Treatment of Helicobacter pylori infection in atrophic gastritis

Abstract

Helicobacter pylori (Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis (AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows: (1) Cure of infection, resolution of inflammation and normalization of gastric functions; (2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and (3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric pH, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infection, there is a paucity of evidence in the subgroup of patients with AG. Bismuth-based therapy may be an attractive treatment in the specific setting of AG, and specific studies on the efficacy of bismuth-based therapies are needed in patients with AG.

Changes in Helicobacter pylori Immunoglobulin G Levels and Gastric Mucosal Atrophy after Successful Eradication of Helicobacter pylori

“…Many studies have reported that H. pylori eradication contributes to improving gastric mucosal atrophy. [17][18][19] Previously, we also reported that the H. pylori eradication ameliorates the risk of development of metachronous gastric neoplasia in patients who underwent endoscopic resection, and it was associated with elevated serum PG I/II ratios in the follow-up, suggesting that the eradication improved the gastric mucosal status. 16 In addition, several studies have attempted to show whether changes in serum PG was related to successful bacterial eradication.…”

Crohn’s disease with isolated gastric involvement as an example of a rare disease phenotype: a clinical case

“…Согласно рекомендации ACG, при лечении пациентов с БК препараты выбираются на основе клинических проявлений и прогноза пациента [28]. Несмотря на то что ИПП могут использоваться в качестве первоначального лечения желудочных поражений при БК [22], их эффективность в лечении подобных поражений остается спорной [42,43]. Различия в определении конечных целей лечения, таких как улучшение симптомов или заживление слизистой оболочки, могут быть одной из причин этого противоречия.…”

“…У нашей пациентки ИПП не использовались в связи с ее отказом принимать данные препараты из-за отсутствия выраженного клинического эффекта в купировании синдрома абдоминальной боли и желудочной диспепсии на начальных этапах лечения. Кроме того, у пациентки имело место снижение секреторной функции желудка (снижение пепсиногена I и гипергастринемия), определялась умеренная атрофия желез и крупноочаговая кишечная метаплазия эпителия желудка при гистологическом исследовании желудочных биоптатов, что также ограничивает использование ИПП [43].…”

Analysis of drug resistance in Helicobacter pylori by complete genome sequencing in Bama County, Guangxi, China

“…Helicobacter pylori (Hp) is recognized as an important human pathogen that colonizes the gastric mucus resulting in super cial gastritis, atrophic gastritis and gastric cancer [1][2][3] . Present treatments for Hp infection include proton pump inhibitors or bismuth in combination with amoxicillin or metronidazole and clarithromycin [4][5] . The rate of drug resistance is increasing due to a wide range of use of antibiotics and high resistance rates to clarithromycin, metronidazole and levo oxacin are associated with the failure of Hp eradication [6][7][8] .…”