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      Helicobacter pylori infection: a dynamic process from diagnosis to treatment

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          Abstract

          Helicobacter pylori, a gram-negative microaerophilic pathogen, causes several upper gastrointestinal diseases, such as chronic gastritis, peptic ulcer disease, and gastric cancer. For the diseases listed above, H. pylori has different pathogenic mechanisms, including colonization and virulence factor expression. It is essential to make accurate diagnoses and provide patients with effective treatment to achieve positive clinical outcomes. Detection of H. pylori can be accomplished invasively and noninvasively, with both having advantages and limitations. To enhance therapeutic outcomes, novel therapeutic regimens, as well as adjunctive therapies with probiotics and traditional Chinese medicine, have been attempted along with traditional empiric treatments, such as triple and bismuth quadruple therapies. An H. pylori infection, however, is difficult to eradicate during treatment owing to bacterial resistance, and there is no commonly available preventive vaccine. The purpose of this review is to provide an overview of our understanding of H. pylori infections and to highlight current treatment and diagnostic options.

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          Most cited references135

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          Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis.

          The epidemiology of Helicobacter pylori infection has changed with improvements in sanitation and methods of eradication. We performed a systematic review and meta-analysis to evaluate changes in the global prevalence of H pylori infection.
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            Global burden of gastric cancer attributable to Helicobacter pylori.

            We previously estimated that 660,000 cases of cancer in the year 2008 were attributable to the bacterium Helicobacter pylori (H. pylori), corresponding to 5.2% of the 12.7 million total cancer cases that occurred worldwide. In recent years, evidence has accumulated that immunoblot (western blot) is more sensitive for detection of anti-H. pylori antibodies than ELISA, the detection method used in our previous analysis. The purpose of this short report is to update the attributable fraction (AF) estimate for H. pylori after briefly reviewing new evidence, and to reassess the global burden of cancer attributable to H. pylori. We therefore reviewed the literature for studies comparing the risk of developing non-cardia gastric cancer (NCGC) in cases and controls, using both ELISA and multiple antigen immunoblot for detection of H. pylori. The results from prospective studies were combined, and the new pooled estimates were applied to the calculation of the AF for H. pylori in NCGC, then to the burden of infection-related cancers worldwide. Using the immunoblot-based data, the worldwide AF for H. pylori in NCGC increased from 74.7% to 89.0%. This implies approximately 120,000 additional cases of NCGC attributable to H. pylori infection for a total of around 780,000 cases (6.2% instead of 5.2% of all cancers). These updated estimates reinforce the role of H. pylori as a major cause of cancer.
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              Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions

              BACKGROUND & AIMS: In 2017, the World Health Organization (WHO) designated clarithromycin-resistant Helicobacter pylori a high priority for antibiotic research and development. However, there are no clear data on the global distribution of resistance or its clinical effects. We performed a systematic review and meta-analysis to assess the distribution of H pylori resistance to commonly used antibiotics and to measure the association between antibiotic resistance and treatment failure. METHODS: We searched publication databases for studies that assessed rates of H pylori resistance to clarithromycin, metronidazole, levofloxacin, amoxicillin, or tetracycline. Pooled estimates of primary and secondary resistance and 95% confidence intervals (CIs) were grouped by WHO region. The association between antibiotic resistance and treatment failure was measured by extracting data on treatment efficacy in patients with resistant and susceptible isolates and pooling odds ratios with 95% CIs. RESULTS: We identified 178 studies, comprising 66,142 isolates from 65 countries. Primary and secondary resistance rates to clarithromycin, metronidazole, and levofloxacin were ≥15% in all WHO regions, except primary clarithromycin resistance in the Americas (10%; 95% CI, 4%–16%) and South-East Asia region (10%; 95% CI, 5%–16%) and primary levofloxacin resistance in the European region (11%; 95% CI, 9%–13%). There was considerable heterogeneity ( I 2 > 75%) among all analyses—this might have resulted from the grouping of resistance rates by country. Increasing antibiotic resistance was observed in most WHO regions. Resistance to clarithromycin was significantly associated with failure of clarithromycin-containing regimens (odds ratio, 6.97; 95% CI, 5.23–9.28; P < .001). CONCLUSIONS: Resistance of H pylori to antibiotics has reached alarming levels worldwide, which has a great effect on efficacy of treatment. Local surveillance networks are required to select appropriate eradication regimens for each region.
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                Author and article information

                Contributors
                Journal
                Front Cell Infect Microbiol
                Front Cell Infect Microbiol
                Front. Cell. Infect. Microbiol.
                Frontiers in Cellular and Infection Microbiology
                Frontiers Media S.A.
                2235-2988
                19 October 2023
                2023
                : 13
                : 1257817
                Affiliations
                [1] 1 School of Traditional Chinese Medicine, Hunan University of Chinese Medicine , Changsha, Hunan, China
                [2] 2 Hunan Provincial Key Laboratory of Traditional Chinese Medicine (TCM) Diagnostics, Hunan University of Chinese Medicine , Changsha, Hunan, China
                [3] 3 School of Medicine, Hunan University of Chinese Medicine , Changsha, Hunan, China
                [4] 4 The First Hospital of Hunan University of Chinese Medicine , Changsha, Hunan, China
                [5] 5 School of International Education, Hunan University of Chinese Medicine , Changsha, Hunan, China
                Author notes

                Edited by: Raquel Mejías-Luque, Technical University of Munich, Germany

                Reviewed by: Michael Vieth, Murdoch University, Australia; Olga Sokolova, Otto von Guericke University Magdeburg, Germany

                *Correspondence: Houpan Song, songhp@ 123456hnucm.edu.cn ; Xiong Cai, caixiong@ 123456hnucm.edu.cn
                Article
                10.3389/fcimb.2023.1257817
                10621068
                37928189
                16769ce9-b73f-4bf1-9e7e-b3b06dab616b
                Copyright © 2023 Sun, Yuan, Zhou, Lu, Zeng, Cai and Song

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 13 July 2023
                : 05 October 2023
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 135, Pages: 14, Words: 7701
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the National Natural Science Foundation of China (nos. 82374429 and 82004427); the Natural Science Foundation of Hunan Province (nos. 2023JJ30460 and 2023JJ40474); the Scientific Research Fund of the Hunan Provincial Education Department (no. 21A0240); the Open-competing Disciple Construction Project of the Hunan University of Chinese Medicine (no. 22JBZ027); and the Guidance Project of the Academician Liu Liang’s Expert Workstation (no. 22YS003).
                Categories
                Cellular and Infection Microbiology
                Review
                Custom metadata
                Bacteria and Host

                Infectious disease & Microbiology
                helicobacter pylori,pathogenesis,diagnostic strategy,treatment,antibiotic resistance

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