Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2021; 27(25): 3913-3924
Published online Jul 7, 2021. doi: 10.3748/wjg.v27.i25.3913
Effect of gastric microbiota on quadruple Helicobacter pylori eradication therapy containing bismuth
Zhan-Yue Niu, Si-Zhu Li, Yan-Yan Shi, Yan Xue
Zhan-Yue Niu, Si-Zhu Li, Yan Xue, Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
Yan-Yan Shi, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
Author contributions: Xue Y was the guarantor and designed the study; Niu ZY, Li SZ and Shi YY participated in the acquisition, analysis, and interpretation of the data and drafted the initial manuscript; Xue Y revised the article critically for important intellectual content; all authors have read and approved the final manuscript.
Supported by The Key Projects of Peking University Third Hospital, No. BYSY2017026.
Institutional review board statement: The study was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee Institutional Review Board (Approval No. M2017389).
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Xue, MD, Doctor, Department of Gastroenterology, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. xueyanby@163.com
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: March 28, 2021
Revised: April 10, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: July 7, 2021
Processing time: 146 Days and 20.9 Hours
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) is an important pathogen that can cause a variety of diseases. Yet, full eradication of H. pylori remains a significant challenge in clinical practice. H. pylori and other microbial communities have complex interactions in the unique gastric microecological environment. However, it is not clear whether the interactions have any effect on the therapeutic effect of H. pylori.

AIM

The aim was to investigate the characteristics of the gastric microbiota with H. pylori infection and the influence on the H. pylori eradication treatment.

METHODS

Patients with H. pylori infection underwent gastroscopy and received treatment for eradication. The prescription included esomeprazole 20 mg bid, Livzon Dele 220 mg bid, amoxicillin 1000 mg bid, and clarithromycin 500 mg bid for 14 d. Patients who did not respond to treatment and failed eradication were compared with those who achieved eradication by 1:2 propensity matching. High-throughput sequencing of the gastric mucosal microbiota was performed, and the results were evaluated by alpha diversity analysis, beta diversity analysis, species correlation analysis, and metabolic pathway correlation analysis.

RESULTS

The eradication rate of all the patients was 95.5% (171/179). Twenty-four patients were enrolled in the study after propensity-matched scoring. There were eight cases in the failure group (patients who did not respond well to therapy) and 16 cases in the success group. The majority phyla in the two groups were the same, and included Proteobacteria, Bacteroides, Firmicutes, Actinomycetes, and Fusobacteria. The microbial diversity in the failure group had a decreasing trend (P = 0.092) and the species abundance was significantly lower (P = 0.031) compared with the success group. The high rate of H. pylori eradication was associated with Rhodococcus, Lactobacillus, and Sphingomonas, as they were significantly enriched in the successful group (P < 0.05). Veronococcus and Cilium were enriched in the mucosa of chronic atrophic gastritis patients compared with chronic superficial gastritis patients (P = 0.0466 and 0.0122, respectively). In both study groups, H. pylori was negatively correlated with other bacterial genera. More bacterial genera were directly related to H. pylori in the successful group compared with the failure group.

CONCLUSION

The effectiveness of quadruple H. pylori eradication therapy containing bismuth depended on gastric microbiota, and the high rate of H. pylori eradication was associated with the presence of Rhodococcus, Lactobacillus, and Sphingomonas.

Keywords: Helicobacter pylori; Eradication; Quadruple therapy; Influence factors; propensity matching; Gastric microbiota

Core Tip: Helicobacter pylori (H. pylori) is an important pathogen that can cause a variety of diseases. Its eradication can be affected by many factors. In this study, we explored the effect of the gastric microbiota on quadruple H. pylori eradication therapy containing bismuth. The results indicated that quadruple H. pylori eradication therapy containing bismuth was affected by the gastric microbiota. A high rate of H. pylori eradication was associated with the presence of Rhodococcus, Lactobacillus, and Sphingomonas. Our findings may provide the basis for clinical treatment.