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Updated: Jun 13, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Clarithromycin-resistant genotypes and eradication of Helicobacter pylori
Ruggiero Francavilla1, Elena Lionetti, Stefania Castellaneta
1Department of Biomedicina dell'Età Evolutiva, University of Bari, Italy. rfrancavilla@bioetaev.uniba.it
Insights
The A2143G mutation in Helicobacter pylori significantly reduces treatment success. A sequential therapy regimen is more effective than standard triple therapy, especially for children with this mutation.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Genetics
Background:
- Clarithromycin resistance in Helicobacter pylori is a growing concern for treatment efficacy.
- Genotypic resistance, specifically point mutations, impacts eradication rates of H. pylori infections.
- Understanding resistance patterns is crucial for optimizing pediatric H. pylori treatment strategies.
Purpose of the Study:
- To compare H. pylori eradication rates based on specific point mutations.
- To evaluate the efficacy of triple therapy versus sequential regimens in relation to genotypic resistance.
- To identify optimal treatment approaches for pediatric H. pylori infections with clarithromycin resistance.
Main Methods:
- A retrospective cohort study involving 168 children with H. pylori.
- Analysis of eradication rates for triple therapy (73 children) and sequential therapy (95 children).
- Real-time PCR used to detect clarithromycin resistance mutations (A2143G, A2142G, A2142C) in gastric biopsy samples.
Main Results:
- Eradication rates were 50% for A2143G mutation, 80% for A2142G/A2142C, and 88.9% for susceptible strains.
- The A2143G mutation was significantly associated with lower cure rates (50% vs. 89%; P = .001).
- Sequential therapy showed a higher cure rate (80%) than triple therapy in patients with A2143G mutant strains (P < .001).
Conclusions:
- The A2143G mutation is a significant predictor of H. pylori treatment failure in children.
- Sequential therapy demonstrates superior efficacy compared to standard triple therapy, particularly in cases with the A2143G mutation.
- Genotypic resistance testing can guide treatment selection for improved H. pylori eradication in pediatric patients.
Objective:
To compare the eradication rates among the different point mutations and the efficacy of triple therapy and a sequential regimen according to genotypic resistance.
Study Design:
Post hoc retrospective cohort study in a tertiary referral center for pediatric gastroenterology in southern Italy. All 168 children who were positive for Helicobacter pylori were enrolled. Patients had received clarithromycin-based 7-day triple therapy (73 children) or 10-day sequential therapy regimen (95 children). Real-time polymerase chain reaction for assessing clarithromycin resistance was performed on sections of paraffin-embedded gastric biopsy samples.
Results:
H pylori eradication was achieved in 16 of 32 (50%) children with the A2143G mutation, in 8 of 10 patients with either A2142G or A2142C strains (80%), and in 112 of 116 children with susceptible strains (88.9%). The presence of A2143G mutation was associated with a lower cure rate compared with the rate in the absence of this mutation (50% vs. 89%; P = .001). The sequential regimen achieved a higher cure rate than triple therapy in patients with A2143G mutant strains (80% vs nil; P < .001).
Conclusions:
The A2143G mutation confers higher risk of treatment failure. Sequential regimen has higher efficacy than standard therapy, even in children with A2143G mutatant strains.
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