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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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
