Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.2950
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
Helicobacter pylori (H. pylori) has been implicated in the development of gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. However, the bacterial eradication reduces the risk of theses gastric complications. The therapeutic regimens currently in use and the duration of therapy differ in different countries, which affects the therapy outcomes. The therapeutic outcomes have been found to be affected by the virulence characteristics of the infecting strains. The strains with more virulent characteristics possessing vacA s1 and m1 are eradicated more efficiently than the strains harboring less virulent characteristics.
To demonstrate that the infecting strains possessing more virulent characteristics are eradicated efficiently with a 14-d triple therapy. The vacA s1-positive H. pylori isolates are easier to eradicate and could be used as an indicator to predict the successful outcome of eradication therapy.
To evaluate the H. pylori infection frequency and its resistance patterns among Egyptian patients and to determine the H. pylori virulence characteristics influencing the eradication success of the 14-d triple therapy regimen.
The patients suggestive of H. pylori infections were subjected to endoscopy-based biopsy specimen collection. The collected biopsy specimens were used to evaluate the H. pylori infection by a combination of diagnostic tests that included urease test, bacterial culture, and histopathological investigation. The extracted DNA was subjected to PCR-based cagA and vacA genotype investigation. The H. pylori-infected patients received triple therapy for 14 d. Six weeks after completion of the therapy, the treatment response was examined utilizing histology and the rapid urease test.
Among the 86 recruited patients, infection was found in 76 individuals. All of the strains were resistant to metronidazole (MNZ), while 52.8% and 81.9% of the isolates were resistant to clarithromycin (CLR) and amoxicillin (AMX), respectively. Successful eradication of H. pylori was significantly associated with vacA s1-positive strains [adjusted odds ratio (aOR) = 0.507, 95%CI: 0.175–0.822]. H. pylori strains resistant to CLR (aOR = 0.204, 95%CI: -0.005 to 0.412) and AMX (aOR = 0.223, 95%CI: 0.026–0.537) were significantly associated with failed eradication rate.
The low eradication rate of 14-d triple therapy in this study is worrisome and indicates that an alternative therapy to achieve effective eradication must be identified. The findings of complete failure of MNZ and reduced efficacy of AMX, CLR, and ciprofloxacin draw attention to the urgent need of antimicrobial susceptibility testing-guided eradication therapy. In addition, the strains with virulent properties of vacA s1 are easier to eradicate and could be used as an indicator to predict the successful outcome of eradication therapy.
CLR, AMX, and MNZ-based 14-d eradication therapy is ineffective and discouraged in these populations. Extensive nationwide studies should be considered to document the efficacy and to find alternative therapeutic regimens in respect to the duration. Furthermore, antimicrobial susceptibility testing based therapy should be encouraged to help reduce the development of antimicrobial resistance.