Pathogenesis, Diagnosis and Treatment of H. pylori Infection

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 4313

Special Issue Editors


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Guest Editor
Section of Gastroenterology, Department of Precision Medicine and Jonic Area, University "Aldo Moro" of Bari, 70124 Bari, Italy
Interests: colorectal cancer; Helicobacter pylori; Inflammatory bowel disease; estrogen receptors

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Guest Editor
Section of Gastroenterology, Department of Precision Medicine and Jonic Area, University "Aldo Moro" of Bari, 70124 Bari, Italy
Interests: Helicobacter pylori; gastritis; endoscopy; celiac disease

Special Issue Information

Dear Colleagues,

The universe revolving around Helicobacter pylori infection is in continuous evolution. H. pylori not only causes gastritis but is involved as well in several extra-gastric conditions. Furthermore, it is the most relevant factor promoting gastric carcinogenesis. The Special Issue, entitled “Pathogenesis, Diagnosis and Treatment of H. pylori Infection” will cover several aspects of diagnosis, starting from traditional methods and investigating novel molecular biology tools and novel endoscopic technologies that may help in the diagnosis of gastric precancerous lesions. Additionally, the increasing rates of antibiotic resistance are a threat to eradication therapies. To date, eradication regimens are based on old antibiotics, and no new antimicrobial has appeared to the horizon. Therefore, a wise combination of antibiotics, possibly based on analysis of susceptibility, could be the solution.

Prof. Dr. Alfredo Di Leo
Prof. Dr. Giuseppe Losurdo
Guest Editors

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Keywords

  • Helicobacter pylori
  • diagnosis
  • endoscopy
  • non invasive methods
  • molecular biology
  • antibiotics therapy
  • eradication

Published Papers (4 papers)

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Review

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18 pages, 910 KiB  
Review
Change in Diagnosis of Helicobacter pylori Infection in the Treatment-Failure Era
by Rocco Spagnuolo, Giuseppe Guido Maria Scarlata, Maria Rosaria Paravati, Ludovico Abenavoli and Francesco Luzza
Antibiotics 2024, 13(4), 357; https://doi.org/10.3390/antibiotics13040357 - 12 Apr 2024
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Abstract
Helicobacter pylori (H. pylori) infection is a prevalent global health issue, associated with several gastrointestinal disorders, including gastritis, peptic ulcers, and gastric cancer. The landscape of H. pylori treatment has evolved over the years, with increasing challenges due to antibiotic resistance [...] Read more.
Helicobacter pylori (H. pylori) infection is a prevalent global health issue, associated with several gastrointestinal disorders, including gastritis, peptic ulcers, and gastric cancer. The landscape of H. pylori treatment has evolved over the years, with increasing challenges due to antibiotic resistance and treatment failure. Traditional diagnostic methods, such as the urea breath test, stool antigen test, and endoscopy with biopsy, are commonly used in clinical practice. However, the emergence of antibiotic-resistant strains has led to a decline in treatment efficacy, necessitating a re-evaluation of common diagnostic tools. This narrative review aims to explore the possible changes in the diagnostic approach of H. pylori infection in the era of treatment failure. Molecular techniques, including polymerase chain reaction and whole genome sequencing, which have high sensitivity and specificity, allow the detection of genes associated with antibiotic resistance. On the other hand, culture isolation and a phenotypic antibiogram could be used in the diagnostic routine, although H. pylori is a fastidious bacterium. However, new molecular approaches are promising tools for detecting the pathogen and its resistance genes. In this regard, more real-life studies are needed to reveal new diagnostic tools suitable for identifying multidrug-resistant H. pylori strains and for outlining proper treatment. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnosis and Treatment of H. pylori Infection)
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12 pages, 822 KiB  
Review
Helicobacter pylori in Inflammatory Bowel Diseases: Active Protagonist or Innocent Bystander?
by Elisabetta Bretto, Simone Frara, Angelo Armandi, Gian Paolo Caviglia, Giorgio Maria Saracco, Elisabetta Bugianesi, Demis Pitoni and Davide Giuseppe Ribaldone
Antibiotics 2024, 13(3), 267; https://doi.org/10.3390/antibiotics13030267 - 17 Mar 2024
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Abstract
Helicobacter pylori (H. pylori) infection is a prominent entity within human infectious diseases which cause chronic gastritis, peptic ulcers, gastric malignancies, and extragastric disorders. Its persistent colonization can lead to a systemic inflammatory cascade, potentially instigating autoimmune responses and contributing to [...] Read more.
Helicobacter pylori (H. pylori) infection is a prominent entity within human infectious diseases which cause chronic gastritis, peptic ulcers, gastric malignancies, and extragastric disorders. Its persistent colonization can lead to a systemic inflammatory cascade, potentially instigating autoimmune responses and contributing to the pathogenesis of autoimmune diseases. While the specific etiopathogenesis of inflammatory bowel diseases (IBDs) is still unknown, it is widely recognized that immunological, genetic, and environmental factors are implicated. Various bacterial and viral pathogens have been implicated in the pathogenesis of IBDs. Numerous studies suggest a correlation between H. pylori infection and IBDs. While subject to debate, this link suggests that the bacterium’s presence somehow impacts the progression of IBDs by modifying the diversity of the gut microbiota, consequently altering local chemical profiles and disrupting the pattern of gut immune response. However, epidemiological evidence indicates a protective role of H. pylori infection against the onset of autoimmune diseases. Additionally, laboratory findings demonstrate H. pylori’s capacity to promote immune tolerance and restrict inflammatory reactions. The aim of this review is to elucidate the proposed mechanisms and confounding factors that underlie the potential association between H. pylori infection and IBDs. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnosis and Treatment of H. pylori Infection)
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Other

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8 pages, 243 KiB  
Brief Report
Concomitant and Bismuth Quadruple Therapy for Helicobacter pylori Eradication in Southern Italy: Preliminary Data from a Randomized Clinical Trial
by Giuseppe Losurdo, Antonia Valeria Borraccino, Adriana Aloisio, Francesco Russo, Giuseppe Riezzo, Grazia Galeano, Maria Pricci, Bruna Girardi, Francesca Celiberto, Andrea Iannone, Enzo Ierardi and Alfredo Di Leo
Antibiotics 2024, 13(4), 348; https://doi.org/10.3390/antibiotics13040348 - 10 Apr 2024
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Abstract
Concomitant therapy (CT) and bismuth quadruple therapy (BQT) are recommended in geographical areas with high clarithromycin resistance for Helicobacter pylori (H. pylori) eradication. We compared CT and BQT as the first lines of treatment in a randomized controlled trial. Consecutive patients [...] Read more.
Concomitant therapy (CT) and bismuth quadruple therapy (BQT) are recommended in geographical areas with high clarithromycin resistance for Helicobacter pylori (H. pylori) eradication. We compared CT and BQT as the first lines of treatment in a randomized controlled trial. Consecutive patients with H. pylori diagnosed by concordance of both a urea breath test and histology were recruited. For BQT, patients received 3 PyleraTM capsules q.i.d.; for CT, 1000 mg of amoxicillin b.i.d, 500 mg of clarithromycin b.i.d and 500 mg of metronidazole b.i.d. As a proton pump inhibitor, 40 mg of pantoprazole b.i.d was administered. Both regimens lasted 10 days. In total, 46 patients received CT and 38 BQT. Both groups were comparable for age (p = 0.27) and sex (p = 0.36). We did not record any drop outs; therefore, the intention to treat and per protocol rates coincided. The most common symptoms were heartburn and post-prandial fullness, which were equally present in both groups. The success rate was 95.6% for CT and 100% for BQT (p = 0.56). Side effects were recorded in 23.9% and 31.6% of patients in the CT and BQT arms, respectively (p = 0.47). The most common ones were abdominal pain (8) and diarrhea (6). In conclusion, CT and BQT are equally effective in our area with high clarithromycin resistance, southern Italy, and showed comparable safety. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnosis and Treatment of H. pylori Infection)
8 pages, 396 KiB  
Brief Report
Helicobacter pylori Secondary Antibiotic Resistance after One or More Eradication Failure: A Genotypic Stool Analysis Study
by Giuseppe Losurdo, Martino Mezzapesa, Ilaria Ditonno, Mariapaola Piazzolla, Maria Pricci, Bruna Girardi, Francesca Celiberto, Grazia Galeano, Giuseppe Riezzo, Francesco Russo, Andrea Iannone, Enzo Ierardi and Alfredo Di Leo
Antibiotics 2024, 13(4), 336; https://doi.org/10.3390/antibiotics13040336 - 7 Apr 2024
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Abstract
Helicobacter pylori (H. pylori) antibiotic resistance is the leading cause for unsuccessful eradication therapy. After one or more failures, the chance of encountering secondary antibiotic resistance increases. The aim of this study was to characterize genotypic secondary resistance in a cohort [...] Read more.
Helicobacter pylori (H. pylori) antibiotic resistance is the leading cause for unsuccessful eradication therapy. After one or more failures, the chance of encountering secondary antibiotic resistance increases. The aim of this study was to characterize genotypic secondary resistance in a cohort of southern Italian H. pylori patients with at least one previous failure. Such patients collected stool samples using a dedicated kit (THD fecal testTM), and bacterial DNA was extracted and amplified using RT-PCR. Resistance to clarithromycin, amoxicillin, metronidazole, levofloxacin, and tetracycline was assessed using a high-resolution melting curve. We enrolled 50 patients. A total of 72% of patients failed one previous antibiotic course, 16% failed two, 10% failed three, and 2% failed four. The rate of secondary antibiotic resistance was 16% for clarithromycin, 18% for metronidazole, 14% for amoxicillin, 14% for levofloxacin, and 2% for tetracycline. Among the eight clarithromycin-resistant patients, five (62.5%) previously received a clarithromycin-based regimen. The same rate was 33.3% (3/9) for metronidazole. The only tetracycline-resistant patient had received Pylera. In conclusion, our data seem to show that, even though secondary resistance is not very high, resistance to clarithromycin could be very likely related to previous exposure to this antibiotic. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnosis and Treatment of H. pylori Infection)
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