ABSTRACT
BACKGROUND AND AIMS: In Japan, 7-day triple therapy for Helicobacter pylori including clarithromycin (CAM) was approved in 2000. However, antibiotic resistance subsequently reduced this rate to an unacceptable level (70%). Vonoprazan, an orally bioavailable potassium-competitive acid blocker (P-CAB), was approved in Japan in 2014. This could improve eradication rates by increasing the intragastric pH, thus increasing bacterial antibiotic susceptibility. This study compared the efficacy of 7-day triple therapies that included CAM and vonoprazan or proton pump inhibitor (PPI). METHODS: We prospectively analyzed H. pylori eradication rates in 146 patients receiving 7-day triple therapy containing P-CAB (April 2015 to September 2015), and in a retrospective cohort of 1,305 patients who received 7-day triple therapy containing a PPI (April 2011 to September 2015). RESULTS: H. pylori was eradicated in a significantly higher number of P-CAB-treated patients (89.7% [131/146]) than PPI-treated patients (73.9% [965/1305]; p < 0.05). The eradication rates in P-CAB-treated CAM-sensitive and CAM-resistant bacteria were 100% (44/44) and 87.5% (28/32), respectively, which were significantly higher than the corresponding rates in PPI-treated patients (88.0% [22/25] and 53.8% [7/13], p < 0.05). CONCLUSION: P-CAB improved the efficacy of CAM-containing 7-day triple therapy and would be a valuable first-line treatment for H. pylori infection.
Subject(s)
Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Clarithromycin/administration & dosage , Helicobacter Infections/drug therapy , Helicobacter pylori/drug effects , Proton Pump Inhibitors/administration & dosage , Pyrroles/administration & dosage , Sulfonamides/administration & dosage , Aged , Amoxicillin/adverse effects , Anti-Bacterial Agents/adverse effects , Clarithromycin/adverse effects , Drug Administration Schedule , Drug Resistance, Bacterial/drug effects , Female , Helicobacter Infections/diagnosis , Helicobacter Infections/microbiology , Helicobacter pylori/pathogenicity , Humans , Japan , Male , Middle Aged , Prospective Studies , Proton Pump Inhibitors/adverse effects , Pyrroles/adverse effects , Remission Induction , Retrospective Studies , Sulfonamides/adverse effects , Time Factors , Treatment OutcomeABSTRACT
Helicobacter heilmannii-like organisms (HHLOs) are associated with mucosa-associated lymphoid tissue lymphoma and peptic ulcer. However, the sensitivity of diagnostic tests for HHLOs, such as rapid urease test (RUT), urea breath test (UBT) and blood antibody, is not high. Tightly coiled spiral microorganisms were found in the gastric mucosal biopsy specimen of a 48-year-old asymptomatic woman. Her findings were positive for RUT and UBT, but negative for blood antibody and stool antigen against H. pylori. A 7-day course of esomeprazole, amoxicillin and clarithromycin was administered, resulting in the successful eradication of the HHLOs. Analysis of the 16S rRNA and urease genes suggested a diagnosis of the HHLO H. suis. The sensitivity results of RUT, UBT, culture, blood antibody, immunohistochemistry and stool antigen were 40.0, 14.8, 0, 23.1, 40.0 and 0%, respectively. We report asymptomatic nodular gastritis due to an HHLO. Histological techniques, most likely with smears, are expected to be the most effective method for diagnosing infections by HHLOs, and genetic diagnosis by polymerase chain reaction can be very useful to identify the species of HHLOs.
