Eradication of Helicobacter pylori infection improves blood pressure values in patients affected by hypertension

Background. Arterial hypertension is a risk factor for atherosclerosis of whose pathogenesis is unknown. Growing evidence underscores the causative role of endothelial dysfunction. A possible association between Helicobacter pylori infection and cardiovascular and autoimmune disorders has been found. The release of cytotoxic substances either of bacterial origin or produced by the host may represent mediators of these systemic sequelae. The aim of our study was to determine the prevalence of H. pylori infection in hypertensive patients and the effects of H. pylori eradication on blood pressure and on digestive symptoms. Materials and Methods. Seventy‐two hypertensive patients (34 male and 38 female; mean age 53 ± 12 years) and 70 normotensive controls (35 male and 35 female; mean age 52 ± 10 years) were enrolled. All patients were subjected to a first ambulatory blood pressure monitoring (ABPM) at enrollment, a ¹³C urea breath test and a test for IgG‐CagA antibodies, and completed the validated dyspepsia questionnaire. H. pylori‐positive patients were treated with triple therapy (amoxicillin, clarithromycin and ranitidine bismute citrate) for 7 days. Control of eradication was assessed by ¹³C urea breath test, and all patients underwent a second ABPM 6 months after enrollment. Results. H. pylori infection was 55% in hypertensive patients, with 90% CagA positivity, and 50% in controls, with 60% CagA positivity. At the first ABPM, blood pressure values were similar in H. pylori‐positive and ‐negative individuals; positive patients showed a significant increase in pyrosis and epigastric pain compared to negative patients. H. pylori was eradicated in 80% of patients and in 85% of controls. At the second ABPM, we found a statistically significant decrease in 24‐hour mean blood pressure values when compared to the first ABPM only in the eradicated hypertensive group. Conclusions. Our study demonstrated a significant decrease in blood pressure values, in particular in diastolic blood pressure values, after H. pylori eradication in hypertensive patients. A high prevalence of CagA positivity was found. The association between cardiovascular disease and H. pylori infection seems pronounced only in CagA‐positive patients. The possible links between hypertensive disease and H. pylori infection may involve the activation of the cytokine cascade with the release of vasoactive substances from the primary site of infection, or molecular mimicry between the CagA antigens of H. pylori and some peptides expressed by endothelial cells and smooth muscle cells.     

Meta-Analysis: The Effect of Supplementation with Lactoferrin on Eradication Rates and Adverse Events During Helicobacter pylori Eradication Therapy

Background: Recent evidence shown that lactoferrin could exert an antimicrobial effect against Helicobacter pylori both in vitro and in vivo models. To systematically evaluate whether adding lactoferrin to H. pylori eradication regimens could improve eradication rates and reduce side-effects during anti- H. pylori treatment.
Materials and Methods:  Eligible articles were identified by searches of electronic databases. We included all randomized trials comparing lactoferrin supplementation to placebo or no treatment during anti- H. pylori regimens. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/Sensitivity analysis was also performed.
Results: We identified nine randomized trials (n = 1343). Pooled H. pylori eradication rates were 86.57% (95% confidence interval (CI) = 83.99–89.15%) and 74.44% (95% CI = 71.14–77.74%) for patients with or without lactoferrin by intention-to-treat analysis, respectively, the odds ratio (OR) was 2.26 (95% CI = 1.70–3.00); the occurrence of total side-effects was 9.05% (95% CI = 6.83–11.27%) and 16.28% (95% CI = 13.43%–19.13%) for groups with or without lactoferrin, especially for nausea, the summary OR was 0.15 (95% CI = 0.04–0.54).
Conclusions: Our review suggests that supplementation with lactoferrin could be effective in increasing eradication rates of anti- H. pylori therapy, and could be considered helpful for patients with eradication failure. Furthermore, lactoferrin shows a positive impact on H. pylori therapy-related side-effects.     

铋剂四联疗法联合不同药物对幽门螺杆菌感染的疗效

目的 分析铋剂四联疗法联合不同药物对幽门螺杆菌感染的疗效。方法 入选患者依据治疗方案不同进行分组,其中A组患者采用铋剂四联方案（1种PPI+1种铋剂+2种抗生素）进行治疗,B组患者采用铋剂四联+思联康治疗,C组患者采用铋剂四联+荆花胃康治疗。3组患者均于根除治疗结束停药1个月后复查13C呼气试验以评估疗效。对各方案的H. pylori根除率进行评比,并分析其临床疗效和成本—效益情况。结果 按ITT集分析时,C组与A组患者根除率比较差异无统计学意义（2=3.642,P=0.056）,B组与A组和C组患者比较差异无统计学意义（2=3.209、0.130,P>0.05）。按PP集分析时,C组患者根除率最高,A组患者根除率最低,B、C组与A组患者比较差异有统计学意义（2=4.620、4.419,P0.05）。A组、B组和C组患者不良反应发生率按PP集计算分别为50.0%、7.9%和26.7%,3组患者不良反应发生率两两比较差异均有统计学意义（均P<0.05）。成本—效益分析结果显示B组患者的成本—效果比值最小。结论 综合有效性、安全性及成本—效益比分析,铋剂四联+思联康方案具有H. pylori根除率高,患者不良反应发生率低,成本效益比低的优势,提示此方案为本研究的最佳方案,值得临床推广应用。     

影响幽门螺杆菌根除疗效相关因素

幽门螺杆菌（Hp）是慢性活动性胃炎和消化性溃疡的主要病因,并与胃癌、MALT淋巴瘤的发生密切相关,其根除治疗在临床上具有重要的意义。大量研究显示Hp的根除疗效在下降,本文就有关影响Hp根除疗效的相关因素做一简要概述。     

微生态制剂联合四联方案在抗幽门螺杆菌感染治疗中的作用

目的 探讨微生态制剂联合四联方案在抗幽门螺杆菌感染中的临床疗效,为根除幽门螺杆菌感染提供参考。 方法 选取2017年7月至2019年6月于我院完成治疗的480例H. pylori感染患者为研究对象,将其随机分为A组、B组、C组、D组,各120例。A组患者采用标准四联方案(雷贝拉唑+胶体果胶铋+阿莫西林+呋喃唑酮)进行治疗。B组患者采用标准四联方案+酪酸梭菌活菌片进行治疗。C组患者采用标准四联方案+复方嗜酸乳杆菌片进行治疗。D组患者采用标准四联方案+复合乳酸菌胶囊进行治疗。分别记录各组患者疗效以及治疗第10天、14天、21天、28天的不良反应发生情况,并于治疗后停药3个月时用碳14呼气试验复查幽门螺杆菌根除情况,分析两组患者治疗前后临床症状改善情况、临床症状评分情况、H. pylori根除率、不良反应及成本—效果情况差异。 结果 治疗后,4组患者H. pylori总根除率为92.5%(444/480),临床有效率为87.92%(422/480),上腹胀、上腹痛、嗳气、纳差评分均较治疗前显著降低,差异有统计学意义(F=130.38,P2=9.47,11.56,P=0.024、0.009)。4组患者不同阶段成本—效果(无不良反应发生率)分析显示治疗21 d时△C/△E值均为最低。 结论 微生态制剂联合四联方案根除幽门螺杆菌感染的疗效与标准四联方案相当,患者临床症状改善率高,不良反应少,但与具体益生菌菌株无明显相关性。治疗21 d时各方案性价比最高,值得推广。     

Helicobacter pylori infection increases serum nitrate and nitrite more prominently than serum pepsinogens

Background. Helicobacter pylori infection causes chronic gastritis and results in increased serum concentrations of pepsinogens I and II as well as gastrin, while the ratio of pepsinogen I to II (I : II) is decreased. Inducible nitric oxide synthase (iNOS) is induced in H. pylori‐associated gastritis and may modulate inflammation. However serum nitrate and nitrite (NOx) concentrations in patients with H. pylori‐induced chronic gastritis have not been reported. We examined differences in serum NOx between H. pylori‐negative and positive volunteers relative to differences in pepsinogens and gastrin. Materials and methods. Sera from 80 healthy asymptomatic volunteers younger than 36 years were analyzed for anti‐H. pylori antibody, NOx, gastrin and pepsinogens. Results. In H. pylori antibody‐positive subjects serum NOx concentrations were higher than in negative subjects (p < .005). In H. pylori‐negative subjects, NOx correlated with pepsinogen II (r = .405, p < .05). In subjects with low pepsinogen I or II, NOx was higher in H. pylori‐positive than negative subjects (p < .001). In subjects with high pepsinogen I : II (6 or higher), serum NOx was higher in H. pylori‐positive than in negative subjects. Conclusions. H. pylori‐induced gastritis increases serum NOx concentrations more prominently than those of pepsinogen. In H. pylori‐negative subjects, serum correlates with serum pepsinogen II.     

Organ-specific autoantibodies in children with Helicobacter pylori infection

BACKGROUND: We compared the prevalence of organ-specific autoantibodies in a group of Helicobacter pylori infected children and a group of uninfected children and investigated the relationship between the presence of relevant autoantibodies and the status of the target organs. PATIENTS AND METHODS: One hundred and twenty-four children with dyspepsia (54 boys, 70 girls; mean age 10.5 years; range 4-19) underwent gastroscopy: 56 had H. pylori infection (31 girls, 25 boys), while 68 (37 girls and 31 boys), were H. pylori-negative. All sera were tested for the presence of: parietal cell autoantibodies (PCA), intrinsic factor autoantibodies (IFA), microsomial autoantibodies, thyroglobulin autoantibodies, islet cell autoantibodies, glutamic acid decarboxylase autoantibodies, adrenal cortex autoantibodies, steroid-producing cell autoantibodies; gastrin, pepsinogen A, pepsinogen C and anti-H. pylori antibodies. The histological features and the ureA and cagA genes were also considered. RESULTS: The frequency of organ-specific autoantibodies was higher in patients with H. pylori infection than in uninfected patients (chi2-test p < .0001). Specifically gastric autoantibodies were significantly higher: seven of the 56 H. pylori-positive children were PCA-positive and one was IFA-positive (chi2-test p = .0004). The presence of autoantibodies was not associated with any clinical or biohumoral signs of disease. CONCLUSIONS: Our study detected a relationship between H. pylori infection in childhood and the presence of organ-specific autoantibodies unassociated with any clinical or biohumoral signs of disease. Helicobacter pylori infection in childhood could trigger the onset of clinical autoimmune gastritis, and/or other clinical autoimmune diseases.     

双歧四联活菌多药联合对根除幽门螺杆菌患者的临床疗效观察

目的:研究双歧四联活菌多药联合对根除幽门螺杆菌(Helicobacter pylori,Hp)患者的临床疗效。方法:从2012年3月到2013年3月,共计60例病患因腹部不适就诊。以数字法随机分成实验组及对照组。对照组以埃索美拉唑镁肠溶片(剂量为20 mg bid)和胶体酒石酸铋钠(剂量为165 mg qid)以及克拉霉素片(剂量为0.5 bid)和阿莫西林胶囊(剂量为1.0 bid)等药物治疗。实验组则在对照组基础之上另以双歧四联活菌(剂量为1.5 tid)药物治疗。对比两组疗效和治疗后不良反应,以及治疗依从性情况。结果:实验组的根除率为86.67%(26/30),显著高于对照组的63.33%(19/30);未根除率为13.33%(4/30),显著低于对照组的36.67%(11/30)。实验组有不良反应者8例,占比26.67%,显著少于对照组的17例,占比56.67%;实验组在治疗后的依从性为好者占比90.00%(27/30),显著高于对照组的66.67%(20/30),依从性为差者占比10.00%(3/30),显著低于对照组的33.33%(10/30),差异均有统计学意义(均P0.05)。结论:双歧四联活菌采用多药联合方式可明显提升对于Hp的根除率,同时减少不良反应,增加病患依从性。效果显著,值得临床推荐。     

布拉酵母菌联合三联疗法根除幽门螺杆菌疗效研究

目的探讨布拉酵母菌（S．Boulardii）散剂联合标准三联疗法根除幽门螺杆菌（Helicobacterpylori,H．pylori）的有效性和安全性。方法将210例初次接受根除治疗的Hpylori阳性患者随机分为2组,A组：口服埃索美拉唑＋阿莫西林＋呋喃唑酮,每日2次,疗程10d;B组：与A相同的三联10d疗法,加s．Boulardii散剂口服500mg／次,2次／d,共用药14d。观察患者不良反应发生情况及对药物耐受情况,停药4周后检测H．pylori根除率。结果A、B组Hpylori根除率按方案（PP）分析分别为70．7％、86．3％,按意向性（ITT）分析分别为66．7％、83．8％,B组PP和ITT根除率均高于A组,差异有统计学意义（P〈0．05）;B组不良反应发生率低于A组（8．8％vs 28．3％,P〈0．05）;在药物耐受程度方面,B组明显优于A组（P〈0．05）。结论S．Boulardii散剂联合标准三联疗法作为初次根除Hpylori治疗时可提高根除率,降低不良反应,增加药物耐受程度。     

以左氧氟沙星为基础的三联疗法根除幽门螺杆菌的疗效分析

目的：本研究的目的是评估以左氧氟沙星为基础的三联疗法根除幽门螺杆菌的疗效分析。方法：112例通过快速尿素酶试验和13C．尿素呼气试验证实感染了幽门螺杆菌的非溃疡性消化不良的患者入组本实验,患者被随机分为7d组（54例）和14d组（58例）,接受包括雷贝拉唑Oomgb-i．d．）加左氧氟沙星（500mgq．d．）和阿莫西林（1000mgb．i．d．）的治疗,并进行6周的随访,治疗结束至少4周后通过13C．尿素呼气试验确定根除率。结果：幽门螺杆菌总的根除率为83．9％（ITT）和88．7％（PP）。7d组51名患者完成了治疗。其根除率为75．9％（ITT）、80．4％（PP）,而14d组的根除率达到91．4％（ITT）、96．4％（PP）,P〈0．05。结论：包含雷贝拉唑、左氧氟沙星和阿莫西林的三联疗法对于根除幽门螺杆菌是有效的,但相同方案的14d疗法疗效明显优于7d疗法。     

The association between Helicobacter pylori infection and insulin resistance: a systematic review

Background: Helicobacter pylori infection has been associated with diverse extradigestive morbidity, including insulin resistance (IR) syndrome. The aim of this systematic review was to summarize the epidemiologic evidence concerning the association between H. pylori infection and IR quantitative indexes. Materials and Methods: A computerized literature search in PubMed electronic databases and Cochrane Central Register of Controlled Trials was performed. Results: Nine studies reporting data on 2120 participants were finally eligible for this systematic review. Seven of them were cross‐sectional studies and two were nonrandomized, open‐label, controlled trials investigating the effect of H. pylori eradication on IR. Homeostatic model of assessment insulin resistance (HOMA‐IR) was used in all studies to quantify IR. There seems to be a trend toward a positive association between H. pylori infection and HOMA‐IR, strengthened by regression analysis in one study. However, there was significant heterogeneity between studies regarding the method(s) of H. pylori infection diagnosis based on and the study populations. The studies for the effect of H. pylori eradication on HOMA‐IR revealed conflicting results. Conclusions: Although data seem to indicate a potential association between H. pylori infection and IR, further studies are needed to strengthen this association and to clarify whether there is a causative link between them. If a causal link is confirmed in the future, this may have a major impact on the pathophysiology and management of IR syndrome, including type 2 diabetes mellitus and nonalcoholic fatty liver disease.     

益生菌对腹痛儿童幽门螺杆菌根除的影响

目的观察微生态制剂金双歧(双歧杆菌、乳杆菌和嗜热链球菌三联活茵片)对腹痛儿童幽门螺杆菌根除治疗的影响。方法将54例幽门螺杆菌(H.pylori)阳性的腹痛儿童随机分成A组(奥美拉唑、克拉霉素、阿莫西林三联疗法)和B组(金双歧联用三联疗法),疗程均为2周,治疗结束4周后复查13C-尿素呼气试验,统计患儿治疗期间的不良反应。结果 A、B两组根除根除率分别为74.3%和88.8%,差异无统计学意义(P>0.05);B组胃肠道不良反应明显少于A组(P<0.01)。结论微生态制剂不能显著增加腹痛儿童幽门螺杆菌根除率,但降低三联根除疗法的胃肠道不良反应。     

以左氧氟沙星为基础的三联疗法根除幽门螺杆菌的疗效分析

目的:本研究的目的是评估以左氧氟沙星为基础的三联疗法根除幽门螺杆菌的疗效分析。方法:112例通过快速尿素酶试验和13C-尿素呼气试验证实感染了幽门螺杆菌的非溃疡性消化不良的患者入组本实验,患者被随机分为7d组(54例)和14d组(58例),接受包括雷贝拉唑(10mgb.i.d.)加左氧氟沙星(500mgq.d.)和阿莫西林(1000mgb.i.d.)的治疗,并进行6周的随访,治疗结束至少4周后通过13C-尿素呼气试验确定根除率。结果:幽门螺杆菌总的根除率为83.9%(ITT)和88.7%(PP)。7d组51名患者完成了治疗,其根除率为75.9%(ITT)、80.4%(PP),而14d组的根除率达到91.4%(ITT)、96.4%(PP),P<0.05。结论:包含雷贝拉唑、左氧氟沙星和阿莫西林的三联疗法对于根除幽门螺杆菌是有效的,但相同方案的14d疗法疗效明显优于7d疗法。     

Long-term Administration of Probiotics to Asymptomatic Pre-school Children for Either the Eradication or the Prevention of Helicobacter pylori Infection

Background:  The role of probiotics in the armamentarium remains to be defined. The aims of this study were to investigate whether the long-time administration of Lactobacillus gasseri OLL2716 (LG21) strain can eradicate H. pylori in asymptomatic pre-school children and/or prevent H. pylori infection.
Methods: A total of 440 children, from 5–7 years of age, attending a kindergarten in Thailand were screened by the Helicobacter pylori stool antigen (HpSA) test. Thereafter 132 H. pylori positive and 308 H. pylori negative children were recruited to eradication and randomized prevention arms, respectively. Children in the active and placebo treatment groups received Lactobacillus gasseri OLL2716 (LG21) containing cheese and ordinary cheese, respectively, for 12 months. Eradication was defined as reversion by HpSA at 12 months. Prevention was defined as persistently HpSA negative at 12 months.
Results:  Eighty-two of 132 H. pylori positive (62%) completed the eradication arm, of which 24 (29.3%) were negative at 12 months according to the HpSA test. In the randomized prevention arm, 123 of 156 (79%) and 99 of 122 (81%) completed active and placebo arms, respectively, of which 4.1% and 8.1%, respectively, were HpSA positive at 12 months based on a per-protocol analysis ( p  = .21).
Conclusion: Further trials are needed.     

Variables Influencing Outcome of Helicobacter pylori Eradication Therapy in South China

Background: Therapy combining a proton pump inhibitor (PPI), clarithromycin and either amoxicillin or metronidazole is widely recommended for first‐line treatment for Helicobacter pylori infection. The purpose of this study was to examine the outcomes of PPI‐containing triple therapy and identify factors influencing the cure rate of H. pylori infection in South China. Materials and Methods: H. pylori positive patients with different occupations from 25 hospitals in five provinces of South China were enrolled. They received a PPI, metronidazole and amoxicillin triple therapy for a week. H. pylori eradication was evaluated by ¹³C‐urea breath test 4 weeks after therapy. Association between H. pylori eradication with occupation, gender, age, educational level, and protocol compliance was evaluated by Logistic regression. Results: Six hundred and seventy‐five were enrolled. The intention‐to‐treat and per‐protocol analyses showed overall cure rates of 60% (95% CI = 56.3–63.7%) and 64.5% (95% CI = 60.7–68.3%), respectively. Multivariate logistic regression showed that occupation, gender and protocol compliance were positively associated with the eradication rate (p < .01). The cure rate for those who took 80% or more of the prescribed drugs was 64.5% (95% CI = 60.7–68.3%) versus 14.6% (95% CI = 6–29%, p < .001) for those who took less. Lower eradication rates were also observed in farmers and women. Conclusions: The eradication rate with a PPI, metronidazole and amoxicillin triple therapy was unacceptably low in South China. These results suggest that studies of the eradication of H. pylori infection in China must take into account antibiotic resistance as well as patient occupation, gender, and protocol compliance. Gastric cancer and peptic ulcer disease are both important in China making methods to effectively and efficiently eradicate H. pylori a priority.     

枸橼酸铋雷尼替丁+克拉霉素7天根除幽门螺旋杆菌疗效观察

目的观察枸橼酸铋雷尼替丁(RBC) 克拉霉素根除幽门螺旋杆菌疗效。方法RBC 350Mg 克拉霉素500mg口服,每天2次,共7d。结果治疗后Hp的根除率为86．5％。结论RBC 克拉霉素7d根除Hp效果满意。     

Brazilian green propolis on Helicobacter pylori infection. a pilot clinical study

Recent in vitro studies suggest that propolis and some of its phenolic components are able to inhibit Helicobacter pylori growth. To date, there are no clinical studies. AIMS: To evaluate the effect of Brazilian green propolis on H. pylori-infected individuals. PATIENTS AND METHODS: Eighteen (11 females, 7 males, mean age 47 years) participants were included. Before treatment, all participants were submitted to gastroscopy, and H. pylori infection was confirmed by histology, urease test, and (13)C-urea breath test (UBT). Participants with UBT showing a delta over baseline (DOB) value higher than 4 per thousand were considered positive for H. pylori infection. Twenty drops from an alcoholic preparation of Brazilian green propolis were administered three times a day for 7 days. Clinical evaluation and UBT were performed at 1-3 days and at 40 days after the end of therapy to evaluate H. pylori suppression or eradication, respectively. RESULTS: All participants took all medication and completed the study. Eighty-three percent of the subjects did not succeed in suppressing or eradicating H. pylori. Two participants reached partial suppression after treatment, but became positive again at UBT performed 40 days after treatment. Another participant presented negative at UBT 40 days after treatment, not confirmed by a second UBT performed 100 days after treatment. CONCLUSIONS: Brazilian green propolis used in popular dose showed minimal effect on H. pylori infection. Larger studies with longer duration, larger dose, and different frequency of administration of propolis extract should be undertaken to define its role on H. pylori therapy.