Changes in Helicobacter pylori Treatment from Discovery to Nowadays: A High-Level Analysis of PubMed Publications.

Abstract

Background: Since the discovery of Helicobacter pylori (H. pylori) 40 years ago, treatment options have changed dramatically adjacent to new drugs development and the emergence of multi-drug resistance. In this study, we aimed to assess published literature on treatment regimens for H. pylori in the past four decades, with regards to specific drug resistance and geographic distribution.

Methods: We have queried PubMed for all available H. pylori-related entries published during 1987-2020. For each entry, we retrieved the title, abstract, and keywords. Two gastrointestinal specialists decided in consensus on a list of terms to classify entries. The terms specify types of treatment and different types of regimens. Annual trends of publications were plotted for different treatment types and sub-analyses.

Results: Overall, 47,170 H. pylori-related entries were published between 1987 and 2020. Medication treatment showed the highest number of total publications 6183/47,170 (13.1%), followed by antibiotics 5493/47,170 (11.6%), and probiotic which was substantially lower (0.7%). For treatment regimens type, triple therapy had the highest number of publications 2400/47,170 (5.1%) followed by sequential therapy 342/47,170 (0.7%), and bismuth quadruple therapy 115/47,170 (0.2%). Analysis by antibiotic resistance showed that clarithromycin treatment had the highest number of publications 3537/47,170 (7.5%). Since 2013, there is a steep upward slope (5.1±0.7 publications/year, p < 0.001) for publications originating from China.

Conclusion: Our findings reflect the changes of the commonly prescribed regimens along the years, following the occurrence and the rise of H. pylori antibiotic resistance. In recent years, there is a steep rise in publications in countries with policies of screening and eradication for gastric cancer prevention, which is currently not applied in Western countries. A text-mining analysis of H. pylori publications contributes to the understanding of treatment options and development trends worldwide.