Systematic review of vonoprazan as Helicobacter pylori eradication therapy / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of vonoprazan （VPZ） for Helicobacter pylori （Hp） eradication therapy. METHODS Retrieved from The Cochrane Library， Embase， PubMed， CNKI， VIP and Wanfang database， randomized controlled trials about VPZ for Hp eradication therapy （trial group） versus proton pump inhibitor （PPI） （control group） were collected during the inception to July 2022. After data extraction and quality evaluation with bias risk assessment tool recommended by Cochrane System Evaluation Manual 5.1.0， meta-analysis was performed by using RevMan5.3 software. RESULTS Nine studies with 2 134 patients were included. Compared with control group， the overall Hp eradication rate of trial group increased significantly in either the ITT analysis or PP analysis， being 87.5% vs. 76.2% [RR＝1.14， 95%CI （1.06，1.21）， P＜0.001] and 92.4% vs. 80.5% [RR＝1.11， 95%CI （1.03，1.21）， P＜0.01]， respectively. According to ITT and PP analysis of primary treatment subgroup， compared with control group， the overall Hp eradication rate of trial group increased significantly， being 88.4% vs. 76.5% [RR＝1.15， 95%CI （1.09，1.22）， P＜0.000 01] and 92.8% vs. 80.9% [RR＝1.12， 95%CI（1.03，1.23）， P＜ 0.05]； according to ITT and PP analysis of rescue therapy subgroup， there was no significant difference in the overall Hp eradication rate between control group and trial group （P＞0.05）. According to ITT and PP analysis of triple therapy subgroup， compared with control group， overall Hp eradication rate of trial group increased significantly， being 88.3% vs. 75.6% [RR＝1.16， 95%CI （1.08， 1.25）， P＜0.000 1] and 92.6% vs. 77.6% [RR=1.15， 95%CI （1.04， 1.28）， P＜0.01]； according to ITT and PP analysis of quadruple therapy subgroup， there was no significant difference in the overall Hp eradication rate between control group and trial group （P＞0.05）. Compared with control group， the incidence of adverse events in trial group decreased significantly， being 34.2% vs. 40.9% [RR＝0.84， 95%CI（0.70，0.99）， P＜ 0.05]. There was no statistical significance in the incidence of serious adverse events between 2 groups （P＞0.05）. CONCLUSIONS Compared with PPI therapy， the efficacy of VPZ-based triple therapy is better， particularly in primary treatment patients. However， VPZ has no significant advantage in rescue treatment and bismuth-containing quadruple regimen. And the safety and tolerance of VPZ for Hp eradication therapy are well， even better than PPI.

Efficacy and cost-effectiveness analysis of probiotics in initial Helicobacter pylori eradication therapy / 中华全科医师杂志

Objective:To analyze the efficacy and cost-effectiveness of probiotics in initial Helicobacter pylori ( H. pylori) eradication therapy. Methods:A total of 267 patients with positive H. pylori infection were randomly assigned to two groups, the control group ( n=133) received a 14-day bismuth agent quadruple therapy and the study group ( n=144) received conventional quadruple therapy plus probiotics from January 2020 to August 2021. Eradication status was assessed 4-12 weeks after treatment. The H.pylori eradication rate, adverse reactions, and cost-effectiveness were compared between the two groups. Results:The H.pylori eradication rate was higher in study group than that in the control group in intention-to-treat (ITT) (80.6%(108/134), 95% CI:73.8%-87.4% vs. 68.4%(91/133), 95% CI:60.4%-76.4%, P=0.022) and per-protocol (83.1%(108/130), 95% CI:76.5%-89.6% vs. 72.2%(91/126), 95% CI:64.3%-80.2%, P=0.037). The incidence of adverse effects in the study group was lower than that in the control group (8.2%(11/134) vs. 18.8%(25/133), χ 2=6.415, P=0.011). Cost-effectiveness analysis showed that compared with the control group, the incremental cost-effectiveness ratio (ICER) of the study group was 1 010.49 yuan. The single factor sensitivity analysis showed that the H.pylori eradication rate of the study group had a greater impact on the results, followed by that of the control group and the cost of bifidobacterium quadruplex viable tablets. The probability sensitivity analysis showed that when the willingness to pay value (WTP) was 2 500 yuan, the probability that the probiotics combined with the bismuth agent quadruple therapy group was more cost-effective than the simple bismuth agent quadruple therapy group was 91.2%. Conclusion:As initial Helicobacter pylori treatment, probiotics combined with the bismuth agent quadruple scheme has a higher eradication rate and a lower incidence of adverse events than the bismuth agent quadruple scheme.

Identification of coccoid forms of Helicobacter pylori and their clinical significance for eradication therapy / 中华传染病杂志

Objective:To investigate the factors associated with the occurrence of coccoid forms in clinical isolates of Helicobacter pylori ( H. pylori) and its relationship with the pathological changes of gastric mucosa. Methods:A total of 66 H. pylori-infected patients admitted to People′s Hospital of Ningxia Hui Autonomous Region from January 2020 to June 2021 were included.The clinical data of the patients were collected. Immunohistochemical staining was performed on gastric mucosal biopsy specimen to observe the occurrence of coccoid forms of H. pylori and pathological changes of gastric mucosa. Chi-square test was used for statistical analysis. Results:After immunohistochemical staining of 66 gastric mucosa biopsy specimens from H. pylori-infected patients, the co-existence of helical and coccoid forms of H. pylori was found in 26(39.39%) specimens, and no simple coccoid H. pylori change was found. Among them, the patients with a history of eradication therapy had a coccoid forms rate of 52.63%(20/38), and those without a history of eradication therapy had a coccoid forms rate of 21.43%(6/28), and the difference was statistically significant ( χ2=6.57, P=0.012). There were no significant differences in the coccoid forms rates between patients with different gender, ethnicity, age and gastric mucosal pathological changes (including atrophy, gastric intestinal metaplasia, inflammation, activity)(all P>0.050). Seventeen (73.9%) of the 23 patients whose endoscopy was more than one to three months from the last eradication therapy developed coccoid forms, while three of 15 patients whose endoscopy was more than three months from the last eradication therapy had coccoid forms, and the difference was statistically significant ( χ2=10.59, P=0.002). Conclusions:The transformation of H. pylori coccoid forms is related to the previous eradication therapy. The coccoid forms of H. pylori is equally pathogenic relative to the helical forms of H. pylori.

Efficacy and safety of potassium-competitive acid blockers versus proton pump inhibitors as Helicobacter pylori eradication therapy: a meta-analysis of randomized clinical trials

Abstract Background and aims: Potassium-Competitive Acid Blockers (P-CABs) have been used in Helicobacter pylori (H. pylori) eradication therapies in recent years. However, the efficacy and safety of P-CABs compared to ProtonPump Inhibitors (PPIs) in this setting remain controversial. Methods: The efficacy and safety of P-CABs and PPIs for H. pylori eradication were compared in a meta-analysis based on a systematic literature search of major electronic databases for relevant Randomized Controlled Trials (RCTs). Results: Seven studies and 1,168 patients were included. The pooled eradication rate determined by Intention-ToTreat (ITT) analysis was 90.2% for P-CAB-based and 75.5% for PPI-based triple therapy (pooled RR [95% CI] = 1.17 [1.08-1.28], p < 0.001). The Per-Protocol (PP) analysis also demonstrated significant superiority of P-CABs (pooled eradication rate = 92.4% vs. 77.8%; pooled RR [95% CI] = 1.14 [1.03-1.26], p < 0.01). In a subgroup evaluation, P-CABs were significantly better than PPIs as a first-line eradication therapy, in both the ITT analysis (pooled eradication rate = 91.8% vs. 76.4%; pooled RR [95% CI] = 1.18 [1.10-1.28], p < 0.0001) and the PP analysis (pooled eradication rate = 93.0% vs. 78.6%; pooled RR [95% CI] = 1.13 [1.02 -1.26], p < 0.05). However, P-CABs were not superior to PPIs when administered as salvage therapy, as determined in the ITT (75.0% vs. 66.0%, pooled RR [95% CI] = 1.11 [0.69-1.78], p = 0.66) and PP (85.7% vs. 70.0%, pooled RR [95% CI] = 1.20 [0.82-1.75], p = 0.34) analyses. In a subgroup analysis limited to Japanese patients, both the ITT analysis (pooled eradication rate = 89.6% vs. 73.9%; RR [95% CI] = 1.21 [1.14 -1.29], p < 0.01) and the PP analysis (pooled eradication rate = 92.0% vs. 75.7%; RR [95% CI] = 1.18 [1.06 -1.32], p < 0.01) showed that P-CABs were significantly superior compared to PPIs as triple eradication therapy. However, in the subgroup analysis of patients from other countries, there was no significant difference in either the ITT analysis (pooled eradication rate = 93.8% vs. 85.2%; RR [95% CI] = 1.10 [0.99-1.22], p = 0.07) or PP analysis (pooled eradication rate = 95.0% vs. 90.8%; RR [95% CI] = 1.05 [0.98-1.14], p = 0.17). The incidence of adverse events associated with the two regimens did not significantly differ (P-CABs vs. PPIs: 33.6% vs. 40.0%; RR [95% CI] = 0.84 [0.71‒1.00], p = 0.05). The incidence of serious adverse events and dropout rate due to adverse events also did not differ (p = 0.44 and p = 0.67, respectively). Conclusions: The efficacy of P-CAB-based triple therapy is superior to that of PPI-based triple therapy as a first-line approach to H. pylori eradication, particularly in Japanese patients. As salvage therapy, the efficacy of the two treatments did not significantly differ. The tolerability of P-CAB-based and PPI-based triple therapy was comparable, as was the incidence of adverse events. HIGHLIGHTS The efficacy of P-CAB-based triple therapy is superior to that of PPI-based triple therapy as a first-line approach to H. pylori eradication, particularly in Japanese patients. P-CABs were not superior to PPIs as a salvage triple eradication therapy. The safety and tolerability of P-CAB are comparable to PPI in H. pylori triple eradication therapies. Further large RCTs conducted in multiple regions and countries are necessary.

Quantitative Analysis of Major Shifts in Gut Microbiota Before and After Helicobacter pylori Eradication / 胃肠病学

Background: Helicobacter pylori (Hp) infection occurs in about half of the world's population, and Hp eradication therapy is an important method for treating Hp infection-related diseases. Aims: To explore the major shifts in gut microbiota before and after Hp eradication by using bismuth-containing quadruple therapy. Methods: Fifty Hp-positive patients in whom the Hp was successfully eradicated by bismuth-containing quadruple therapy from January 2016 to January 2017 at the Third People's Hospital of Shenzhen were enrolled. Using genus-specific primers and genomic DNA extracted from the fecal samples collected before and within 3 days after eradication therapy, a quantitative analysis of the major shifts in gut microbiota was accomplished by real-time PCR. Results: Compared with those before Hp eradication, fecal Enterobacterium and Enterococcus were significantly increased and Bifidobacterium, Bacteroides, Clostridium and total bacteria were significantly decreased after Hp eradication (P0.05). Conclusions: Eradication of Hp infection by bismuth-containing quadruple therapy may cause changes in gut microbiota composition and resulting in dysbiosis.

Efficacies of Reverse Hybrid Therapy in Eradication of Helicobacter pylori Infection

Introduction: Because the prevalence of antibiotic resistancemarkedly increases with time worldwide, anti-H. pyloritreatment is continuing to be a great challenge for physiciansin clinical practice. Eradication of H. pylori infection markedlychanges the natural history of peptic ulcer in patients withduodenal or gastric ulcer. Most peptic ulcers associated withH. pylori infection are curable. Aim of present study was tostudy the efficacies of 14 days ‘ Reverse Hybrid Therapy’ inH.pylori positive G.I.patients.Material and methods: 100 H.pylori positive patients withupper G.I. complaints who underwent upper GI endoscopywere included in the study. H.pylori infection was documentedby at least 2 positive results of Rapid Urease Test. Subjectswith any of the following criteria were excluded from thestudy. 1. Previous eradication therapy 2. Allergy to anyantibiotic used in study. 3. Co- existence of any serious illness.4. Pregnancy or lactating women 5. Previous gastrectomy6. Use of antibiotics within last 4 week. Detailed medicalhistory and demographic details of the patients were recorded.Routine haematogical tests and USG was done. Patients weregiven 14 days dual therapy ie quadruple regimen (proton pumpinhibitor + amoxicillin + clarithromycin + metronidazole) forfirst 7 days followed by dual regimen of PPI+ amoxicillin fornext 7 days. Patients were asked to report at 7, 14 days and at6 weeks interval.Results: Out of 97 patients 93 patients became negative forH.pylori after 6 week of Reverse Hybrid eradication therapy.It was observed that majority of patients enrolled in the studywere in the age group of 41–60 years (50%) followed bybelow 40 yrs (27%), above 60 yrs (23%). Out of them, 74%were male and 26% were female.Conclusion: Out of 97 patients 93 patients became negativefor H.pylori after 6 week of Reverse Hybrid eradicationtherapy. Hence, Reverse Hybrid Therapy is equally potenttherapy to Bismuth based therapy though the latter has a lotof side effects.

Oral medical dissolution of gallstones in patients with gallstone disease

Being the main treatment for cholelithiasis, laparoscopic cholecystectomy does not always solve the problem. It often entails postcholecystectomy syndrome (PCS). Oral medication to dissolve gallstones with bile acids is alternative therapy for some patients. However, lack of efficacy and limited medical indications make it necessary to apply combination treatment tactics. This study was conducted to investigate the dissolution of gallstones during the combined effects of ursodeoxycholic acid (UDCA) and rosuvastatin as well as to assess the results of eradication therapy in the presence of H. pylory as a measure to prevent cholelithiasis in the course of treatment.

Efficacy analysis of probiotics combined with standard therapy for eradication of Helicobacter pylori in children / 中华实用儿科临床杂志

Objective@#To evaluate the efficacy and safety of compound Lactobacillus acidophilus tablets or Saccharomyces boulardii Sachets combined with standard protocols for eradication of Helicobacter pylori(Hp) in children.@*Methods@#From March 2017 to March 2018, 120 children aged 3-10 years with Hp infection were admitted into the Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, including 67 male and 53 female childen.They were divided into 3 groups (control group, compound Lactobacillus acidophilus group, Saccharomyces boulardii Sachets group) by the method of random number table.Control group was given Clarithromycin+ Amoxicillin+ Omeprazole, for 14 days orally; compound Lactobacillus acidophilus group and Saccharomyces boulardii Sachets group were given drugs respectively on the first day, 500 mg of compound Lactobacillus acidophilus was added, twice a day or 250 mg of Saccharomyces boulardii Sachets group, twice a day orally, for 14 days, respectively.The adverse reactions in children were observed during the treatment, andurea 13C breath test or the stool Hp antigen test was performed at least 4 weeks by the end of the treatment, and the children with negative results were judged to be eradicated successfully.The ulcer healing, Hp eradication rate and incidence of adverse reactions(nausesa, vomiting, loss of appetite, constipation, diarrhea) among the 3 groups were observed and the Hp eradication rate and the incidence of adverse reactions (nausea, vomiting, loss of appetite, constipation, diarrhea) were compared.@*Results@#The eradication rates in the control group, the compound Lactobacillus group, and Saccharomyces boulardii Sachets group were 80.0% (32/40 cases), 85.0% (34/40 cases), and 87.5% (35/40 cases), respectively, and the difference was not statistically significant (P=0.646); the ulcer healing rate was 100.0% of 101 Hp eradicators in 3 groups, and the ulcer healing rate of 19 cases without Hp eradicated was 48.15%, and there was a significant difference between them (χ2=51.30, P<0.01). However, there was no significant difference in the total effective rate among 3 groups (P>0.05). The overall incidence of adverse reactions in Saccharomyces boulardii Sachets group (P=0.021) and the incidence of diarrhea (P=0.002) and loss of appetite (P=0.021) was lower than that in the control group, and the differences were statistically significant.There was no significant difference in the incidence of adverse reactions between the two probiotic groups (P>0.05).@*Conclusions@#Both compound Lactobacillus acidophilus tablets and Saccharomyces boulardii Sachets group can reduce the overall incidence of adverse reactions and the incidence of diarrhea and appetite declines in children′s standard Hp eradication regimen without affecting Hp eradication rate.

Role of Helicobacter pylori Eradication in Diarrhea-predominant Irritable Bowel Syndrome / 胃肠病学

Background:Irritable bowel syndrome (IBS)is a commonly seen functional intestinal disorder. The association between Helicobacter pylori (Hp)infection and IBS is not clarified yet. Aims:To investigate the role of Hp eradication in diarrhea-predominant IBS (IBS-D)and the relationship between Hp infection and IBS-D. Methods:A total of 335 IBS-D patients and 335 health examination subjects were recruited from Jan. 2009 to Dec. 2015 at Transportation Center Hospital of Yunnan Province and People's Hospital of Xishuangbanna Dai Autonomous Prefecture. All IBS-D patients were hospitalized patients and fulfilled the Rome Ⅲ criteria. Positive for both rapid urease test and 14 C-urea breath test was defined as Hp infection. Hp-positive IBS-D patients recruited in 2005 received Hp eradication therapy and were allocated into two groups according to the results of eradication therapy. Pinaverium bromide and montmorillonite powder were given in both groups and the clinical efficacy for IBS symptoms was assessed after treatment and followed up for 6 months. Results:The Hp infection rate of IBS-D patients was significantly higher than that in healthy controls (53. 7% vs. 41. 8%,P 0. 05). After a 6-month follow up,the differences were still insignificant (P > 0. 05). Conclusions:Hp infection is more prevalent in IBS-D patients than in general population,however,eradication of Hp has no impact on IBS symptoms. The association between Hp infection and IBS-D needs further study.

Advances in Study on Effects of Helicobacter pylori Eradication Therapy on Intestinal Microecology / 胃肠病学

It is documented that nearly half of the global population have been infected with Helicobacter pylori (Hp).In Chinese consensus report on management of Hp infection,bismuth quadruple therapy composed of proton pump inhibitor,bismuth and two antibiotics is recommended as the first-line Hp eradication regimen.However,large doses of oral antibiotics and PPI often disrupt the well-balanced host-microbial symbiotic state,and impair the protective effect of biological barrier.Furthermore,the alteration of microbial composition secondary to eradication therapy might be associated with the increased adverse effects of Hp eradication therapy and re-infection.This paper summarized the advances in study on effects of Hp eradication therapy on intestinal microecology and the advantages of probiotics supplementation in Hp eradication therapy.

Weifuchun Tablet or Bismuth Combined with Standard Triple Therapy for Helicobacter pylori Eradication: A Clinical Trial / 胃肠病学

Background: Integrative traditional Chinese and western medicine may be a new approach to improve the eradication rate of Helicobacter pylori (Hp).Aims: To compare the efficacy and safety of Weifuchun tablet versus bismuth combined with standard triple regimen as the first-line therapy of Hp infection.Methods: A total of 141 patients with Hp infection and na(i)ve to treatment were randomly assigned into 3 groups receiving a 14-day eradication therapy.In standard triple therapy group, esomeprazole, amoxicillin and clarithromycin were given twice a day;while in Weifuchun group and bismuth group, Weifuchun tablet and bismuth potassium citrate were added, respectively, to the standard triple therapy.Hp eradication was assessed by 13C-urea breath test at least 6 weeks after the end of treatment.Hp isolates were tested for resistance to antibiotics.Results: One hundred and twenty-eight patients completed the study.Hp eradication rates in Weifuchun group, bismuth group and standard triple therapy group were 83.7%, 91.8% and 79.1%, respectively by ITT analysis and 88.4%, 97.8% and 84.6%, respectively by PP analysis.The eradication rate of Weifuchun group was lower than that of bismuth group and higher than that of standard triple therapy group, but the differences were not statistically significant (P>0.05).Only PP eradication rate of bismuth group was significantly higher than that of standard triple therapy group (P0.05).Conclusions: Weifuchun tablet combined with standard triple regimen is safe and effective for use as first-line treatment for Hp infection, however, the eradication rate is relatively low in cases infected with clarithromycin resistant strains.Bismuth combined with standard triple regimen is a good alternative in areas with high clarithromycin resistance and regions where tetracycline is unavailable.

Erradicación de Helicobacter pylori para la trombocitopenia inmune: protocolo de una revisión sistemática / Eradication of Helicobacter pylori for immune thrombocytopenia: protocol of a systematic review

Introducción: La trombocitopenia inmune es una enfermedad caracterizada por destrucción plaquetaria mediada por anticuerpos. Se ha planteado que Helicobacter pylori podría actuar como gatillante y modulador de dicha enfermedad, por lo que el objetivo de esta revisión es evaluar si la erradicación de este agente podría constituir un tratamiento efectivo para la trombocitopenia inmune. Métodos: El protocolo fue diseñado, y será reportado, en línea con Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Se realizará una búsqueda de estudios controlados aleatorizados, que incluyan pacientes con trombocitopenia inmune y que hayan recibido terapia de erradicación para Helicobacter pylori. Los desenlaces a evaluar serán el sangrado, la mortalidad, la necesidad de esplenectomía, el incremento en el recuento plaquetario, entre otros. Realizaremos búsquedas sensibles en MEDLINE, CENTRAL y EMBASE, sin restricción por lenguaje o publicación, las cuales serán complementadas con búsquedas en otras fuentes. Al menos dos investigadores realizarán de manera independiente la selección de los estudios y la extracción de los datos. Se evaluará el riesgo de sesgo utilizando la herramienta recomendada por la colaboración Cochrane. Se realizará metanálisis y se presentarán los datos mediante el método GRADE. Fortalezas y debilidades: Esta revisión sistemática entregará una síntesis rigurosa y actualizada de los efectos de la erradicación de Helicobacter pylori en la trombocitopenia inmune. La principal limitación podría provenir de la baja revisión sistemática (PROSPERO): CRD42015022161.(AU)

Background: Immune Thrombocytopenia is a condition characterized by antibody-mediated platelet destruction. Helicobacter pylori has been postulated as a potential trigger or modulator in this disease, so Helicobacter pylori eradication has been proposed as a reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We will conduct a search of randomized controlled trials, including patients with immune thrombocytopenia that received eradication therapy for Helicobacter pylori. The evaluated outcomes will be bleeding, mortality, need of splenectomy, platelet count, among others. We will develop sensitive search strategies for MEDLINE, EMBASE and CENTRAL, with no language or publication restriction. We will complement electronic searches with other sources. At least two reviewers will independently select trials and extract data. We will use Cochrane tool for risk of bias assessment to assess included studies. We will conduct meta-analysis and data will be presented using the GRADE approach. Strengths and limitations: This systematic review will provide a rigorous and updated summary of the effects of Helicobacter pylori eradication on immune thrombocytopenia. The main limitation might arise from the low quantity or quality of trials identified for this topic. Systematic review register number (PROSPERO): CRD42015022161(AU)

The Clinical Features and Helicobacter pylori Eradication Therapy in Lymphofollicular Gastritis: A Single Center Experience

BACKGROUND/AIMS: Lymphofollicular gastritis (LFG) is defined as antral gastritis with endoscopic findings characterized by a miliary pattern resembling “goose flesh”. We aimed to analyze the clinical features of LFG and the utility of Helicobacter pylori eradication therapy in LFG. MATERIALS AND METHODS: Patients with LFG, regardless of upper gastrointestinal symptoms (7 men, 28 women; age range, 21~67 years), were examined for H. pylori using the CLO test during endoscopy. One specimen was obtained from the greater curvatures of the lower body and the antrum. Clinical features were compared according to H. pylori-positive status. RESULTS: Among 35 patients with LFG, 31 (88.6%) were infected with H. pylori. LFG predominantly affected young women (28/35, 80.0%; mean age, 43.73 years). One case of gastric cancer with H. pylori-positive LFG was found. H. pylori eradication rate in LFG patients was low (3/12, 25.0%). CONCLUSIONS: LFG is closely associated with H. pylori infection and predominantly affects women and young adults. Future studies are needed to determine whether H. pylori eradication reduces the risk of gastric cancer.

The Effects of Helicobacter pylori Eradication Therapy for Chronic Idiopathic Thrombocytopenic Purpura

BACKGROUND/AIMS: The aim of this study was to evaluate the ability of Helicobacter pylori eradication treatment to increase platelet counts in Korean patients with chronic idiopathic thrombocytopenic purpura (ITP). METHODS: A total of 102 patients were evaluated against two criteria. First, those diagnosed with H. pylori infections in whom eradication was successful were assigned to the H. pylori-positive and -eradicated group (n=39), whereas those diagnosed with H. pylori infections in whom eradication failed were assigned to the H. pylori-positive and -non-eradicated group (n=3), and those without H. pylori infections were assigned to the H. pylori-negative group (n=60). Second, patients with complete remission in whom the platelet recovery effect was maintained over the average follow-up period of 6 months after eradication therapy were defined as the responder group (n=58), whereas those with partial or no response were defined as the nonresponder group (n=44). RESULTS: The platelet counts of the H. pylori-positive and -eradicated group were significantly increased 6 months after eradication therapy compared to those of the H. pylori-positive and -non-eradicated group and the H. pylori-negative group (43.2±29.1 to 155.3±68.7×10(3)/μL vs 42.5±28.1 to 79.8±59.7×10(3)/μL vs 43.1±28.9 to 81.2±62.2×10(3)/μL; p=0.041). The eradication therapy success rate in the responder group was 100.0% (39/39), in contrast to the nonresponder group (0%, 0/3) (p<0.001). CONCLUSIONS: H. pylori eradication therapy was related to increased platelet count, and successful eradication affected the increased platelet count in Korean patients with chronic ITP.

Clinical significance of drug sensitive test for the eradication of Helicobacter pylori infection and peptic ulcer / 中国生化药物杂志

Objective To explore the value of Helicobacter pylori( Hp) drug sensitivity test for clinical treatment of Hp infection and peptic ulcer. Methods Selected from February 2013 to October 2014 gastroenterology clinic in the hospital inpatient treatment and 120 patients( Steering Group) , of which 69 cases of gastric ulcer, duodenal ulcer 51 patients, mucosal lesions in patients took tissue culture Hp, Hp strain cultured to antibiotic susceptibility testing by disk diffusion method and based on susceptibility testing to guide treatment , alternative 120 cases of peptic ulcer patients as a routine group, ulcer treatment effect was observed between two groups and Hp eradication therapy.Results Steering group of 120 patients, 75 patients were successfully cultured Hp, susceptibility test results: the most sensitive to gentamicin(94.67%), followed furazolidone(88.00%), the lowest sensitivity to metronidazole(8.00 %);reviewed 4 weeks after treatment, ulcer healing rate of steering group of patients 93.33% was significantly higher than the end of treatment 4 weeks after the ulcer healing rate of regular group of 81.67%, steering group of patients with abdominal pain short time (3.5 ±1.5)d was significantly shorter than conventional group of patients(4.3 ±1.7) d; Hp eradication of steering group patients was 89.17%significantly higher than conventional group were 78.33% and the difference was statistically significant ( P<0.05 ) .Conclusion According Hp susceptibility testing, can choose Hp sensitive proton pump inhibitor combination of antibiotics amoxicillin treatment, can achieve more significant clinical effect.

Relevance between Gastrointestinal Microbiota and Helicobacter pylori Eradication Therapy / 胃肠病学

Gastrointestinal microbiota is a huge and complex system that has multiple influential factors. As an exogenous pathogen,Helicobacter pylori(Hp)may interact with gastrointestinal microbiota. It has been revealed that Hp infection led to an increase in Lactobacillus acidophilus in intestinal tract and a decrease in Actinobacteria,Bacteroidetes and Firmacutes in stomach. Proton pump inhibitors and antibiotics,the major components of eradication regimens for Hp infection,may also have an impact on gastrointestinal microbiota. On the other hand,gastrointestinal microbiota interferes with Hp’s attachment into gastric mucosa. Probiotics combined with eradication therapy could benefit the eradication rate of Hp infection and reduce adverse events.

Roadmap for elimination of gastric cancer in Korea

Most gastric cancers are caused by infection with the common human bacterial pathogen, Helicobacter pylori. It is now accepted that gastric cancer can be prevented and virtually eliminated by H. pylori eradication and this knowledge was responsible for country-wide H. pylori eradication combined with secondary cancer prevention for those with residual risk that was introduced in Japan in 2013. Korea is a high H. pylori prevalence and high gastric cancer incidence country and a good candidate for a gastric cancer elimination program. The presence of an H. pylori infection is now considered as an indication for treatment of the infection. However, antimicrobial drug resistance is common among H. pylori in Korea making effective therapy problematic. Country-wide studies of the local and regional antimicrobial resistance patterns are needed to choose the most appropriate therapies. H. pylori and gastric cancer eradication can be both efficient and cost effective making it possible and practical to make Korea H. pylori and gastric cancer free. There is no reason to delay.

Changes in Upper Gastrointestinal Diseases according to Improvement of Helicobacter pylori Prevalence Rate in Korea / 대한소화기학회지

Helicobacter pylori can cause variety of upper gastrointestinal disorders such as peptic ulcer, mucosa associated lymphoid tissue (MALT)-lymphoma, and gastric cancer. The prevalence of H. pylori infection has significantly decreased in Korea since 1998 owing to active eradication of H. pylori. Along with its decrease, the prevalence of peptic ulcer has also decreased. However, the mean age of gastric ulcer increased and this is considered to be due to increase in NSAID prescription. Gastric cancer is one of the leading causes of cancer deaths in Korea and Japan, and IARC/WHO has classified H. pylori as class one carcinogen of gastric cancer. Despite the decreasing prevalence of H. pylori infection, the total number of gastric cancer in Korea has continuously increased from 2006 to 2011. Nevertheless, the 5 year survival rate of gastric cancer patients significantly increased from 42.8% in 1993 to 67% in 2010. This increase in survival rate seems to be mainly due to early detection of gastric cancer and endoscopic mucosal dissection treatment. Based on these findings, the prevalence of peptic ulcer is expected to decrease even more with H. pylori eradication therapy and NSAID will become the main cause of peptic ulcer. Although the prevalence of gastric cancer has not changed along with decreased the prevalence of H. pylori, gastric cancer is expected to decrease in the long run with the help of eradication therapy and endoscopic treatment of precancerous lesions.

Prevalence of Helicobacter pylori infection in 125 patients with type 2 diabetes and its effects on diabetic gastroparesis / 中华消化杂志

Objective To investigate the prevalence of Helicobacter pylori (H .pylori)infection in type 2 diabetic patients and its effects on diabetic gastroparesis.Methods Prospective clinical case-control study was applied.From January 2011 to December 2013,125 hospitalized patients with type 2 diabetes and 142 healthy controls without dyspeptic symptoms were enrolled.The prevalence of H .pylori infection and the incidence of gastroparesis in 125 patients with diabetes were investigated in both two groups.The patients with type 2 diabetes were divided into groups according to the course of the disease,and the prevalence of gastroparesis and H .pylori infection of each group were analyzed.The patients with type 2 diabetes and healthy controls confirmed with H .pylori infection were treated with eradication therapy,the rate of eradication of two groups was compared.The improved symptoms of gastroparesis before and after eradication therapy of patients with type 2 diabetes were compared.The chi-square test was performed for statistical analysis.Results The prevalence of H .pylori infection in type 2 diabetic patients was 66.4%(83/125),which was significantly higher than that of healthy control group (51 .4%,73/142 )(χ2 =5 .549,P <0.05).The prevalence of gastroparesis in diabetic patients with the disease course less than 10 years,10 to 20 years and more than 20 years was 33.8% (27/80 ),47.1 % (16/34 )and 8/11 , respectively.The difference was statistically significant (χ2 = 6.554,P < 0.05).The prevalence of H .pylori infection in patients with gastroparesis was 78.4% (40/51 ),which was significantly higher than that of patients without gastroparesis (58.1 %,43/74)(χ2 =4.716,P <0.05).The eradication rate of H .pylori infection in patients with type 2 diabetes was 68.7% (57/83),which was lower than that of healthy control group (87.8%,36/41),and the difference was statistically significant (χ2 =4.385 ,P <0.05).The incidence of epigastric pain and distension,early satiety and apocleisis before H .pylori eradication in type 2 diabetes patients was 75 .9% (63/83 ),66.3% (55/83 )and 67.5 % (56/83 ), respectively,while after eradication which was 44.6%(37/83),37.3%(31/83)and 39.8%(33/83)after eradication,respectively.The differences were statistically significant (χ2 =15 .720,12.764 and 11 .724;all P <0.01).Conclusions The prevalence of H .pylori infection is significantly higher in type 2 diabetic patients,and gastroparesis in type 2 diabetic patients may be correlated with H .pylori infection.The eradication rate in type 2 diabetic patients was lower,and H .pylori eradication therapy can efficiently improve the symptoms of dyspepsia in diabetic patients with gastroparesis.

The relationship between helicobacter pylori eradication and curative effect of gastroesophageal reflux disease / 重庆医学

Objective To investigate the relationship between helicobacter pylori(HP)eradication and curative effect of gastroe-sophageal reflux disease(GERD) .Methods Two hundred and fifty four patients with GERD were prospectively recruited for endo-scope and acid reflux evaluation .According to the results of gastroscope ,the eligible patients were divided into non-erosive reflux disease (NERD) and erosive esophagitis (EE) group ,and each divided into HP positive and HP negative group ,the HP positive group were randomly divided into the anti HP treatment group and not .These patients were assigned to rabeprazole triple therapy (the anti HP treatment group) or rabeprazole(20 mg ,twice per day) single(other groups) for 10 d ,then rabeprazole (20mg ,twice per day) was given to all patients until two months .Then all patients underwent acid reflux evaluation ,EE group underwent endos-copy ,and all patients underwent a 13 C urea breath test 4 weeks after cessation of rabeprazole to determine HP status .Results One hundred and seventy nine GERD patients were included in the study(NERD group 119 cases ,including anti HP treatment group 47 cases ,not anti HP treatment group 32 cases ,HP negative group 40 cases ;EE group 60 cases ,including anti HP treatment group 24 cases ,not anti HP treatment group 15 cases ,HP negative group 21 cases) .HP was eradicated in 76 .6% of the NERD anti HP treatment group and in 75 .0% of the EE anti HP treatment group .Overall ,there is no difference between the anti HP treatment group and other groups on these aspects ,including symptom、esophagitis and acid reflux improvement .Conclusion There are no significant correlation between HP eradication and GERD .