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Apparent Intracellular Helicobacter pylori Detected by Immunohistochemistry: The Missing Link in Eradication Failure
Andrea Beer1, Helmut Hudler2, Maria Hader3
1Department of Pathology, Medical University of Vienna, Vienna, Austria.
Background:
Helicobacter pylori is primarily an extracellularly living bacterium. However, seemingly intracellular occurrence can often be detected by immunohistochemical stains. Considering antimicrobial resistance, we investigated the impact of the apparent intracellular H. pylori (aiHp) on treatment failure of first-line triple therapies.
Methods:
Gastric biopsies of 814 patients infected with H. pylori naive to treatment were analyzed before and after eradication therapy by immunohistochemistry. Of these, 373 received treatment consisting of amoxicillin, clarithromycin, and proton pump inhibitor (AC/PPI). Availability of polymerase chain reaction-based clarithromycin susceptibility test results from pretreatment gastric biopsies was a precondition for matching 52 aiHp to 52 non-aiHp cases within the AC/PPI group.
Results:
AiHp were detected mostly in low counts predominantly in corpus biopsies, rarely in antrum biopsies (95.2% vs 24.6%); they were found in 497 (61%) of all patients and in 192 of 373 patients (51.5%) in the AC/PPI group. The eradication rate in aiHp versus non-aiHp cases was 44.4% versus 72.9% in the entire sample and 45.3% versus 66.8% in the AC/PPI group. Among the 104 paired patients, respective values were 46.2% versus 78.8%; in clarithromycin-susceptible cases, 60.6% versus 91.9%. Both aiHp and resistance to clarithromycin proved to be highly significant (P ≤ .001) and independent predictors of eradication failure. Twelve of 13 aiHp cases with a clarithromycin-sensitive strain who failed eradication developed resistance to the antibiotic.
Conclusions:
AiHp found by immunohistochemical staining especially in corpus biopsies proved to be a risk factor for failure of first-line triple therapies; occurrence of aiHp should be considered with regard to therapy options.
Insights
Apparent intracellular Helicobacter pylori (aiHp) significantly increases the risk of treatment failure for common H. pylori eradication therapies. Identifying aiHp is crucial for selecting effective treatment options and overcoming antimicrobial resistance.
Area of Science:
- Gastroenterology
- Microbiology
- Infectious Diseases
Background:
- Helicobacter pylori is typically extracellular, but intracellular forms (aiHp) are detectable via immunohistochemistry.
- Antimicrobial resistance is a growing concern in H. pylori infections.
- The impact of aiHp on treatment outcomes remains unclear.
Purpose of the Study:
- To investigate the influence of apparent intracellular H. pylori (aiHp) on the failure rates of first-line triple therapies.
- To assess aiHp as a predictor of eradication failure in H. pylori infections.
Main Methods:
- Analysis of gastric biopsies from 814 H. pylori-infected patients naive to treatment using immunohistochemistry.
- Matching of 52 aiHp cases with 52 non-aiHp cases based on clarithromycin susceptibility testing (PCR) within the amoxicillin, clarithromycin, and PPI (AC/PPI) treatment group.
- Comparison of eradication rates between aiHp and non-aiHp groups.
Main Results:
- AiHp were detected in 61% of all patients, predominantly in corpus biopsies.
- Eradication rates were significantly lower in patients with aiHp (44.4%) compared to non-aiHp cases (72.9%).
- Both aiHp presence and clarithromycin resistance were independent predictors of eradication failure (P ≤ .001).
Conclusions:
- Apparent intracellular H. pylori (aiHp) detected by immunohistochemistry is a significant risk factor for first-line triple therapy failure.
- The presence of aiHp should be considered when determining H. pylori treatment strategies.
- AiHp may contribute to the development of antibiotic resistance post-treatment.
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