Introduction

The increasing prevalence of antibiotic resistance and the scarcity of therapeutic options for patients with penicillin allergy have highlighted the necessity for novel treatment regimens. Keverprazan, a novel potassium-competitive acid blocker, provides potent and sustained gastric acid suppression.

Aims & Methods

This study was designed to evaluate the efficacy and safety of keverprazan-minocycline (KM) dual therapy compared with keverprazan-amoxicillin (KA) dual therapy in patients with Helicobacter pylori (H. pylori) infection. From October 2024 to April 2025, a total of 240 patients with H. pylori infection were recruited from six hospitals in Fujian province and randomly assigned to receive either KA dual therapy (amoxicillin 1 g three times daily plus keverprazan 20 mg once daily) or KM dual therapy (minocycline 100 mg twice daily plus keverprazan 20 mg once daily) for a duration of 14 days. The primary endpoint was the H. pylori eradication rate assessed at 4 weeks post-treatment. Secondary endpoints included the symptom relief rate, incidence of adverse events, and patient compliance.

Results

In the intention-to-treat (ITT) analysis, the H. pylori eradication rates were 85.83% (103/120) in the KA group and 87.50% (105/120) in the KM group. In the per-protocol (PP) analysis, the eradication rates were 86.95% (100/115) in the KA group and 90.35% (102/113) in the KM group. No statistically significant differences were observed between the two groups (P = 0.704 for ITT and P = 0.421 for PP analysis). Additionally, symptom remission rates (73.88% vs. 82.50%) and treatment adherence rates (97.01% vs. 97.50%) also showed no significant intergroup differences (both P > 0.05). However, the KM group exhibited a significantly higher overall incidence of adverse events compared with the KA group (38.33% vs. 17.16%, P < 0.001), primarily driven by mild dizziness (25.83% vs. 2.23%, P < 0.001). However, these adverse reactions were mild and did not affect treatment adherence.

Conclusion

The keverprazan-minocycline dual regimen demonstrated high eradication efficacy and acceptable safety in patients with H. pylori infection, with eradication effectiveness comparable to that of the keverprazan-amoxicillin dual therapy and mild adverse reactions. This regimen is recommended for the clinical treatment of H. pylori infection, particularly in patients with penicillin allergy.

Disclosure

There is no conflict of interest.

Clinical Case Summary

Schistosomiasis is a helminthiasis caused by a trematode of which seven species are reported and almost all of them produce digestive manifestation. Symptoms usually appear in those from non-endemic areas who have traveled to endemic ones.

We present a case of a 58-year-old male who presented with subacute abdominal pain and fever, together with C-reactive protein elevation and CT reported as acute perforated cholecystitis, so conservative management with antibiotic therapy was decided at first. During hospitalization, he started with progressive cholestasis and hyperbilirubinemia (maximum total bilirubin levels c. 15 mg/dl) together with high eosinophilia (>2000/mm3). MRI cholangiography was performed, showing stenosis at the bifurcation of the hepatic ducts with retrograde intrahepatic bile duct dilatation. It was later completed with ERCP, showing an area of stricture with marked fibrinoid tissue at the confluence, with biopsies negative for malignancy but highlighting the presence of fibrous tissue with marked eosinophilia, fibrinoid necrosis and PAS-positive structures, all suggestive of parasitic infestation. Finally, a temporary plastic stent was placed for a right biliary drainage. Serology results were positive for Schistosoma (then the patient confirmed history of multiple trips to Southeast Asia), so treatment with praziquantel was started, with progressive improvement of the analytics and symptoms.

Out of the endemic area, schistosomiasis is associated with significant morbidity and diagnostic delay. On the other hand, if the disease becomes chronic, the clinical picture may include colonic involvement -diarrhea, sometimes dysenteriform with hemorrhagic component, sub-occlusive symptoms- and also hepatic, leading to portal hypertension classically presinusoidal, due to granulomatous reactions produced by the eggs besides portal area. Therefore, the importance of investigating the epidemiological patient background is essential.

References

Image 1: during ERCP procedure

Introduction

Managing biliopancreatic disease in elderly patients is a growing challenge, where the balance between benefit and risk becomes increasingly delicate. ERCP remains a fundamental tool, but its application in older adults requires individualized technical and clinical considerations. The aim of our study was to evaluate the characteristics of elderly patients who underwent ERCP.

Aims & Methods

We conducted a retrospective descriptive study from January 2019 to January 2025, including all patients aged ≥65 years who underwent ERCP. Collected data encompassed demographic characteristics, clinical presentation, procedural indications, technical success, therapeutic approaches, and procedure-related complications.

Results

We recorded 186 patients : 62.36% women (n=116) and 37.6% men (n=70), with a median age of 75 years [IQR: 71–80]. The most frequent presenting symptoms were biliary colic (43.4%, n=79), acute cholangitis (23.6%, n=43), cholestatic jaundice (11.8%, n=22), and acute pancreatitis (10.8%, n=20).
ERCP was indicated for benign pathology in the majority of cases, primarily for choledocholithiasis (56.5%, n=104). Other benign etiologies (11%, n=12) included post-cholecystectomy syndrome, biliary pancreatitis, bile duct injury, and Sump syndrome.
Malignant indications included pancreatic head tumors (20.7%, n=38), hilar cholangiocarcinoma (7.1%, n=13), ampullary carcinoma (6.5%, n=12), and gallbladder carcinoma (3.8%, n=7).
The technical success rate for benign pathology was 97.4% (n=113), with a failure rate of 2.6% (n=3). In malignant indications, the success rate was 90% (n=63), with failures (10%, n=7) primarily due to duodenal obstruction or an intradiverticular papilla.
Stenting strategies included uncovered self-expandable metal stents (33.2%, n=43), covered metal stents (3.8%, n=7), and plastic stents (7.6%, n=14).
Intra-procedural bleeding following sphincterotomy occurred in 2.7% of cases (n=3); two were managed with epinephrine injection and one with hemostatic clipping. No delayed post-procedural complications were reported.

Conclusion

ERCP appears to be a safe, effective, and well-tolerated procedure in elderly patients. When guided by appropriate indications and expert technique, age does not represent a limitation but rather a parameter requiring adapted procedural planning.