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Author Spotlight: Detection and Treatment of Helicobacter pylori Infection
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Author Spotlight: Detection and Treatment of Helicobacter pylori Infection

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Efficacies of Genotypic Resistance-Guided vs Empirical Therapy for Refractory Helicobacter pylori Infection

Jyh-Ming Liou1, Po-Yueh Chen2, Jiing-Chyuan Luo3

  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

Gastroenterology
|July 3, 2018
PubMed
Abstract

Insights

Genotypic resistance-guided therapy and empirical therapy show similar efficacy for eradicating refractory Helicobacter pylori infection. Empirical therapy is a viable alternative, considering cost and patient preference.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Refractory Helicobacter pylori infections pose a significant challenge, often requiring retreatment.
  • Previous treatment regimens may fail due to antibiotic resistance.
  • Genotypic resistance-guided therapy aims to optimize treatment based on specific mutations.

Purpose of the Study:

  • To compare the efficacy of genotypic resistance-guided therapy versus empirical therapy for eradicating refractory H. pylori infection.
  • To evaluate treatment outcomes in patients with persistent H. pylori infections.
  • To determine if tailoring therapy based on genotype improves eradication rates.

Main Methods:

  • Two multicenter, open-label randomized controlled trials were conducted in Taiwan.
  • Patients with H. pylori infection (≥20 years) who failed ≥2 prior regimens were enrolled.
  • Participants received either 14-day genotypic resistance-guided sequential therapy or empirical therapy based on medication history.

Main Results:

  • In Trial 1, eradication rates were 81% for genotypic-guided therapy vs 60% for empirical therapy (P=.181).
  • Trial 1 was stopped early due to low eradication with doxycycline sequential therapy (57.7%).
  • In Trial 2, eradication rates were 78% for genotypic-guided therapy vs 72.2% for empirical therapy (P=.170).

Conclusions:

  • Empirical therapy, guided by patient medication history, is a suitable alternative to genotypic resistance-guided therapy for refractory H. pylori.
  • Treatment decisions should consider accessibility, cost, and patient preferences.
  • No significant differences in adverse effects or compliance were observed between the groups.
Keywords:
23S rRNAGyrase ASusceptibility TestingThird-Line

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