLHE40 in gastric epithelial cells increases CXCL12 production through interaction with p‐STAT3 in Helicobacter pylori ‐associated gastritis

Gastritis and gastropathy

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