Types of 23S Ribosomal RNA Point Mutations and Therapeutic Outcomes for Helicobacter pylori

Area of Science:

• Microbiology
• Genetics
• Pharmacology

Background:

• Point mutations in the 23S ribosomal RNA gene are linked to *Helicobacter pylori* clarithromycin resistance.
• Understanding these mutations is crucial for effective *H. pylori* eradication therapy.

Purpose of the Study:

• To determine the prevalence of 23S rRNA gene point mutations in *H. pylori*.
• To evaluate the efficacy of different eradication therapies based on mutation status.

Main Methods:

• Retrospective analysis of 464 patients undergoing *H. pylori* testing via multiplex PCR.
• Comparison of standard triple therapy versus bismuth-quadruple therapy in patients with and without specific 23S rRNA gene mutations (A2142G, A2143G).

Main Results:

• No significant difference in eradication rates between therapies for mutation-negative or A2142G mutation patients.
• Bismuth-quadruple therapy showed significantly higher eradication rates (25.8% vs 92.1% per-protocol) for A2143G or double mutations compared to standard triple therapy (24.2% vs 85.2% intention-to-treat).

Conclusions:

• The A2143G point mutation is a primary driver of clarithromycin resistance in *H. pylori*.
• Bismuth-quadruple therapy is demonstrably superior to standard triple therapy for *H. pylori* eradication in patients with A2143G or double 23S rRNA gene mutations.