Eradication of Helicobacter pylori: challenges and advances
-
Yousra Sbibih
,
Abderrazak Saddari
,
Ilham Alla
,
Said Ezrari
,
Elmostapha Benaissa
,
Yassine Ben Lahlou
,
Mostafa Elouennass
,
Adil Maleb
Abstract
Background and Objectives: Helicobacter pylori, identified in 1982, remains a major cause of gastric infections. Despite extensive research, an ideal treatment regimen for its eradication is yet to be determined, with antibiotic resistance posing a significant challenge. This study, conducted at Mohammed VI University Hospital, aimed to evaluate and compare the effectiveness of different therapeutic protocols for H. pylori eradication.
Materials and Methods: This 13-month retrospective descriptive study was conducted at the Microbiology Laboratory of Mohammed VI University Hospital in Oujda, Morocco, to evaluate patients suspected of H. pylori infection using the urea breath test.
Results: A total of 190 patients were included, with an overall eradication rate of 73%. Three therapeutic protocols were tested, and bismuth concomitant therapy showed the highest eradication rate at 82%, outperforming the other regimens.
Conclusion: These findings highlight the importance of combining antimicrobial agents with antisecretory treatments to enhance eradication outcomes. The study also emphasizes the need for novel treatment strategies, particularly in light of rising antibiotic resistance. Vonoprazan-based regimens appear to offer a promising alternative, especially in the absence of antibiotic sensitivity testing. Future research should focus on optimizing treatment protocols while preserving beneficial gut flora.
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25. Horii T, Suzuki S, Takano C, Shibuya H, Ichijima R, Kusano C, et al. Lower impact of vonoprazan–amoxicillin dual therapy on gut microbiota for Helicobacter pylori eradication. J Gastroenterol Hepatol 2021; 36: 3314-3321.
2. Zou Y, Qian X, Liu X, Song Y, Song C, Wu S, et al. The effect of antibiotic resistance on Helicobacter pylori eradication efficacy: a systematic review and meta‐analysis. Helicobacter 2020; 25(4): e12714.
3. Terreni M, Taccani M, Pregnolato M. New antibiotics for multidrug-resistant bacterial strains: latest research developments and future perspectives. Molecules 2021; 26: 2671.
4. Alzoubi H, Al-Mnayyis A, Al Rfoa I, Aqel A, Abu-Lubad M, Hamdan O, et al. The use of 13C-urea breath test for non-invasive diagnosis of Helicobacter pylori infection in comparison to endoscopy and stool antigen test. Diagnostics (Basel) 2020; 10: 448.
5. Lee YC, Dore MP, Graham DY. Diagnosis and treatment of Helicobacter pylori infection. Annu Rev Med 2022; 73: 183-195.
6. Hu Y, Zhu Y, Lu NH. Recent progress in Helicobacter pylori treatment. Chin Med J (Engl) 2020; 133: 335-343.
7. Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology 2018; 155: 1372-1382.e17.
8. Francesco VD, Zullo A, Hassan C, Giorgio F, Rosania R, Ierardi E. Mechanisms of Helicobacter pylori antibiotic resistance: an updated appraisal. World J Gastrointest Pathophysiol 2011; 2: 35-41.
9. Best LM, Takwoingi Y, Siddique S, Selladurai A, Gandhi A, Low B, et al. Non‐invasive diagnostic tests for Helicobacter pylori infection. Cochrane Database Syst Rev 2018; 3: CD012080.
10. Yang JC, Lu CW, Lin CJ. Treatment of Helicobacter pylori infection: current status and future concepts. World J Gastroenterol 2014; 20: 5283-5293.
11. Pohl D, Keller PM, Bordier V, Wagner K. Review of current diagnostic methods and advances in Helicobacter pylori diagnostics in the era of next-generation sequencing. World J Gastroenterol 2019; 25: 4629-4660.
12. Nguyen CT, Davis KA, Nisly SA, Li J. Treatment of Helicobacter pylori in special patient populations. Pharmacotherapy 2019; 39: 1012-1022.
13. Rokkas T, Gisbert JP, Malfertheiner P, Niv Y, Gasbarrini A, Leja M, et al. Comparative effectiveness of multiple different first-line treatment regimens for Helicobacter pylori infection: a network meta-analysis. Gastroenterology 2021; 161: 495-507.e4.
14. Kim SE, Park MI, Park SJ, Moon W, Kim JH, Jung K, et al. Second-line bismuth-containing quadruple therapy for Helicobacter pylori eradication and impact of diabetes. World J Gastroenterol 2017; 23: 1059-1066.
15. Liou JM, Jiang XT, Chen CC, Luo JC, Bair MJ, Chen PY, et al. Second-line levofloxacin-based quadruple therapy versus bismuth-based quadruple therapy for Helicobacter pylori eradication and long-term changes to the gut microbiota and antibiotic resistome: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8: 228-241.
16. Tepler A, Narula N, Peek RM Jr, Patel A, Edelson C, Colombel JF, et al. Systematic review with meta‐analysis: association between Helicobacter pylori CagA seropositivity and odds of inflammatory bowel disease. Aliment Pharmacol Ther 2019; 50: 121-131.
17. Megraud F, Bruyndonckx R, Coenen S, Wittkop L, Huang TD, Hoebeke M, et al. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut 2021; 70: 1815-1822.
18. World Health Organization (2024). WHO bacterial priority pathogens list, 2024: bacterial pathogens of public health importance, to guide research, development, and strategies to prevent and control antimicrobial resistance. https://www.who.int/publications/i/item/9789240093461
19. Yu Y, Xue J, Lin F, Liu D, Zhang W, Ru S, et al. Global primary antibiotic resistance rate of Helicobacter pylori in recent 10 years: a systematic review and meta‐analysis. Helicobacter 2024; 29(3): e13103.
20. Zhou J, Shen Y, Song X, Zhou L, Tang H, Li H. Evaluation of a molecular Mosprie assay for detection of Helicobacter pylori and resistance to clarithromycin and levofloxacin. J Infect Dis 2022; 226 (Suppl 5): S503-S509.
21. Piscione M, Mazzone M, Di Marcantonio MC, Muraro R, Mincione G. Eradication of Helicobacter pylori and gastric cancer : a controversial relationship. Front Microbiol 2021; 12: 630852.
22. Cheng KP, Yang YJ, Hung HC, Lin CH, Wu CT, Hung MH, et al. Helicobacter pylori eradication improves glycemic control in type 2 diabetes patients with asymptomatic active Helicobacter pylori infection. J Diabetes Investig 2019; 10: 1092-1101.
23. Li D, Wang P, Wang P, Hu X, Chen F. The gut microbiota: a treasure for human health. Biotechnol Adv 2016; 34: 1210-1224.
24. Liou JM, Chen CC, Chang CM, Fang YJ, Bair MJ, Chen PY, et al. Long-term changes of gut microbiota, antibiotic resistance, and metabolic parameters after Helicobacter pylori eradication: a multicentre, open-label, randomised trial. Lancet Infect Dis 2019; 19: 1109-1120.
25. Horii T, Suzuki S, Takano C, Shibuya H, Ichijima R, Kusano C, et al. Lower impact of vonoprazan–amoxicillin dual therapy on gut microbiota for Helicobacter pylori eradication. J Gastroenterol Hepatol 2021; 36: 3314-3321.
| Files | ||
| Issue | Vol 17 No 4 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v17i4.19248 | |
| Keywords | ||
| Helicobacter pylori Urea breath test Antibiotic resistance Eradication Antimicrobial therapy Treatment protocols | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sbibih Y, Saddari A, Alla I, Ezrari S, Benaissa E, Lahlou Y, Elouennass M, Maleb A. Eradication of Helicobacter pylori: challenges and advances. Iran J Microbiol. 2025;17(4):593-599.
