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Updated: Nov 7, 2025
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Application of Visual Gene Clip-Based Tailored Therapy for the Eradication of Helicobacter pylori
Lili Yang1, Ao Zou1, Huihua Wu1
1Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, 518036, China.
Background:
Helicobacter pylori eradication with therapies employing a proton pump inhibitor (PPI) and antimicrobial agents is mainly achieved via bacterial susceptibility to antimicrobial agents and the magnitude of acid secretion inhibition. However, annual eradication rates have greatly declined in Mainland China, and therefore, tailored H. pylori eradication regimens that inhibit acid secretion and employ optimal antimicrobial agents determined based on gene clip testing may improve eradication rates. This study was aimed at evaluating the efficacy of tailored H. pylori eradication therapy guided by visual gene clip testing for antibiotic resistance and PPI metabolism genotypes.
Methods:
This prospective study included 244 patients (141 men and 103 women aged 20-79 years) receiving initial treatment for H. pylori infection. Visual gene clip testing using gastric mucosal specimens was performed to detect antibiotic resistance to clarithromycin conferred by the A2142G and A2143G point mutations of the H. pylori 23S rRNA gene and to levofloxacin conferred by the Asn87 and Asp91 point mutations of the H. pylori gyrA gene. Patients received a 14-day bismuth quadruple therapy regimen guided by testing for antibiotic resistance and CYP2C19 polymorphisms, and primary H. pylori eradication was assessed at least 4 weeks after therapy.
Results:
H. pylori strains were successfully isolated from the gastric mucosa tissues of 244 patients. Antibiotic resistant isolates were identified in 63 patients, with clarithromycin resistance observed in 50 patients, levofloxacin resistance in 7 patients, and dual resistance in 6 patients. The PPI metabolic genotype of CYP2C19 was detected in 242 of 244 cases, and 97 cases were categorized as extensive metabolizers, 141 as intermediate metabolizers, and 4 as poor metabolizers. Among the 242 patients who received tailored therapy, the H. pylori eradication rate was 90.9% (95% confidence interval 87.3%~94.6%) in the intention-to-treat analysis and 96.9% (95% confidence interval 94.7%~99.2%) in the per protocol analysis.
Conclusions:
Tailored therapy for H. pylori infection guided by determination of antibiotic resistance and CYP2C19 polymorphism using visual gene chip technology may provide high clinical effectiveness as initial H. pylori eradication therapy.
Insights
Tailored therapy for Helicobacter pylori (H. pylori) infection, guided by antibiotic resistance and CYP2C19 gene testing, achieved high eradication rates. This approach shows promise for improving initial H. pylori treatment effectiveness.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacogenomics
Background:
- Helicobacter pylori eradication relies on antimicrobial susceptibility and acid inhibition.
- Declining eradication rates in China necessitate optimized treatment strategies.
- Tailored regimens considering antibiotic resistance and PPI metabolism may improve outcomes.
Purpose of the Study:
- To evaluate the efficacy of tailored H. pylori eradication therapy.
- To guide therapy using visual gene clip testing for antibiotic resistance and PPI metabolism genotypes.
Main Methods:
- Prospective study of 244 patients undergoing initial H. pylori treatment.
- Visual gene clip testing for clarithromycin and levofloxacin resistance mutations.
- 14-day bismuth quadruple therapy guided by resistance and CYP2C19 polymorphism testing.
Main Results:
- Antibiotic resistance identified in 63 patients (clarithromycin, levofloxacin, or dual).
- CYP2C19 genotypes determined in 242 patients (extensive, intermediate, poor metabolizers).
- H. pylori eradication rate of 90.9% (ITT) and 96.9% (PP) with tailored therapy.
Conclusions:
- Tailored H. pylori therapy guided by resistance and CYP2C19 testing demonstrates high clinical effectiveness.
- Visual gene chip technology can guide initial H. pylori eradication regimens.
- Personalized treatment approaches are crucial for combating H. pylori infection.
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