Short‐term and long‐term impacts of Helicobacter pylori eradication with reverse hybrid therapy on the gut microbiota

Abstract

Background and Aims:Anti-Helicobacter pylori therapy may lead to the growth of pathogenic or antibiotic-resistant bacteria in the gut. The study aimed to investigate the shortterm and long-term impacts of H. pylori eradication with reverse hybrid therapy on the components and macrolide resistance of the gut microbiota. Methods: Helicobacter pylori-related gastritis patients were administered a 14-day reverse hybrid therapy. Fecal samples were collected before treatment and at the end of week 2, week 8, and week 48. The V3-V4 region of the bacterial 16S rRNA gene in fecal specimens was amplified by polymerase chain reaction and sequenced on Illumina MiSeq platform. Additionally, amplification of erm(B) gene (encoding erythromycin resistance methylase) was performed. Results: Reverse hybrid therapy resulted in decreased relative abundances of Firmicutes (from 62.0% to 30.7%; P < 0.001) and Actinobacteria (from 3.4% to 0.6%; 0.032) at the end of therapy. In contrast, the relative abundance of Proteobacteria increased from 10.2% to 49.1% (0.002). These microbiota alterations did not persist but returned to the initial levels at week 8 and week 48. The amount of erm(B) gene in fecal specimens was comparable with the pretreatment level at week 2 but increased at week 8 (0.025) and then returned to the pretreatment level by week 48. Conclusions: Helicobacter pylori eradication with reverse hybrid therapy can lead to short-term gut dysbiosis. The amount of erm(B) gene in the stool increased transiently after treatment and returned to the pretreatment level at 1-year post-treatment.

Helicobacter pylori infection and eradication: Exploring their impacts on the gastrointestinal microbiota

“…Previous multiple time‐point follow‐up studies found that alpha diversity was recovered 8 weeks after eradication 51 . Similarly, other researchers recorded alpha diversity at weeks 0, 2, 8, and 48 reporting that the value was recovered at week 8 as well 53 . In accordance with these reports, most studies gathering follow‐up information within 2 months showed a decreased alpha diversity, whereas studies gaining information thereafter frequently reported no significant differences with baseline 9,50,51,53‐57 .…”

“…As a general trend, alpha diversity tended to decrease immediately after eradication and reverted thereafter (Figure 2; Table 4). 50‐53 Specifically, how much time is needed for restoration remains to be elucidated. Previous multiple time‐point follow‐up studies found that alpha diversity was recovered 8 weeks after eradication 51 .…”

Long‐term changes in the gut microbiota after 14‐day bismuth quadruple therapy in penicillin‐allergic children

“…We searched PubMed using the terms “Helicobacter”, “eradication” and “microbiota” for papers published from January 1, 2000, to March 12, 2020, in English. Sixteen studies using high‐throughput sequencing to assess alterations in the gut microbiota before and after H pylori eradication are summarized in Table 17‐32 . 10 publications focus on the impact of standard triple therapy and 5 studies address the long‐term (at least one year) effect after treatment.…”

The Efficacy of Washed Microbiota Transplantation on Helicobacter pylori Eradication: A Pilot Study

“…The increased antibiotic resistance in H. pylori will further reduce patients' quality of life and increase the cost-effectiveness of antibiotic-based therapy [ 8 ]. In addition, prolonged eradication therapy for H. pylori infection also leads to dysbiosis of the intestinal microbiota and increases the expression of resistance genes, which may further induce various diseases [ 12 , 15 , 16 , 29 ]. However, with the emergence of WMT and fecal suspension capsules, the safety and convenience of WMT have been significantly improved [ 23 , 30 ].…”

“…Previous studies have shown that H. pylori infection causes gastrointestinal microbiota disorder, and this change is reversible after H. pylori eradication [ 12 – 14 ]. In addition, antibiotic-based treatments for H. pylori eradication have been shown to cause gut microbiota dysbiosis and lead to the increase of erm (B) gene (a gene encoding erythromycin-resistant methylase), which would compromise the efficacy of eradiation therapy regimens including a macrolide [ 12 , 15 , 16 ]. Therefore, it may be possible to reverse the colonization of H. pylori by restoring the gastrointestinal microbiota.…”