pectins and Helicobacter-Infections

Our team previously reported the use of antofloxacin-based bismuth quadruple therapy for the eradication of Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of 10 and 14 days of antofloxacin-based versus 14 days of clarithromycin-based bismuth quadruple therapy in the first-line treatment for H. pylori infection.. 1174 patients with H. pylori infection were randomized into three groups: 10-days and 14-days antofloxacin (ANT10 and ANT14) groups who received 10 and 14 days of antofloxacin-based bismuth quadruple therapy (colloidal bismuth pectin 200 mg t.i.d., esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and antofloxacin 200 mg q.d.), 14-days clarithromycin (CLA14) group who received 14 days of clarithromycin-based bismuth quadruple therapy (colloidal bismuth pectin 200 mg t.i.d., esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d.). Eradication rate, antibiotic resistance and adverse events were analyzed.. The intention-to-treat (ITT) and per-protocol (PP) analyses have showed statistically different eradication rates between ANT14 group and ANT10 group (ITT p = 0.001; PP p < 0.001), but no statistical difference between ANT10 group and CLA14 group (ITT p = 0.340; PP p = 0.092). Treatment regimen, drug resistance and therapy duration were important clinical factors related to H. pylori eradication rates in multivariate logistic analysis. Longer durations had significantly higher eradication rates in patients with antibiotic-resistant strains or antibiotic-susceptible strains. The incidences of nausea and bitter taste were significantly higher in CLA group compared with ANT group (p = 0.002 for nausea; p = 0.002 for bitter taste). The ANT10 and ANT14 group had similar adverse event rates of gastrointestinal reactions.. The study showed that the H. pylori eradication rate with ANT14 therapy was higher than that with ANT10 and CLA14 therapy without significantly increasing the rates of adverse event. 14 days of antofloxacin-based bismuth quadruple therapy may be a more effective way as the first-line treatment for H. pylori infection.

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Esomeprazole; Helicobacter Infections; Helicobacter pylori; Humans; Nausea; Pectins; Proton Pump Inhibitors; Treatment Outcome

Bismuth-containing quadruple therapy is an effective regimen for Helicobacter pylori (H. pylori) treatment. No head-to-head comparison trials have been conducted to evaluate the efficacy of colloidal bismuth pectin (CBP) in quadruple therapy for eradicating H. pylori. We aimed to compare the efficacy and safety of CBP quadruple therapy and bismuth potassium citrate (BPC) quadruple therapy for 14 days in the first-line treatment of H. pylori.. In this multicenter, randomized, double-blind, non-inferiority clinical trial, H. pylori-infected subjects without eradication history were randomized to receive amoxicillin 1 g twice daily, tetracycline 500 mg three time daily, esomeprazole 20 mg twice daily in combination with CBP 200 mg three time daily or BPC 240 mg twice daily for 14 days.. Between April 2021 and July 2022, 406 patients were assessed for eligibility and 339 subjects were randomized. The cure rates (primary outcome) of CBP and BPC quadruple therapy were 90.5% and 92.3% (p = 0.56) by intention-to-treat analysis, respectively, and 96.1% and 96.2% (p = 1.00) by per-protocol analysis, respectively. CBP quadruple therapy was non-inferior to BPC quadruple therapy in the intention-to-treat and per-protocol analysis (p < 0.025). The frequency of adverse events and compliance were not different among the two groups (p > 0.05).. Both CBP and BPC quadruple therapy for 14 days provide high efficacy, good compliance, and safety in the first-line treatment of H. pylori in China.

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Pectins; Proton Pump Inhibitors; Treatment Outcome

To investigate the effects of twice daily short-message-based re-education (SMRE) before taking medicine for Helicobacter pylori (H pylori) eradication.. Treatment-naive patients with H pylori infection were prescribed 14-day quadruple regimen consisting of lansoprazole 30 mg, colloidal bismuth pectin 200 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily. Patients were randomly allocated to SMRE group or control group. Patients in control group received oral and written instructions at outpatient clinic. In contrast, patients in the SMRE group received extra short messages including dosage and time of administration twice daily. Successful H pylori eradication was assessed using the. A total of 310 patients were enrolled in the intention-to-treat (ITT) and 283 in the per-protocol (PP) analysis. For young patients, the eradication rates were significantly higher in SMRE group than those in control group in PP analysis (88.6% vs 71.2%, P = 0.036), while for patients of all age groups, the eradication rate improvements were not statistically significant. The eradication rates in SMRE group and control group were 74.2% and 67.7% (P = 0.211) in ITT analysis and 82.1% and 73.4% (P = 0.078) in PP analysis, respectively. The compliance in SMRE group was significantly better than that in control group (84.8% vs 72.8%, P = 0.011).. Twice daily SMRE could improve the eradication rate in young population, as well as the compliance with treatment during H pylori eradication.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Bismuth; Clarithromycin; Disease Eradication; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Male; Middle Aged; Patient Education as Topic; Pectins; Prospective Studies; Text Messaging; Young Adult

To compare the effectiveness of standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori (H. pylori) eradication in a randomized, double-blinded, comparative clinical trial in China.. A total of 215 H. pylori-positive patients were enrolled in the study and randomly allocated into three groups: group A (n = 72) received a 10-d bismuth pectin quadruple therapy (20 mg rabeprazole bid, 1000 mg amoxicillin bid, 100 mg bismuth pectin qid, and 500 mg levofloxacin qd); group B (n = 72) received the sequential therapy (20 mg omeprazole bid, 1000 mg amoxicillin bid, in 5 d, followed by 20 mg omeprazole bid, 500 mg tinidazole bid, 500 mg clarithromycin bid, for another 5 d); group C (n = 71) received a standard 1-wk triple therapy (20 mg omeprazole bid, 1000 mg amoxicillin bid, 500 mg clarithromycin bid). After all these treatments, 20 mg omeprazole bid was administrated for 3 wk. H. pylori status was assessed by histology, 13C-urea breath test and rapid urease test at baseline and 4-6 wk after completion of treatment. Ulcer cicatrization was assessed by gastroscopy. chi(2) test (P < 0.05) was used to compare the eradication rates and ulcer cicatrisation rates among the three groups.. The eradication rate was 83.33% (60/72) in group A, 88.89% (64/72) in group B, and 80.56% (58/71) in group C. The ulcer cicatrisation rate was 86.44% (51/59) in group A, 90.16% (55/61) in group B, and 84.91% (45/53) in group C. The sequential therapy yielded a higher eradication rate and ulcer cicatrisation rate than the standard triple and bismuth pectin quadruple therapies. Statistically, the eradication rate of group B was significantly different from groups A and C (P < 0.05), but the difference of ulcer cicatrisation rate and side effects was not statistically significant among the three groups (P > 0.05). The three protocols were generally well tolerated.. The sequential therapy has achieved a significantly higher eradication rate, and is a more suitable first-line alternative protocol for anti-H. pylori infection compared with the standard triple and bismuth pectin quadruple therapies.

Topics: Adult; Aged; Amoxicillin; Bismuth; Clarithromycin; Double-Blind Method; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Medication Adherence; Middle Aged; Omeprazole; Pectins; Prospective Studies

Bismuth triple therapy provides consistently good results in Helicobacter pylori eradication worldwide, whereas quadruple therapy using a combination of omeprazole and bismuth triple regimen has produced cure rates in excess of 90%. The prevalence of metronidazole-resistant strains was 26.8% in our area. Colloidal bismuth pectin (CBP) is a new, lower-priced bismuth salt made in China. The purpose of this study was to investigate the efficacy and safety of CBP triple and quadruple regimens in the treatment of H. pylori-positive duodenal ulcer.. In this prospective trial, 205 patients with H. pylori-positive duodenal ulcer were allocated randomly to receive one of four regimens: metronidazole, 200 mg; amoxicillin, 250 mg; and colloidal bismuth subcitrate (CBS), 120 mg (group 1), or CBP, 100 mg qid (group 2) for 2 weeks, then continued CBS, 240 mg, or CBP, 200 mg bid for a further 2 weeks. A quadruple regimen using a combination of omeprazole, 20 mg bid, and CBS triple therapy (group 3) or CBP triple therapy (group 4), respectively, was given to patients for 1 week, followed by omeprazole, 20 mg once daily for a further 3 weeks. Further endoscopy was performed at least 4 weeks after cessation of the treatment. H. pylori status was determined by histology, a 14C urea breath test, and a urease test.. The per-protocol H. pylori cure rates were 85% (22 of 26 patients), 90% (35 of 39), 96% (46 of 48), and 95% (75 of 79) for groups 1 through 4. In the intention-to-treat analysis, cure rates were 79% (22 of 28), 83% (35 of 42), 90% (46 of 51), and 89% (75 of 84), respectively. The cure rates of quadruple therapy were higher than those of triple therapy; an 8.2% difference was not statistically significant (95% confidence interval [CI], 2.3-18.7%). The ulcer-healing rates were 88%, 87%, 98%, and 97%, respectively, for groups 1 through 4. The ulcer pain was relieved more rapidly in quadruple- than in triple-therapy regimens. Two patients discontinued treatment prematurely owing to drug-related side effects.. One-week quadruple therapy is highly effective and safe in H. pylori eradication in Chinese patients. CBP is as effective as CBS.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; China; Colloids; Drug Therapy, Combination; Duodenal Ulcer; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Pectins

The present study was designed to observe the effect of quadruple therapy combined with probiotics on

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Gastrins; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Motilin; Pectins; Peptic Ulcer; Probiotics; Proton Pump Inhibitors; Somatostatin; Tablets, Enteric-Coated

Antiulcer potency and inhibitory effects on Helicobacter pylori of structurally defined low molecular weight modified pectin from turmeric (MTrPP) has been previously demonstrated by us. Given that ulcer is a disorder characterized by inflammatory responses leading to initiation, aggravation and perpetuation of disease conditions, the present study aims to understand the possible anti-inflammatory mechanisms through which MTrPP delivered antiulcer effects. Rats triggered with early phase gastric inflammation (LPS) followed by ulcer induction (swim-stress) were pretreated with MTrPP (150 mg/kg b.w.) for 14 days. Inflammation and ulcer-specific markers were screened to assess the protective effects. MTrPP offered up to 91% protection by limiting the production of pro-inflammatory factors (TNF-α, IL-8, NF-κB) and by the tight differential regulation of cyclooxygenase (COX-1, 2), mitogen-activated-protein-kinase (p-p38, p-ERK-1/2) and matrix metalloproteinase (pro-MMP-9). MTrPP showed modulatory effects through inhibition of galectin-3, oxidative stress, H

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Curcuma; Helicobacter Infections; Helicobacter pylori; Interleukin-10; Male; Pectins; Peptic Ulcer; Rats; Rats, Wistar

Polysaccharide containing extracts from immature fruits of okra (Abelmoschus esculentus) are known to exhibit antiadhesive effects against bacterial adhesion of Helicobacter pylori (H. pylori) to stomach tissue. The present study investigates structural and functional features of polymers responsible for this inhibition of bacterial attachment to host cells. Ammonium sulfate precipitation of an aqueous extract yielded two fractions at 60% and 90% saturation with significant antiadhesive effects against H. pylori, strain J99, (FE60% 68% ± 15%; FE90% 75% ± 11% inhibition rates) after preincubation of the bacteria at 1 mg/mL. Sequential extraction of okra fruits yielded hot buffer soluble solids (HBSS) with dose dependent antiadhesive effects against strain J99 and three clinical isolates. Preincubation of H. pylori with HBSS (1 mg/mL) led to reduced binding to 3'-sialyl lactose, sialylated Le(a) and Le(x). A reduction of bacterial binding to ligands complementary to BabA and SabA was observed when bacteria were pretreated with FE90%. Structural analysis of the antiadhesive polysaccharides (molecular weight, monomer composition, linkage analysis, stereochemistry, and acetylation) indicated the presence of acetylated rhamnogalacturonan-I polymers, decorated with short galactose side chains. Deacetylation of HBSS and FE90% resulted in loss of the antiadhesive activity, indicating esterification being a prerequisite for antiadhesive activity.

Topics: Abelmoschus; Acetylation; Adenocarcinoma; Bacterial Adhesion; Bacterial Outer Membrane Proteins; Fruit; Helicobacter Infections; Helicobacter pylori; Humans; Pectins; Plant Extracts; Polysaccharides; Stomach Neoplasms; Tumor Cells, Cultured

To investigate whether acid suppression therapy influences the absorption of bismuth from colloidal bismuth pectin (CBP).. 48 male SD rats were randomly divided into five groups to be administer with different medicines once a day for 14 days: group A1 (administered with CBP only and killed on the cessation day of administration), group B1 (administered with CBP only and killed 8 weeks after the cessation of administration), group A2 [administered with CBP + amoxicillin (AMO) + metronidazole (MTR) + losec and killed on the cessation day of administration], group B2 (administered with CBP + AMO + MTR + losec and killed 8 weeks after the cessation of administration), and control group (administered with distilled water). The kidney issue sections were counterstained after AMG development. The bismuth deposited in tissues was observed by microscopy. The gray level of kidney tissue sections were measured and compared through image processing program. The deposition of bismuth and the degrees of cell organ's impairment were observed by electron microscopy. By using electron probe microanalysis bismuth was identified from the chemical elements in the specimens.. Under the light microscopy, black-brown granules were discovered in the cell bodies of the proximal convoluted renal tubule. The amounts of bismuth accumulated in kidney of the 2 quadruple therapy groups were much more than those of the 2 single compound therapy groups (all P < 0.05). The amount of bismuth accumulated in kidney on the cessation day of administration was more than that eight weeks later (both P < 0.01). Under electron microscopy, black-brown granules were observed exclusively in the lysosomes of the proximal convoluted renal tubule cell. Electron microscopy found cell impairment in the quadruple therapy groups. Impairment of these cells could be recovered 8 weeks after the cessation of administration.. Acid suppression therapy causes an increase of absorption and accumulation of bismuth from CBP in the kidney. Bismuth can be accumulated in the cell bodies of proximal convoluted renal tubule after its absorption. The absorbed bismuth can be discharged out of the body via kidney. Large amounts of bismuth accumulation in kidney can impair the functions of proximal convoluted renal tubule cells.

Topics: Amoxicillin; Animals; Antacids; Bismuth; Colloids; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Kidney; Male; Metronidazole; Pectins; Random Allocation; Rats; Rats, Sprague-Dawley

To investigate whether the quadruple therapy influences the absorption of bismuth from Colloidal Bismuth Pectin (CBP).. 24 male Wistar rats weighing from 400 g to 500 g were randomly divided into two groups: CBP group (group A(1)) and CBP+AMO+MTR+ LAN group (group A(2)). The serum bismuth concentration was observed at 0,1,2,3,4,5,6 hour after these medicines were fed. Other 24 male Wistar rats weighing from 200 g to 250 g were randomly divided into two groups: CBP group (group B( 1)), CBP+AMO+MTR+LAN group (group B(2)). These medicines had been taken every day for 14 days. The accumulation of bismuth in the heart, brain, kidney and liver of rats were detected eight weeks later.. The serum peak value of bismuth is not significantly different between group A(1) and group A(2) (P > 0.05), but the peak time of bismuth of the group A(2) is one hour earlier than that of group A(1). The amounts of the accumulation of bismuth in the kidney are 154 +/- 15 ng/g and 212 +/- 20 ng/g in the group B(1) and B(2) respectively at the eighth week after the medicines were fed in rats with a significant difference (P < 0.05).. The quadruple therapy causes an increase of the absorption and the accumulation of bismuth from CBP in the kidney in rats.

Topics: Absorption; Animals; Bismuth; Colloids; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Male; Pectins; Rats; Rats, Wistar