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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Susceptibility patterns and virulence genotypes of Helicobacter pylori affecting eradication therapy outcomes among Egyptian patients with gastroduodenal diseases
Ahmed Morad Asaad, Gasser El-Azab, Eman Abdelsameea, Osama Elbahr, Ahmed Kamal, Mohamed Abdel-Samiee, Ahmed Abdelfattah, Heba Abdallah, Doha Maher, Ahmed El-Refaie, Samar Ebrahim Ghanem, Shamshul Ansari, Samah Mohammed Awad
Ahmed Morad Asaad, Department of Microbiology, College of Medicine, Zagazig University, Zagazig 44519, Egypt
Gasser El-Azab, Eman Abdelsameea, Osama Elbahr, Ahmed Kamal, Mohamed Abdel-Samiee, Ahmed Abdelfattah, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Heba Abdallah, Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Doha Maher, Ahmed El-Refaie, Department of Pathology, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Samar Ebrahim Ghanem, Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Shamshul Ansari, Department of Health Sciences, Higher Colleges of Technology, Abu Dhabi Women's College, Abu Dhabi 25026, United Arab Emirates
Samah Mohammed Awad, Department of Clinical Microbiology and Immunology, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Author contributions: Asaad AM and Awad SM conceived and designed the study; El-Azab G, Abdelsameea E, El-Bahr O, Kamal A, Abdel-Samiee M, and Abdelfattah A collected the data and performed the clinical part of the study; Abdallah H, Maher D, El-Refaie A, Ghanem SE, and Awad SM contributed to the laboratory investigations of the study; Ghanem SE and Awad SM performed the data analysis; Asaad AM, Ansari S, and Awad SM wrote the paper; All authors extensively revised the manuscript.
Institutional review board statement: The study protocol was approved by the local ethics committee of National Liver Institute Menoufia University, No. 00308/2022.
Informed consent statement: Patient consent was taken from all studied patients before the start of the study. The authors affirm that human research participants provided informed consent for publication.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to confidential and institutional ethical issues.
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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Shamshul Ansari, MSc, PhD, Assistant Professor, Department of Health Sciences, Higher Colleges of Technology, Abu Dhabi Women’s College, Hazza Bin Zayed Street, Al Dhafrah-Abu Dhabi, Abu Dhabi 25026, United Arab Emirates.
shamshulansari483@yahoo.com
Received: December 7, 2022
Peer-review started: December 7, 2022
First decision: January 22, 2023
Revised: February 11, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: May 21, 2023
Processing time: 159 Days and 10.7 Hours
BACKGROUND
Helicobacter pylori (H. pylori) is a significant human pathogen that is responsible for a variety of illnesses, including mucosa-associated lymphoid tissue lymphoma, gastric cancer, peptic ulcers, and gastritis.
AIM
To investigate the frequency of H. pylori infection and its resistance patterns among Egyptian patients and to determine the influence of H. pylori virulence genetic determinants on the eradication success of 14-d triple therapy regimen.
METHODS
H. pylori infections were investigated in 72 patients with gastroduodenal complications suggestive of H. pylori infection. The cagA and vacA genotypes of cultured strains were studied using polymerase chain reaction. The patients underwent 14 d of triple-therapy treatment. The treatment response was examined using histology and a rapid urease test 6 wk after therapy discontinuation.
RESULTS
The intention-to-treat eradication rate was 59.2% (95%CI: 48.2%–70.3%). Rates of H. pylori resistance to clarithromycin, amoxicillin, and metronidazole were 52.8%, 81.9%, and 100%, respectively. Successful eradication of H. pylori was more significantly associated with vacA s1-positive strains [adjusted odds ratio (aOR) = 0.507, 95%CI: 0.175–0.822]. A significant association was found between failed eradication rate and H. pylori strains resistant to clarithromycin (aOR = 0.204, 95%CI: –0.005 to 0.412) and amoxicillin (aOR = 0.223, 95%CI: 0.026–0.537).
CONCLUSION
This study’s low H. pylori eradication rate following 14-d triple therapy is concerning and worrying. H. pylori pan-resistance to metronidazole followed by the high resistance to ciprofloxacin, amoxicillin, and clarithromycin in this research is challenging and of great concern.
Core Tip: In this study, 72 patients with Helicobacter pylori infections were investigated. Half of the Helicobacter pylori strains had the cagA gene, and more than half of the strains were resistant to antibiotics except tetracycline and clarithromycin (CLR). However, CLR and tetracycline were effective at higher doses to achieve effective eradication by the CLR-based therapy. Most importantly, this study demonstrated that an alternative therapeutic regimen should be adopted to achieve effective infection eradication in Egypt.
