Helicobacter最新文献

{"title":"Overview of Gastric Cancer Prevention Initiatives in Europe.","authors":"Marcis Leja, Danute Ražuka-Ebela, Bojan Tepes, Jan Bornschein, Mário Dinis Ribeiro, Tamara Matysiak Budnik, Jochen Weigt, Viktoria Knaze, Colm O'Morain, Duco T Mülder, Iris Lansdorp-Vogelaar, Marianna Vitaloni, Tessa Groen, Marlon van Loo, Janet Takens, Javier P Gisbert, Jin Young Park","doi":"10.1111/hel.70126","DOIUrl":"10.1111/hel.70126","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer continues to impose a substantial health burden in Europe. The European Council Recommendations have called for consideration of implementing measures aimed at reducing gastric cancer-related mortality.</p><p><strong>Methods: </strong>This manuscript reviews current gastric cancer prevention initiatives in Europe. The GISTAR study in Latvia has been enrolling participants from the general population for Helicobacter pylori screen-and-treat intervention together with serological testing for pepsinogens. The EUROHELICAN study was the first to evaluate an H. pylori screen-and-treat strategy in young adults, which has been expanded within the TOGAS project. In addition, TOGAS has addressed stakeholder perspectives, the cost-effectiveness of screen-and-treat strategies, and the prevalence of gastric precancerous conditions among individuals participating in colorectal cancer screening. The GISTAR cohort has also enabled the assessment of long-term outcomes following H. pylori eradication. The EUGastScreen project, carried out within the EUCanScreen Joint Action, aims to evaluate the feasibility of simultaneous screening for H. pylori infection and colorectal cancer using a stool-based test. The European Registry on H. pylori Management (Hp-EuReg) supports the collection of important clinical data from routine clinical practice. Furthermore, the development of European guidelines for gastric cancer prevention has been initiated as part of the European Commission Initiative on Gastric Cancer and is expected to continue until 2027. The recently published 5th edition of the European Code Against Cancer includes recommendations on H. pylori management for the first time.</p><p><strong>Conclusions: </strong>Ongoing initiatives will provide important evidence to support the future implementation of gastric cancer prevention strategies, including data on feasibility, acceptability among the general population and stakeholders, and cost-effectiveness. However, additional implementation studies for gastric cancer prevention will be required.</p>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 2","pages":"e70126"},"PeriodicalIF":4.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Susceptibility-Guided Versus Empirical First-Line Therapy of Helicobacter pylori Infection in Adults: A Systematic Review and Meta-Analysis.","authors":"Manuel Coelho Rocha, Tiago Gaspar, Carlos Bernardes, Pedro Pimentel Nunes","doi":"10.1111/hel.70125","DOIUrl":"10.1111/hel.70125","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance undermines empirical first-line regimens for Helicobacter pylori. We compared susceptibility-guided therapy (SGT) versus empirical therapy in adults receiving first-line treatment, focusing on intention-to-treat (ITT) eradication.</p><p><strong>Materials and methods: </strong>We searched MEDLINE (PubMed), Web of Science, and Scopus from inception to 30 September 2025 for randomized controlled trials (RCTs) and non-randomized comparative studies (NRS) in adults with confirmed H. pylori. Interventions included phenotypic (culture/E-test) or genotypic (PCR) SGT applied to biopsy, stool, or gastric juice specimens; comparators were empirical regimens including bismuth quadruple therapy (BQT) and non-BQT options. The primary outcome was ITT eradication. We pooled risk ratios (RR) with DerSimonian-Laird random-effects, reported I²/τ², and derived 95% prediction intervals (PI). Subgroups were prespecified by comparator family (BQT vs. other) and specimen/method. Multi-arm studies combined empirical arms within family or split across distinct families.</p><p><strong>Results: </strong>Forty-two studies met inclusion criteria; all contributed ITT data. RCTs (k = 33) favored SGT over empirical therapy (pooled RR 1.09, 95% CI 1.05-1.13; I² 73%; 95% PI 0.92-1.30). NRS (k = 12) were directionally consistent (pooled RR 1.15, 95% CI 1.10-1.22; I² 75%; 95% PI 0.99-1.35). In RCTs, effects were neutral-to-modest vs. BQT (RR 1.03, 95% CI 0.97-1.10) and clearer vs. other empirical regimens (RR 1.12, 95% CI 1.06-1.18).</p><p><strong>Conclusions: </strong>In adult first-line therapy, SGT achieves at least non-inferior-and often superior-eradication versus empirical regimens; the incremental benefit is attenuated where BQT is standard. These findings support selective, and increasingly justified, integration of susceptibility testing in settings with clinically relevant resistance.</p>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 2","pages":"e70125"},"PeriodicalIF":4.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploration of a Potential Amoxicillin MIC Threshold in Bismuth Quadruple Therapy for H. pylori Infection in Southeastern China.","authors":"Ding Lu, Zhen-Wei Yang, Yun-Fan Dong, Yu-Wei Zhang, Jiang Liu","doi":"10.1111/hel.70117","DOIUrl":"10.1111/hel.70117","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The European Committee on Antimicrobial Susceptibility Testing (EUCAST) defines the amoxicillin resistance breakpoint at a minimum inhibitory concentration (MIC) of 0.125 μg/mL. This breakpoint is widely applied, and its clinical relevance has been validated in regions where amoxicillin-based triple therapy is the standard. However, in the context of China's predominant use of quadruple therapy, the applicability of this breakpoint remains unclear. This study aimed to collect Southeastern China resistance data, assess the impact of different amoxicillin MIC thresholds on the efficacy of amoxicillin-containing quadruple therapy, and to explore candidate amoxicillin MIC thresholds potentially associated with treatment outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Gastric mucosal specimens were obtained from patients undergoing gastroscopy between March 2024 and March 2025. A total of 4203 Helicobacter pylori isolates were successfully cultured and included for in vitro susceptibility testing. In vitro susceptibility testing of H. pylori isolates was performed using the agar dilution method, with MIC thresholds for amoxicillin set at 0.125 μg/mL, 0.25 μg/mL, 0.5 μg/mL, 1 μg/mL, and 2 μg/mL and other antibiotics (clarithromycin, metronidazole, levofloxacin) was performed on H. pylori isolates via agar dilution method. Patients treated with an amoxicillin-containing quadruple regimen (rabeprazole 10 mg twice daily + bismuth potassium citrate 220 mg twice daily + amoxicillin 1.0 g twice daily + furazolidone 100 mg twice daily or tetracycline 100 mg twice daily) were followed up. Eradication status was assessed by &lt;sup&gt;13&lt;/sup&gt;C-urea breath test 6-8 weeks post-treatment. Eradication rates were calculated using both intention-to-treat (ITT) and per-protocol (PP) analyses. χ&lt;sup&gt;2&lt;/sup&gt; test with Yates' continuity correlation and Fisher's exact tests were applied for group comparisons. Kappa statistics were used to evaluate the level of agreement between resistance classification under different MIC thresholds and clinical eradication outcomes. Prespecified stratified analyses were performed, and interaction terms were included in regression models to examine whether the association between amoxicillin MIC and eradication outcomes was consistent across treatment regimens and clinical subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 342 patients were included in the ITT analysis, and 330 patients were included in the PP analysis after excluding 14 patients due to adverse events or loss to follow-up. When the MIC breakpoint was set at 0.125 μg/mL or 0.25 μg/mL, no statistically significant difference was observed between resistant and susceptible groups in eradication rates (0.125 μg/mL: resistant ITT 88.57%, PP 90.29% vs. susceptible ITT 91.56%, PP 95.59%; 0.25 μg/mL: resistant ITT 86.89%, PP 88.33% vs. susceptible ITT 91.46%, PP 95.19%; all p &gt; 0.05). At 0.5 μg/mL, eradication rates in resistant patients were significantly ","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 2","pages":"e70117"},"PeriodicalIF":4.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Primary Amoxicillin Resistance in Helicobacter pylori in Vietnam: Evidence of Erosion of a Long-Standing Beta-Lactam Backbone.","authors":"Duc Trong Quach, Anh Tuan Nguyen, Nhu Thi Hanh Vu, Doan Thi Nha Nguyen","doi":"10.1111/hel.70129","DOIUrl":"https://doi.org/10.1111/hel.70129","url":null,"abstract":"","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 2","pages":"e70129"},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Effect of Macrolides on Helicobacter pylori Eradication: Data From the European Registry on Helicobacter pylori Management (Hp-EuReg)","authors":"Olga P. Nyssen,&nbsp;Guillermo J. Ortega,&nbsp;Laimas Jonaitis,&nbsp;Ángeles Pérez-Aísa,&nbsp;Bojan Tepes,&nbsp;Alfredo J. Lucendo,&nbsp;Javier Tejedor-Tejada,&nbsp;Renate Bumane,&nbsp;Ana Garre,&nbsp;Jose M. Huguet,&nbsp;Monica Perona,&nbsp;Óscar Núñez,&nbsp;Manuel Pabón-Carrasco,&nbsp;Manuel Castro-Fernández,&nbsp;Miguel Areia,&nbsp;Jesús Barrio,&nbsp;Antonio Moreno Loro,&nbsp;Thomas J. Butler,&nbsp;María Soledad Marcos,&nbsp;Alma Keco-Huerga,&nbsp;Manuel Domínguez Cajal,&nbsp;Maja Denkovski,&nbsp;Matteo Pavoni,&nbsp;György Miklós Buzás,&nbsp;Frode Lerang,&nbsp;Giuseppe Losurdo,&nbsp;Pablo M. Wolfe García,&nbsp;Perminder S. Phull,&nbsp;Samuel J. Martínez-Domínguez,&nbsp;Juozas Kupcinskas,&nbsp;Mārcis Leja,&nbsp;Ricardo Marcos-Pinto,&nbsp;Sinead M. Smith,&nbsp;Antonio Gasbarrini,&nbsp;Veronika Papp,&nbsp;Blas José Gómez Rodríguez,&nbsp;Mónica Sánchez Alonso,&nbsp;Ramón Pajares Villarroya,&nbsp;Pilar Pazo Mejide,&nbsp;Manuel Jiménez-Moreno,&nbsp;Marta Pascual-Mato,&nbsp;Concepción Bravo-Pache,&nbsp;Milagrosa Montes,&nbsp;Anna Cano-Català,&nbsp;Pablo Parra,&nbsp;Leticia Moreira,&nbsp;Francis Mégraud,&nbsp;Colm O’Morain,&nbsp;Luis Bujanda,&nbsp;Javier P. Gisbert,&nbsp;the Hp-EuReg investigators","doi":"10.1111/hel.70107","DOIUrl":"10.1111/hel.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Previous antibiotic use influences <i>Helicobacter pylori</i> antibiotic resistance. This study evaluated how prior population-level macrolide (especially clarithromycin) use affects <i>H. pylori</i> eradication success in naïve patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective, multicenter, ecological study. Multivariate logistic regression was performed with modified intention-to-treat effectiveness as the main outcome. Key variables included first-line clarithromycin-based treatments, therapy duration (7, 10, 14 days), proton pump inhibitor dose (low, standard, high), compliance (&gt; 90%), and clarithromycin consumption (defined daily doses/1000 inhabitants/day, from the European Surveillance of Antimicrobial Consumption Network). Nested hierarchical models incorporated macrolide consumption, matched by year and country, and assessed the interaction between consumption and first-line empirical treatments from the European Registry on <i>H. pylori</i> Management (Hp-EuReg).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 27,549 naïve patients from 23 countries with macrolide consumption data from 2013 to 2022. Higher macrolide consumption, within 0 to 8 years before treatment, was associated with reduced treatment effectiveness. The eradication rate consistently decreased as macrolide consumption increased, particularly within the previous 4 years. The efficacy of triple-clarithromycin-metronidazole, triple-clarithromycin-amoxicillin, and some bismuth-quadruple therapies containing clarithromycin decreased with higher macrolide consumption. At the country level, higher population consumption of clarithromycin 2 years before treatment was associated with a decrease in eradication rates from 93% to 82%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher macrolide consumption in the general population negatively impacts the effectiveness of first-line <i>H. pylori</i> regimens. These findings support that clarithromycin should only be administered as a susceptibility-based therapy, with the strongest negative impact of prior population-level exposure observed within 5 years and diminishing thereafter. ClincialTrials.gov number, NCT02328131.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Keverprazan–Amoxicillin Dual Regimen in Initial Eradication of Helicobacter pylori Infection: A Multicenter, Randomized Controlled Trial","authors":"Shanshan Wei,&nbsp;Zhihao Huang,&nbsp;Huizhen Xiong,&nbsp;Ji Wu,&nbsp;Dihua Mei,&nbsp;Jing Zhao,&nbsp;Wei Liu,&nbsp;Qingyun Liu,&nbsp;Yu Lin,&nbsp;Fang Liu,&nbsp;Xiang Peng,&nbsp;Honglei Chen","doi":"10.1111/hel.70100","DOIUrl":"10.1111/hel.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The efficacy of keverprazan–amoxicillin dual therapy (KA) in the treatment of <i>Helicobacter pylori</i> (<i>H. pylori</i>) has not yet been demonstrated. Here, we aimed to compare the eradication rate of the KA regimen with esomeprazole-based bismuth quadruple therapy (EBQT) containing amoxicillin and clarithromycin for <i>H. pylori</i> initial eradication in the Chinese population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged between 18–75 years were randomly assigned into KA group or the EBQT group. The KA group patients received keverprazan 20 mg (b.i.d.) and amoxicillin 1.0 g (t.i.d.) for 14 days. The EBQT group patients took esomeprazole 20 mg (b.i.d.), amoxicillin 1.0 g (b.i.d.), clarithromycin 0.5 g (b.i.d.), and bismuth potassium citrate 220 mg (b.i.d.) for 14 days. The primary outcome was the <i>H. pylori</i> eradication rate 28 days after therapy. Secondary outcomes included compliance and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 394 patients were enrolled in this study. Eradication rates in the KA group and the EBQT group were 87.88% and 84.18% in intention-to-treat analysis (ITT) (rate difference: 3.70%, 95% CI: −3.14% to 10.53%), 92.55% and 88.24% in modified ITT analysis (rate difference: 4.32%, 95% CI: −1.63% to 10.27%), and 93.99% and 90.56% in per-protocol analysis (PP) (rate difference: 3.43%, 95% CI: −2.05% to 8.92%), respectively. The eradication rates for the KA group were not inferior to those of the EBQT group in ITT, modified ITT, and PP analysis. The incidences of nausea and overall adverse effects in the KA group were significantly lower than those of the EBQT group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Keverprazan 20 mg twice daily with high-dose amoxicillin demonstrates a noninferior efficacy to bismuth quadruple therapy for initial <i>H. pylori</i> eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Chinese Clinical Trial Registry, registration No: ChiCTR2400092511</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Cancer Prevention in Taiwan: Past Achievements and Future Perspectives","authors":"Shu-Lin Chuang,&nbsp;Teresa Cheng-Chieh Chu,&nbsp;Tsung-Hsien Chiang,&nbsp;Yi-Ru Chen,&nbsp;Wei-Yi Lei,&nbsp;Chien-Lin Chen,&nbsp;Ming-Jong Bair,&nbsp;Jeng-Yih Wu,&nbsp;Deng-Chyang Wu,&nbsp;Felice Tien O'Donnell,&nbsp;Hui-Wen Tien,&nbsp;Sherry Yueh-Hsia Chiu,&nbsp;Hsiu-Chi Cheng,&nbsp;Yu-Hsin Hsu,&nbsp;Tsui-Hsia Hsu,&nbsp;Pei-Chun Hsieh,&nbsp;Li-Ju Lin,&nbsp;Yi-Maun Subeq,&nbsp;Shu-Hui Wen,&nbsp;Chia-Hsiang Chu,&nbsp;Ming-Shiang Wu,&nbsp;Yi-Chia Lee","doi":"10.1111/hel.70102","DOIUrl":"https://doi.org/10.1111/hel.70102","url":null,"abstract":"<div>\u0000 \u0000 <p>Population-based screen-and-treat of <i>Helicobacter pylori</i> infection, a well-established cause of gastric cancer, is emerging as an effective strategy to reduce gastric cancer incidence and mortality, in line with recommendations from the working group convened by the International Agency for Research on Cancer. This report reviews the development of the population-based <i>H. pylori</i> screen-and-treat strategy as a healthcare policy for gastric cancer prevention in Taiwan from 2004 to 2025, tracing its evolution from localized pilot programs to regional initiatives and, ultimately, to full population-wide implementation. To support systematic implementation at the population level, Taiwan adopted a three-tiered foundation that includes: (1) a centralized planning committee; (2) screening service delivery through primary care providers, guided by clinical guidelines established by medical societies; and (3) community engagement to raise awareness of stomach health and promote participation in screen-and-treat programs through social media campaigns. Program execution strictly follows the principles of organized screening, supported by standardized quality indicators, integrated digital tracking systems, structured audit mechanisms, and both effectiveness and cost-effectiveness assessments. Strategies are tailored to local contexts: in the Matsu Islands, mass screening using the ¹³C urea breath test and subsequent eradication treatment led to reductions in <i>H. pylori</i> prevalence and gastric cancer incidence and mortality; in Changhua County, a pragmatic randomized clinical trial showed that stool sample-based screening using <i>H. pylori</i> stool antigen and fecal immunochemical testing improved participation and reduced gastric cancer incidence; and in indigenous communities, household-based approaches utilizing the ¹³C urea breath test could enhance <i>H. pylori</i> detection rate and reduce the intrafamilial transmission. In addition to the continuous assessment of its effectiveness in preventing both gastric cancer and peptic ulcer disease, it is also essential to evaluate the potential impacts on antibiotic resistance and gut microbial succession after mass <i>H. pylori</i> eradication. All these programs consistently maintain high standards of quality and equity, ensuring accessibility for diverse populations with varying socioeconomic positions. Collectively, it demonstrates how robust scientific evaluations, when combined with organized screening principles and systematic performance monitoring, can be effectively translated into sustainable, evidence-based programs for population-wide gastric cancer prevention.</p>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146136520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tegoprazan-Based Triple Therapy for Helicobacter pylori Eradication: A Phase III Multicenter Randomized Clinical Trial","authors":"Jae Yong Park,&nbsp;Su Jin Hong,&nbsp;Il Ju Choi,&nbsp;Gwang Ho Baik,&nbsp;Sun Moon Kim,&nbsp;Jong-Jae Park,&nbsp;Seong Woo Jeon,&nbsp;Kyung-Oh Kim,&nbsp;Sang Kil Lee,&nbsp;Hwoon-Yong Jung,&nbsp;Jung-Hwan Oh,&nbsp;Chan Hyuk Park,&nbsp;Sang Wook Kim,&nbsp;Ki-Nam Shim,&nbsp;Sam Ryong Jee,&nbsp;Hee Seok Moon,&nbsp;Jeong Seop Moon,&nbsp;Cheol Woong Choi,&nbsp;Wan-Sik Lee,&nbsp;Jae Gyu Kim","doi":"10.1111/hel.70106","DOIUrl":"10.1111/hel.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tegoprazan, a potassium-competitive acid blocker, offers potent and sustained acid inhibition and potentially improves eradication efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to evaluate the efficacy and safety of tegoprazan-based triple therapy with two dosing regimens compared with that of lansoprazole-based therapy for first-line <i>Helicobacter pylori</i> eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This randomized, double-blind, active-controlled, multicenter trial was conducted at 19 referral hospitals in South Korea (February 2023–April 2024). Treatment-naïve adults with <i>H. pylori</i> infection were randomized 1:1:1 to receive 14-day triple therapy with tegoprazan, 50 mg (TAC1), tegoprazan, 100 mg (TAC2), or lansoprazole, 30 mg (LAC), each combined with amoxicillin 1000 mg and clarithromycin 500 mg, administered twice daily. The primary endpoint was <i>H. pylori</i> eradication rate in the modified intention-to-treat (mITT) population, with a non-inferiority margin of −10%. Secondary endpoints included subgroup analyses based on clarithromycin resistance and safety assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 564 screened patients, 382 were randomized. In the mITT analysis (mean age, 54.9 years; 54.3% male), eradication rates were 86.0%, 85.5%, and 78.7% for TAC1, TAC2, and LAC, respectively. Both tegoprazan-based regimens met the non-inferiority criteria. Among clarithromycin-resistant infections, the eradication rates were higher for TAC1 (47.8%) and TAC2 (50.0%) than for LAC (35.5%), although the difference was not statistically significant. Safety profiles were comparable across the groups, with no serious drug-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tegoprazan-based triple therapies, at 50- and 100-mg doses, were non-inferior to lansoprazole-based therapy and were well tolerated. Our findings indicated that tegoprazan-based triple therapy is a viable first-line option for <i>H. pylori</i> eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT05933031</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Bismuth Quadruple Concomitant Treatment for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis","authors":"Pablo Parra,&nbsp;Olga P. Nyssen,&nbsp;Javier P. Gisbert","doi":"10.1111/hel.70099","DOIUrl":"https://doi.org/10.1111/hel.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Standard triple therapy fails to eradicate <i>Helicobacter pylori</i> (<i>H. pylori</i>) in at least 20% of the cases, largely due to antibiotic resistance. Non-bismuth concomitant quadruple therapy has emerged as a widely used alternative therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To conduct a meta-analysis evaluating the efficacy and safety of concomitant therapy—comprising a proton pump inhibitor, clarithromycin, amoxicillin, and a nitroimidazole—for <i>H. pylori</i> eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed, EMBASE, and relevant conference abstracts was conducted through November 2025. Meta-analyses included studies assessing concomitant therapy and comparisons with standard triple, sequential, hybrid, and bismuth-based quadruple therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 144 studies (92 randomized clinical trials), involving 26,467 patients were included. Pooled eradication rates for concomitant therapy were 86% (intention-to-treat) and 91% (per-protocol). Analysis of randomized clinical trials showed that concomitant therapy demonstrated significantly higher efficacy than triple therapy (<i>risk difference</i> [RD] = 0.11; 95% CI = 0.08–0.13) and sequential therapy (RD = 0.03; 0.01–0.05), but similar efficacy to hybrid and bismuth quadruple regimens (containing nitroimidazole–tetracycline and clarithromycin–amoxicillin). Concomitant therapy achieved 87% and 95% eradication rates in clarithromycin- and metronidazole-resistant strains, respectively, but only 67% in dual-resistant strains. Adverse events were frequent (38%), although generally mild.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Concomitant therapy is a highly effective first-line option for <i>H. pylori</i> eradication, particularly in single clarithromycin- or nitroimidazole-resistant strains. However, its efficacy is reduced in dual-resistant cases, in which alternative regimens may be preferred. Overall, its efficacy is comparable to that of hybrid and bismuth quadruple therapy. Its tolerability is generally acceptable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Levofloxacin- Versus Moxifloxacin-Based Nitazoxanide Quadruple Therapy as Second-Line Treatment for Helicobacter pylori in Egypt: A Randomized Multicenter Trial","authors":"Gasser El-Azab,&nbsp;Sherief Abdel Salam,&nbsp;Ehab Moustafa,&nbsp;Ahmed Abuoelhassan,&nbsp;Ayman Shamseya,&nbsp;Ahmed Ellakany,&nbsp;Usama Abdelaal,&nbsp;Medhat Assem,&nbsp;Fatma Khalil,&nbsp;Amal Mahmoud,&nbsp;Maha Elsabaawy,&nbsp;Boshra Hussein,&nbsp;Mohammed Ezz-Eldin,&nbsp;Sahar Hassany,&nbsp;Nariman Zaghloul,&nbsp;Mai Magdy","doi":"10.1111/hel.70104","DOIUrl":"10.1111/hel.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Eradication of <i>Helicobacter pylori</i> remains challenging in countries with high antimicrobial resistance and limited access to bismuth-based therapies. Quinolone-containing regimens represent a practical alternative, yet comparative data between levofloxacin- and moxifloxacin-based nitazoxanide quadruple therapies are scarce, particularly in Egypt. This multicenter trial evaluated the efficacy, safety, and tolerability of two nitazoxanide-based second-line regimens after failure of first-line eradication therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, randomized, single-blind, parallel-group study conducted at six Egyptian centers, adults aged 18–70 years with documented failure of first-line <i>H. pylori</i> therapy were enrolled. Patients were randomized 1:1 to receive either LNDL (levofloxacin 750 mg once daily, nitazoxanide 500 mg twice daily, doxycycline 100 mg twice daily, lansoprazole 30 mg twice daily) or MNDL (moxifloxacin 400 mg once daily with the same adjunct medications) for 14 days. Eradication was assessed using a stool antigen test ≥ 4 weeks after treatment. Safety, tolerability, and symptom improvement were recorded. Analyses were performed using both intention-to-treat (ITT) and per-protocol (PP) populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 430 patients were randomized. ITT eradication rates were 65.6% (95% CI: 59.2% – 72%) for LNDL and 74.9% (95% CI: 69% – 80.7%) for MNDL (<i>p</i> = 0.035). PP eradication rates were 70.9% (95% CI: 64.5% – 77.2%) and 78.5% (95% CI: 72.9% – 84.2%), respectively (<i>p</i> = 0.076). Among patients previously treated with levofloxacin, MNDL achieved significantly higher eradication rates than LNDL (65.8%, 95% CI: 50–81.6 vs. 42.6%, 95% CI: 29–56.2, <i>p</i> = 0.028). Both regimens produced significant symptom improvement and were well tolerated; no serious adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both nitazoxanide-based quinolone quadruple regimens demonstrated modest but clinically relevant efficacy as second-line therapy. Moxifloxacin showed superior performance in patients with prior levofloxacin exposure. These findings support the use of moxifloxacin-based rescue therapy in settings with high resistance and limited access to bismuth-containing regimens.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"31 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}