Introduction

Global rise in primary Helicobacter pylori (H. pylori) antibiotic resistance has led to a decrease in the treatment efficacy. Understanding the rates of clarithromycin resistance in H. pylori management is essential for determining the optimal eradication therapy and achieve successful clinical outcomes.

Aims & Methods

This review aimed to evaluate the prevalence and geographical distribution of H. pylori primary clarithromycin resistance in Europe. Bibliographical searches were performed in PubMed up to March 2024. Selection: Included studies assessing rates of H. pylori primary resistance to clarithromycin with no time restriction. Publications in any language were considered. Studies that focused on children only or non-European countries were excluded.

Results

Overall, 188 studies were included, evaluating 81,458 patients over more than 30 years (1990-2024). In this time span, the mean prevalence of primary H. pylori clarithromycin resistance in Europe was 17%. This rate increased from 7.3% in the period 1990-1999, to 13% in 2000-2009, reaching 26% in 2010-2019; and then reported a decreased rate to 22% in 2020-2024. In almost all European countries, the clarithromycin resistance rate increased over time, reporting the highest rates in Switzerland (67%), Ireland (50%), Israel (44%), Portugal (40%) and Poland (39%) (2010-2019). The prevalence remained stable in recent years in France (decreasing from 21% to 17%), in Spain (around 15%), and in Turkey (decreasing from 28% to 15%). Southern European countries reported higher rates (>15-20%) than in northern countries (<10-15%).

Table 1. Clarithromycin primary resistance prevalence in Europe in the last four decades (1990-2024). Number of patients tested for Clarithromycin: n (positive resistance results)/N (total with H. pylori). NA: not available.

Conclusion

In Europe, overall H. pylori primary clarithromycin resistance was above 15% in the last 30 years. Variability exists between countries, with Southern European and Mediterranean countries showing higher levels of resistance.

References

Bujanda, Luis et al. “Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013-2020: Results of the European Registry on H. pylori Management (Hp-EuReg).” Antibiotics (Basel, Switzerland). 2021,10(9):1058.
Macías-García, Fernando et al. “High primary antibiotic resistance of Helicobacter Pylori strains isolated from dyspeptic patients: A prevalence cross-sectional study in Spain.” Helicobacter. 2017,22(6):10.1111/hel.12440.
Tamayo, Esther et al. “Clarithromycin resistance in Helicobacter pylori and its molecular determinants in Northern Spain, 2013-2015.” Journal of global antimicrobial resistance. 2017,9:43-46.
Saracino, Ilaria Maria et al. “Trends in Primary Antibiotic Resistance in H. pylori Strains Isolated in Italy between 2009 and 2019.” Antibiotics (Basel, Switzerland). 2020,9(1):26.
Megraud, Francis et al. “Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community.” Gut. 2021,70(10):1815-1822.

Introduction

Recents meta-analyses have shown that Tegoprazan (Tego) could be equal or superior to proton pump inhibitors in the eradication of Helicobacter pylori (HP). However, virtually all primary studies have been conducted in Asian populations, so validation in other regions is required.

Aims & Methods

Aim: To assess the efficacy and safety of Tego compared to Esomeprazole (Eso) in Latin population. Methods: We studied 117 consecutive treatment-naive HP infected patients [51.04±12.11 (48.85-53.24) years, 75% females] evidenced by endoscopic biopsy. Patients were randomized to receive either Tego (50 mg) or Eso (40 mg), both in combination with Amoxicillin (1 g) and Clarithromycin (500 mg), all administered twice daily for 14 days. Treatment efficacy was assessed using a urea breath test performed 35±2 days post-therapy. Treatment safety was monitored by recording adverse events. Additionally, dyspeptic symptoms, general laboratories and quality of life (SF-36 questionnaire) were assessed. Data expressed mean±SD and 95% CI or percentages, while statistical differences were evaluated with the unpaired and paired Student t test or the chi-square test, as appropriate. Alpha = 0.05.

Results

There were no differences between Tego and Eso groups in age [51±12.14 (47.79-54.21) vs. 51.08±12.28 (48.02-54.14) years respectively, p= 0.97] or sex (75.4% vs. 74.6% women respectively, p=0.76). Tego and Eso groups showed similar efficacy (94.55% vs 93.55% respectively, p=0.82) and adverse events (14.55% vs 22.58% respectively, p=0.26). Main symptoms in Tego group were diarrhea (n=4) and headache (n=2) meanwhile Eso group referred diarrhea (n=4) and abdominal pain (n=4). All adverse events were mild and suspend treatment was not required. Dyspeptic symptoms decreased after treatment in both Tego (78.88% vs 45.45%, p=0.0004) and Eso (79.03% vs 46.77%, p=0.0002) groups but there were no differences before (p=0.9108) and after (p=0.8864) treatment between them. There were no differences in the 18 components of the general laboratories (all in normal range) between groups before and after treatment. Physical component summary (CS) improved post treatment in both Tego [48.56±13.96 (44.87-52.25) vs 51.83±13.17 (48.35-55.31), p=0.03] and Eso [46.95±11.35 (44.13-49.78) vs 52.29±13.22 (49-55.58), p=0.01] groups. Mental CS showed no differences after treatment en Tego [47.35±5.99 (45.77-48.94) vs 47.8±6.48 (46.09-49.51), p=0.62] nor Eso [47.51±6.67 (45.86-49.17) vs 47.82±5.39 (46.47-49.16), p=0.78] groups. There was no difference in physical or mental CS between Tego and Eso groups before (p=0.49 and p=0.85, respectively) or post treatment (p=0.89 and p=0.98, respectively) Table 1.

Table 1. The 8 domains of SF-36 in both groups (*p<0.05 vs basal)

Conclusion

Our work shows that Tegoprazan is equally effective and safe as Esomeprazole for triple therapy to eradicate Helicobacter pylori in Latin population. We also found that eradication treatment improves general health, physical functioning, and physical component summary, which warrants further investigation. Clinical Trials registration: NCT06318104.

References

(/10.1080/14787210.2025.2459722) (10.1002/jgh3.70134)

Disclosure

We would like to thank Carnot Laboratories for providing tegoprazan for this study.

Introduction

Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic disorder of the bile ducts, associated with significant morbidity and an increased risk of malignancy. Preclinical studies in mice deficient in the multidrug resistance protein 2 (Mdr2−/−) have demonstrated that the integrin αvβ6 plays a critical role in biliary fibrosis by activating latent transforming growth factor (TGF)-β1, the main profibrotic cytokine in the liver. Moreover, several studies have shown that autoantibodies against integrin αvβ6 exhibit good diagnostic accuracy in ulcerative colitis (UC). The aim of this meta-analysis is to evaluate the diagnostic performance of anti-integrin αvβ6 autoantibodies in PSC.

Aims & Methods

A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (PubMed, Scopus, ScienceDirect, and the Cochrane Library) were systematically searched up to February 2025. Eligible studies included those involving patients with PSC as well as non-PSC control groups, in which the overall sensitivity and specificity of serum anti-integrin αvβ6 autoantibodies for the diagnosis of PSC were reported. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated using a random-effects model. Subgroup analyses were conducted based on the presence or absence of concomitant UC. Meta-analyses were performed using RevMan version 5.4.

Results

Four studies, comprising a total of 1,228 participants, met the predefined eligibility criteria. All studies defined the positivity threshold as the mean value in control groups plus three standard deviations (SD). The pooled sensitivity and specificity for the diagnosis of PSC were 0.679 (95% CI: 0.670–0.689) and 0.940 (95% CI: 0.939–0.941), respectively, with high heterogeneity (I² = 99%).
In the subgroup analysis, the sensitivity and specificity of the test for diagnosing PSC in the absence of concomitant UC were 0.075 (95% CI: 0.071–0.080) and 0.940 (95% CI: 0.939–0.941), respectively. In contrast, in the subgroup of patients with both PSC and UC, sensitivity reached 0.960 (95% CI: 0.959–0.961), while specificity was 0.720 (95% CI: 0.713–0.727).
Sensitivity analyses performed to explore the observed heterogeneity revealed that exclusion of one study (Bloeman, 2024) significantly improved diagnostic performance across all subgroups, with a pooled sensitivity of 0.831 (95% CI: 0.8236–0.8384) and specificity of 0.946 (95% CI: 0.9451–0.9468).

Conclusion

Serum anti-integrin αvβ6 autoantibodies demonstrate diagnostic value in PSC, with consistently high specificity across all patient groups and notably high sensitivity in those with concomitant ulcerative colitis. The high specificity supports a strong negative predictive value. Given the supporting preclinical evidence, integrin αvβ6 warrants further investigation not only as a diagnostic biomarker but also as a potential therapeutic target.

Disclosure

​No conflict of ​Interest

Introduction

Gastric outlet obstruction (GOO) is a debilitating condition commonly caused by malignant or benign diseases, impairing gastric emptying and nutritional status. While surgical gastrojejunostomy (SGJ) has traditionally been the standard palliative approach, endoscopic ultrasound-guided gastrojejunostomy (EUSGJ) has recently emerged as a minimally invasive alternative. This systematic review and meta-analysis aimed to compare the efficacy and safety of EUSGJ versus SGJ for the management of GOO.

Aims & Methods

A systematic search of PubMed, Embase, Medline, and Cochrane Library was conducted to identify studies directly comparing EUSGJ and SGJ in adult patients with GOO. Nine retrospective studies comprising 1,086 patients (654 EUSGJ; 432 SGJ) were included. Primary outcomes included technical and clinical success, length of hospital stay (LOS), operative time, and overall complication rates. Secondary outcomes included infection, ileus, hemorrhage, perforation, and re-intervention. Meta-analyses were performed using fixed or random effects models depending on data heterogeneity.

Results

EUSGJ was significantly superior to SGJ in terms of technical success (OR = 0.16; 95% CI: 0.05–0.45; p = 0.0006), shorter operative time (MD = –96.89 minutes; 95% CI: –146.16 to –47.61; p < 0.00001), reduced postoperative LOS (MD = –4.79 days; 95% CI: –6.52 to –3.06; p < 0.0001), lower overall complication rates (OR = 0.24; 95% CI: 0.17–0.33; p < 0.00001), reduced postoperative ileus (OR = 0.07; 95% CI: 0.02–0.17; p < 0.00001), and fewer infections (OR = 0.17; 95% CI: 0.08–0.37; p < 0.00001). No statistically significant differences were found regarding clinical success, re-intervention, hemorrhage, or perforation.

Conclusion

EUSGJ demonstrates superior procedural outcomes and safety profiles compared to SGJ in the management of GOO and represents a valuable tool in expert hands. However, further prospective studies and randomized trials are necessary to validate these findings, assess long-term outcomes, and define its role within individualized patient care and clinical guidelines.

Disclosure

No conflict of interest

Introduction

Helicobacter pylori (H. pylori) antibiotic resistances are the leading cause for unsuccessful eradication therapy. After one or more failures, the chance of encountering secondary antibiotic resistances increases. The aim of this study was to characterize genotypic secondary resistances in a cohort of Southern Italy H. pylori patients with at least one previous failure.

Aims & Methods

Patients with at least one previous eradication failure collected stool samples by a dedicated kit (THD fecal testTM) and bacterial DNA was extracted and amplified by RT-PCR. Resistance to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline was assessed by high-resolution melting curve.

Results

We enrolled 50 patients. The 72% failed one previous antibiotic course, the 16% two, the 10% three and the 2% four. The rate of secondary antibiotic resistance was 16% for clarithromycin, 18% for metronidazole, 14% for amoxicillin, 14% for levofloxacin and 2% for tetracycline. Multi-resistance was detected in 9 patients (18%) and double resistance to clarithromycin + metronidazole was the most common one (n = 5). Among patients with a previous failure to an amoxicillin-containing regimen, amoxicillin resistance was found in 4 out of 20 (20%). Among patients with a previous failure to a clarithromycin-containing regimen, resistance to such antibiotic was detected in 6 out of 19 (31.6%). Among patients with a previous failure to a metronidazole-containing regimen (n = 21), metronidazole resistance was found in 3 cases (14.3%). A failed levofloxacin-based therapy was given in 3 patients, but in none of them resistance was found (0%). Finally, among patients with a previous failure to a tetracycline-containing therapy, resistance to such antibiotic was detected in 1 out of 12 (8.3%)

Conclusion

In conclusion, our data seem to show that, despite secondary resistances are not so high, a resistance to clarithromycin could be very likely related to previous exposure to this antibiotic.