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| 1 | Treatment of Helicobacter pylori infection in atrophic gastritis显示文摘Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis(AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows:(1) Cure of infection, resolution of inflammation and normalization of gastric functions;(2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and(3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric p H, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infection, there is a paucity of evidence in the subgroupof patients with AG. Bismuth-based therapy may be an attractive treatment in the specific setting of AG, and specific studies on the efficacy of bismuth-based therapies are needed in patients with AG. | Edith Lahner Marilia Carabotti Bruno Annibale | 2018 | World Journal of Gastroenterology2018，24，22： | 57 |
| 2 | Standard triple therapy for Helicobacter pylori infection in China: A meta-analysis显示文摘AIM:To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.METHODS:Literature searches were conducted in the following databases:PubMed,EMBASE,the Cochrane Central Register of Controlled Trials,the VIP database,the China National Knowledge Infrastructure database,and the Chinese Biomedical Database.A meta-analysis of all randomized controlled trials(RCTs)comparing standard triple therapy for the eradication of Helicobacter pylori with pre-existing and new therapies in China was performed using Comprehensive Meta-Analysis 2.0.There were 49 studies that met our criteria and the qualities of these studies were assessed using the Jadad scale.The Mantel-Haenszel method was used for pooling dichotomous data.We also conducted subgroupanalyses according to age,duration of treatment and drug type.Sensitivity analyses and a cumulative metaanalysis were also performed with CMA 2.0.Publication bias was evaluated using Egger’s test,Begg’s test or a funnel plot.RESULTS:A total of 49 RCTs including 8332 patients were assessed.This meta-analysis showed that standard triple therapy with proton pump inhibitors(PPIs),amoxicillin(AMO)and clarithromycin(CLA)was inferior to sequential therapy[relative risk(RR)=0.863;95%confidence interval(CI):0.824-0.904],but was not superior to quadruple therapy(RR=1.073;95%CI:0.849-1.357)or other triple therapies(RR=1.01;95%CI:0.936-1.089).The meta-analysis also suggested that standard triple therapy is slightly more effective than dual therapy(RR=1.14;95%CI:0.99-1.31).However,the differences were not statistically significant.We removed the only trial with a regimen lasting14 d by sensitivity analysis and found that 7-d standard triple therapy was superior to 7-d dual therapy(RR=1.222;95%CI:1.021-1.461).Moreover,a sub-analysis based on the duration of quadruple therapy indicated that the 7-d and 10-d standard triple therapies were inferior to sequential therapy(RR=0.790;95%CI:0.718-0.868;RR=0.917;95%CI:0.839-1.002,respectively).Additionally,there were no significant differences in cure rate or adverse events among standard triple therapy,quadruple therapy,and other triple therapies(RR=0.940;95%CI:0.825-1.072;RR=1.081;95%CI:0.848-1.378,respectively).Standard triple therapy had a higher occurrence of side effects than sequential therapy(RR=1.283;95%CI:1.066-1.544).CONCLUSION:The eradication rates with a standard triple therapy consisting of PPI,AMO,and CLA are suboptimal in China,and new treatment agents need to be developed. | Ben Wang Zhi-Fa Lv You-Hua Wang Hui Wang Xiao-Qun Liu Yong Xie Xiao-Jiang Zhou | 2014 | World Journal of Gastroenterology2014，20，40： | 46 |
| 3 | Can eradication rate of gastric Helicobacter pylori be improved by killing oral Helicobacter pylori ?显示文摘AIM:To evaluate the influence of oral Helicobacter pylori(H.pylori)on the success of eradication therapy against gastric H.pylori.METHODS:A total of 391 patients with dyspepsia were examined for H.pylori using the saliva H.pylori antigen test(HPS),13C-urea breath test(UBT),gastroscopy,and gastric mucosal histopathological detection.Another 40 volunteers without discomfort were subjected to HPS and13C-UBT,and served as the control group.The 233 patients who were13C-UBT+were enrolled in this study and divided into 4 groups.Patients who were HPS-and13C-UBT+(n=53)received triple therapy alone.Those who were both HPS+and13CUBT+(n=180)were randomly divided into 3 groups:(1)the O+G+t group which received triple therapy alone(n=53);(2)the O+G+tm group which received both triple therapy and mouthrinse treatment(n=65);and(3)the O+G+tmp group which received triple therapy,mouthrinse,and periodontal treatment(n=62).The HPS and13C-UBT were continued for 4 wk after completion of treatment,and the eradication rate of gastric H.pylori and the prevalence of oral H.pylori in the 4 groups were then compared.RESULTS:The eradication rates of gastric H.pylori in the O-G+t group,the O+G+tm group,and the O+G+tmp group were 93.3%,90.0%,and 94.7%respectively;all of these rates were higher than that of the O+G+t group(78.4%)[O-G+t group vs O+G+t group(P=0.039);O+G+tm group vs O+G+t group(P=0.092);O+G+tmp group vs O+G+t group(P=0.012);O+G+tm group vs O-G+t group(P=0.546);O+G+tmp group vs O-G+t group(P=0.765);O+G+tm group vs O+G+tmp group(P=0.924)].The eradication of gastric H.pylori was significantly improved using the combination of triple therapy,mouthrinse,and periodontal treatment.The eradication rates of gastric H.pylori in the peptic ulcer group,chronic atrophic gastritis group and control group were higher than in the duodenitis group and the superficial gastritis group.The prevalence rates of oral H.pylori in the O-G+t group,O+G+t group,O+G+tm group and O+G+tmp group following treatment were 0%,76.5%,53.3%,and 50.9%,respectively[O-G+t group vs O+G+t group(P<0.0001);O+G+tm group vs O+G+t group(P=0.011);O+G+tmp group vs O+G+t group(P=0.006);O+G+tm group vs O-G+t group(P<0.0001);O+G+tmp group vs O-G+t group(P<0.0001);O+G+tm group vs the O+G+tmp group(P=0.790)].Both mouthrinse and periodontal treatment significantly reduced the prevalence of oral H.pylori.CONCLUSION:Mouthrinse treatment alone or combined with periodontal treatment can,to some extent,reduce the prevalence of oral H.pylori and improve the eradication rate of gastric H.pylori. | Han-Yi Song Yan Li | 2013 | World Journal of Gastroenterology2013，19，39： | 29 |
| 4 | Are probiotics useful in Helicobacter pylori eradication?显示文摘Helicobacter pylori(H. pylori) is considered an etiologic factor for the development of peptic ulcer disease,gastric adenocarcinoma, and MALT lymphoma.Therapeutic schemes to eradicate the bacteria are based on double antibiotic therapy and proton pump inhibitor. Despite many therapeutic improvements in H. pylori eradication treatment, it is still associated with high infection rate also in developed countries.Bacterial resistance and adverse events occurrence are among most frequent causes for anti- H. pylori treatment failure. Several studies have reported that certain probiotic strains can exhibit inhibitory activity against H. pylori bacteria. In addition, some probiotic strains can reduce the occurrence of side effects due to antibiotic therapy and consequently increase the H.pylori eradication rate. The results of the prospective double-blind placebo-controlled studies suggest that specific probiotics, such as S. boulardii and L.johnsonni La1 probably can diminish the bacterial load,but not completely eradicate the H. pylori bacteria.Furthermore, it seems that supplementation with S. boulardii is a useful concomitant therapy in the standard H. pylori eradication treatment protocol and most probably increases eradication rate. L. reuteri is equally effective, but more positive studies are needed. Finally, probiotic strains, such as S. boulardii,L. reuteri and L. GG, decrease gastrointestinal antibiotic associated adverse effects. | Matjaz Homan Rok Orel | 2015 | World Journal of Gastroenterology2015，21，37： | 29 |
| 5 | Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis显示文摘AIM: To evaluate whether Helicobacter pylori(H. pylori) eradication therapy benefits patients with functional dyspepsia(FD).METHODS: Randomized controlled trials(RCTs) investigating the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English(up to May 2015) were identified by searching Pub Med, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio(RR) or a standard mean difference(SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0.RESULTS: This systematic review included 25 RCTs with a total of 5555 patients with FD. Twenty-three of these studies were used to evaluate the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.23(95%CI: 1.12-1.36, P < 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year(RR = 1.24; 95%CI: 1.12-1.37, P < 0.0001) but not during short-term follow-up at < 1 year(RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Seven studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of-0.01(95%CI:-0.11 to 0.08, P = 0.80). Six studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy(RR = 0.35; 95%CI: 0.18-0.68, P = 0.002). Eight studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy(RR = 2.02; 95%CI: 1.12-3.65, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy(RR = 7.13; 95%CI: 3.68-13.81, P < 0.00001).CONCLUSION: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment. | Li-Jun Du Bin-Rui Chen John J Kim Sarah Kim Jin-Hua Shen Ning Dai | 2016 | World Journal of Gastroenterology2016，22，12： | 30 |
| 6 | Efficacy of tailored Helicobacter pylori eradication therapy based on antibiotic susceptibility and CYP2C19 genotype显示文摘The cure rates of Helicobacter pylori(H.pylori)eradication therapy using a proton pump inhibitor(PPI)and antimicrobial agents such as amoxicillin,clarithromycin,and metronidazole are mainly influenced by bacterial susceptibility to antimicrobial agents and the magnitude of the inhibition of acid secretion.Annual cure rates have gradually decreased because of the increased prevalence of H.pylori strains resistant to antimicrobial agents,especially to clarithromycin.Alternative regimens have therefore been developed incorporating different antimicrobial agents.Further,standard PPI therapy(twice-daily dosing)often fails to induce a long-term increase in intragastric pH>4.0.Increasing the eradication rate requires more frequent and higher doses of PPIs.Therapeutic efficacy related to acid secretion is influenced by genetic factors such as variants of the genes encoding drug-metabolizing enzymes(e.g.,cytochrome P450 2C19,CYP2C19),drug transporters(e.g.,multidrug resistance protein-1;ABCB1),and inflammatory cytokines(e.g.,interleukin-1β).For example,quadruple daily administration of PPI therapy potently inhibits acid secretion within 24 h,irrespective of CYP2C19 genotype.Therefore,tailored H.pylori eradication regimens that address acid secretion and employ optimal antimicrobial agents based on results of antimicrobial agent-susceptibility testing may prove effective in attaining higher eradication rates. | Mitsushige Sugimoto Takahisa Furuta | 2014 | World Journal of Gastroenterology2014，20，21： | 28 |
| 7 | First-line eradication of Helicobacter pylori:Are the standard triple therapies obsolete? A different perspective显示文摘Studies concerning the eradication of Helicobacter pylori have resulted in a proliferation of meta-analyses. To date, there are 303 meta-analyses cited in PubMed, 113 dealing with the therapy of the infection. A chronological analysis of the results of meta-analyses performed between 1998 and 2010 shows that first-line standard triple therapies achieved eradication rates on an intention-to-treat basis of around 80%; prolonging treatment to 14, but not 10 d should improve the results. The proton pump inhibitors have a similar efficiency, and giving a double dose is more efficient than the standard doses of these drugs. Triple and quadruple therapies proved to be equivalent. Based on meta-analytical data, the decrease in efficiency over time cannot be substantiated: eradication rates < 80% followed from the introduction of triple therapies. As alternatives, ranitidine bismuth citrate-, levofloxacinor furazolidone-based therapies were shown to obtain the same eradication rates as standard triple regimens. Sequential therapies and quadruple non-bismuth-based therapies were superior to standard triple therapies but their use is limited to certain countries. In the author's opinion, and from a meta-analytical viewpoint, standard triple therapies cannot yet be considered obsolete. Furthermore, noninferiority trials are proposed for the future, including assessment of local contemporary antimicrobial resistance profi les and the CagA and CYP2C19 status of the enrolled patients. | Gyrgy Miklós Buzás | 2010 | World Journal of Gastroenterology2010，16，31： | 26 |
| 8 | Characteristics and predictors of gastric cancer after Helicobacter pylori eradication显示文摘Helicobacter pylori(H. pylori) eradication can reduce gastric cancer. However, gastric cancer still develops after eradication, and cases who received eradication therapy are increasing. In this study, we have reviewed the characteristics and predictors of primary gastric cancer developing after H. pylori eradication. In terms of the characteristics, endoscopic, histologic, and molecular characteristics are reported. Endoscopically, gastric cancer after eradication is often depressedtype and shows a gastritis-like appearance, which sometimes makes the diagnosis difficult. Histologically, most gastric cancer after eradication is intestinal type, and non-neoplastic epithelium, also called epithelium with low-grade atypia, is frequently seen over the tumor, which is presumably the cause of the endoscopic gastritis-like appearance. As for molecular characteristics, some markers, such as Ki67, MUC2, and Wnt5a expression, are lower in cancer from patients in whom H. pylori has been eradicated. In terms of predictors, several Japanese studies have reported that severe endoscopic atrophy at eradication is a risk factor for gastric cancer development. Histologic intestinal metaplasia, especially in the corpus, and long-term use of proton pump inhibitors, are also reported as risk factors for gastric cancer after H. pylori eradication. These studies on the characteristics and predictors of gastric cancer development will become the cornerstone for establishing a novel surveillance program based on the gastric cancer risk stratification specific to H. pylori-eradicated patients. | Satoki Shichijo Yoshihiro Hirata | 2018 | World Journal of Gastroenterology2018，24，20： | 25 |
| 9 | Histological changes of gastric mucosa after Helicobacter pylori eradication:a systematic review and meta-analysis显示文摘AIM:To systematically review pathological changes of gastric mucosa in gastric atrophy(GA)and intestinal metaplasia(IM)after Helicobacter pylori(H.pylori)eradication.METHODS:A systematic search was made of PubMed,Web of Science,EMBASE,ClinicalTrials.gov,OVID and the Cochran Library databases for articles published before March 2013 pertaining to H.pylori and gastric premalignant lesions.Relevant outcomes from articles included in the meta-analysis were combined using Review Manager 5.2 software.A Begg’s test was applied to test for publication bias using STATA 11software.χ2 and I2 analyses were used to assess heterogeneity.Analysis of data with no heterogeneity(P>0.1,I2<25%)was carried out with a fixed effects model,otherwise the causes of heterogeneity were first analyzed and then a random effects model was applied.RESULTS:The results of the meta-analysis showed that the pooled weighted mean difference(WMD)with 95%CI was 0.23(0.18-0.29)between eradication and non-eradication of H.pylori infection in antral IM with a significant overall effect(Z=8.19;P<0.00001)and no significant heterogeneity(χ2=27.54,I2=16%).The pooled WMD with 95%CI was-0.01(-0.04-0.02)for IM in the corpus with no overall effect(Z=0.66)or heterogeneity(χ2=14.87,I2=0%)(fixed effects model).In antral GA,the pooled WMD with 95%CI was 0.25(0.15-0.35)with a significant overall effect(Z=4.78;P<0.00001)and significant heterogeneity(χ2=86.12,I2=71%;P<0.00001).The pooled WMD with 95%CI for GA of the corpus was 0.14(0.04-0.24)with a significant overall effect(Z=2.67;P=0.008)and significant heterogeneity(χ2=44.79,I2=62%;P=0.0003)(random effects model).CONCLUSION:H.pylori eradication strongly correlates with improvement in IM in the antrum and GA in the corpus and antrum of the stomach. | Yan-Jun Kong Hong-Gang Yi Jun-Cheng Dai Mu-Xin Wei | 2014 | World Journal of Gastroenterology2014，20，19： | 24 |
| 10 | Outcomes of furazolidone-and amoxicillin-based quadruple therapy for Helicobacter pylori infection and predictors of failed eradication显示文摘AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy(January 2015 to December 2015) who received the ^(13)C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTS Of the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval(CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0%(95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3%(95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144(17%) reported treatment-related adverse events including 24(3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio(AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments(AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy(AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy(AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication. CONCLUSION Furazolidone-and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication. | Ya-Wen Zhang Wei-Ling Hu Yuan Cai Wen-Fang Zheng Qin Du John J Kim John Y Kao Ning Dai Jian-Min Si | 2018 | World Journal of Gastroenterology2018，24，40： | 18 |
| 11 | Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis显示文摘AIM To define probiotic monotherapy effect on Helicobacter pylori(H. pylori) status by performing a systematic review.METHODS Methods of analysis and inclusion criteria were based on PRISMA recommendations. Relevant publications were identified by searching Pub Med, MEDLINE, Science Direct, and EMBASE. The end-point was to estimate eradication rate and urea breath test delta value before and after probiotic monotherapy across all studies and, overall, with a pooled data analysis. Adverse events of probiotic therapy were evaluated. The data were expressed as proportions/percentages, and 95%CIs were calculated. For continuous variables, we evaluated the weighted mean difference. Odd ratios(ORs) were calculated according to the Peto method for the comparison of eradication rates between probiotics and placebo.RESULTS Eleven studies were selected. Probiotics eradicated H. pylori in 50 out of 403 cases. The mean weighted eradication rate was 14%(95%CI: 2%-25%, P =0.02). Lactobacilli eradicated the bacterium in 30 out of 235 patients, with a mean weighted rate of 16%(95%CI: 1%-31%). Saccharomyces boulardii achieved eradication in 6 out of 63 patients, with a pooled eradication rate of 12%(95%CI: 0%-29%). Multistrain combinations were effective in 14 out of 105 patients, with a pooled eradication rate of 14%(95%CI: 0%-43%). In the comparison of probiotics vs placebo, we found an OR of 7.91 in favor of probiotics(95%CI: 2.97-21.05, P < 0.001). Probiotics induced a mean reduction in delta values higher than placebo(8.61% with a 95%CI: 5.88-11.34, vs 0.19% for placebo, P < 0.001). Finally, no significant difference in adverse events was found between probiotics and placebo(OR = 1, 95%CI: 0.06-18.08).CONCLUSION Probiotics alone show a minimal effect on H. pylori clearance, thus suggesting a likely direct role. | Giuseppe Losurdo Rossella Cubisino Michele Barone Mariabeatrice Principi Gioacchino Leandro Enzo Ierardi Alfredo Di Leo | 2018 | World Journal of Gastroenterology2018，24，1： | 18 |
| 12 | Predictive findings forHelicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: Validation study显示文摘AIM:To validate the usefulness of screening endoscopy findings for predictingHelicobacter pylori (H. pylori) infection status. METHODS:H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori -uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings:regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated. RESULTS:Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases:uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19). CONCLUSION:The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status. | Kazuhiro Watanabe Naoyoshi Nagata Ryo Nakashima Etsuko Furuhata Takuro Shimbo Masao Kobayakawa Toshiyuki Sakurai Koh Imbe Ryota Niikura Chizu Yokoi Junichi Akiyama Naomi Uemura | 2013 | World Journal of Gastroenterology2013，19，27： | 17 |
| 13 | Gastric cancer, Helicobacter pylori infection and other risk factors显示文摘Gastric cancer incidence is declining. However, it is too early to consider this neoplastic disease as rare and the worldwide mortality rate still remains high. Several risk factors have been identif ied for non-cardia gastric cancer and primary prevention is feasible since most of the risk factors can be removed. Helicobacter pylori eradication treatment reduces but does not abolish gastric cancer risk. Indeed, gastric cancer is a multifactorial disease and removing one factor does not therefore prevent all cases. Endoscopic surveillance is still needed, especially in subjects at higher risk. The def inition of high-risk patients will be the future challenge as well as identifying the best surveillance strategy for such patients. | Lorenzo Fuccio Leonardo Henry Eusebi Franco Bazzoli | 2010 | World Journal of Gastrointestinal Oncology2010，2，9： | 17 |
| 14 | Optimizing proton pump inhibitors in Helicobacter pylori treatment:Old and new tricks to improve effectiveness显示文摘The survival and replication cycle of Helicobacter pylori(H.pylori)is strictly dependant on intragastric pH,since H.pylori enters replicative phase at an almost neutral pH(6-7),while at acid pH(3-6)it turns into its coccoid form,which is resistant to antibiotics.On these bases,it is crucial to increase intragastric pH by proton pump inhibitors(PPIs)when an antibiotic-based eradicating therapy needs to be administered.Therefore,several tricks need to be used to optimize eradication rate of different regimens.The administration of the highest dose as possible of PPI,by doubling or increasing the number of pills/day,has shown to be able to improve therapeutic outcome and has often proposed in rescue therapies,even if specific trials have not been performed.A pre-treatment with PPI before starting antibiotics does not seem to be effective,therefore it is discouraged.However,the choice of PPI molecule could have a certain weight,since second-generation substances(esomeprazole,rabeprazole)are likely more effective than those of first generation(omeprazole,lansoprazole).A possible explanation is due to their metabolism,which has been proven to be less dependent on cytochrome P450(CYP)2C19 genetic variables.Finally,vonoprazan,a competitive inhibitor of H+/K+-ATPase present on luminal membrane of gastric parietal cells has shown the highest efficacy,due to both its highest acid inhibition power and rapid pharmacologic effect.However current data come only from Eastern Asia,therefore its strong power needs to be confirmed outside this geographic area in Western countries as well as related to the local different antibiotic resistance rates. | Enzo Ierardi Giuseppe Losurdo Rosa Federica La Fortezza Mariabeatrice Principi Michele Barone Alfredo Di Leo | 2019 | World Journal of Gastroenterology2019，25，34： | 15 |
| 15 | Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori eradication: A prospective single-center study from China显示文摘AIM: To investigate the effects of daily telephonebased re-education(TRE) before taking medicine for the eradication of Helicobacter pylori(H. pylori) on the compliance and the eradication rate in a Chinese patient population.METHODS : Aprospective, physician-blind e d, randomized, controlled clinical study was conducted. The patients were randomly assigned to receive TRE every day before taking medicine(TRE group) or no TRE(control group). The patients in the TRE group received regular instructions before taking medicine for the eradication of H. pylori during the entire courseof treatment through telephone calls. The patients in the control group received detailed instructions at the time of seeing a doctor for the guidance. The primary outcome was the H. pylori eradication rate after treatment. The secondary outcomes included the clinical remissions after treatment, adverse events, compliance, and patients' satisfaction.RESULTS: A total of 140 patients were randomized, 70 to the TRE group and 70 to the control group. As the primary outcome, the H. pylori eradication rates in the TRE and control groups were 62.7% and 71.2% in per protocol analysis(P = 0.230), and 52.9% and 52.9% in intention-to-treat analysis(P = 0.567), respectively. As the secondary outcomes, there were no significant differences in the patients' satisfaction between the two groups(good, 79.7% vs 76.9%; fair, 13.6% vs 19.2%; poor, 6.7% vs 3.9%, for the TRE group and control group, respectively; P > 0.05 for all); the rates of adverse effects were 15.2% and 63.5% in the TRE and control groups, respectively(P < 0.001); the compliance rates in the TRE and control groups were 85.7% and 74.3%, respectively(P = 0.069).CONCLUSION: Daily TRE before taking medicine had no significant impact on the patients' compliance, satisfaction, or H. pylori eradication, but reduced the rate of adverse events. | Chun-Hua Wang Sheng-Tao Liao Jun Yang Chun-Xia Li Ying-Ying Yang Ran Han Dong-Feng Chen Chun-Hui Lan | 2015 | World Journal of Gastroenterology2015，21，39： | 15 |
| 16 | Characteristics of gastric cancer in peptic ulcer patients with Helicobacter pylori infection显示文摘AIM:To evaluate the incidence and clinical characteristics of gastric cancer(GC) in peptic ulcer patients with Helicobacter pylori(H.pylori) infection.METHODS:Between January 2003 and December 2013, the medical records of patients diagnosed with GC were retrospectively reviewed.Those with previous gastric ulcer(GU) and H.pylori infection were assigned to the Hp GU-GC group(n = 86) and those with previous duodenal ulcer(DU) disease and H.pylori infection were assigned to the Hp DUGC group(n = 35).The incidence rates of GC in the Hp GU-GC and Hp DU-GC groups were analyzed.Data on demographics(age, gender, peptic ulcer complications and cancer treatment), GC clinical characteristics [location, pathological diagnosis, differentiation, T stage, Lauren's classification, atrophy of surrounding mucosa and intestinal metaplasia(IM)], outcome of eradication therapy for H.pylori infection, esophagogastroduodenoscopy number and the duration until GC onset were reviewed.Univariate and multivariate analyses were performed to identify factors influencing GC development.The relative risk of GC was evaluated using a Cox proportional hazards model.RESULTS:The incidence rates of GC were 3.60%(86/2387) in the Hp GU-GC group and 1.66%(35/2098) in the Hp DU-GC group.The annual incidence was 0.41% in the Hp GU-GC group and 0.11% in the Hp DUGC group.The rates of moderate-to-severe atrophy of the surrounding mucosa and IM were higher in the Hp GU-GC group than in the Hp DU-GC group(86% vs 34.3%, respectively, and 61.6% vs 14.3%, respectively, P < 0.05).In the univariate analysis, atrophy of surrounding mucosa, IM and eradication therapy for H.pylori infection were significantly associated with the development of GC(P < 0.05).There was no significant difference in the prognosis of GC patients between the Hp GU-GC and Hp DU-GC groups(P = 0.347).The relative risk of GC development in the Hp GUGC group compared to that of the Hp DU-GC group,after correction for age and gender,was 1.71(95%CI:1.09-2.70;P=0.02).CONCLUSION:GU patients with H.pylori infection had higher GC incidence rates and relative risks.Atrophy of surrounding mucosa,IM and eradication therapy were associated with GC. | Jae Jin Hwang Dong Ho Lee Ae-Ra Lee Hyuk Yoon Cheol Min Shin Young Soo Park Nayoung Kim | 2015 | World Journal of Gastroenterology2015，21，16： | 15 |
| 17 | Reinfection rate and endoscopic changes after successful eradication of Helicobacter pylori显示文摘AIM:To determine the long-term outcomes regarding reinfection with Helicobacter pylori(H.pylori)and endoscopic changes after successful H.pylori eradication. METHODS:From June 1994 to January 2007,186 patients(M:F=98:88;mean age 50.0±11.4 years), in whom H.pylori had been successfully eradicated, were enrolled.The mean duration of follow up was 41.2±24.0 mo. RESULTS:H.pylori reinfection occurred in 58 patients (31.2%).The average annual reinfection rate was 9.1% per patient year.No recurrence of peptic ulcer was detected at the follow up endoscopy.There were no significant differences between the H.pylori eradication regimens for the reinfection rate and no significant differences in endoscopic findings between the H.pylorirecurred group and the H.pylori-cured group.CONCLUSION:The reinfection rate in Korea is 9.1% which represents a decreasing trend.There was no relationship between H.pylori infection status and changes in endoscopic findings.There was also no recurrence or aggravation of ulcers. | Kum Hei Ryu Sun Young Yi Youn Ju Na Su Jung Baik Su Jin Yoon Hae-Sun Jung Hyun Joo Song | 2010 | World Journal of Gastroenterology2010，16，2： | 14 |
| 18 | Current status of Helicobacter pylori eradication and risk factors for eradication failure显示文摘BACKGROUND The Helicobacter pylori(H.pylori)eradication rate is decreasing in the general population of China.AIM To evaluate the H.pylori eradication status in real-world clinical practice and to explore factors related to eradication failure.METHODS Patients with H.pylori infection who were treated with standard 14-d quadruple therapy and received a test of cure at a provincial medical institution between June 2018 and May 2019 were enrolled.Demographic and clinical data were recorded.Eradication rates were calculated and compared between regimens and subgroups.Multivariate analysis was performed to identify predictors of eradication failure.RESULTS Of 2610 patients enrolled,eradication was successful in 1999(76.6%)patients.Amoxicillin-containing quadruple regimens showed a higher eradication rate than other quadruple therapy regimens(83.0%vs 69.0%,P<0.001).The quadruple therapy containing amoxicillin plus clarithromycin achieved the highest eradication rate(83.5%).Primary therapy had a higher eradication rate than rescue therapy(78.3%vs 66.5%,P<0.001).In rescue therapy,the amoxicillinand furazolidone-containing regimens achieved the highest eradication rate(80.8%).Esomeprazole-containing regimens showed a higher eradication rate than those containing other proton pump inhibitors(81.8%vs 74.9%,P=0.001).Multivariate regression analysis found that older age,prior therapy,and use of omeprazole or pantoprazole were associated with an increased risk of eradication CONCLUSION The total eradication rate is 76.6%.Amoxicillin-containing regimens are superior to other regimens.Age,prior therapy,and use of omeprazole or pantoprazole are independent risk factors for eradication failure. | Tian-Lian Yan Jian-Guo Gao Jing-Hua Wang Dan Chen Chao Lu Cheng-Fu Xu | 2020 | World Journal of Gastroenterology2020，26，32： | 13 |
| 19 | Comparative study of esomeprazole and lansoprazole in triple therapy for eradication of Helicobacter pylori in Japan显示文摘AIM:To evaluate the efficacy and safety of esomeprazole-based triple therapy compared with lansoprazole therapy as first-line eradication therapy for patients with Helicobacter pylori(H.pylori)in usual post-marketing use in Japan,where the clarithromycin(CAM)resistance rate is 30%.METHODS:For this multicenter,randomized,openlabel,non-inferiority trial,we recruited patients(≥20years of age)with H.pylori infection from 20 hospitals in Japan.We randomly allocated patients to esomeprazole therapy(esomeprazole 20 mg,CAM 400 mg,amoxicillin(AC)750 mg for the first 7 d,with all drugs given twice daily)or lansoprazole therapy(lansoprazole30 mg,CAM 400 mg,AC 750 mg for the first 7 d,with all drugs given twice daily)using a minimization method with age,sex,and institution as adjustment factors.Our primary outcome was the eradication rate by intention-to-treat(ITT)and per-protocol(PP)analyses.H.pylori eradication was confirmed by a urea breath test from 4 to 8 wk after cessation of therapy.RESULTS:ITT analysis revealed the eradication rates of 69.4%(95%CI:61.2%-76.6%)for esomeprazole therapy and 73.9%(95%CI:65.9%-80.6%)for lansoprazole therapy(P=0.4982).PP analysis showed eradication rate of 76.9%(95%CI:68.6%-83.5%)for esomeprazole therapy and 79.8%(95%CI:71.9%-86.0%)for lansoprazole therapy(P=0.6423).There were no differences in adverse effects between the two therapies.CONCLUSION:Esomeprazole showed non-inferiority and safety in a 7 day-triple therapy for eradication of H.pylori compared with lansoprazole. | Tsutomu Nishida Masahiko Tsujii Hirohisa Tanimura Shusaku Tsutsui Shingo Tsuji Akira Takeda Atsuo Inoue Hiroyuki Fukui Toshiyuki Yoshio Osamu Kishida Hiroyuki Ogawa Masahide Oshita Ichizo Kobayashi Shinichiro Zushi Makoto Ichiba Naoto Uenoyama Yuichi Yasunaga Ryu Ishihara Mamoru Yura Masato Komori Satoshi Egawa Hideki Iijima Tetsuo Takehara | 2014 | World Journal of Gastroenterology2014，20，15： | 13 |
| 20 | Vaccine against Helicobacter pylori : Inevitable approach显示文摘Over three decades have passed since the discovery of Helicobacter pylori(H. pylori), and yet many questions about its treatment remain unanswered. For example, there is no certainty regarding continued use of current antibiotic therapy against H. pylori. The bad news is that even combined regimens are also unable to eradicate bacterial colonization. The worst problem with H. pylori chemotherapy is that even if we identify the most successful regimen, it cannot eliminate the risk of re-infection. This problem is further complicated by the fact that clinicians have no information as to whether probiotics are useful or not. Moreover, to date, we have no large scale produced vaccine effective against H. pylori. Due to the relatively rapid and abundant dissemination of guidelines globally reported concerning management of gastric cancer prevention and therapeutic regimens, clinicians may choose a vaccine as better effective weapon against H. pylori. Therefore, a radical shift in adopted strategies is needed to guide ultimate decisions regarding H. pylori management. In light of failures in vaccine projects, we should identify better vaccine design targeting conserved/essential genes. The unique character and persistence of H. pylori pose obstacles to making an effective vaccine. Preferably, in developing countries, the best reasonable and logical approach is to recommend prophylactic H. pylori vaccine among children as an obligatory national program to limit primary colonization. Trying to produce a therapeutic vaccine would be postponed until later. In reality, we should not forget to prescribe narrow spectrum antibiotics. In the current review, I draw a route to define the best adopted strategy against this rogue bacterium. | Amin Talebi Bezmin Abadi | 2016 | World Journal of Gastroenterology2016，22，11： | 13 |
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