H. pylori Infection

Helicobacter pylori infection, atrophic gastritis, and disabling dementia: the Japan Public Health Center-based Prospective Study.

Matsunaga T, Yamagishi K, Iso H, Yasuda N, Inoue M, Tsugane S · Environmental health and preventive medicine · 2026 · n=817

A meta-analysis reported a positive association between Helicobacter pylori (H. pylori) infection and dementia incidence. H. pylori infection leads to atrophic gastritis (AG) and affects the absorption of nutrients needed for nerve growth, such as vitamin B12 and folate. We aimed to clarify the associations of H. pylori IgG titer, AG, and their combination with disabling dementia incidence and to examine the interaction with vitamin B12 and folate. Anti-H. pylori immunoglobulin G (IgG) titer and pepsinogen levels were measured in 6,817 participants in 1993 (40-69 years), and the incidence of disabling dementia was followed during a median follow-up of 11.0 years. Associations of anti-H. pylori IgG titer, AG, and their combination with disabling dementia were examined using a multivariable-adjusted Cox proportional hazard model, with stratified analyses by dietary intake of vitamin B12 and folate. 1,325 (19.4%) developed disabling dementia during the follow-up period from 2006 to 2016

Helicobacter pylori infection, anti-Helicobacter pylori treatment and risk of colorectal cancer and adenoma: an observational study and a meta-analysis.

Li X, Tao HQ, Zhao JE, Zhu J, Du LB, Gerhard M · EClinicalMedicine · 2025 · n=31

Recent studies suggest a possible link between Helicobacter pylori (H. pylori) infection and risk of colorectal cancer. We examined the association between H. pylori infection, anti-H. pylori treatment, and colorectal cancer and its precursor, adenoma, based on an observational study and a meta-analysis. The observational study part included 3475 participants undergoing colonoscopy and H. pylori testing within the framework of a screening program in Zhejiang Province, China between March 8 and December 29, 2023. Logistic regression models were used to analyze the associations between H. pylori infection and the risk of colorectal cancer and adenoma. Additionally, a meta-analysis was conducted on the associations of H. pylori infection, anti-H. pylori treatment and risk of colorectal cancer and adenoma. Three databases (PubMed, Embase, and Cochrane Library) were searched for relevant studies from inception up to April 9, 2025. Two reviewers independently screened records for eligibilit

Vonoprazan-based therapies versus PPI-based therapies in patients with H. pylori infection: Systematic review and meta-analyses of randomized controlled trials.

Liu L, Shi H, Shi Y, Wang A, Guo N, Li F · Helicobacter · 2024

This study aims to evaluate the efficacy and safety of vonoprazan-amoxicillin (VA), vonoprazan-amoxicillin-clarithromycin (VAC), vonoprazan-based bismuth-containing quadruple therapy (VBQT), and PPI-based triple (PAC) or quadruple therapy (PBQT) for H. pylori infection with the consideration of duration of therapy and amoxicillin dose (H: high; L: low). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs) up to December 15, 2023. The efficacy outcome was eradication rate, and safety outcomes included the rates of adverse events and treatment discontinuation. Twenty-seven RCTs were included. The pooled eradication rates were 82.8% for VA, 89.1% for VAC, and 91.8% for VBQT, which increased with the higher amoxicillin frequency of administration and extended duration of therapy within each regimen. There were no significant differences in eradication rate when comparing 7-VA versus 7-VAC and 14-VA versus 14

Intravenous Antibiotics in the Management of H. pylori Infection: A Systematic Review.

Chau YA, Milic T, Perrott J · Journal of intensive care medicine · 2025

Background: Helicobacter pylori is implicated in the development of gastritis, ulcers, and various gastric cancers, representing significant morbidity, mortality, and healthcare spending. Patients with H. pylori infection have traditionally been treated with oral antibiotics, however, oral therapy is not feasible in all clinical situations. We examined the available evidence supporting the use of intravenous (IV) antibiotics in H. pylori. Methods: This systematic review was carried out by reviewing multiple electronic databases: MEDLINE, CENTRAL, EMBASE, CINAHL, Clinicaltrials.org, and the World Health Organization (WHO) database of clinical trials. Articles published from database inception until February 12, 2023 that discussed the use of IV antibiotics in H. pylori management were included. Results: The search strategy identified 978 studies, with 11 meeting the inclusion criteria. The results demonstrate that there is a lack of robust trials examining the use of IV antibiotics in H

Newer Therapies for Refractory Helicobacter pylori Infection in Adults: A Systematic Review.

Liu L, Nahata MC · Antibiotics (Basel, Switzerland) · 2024

Helicobacter pylori (H. pylori) infection is a global health concern, affecting approximately two-thirds of the world's population. Standard first-line treatment regimens often fail, necessitating alternative rescue therapies. This review aims to evaluate the efficacy and safety of newer treatment regimens in patients who have failed initial H. pylori eradication therapy. A comprehensive literature search was conducted in PubMed, the Cochrane Library, and Embase. Inclusion criteria were randomized controlled trials (RCTs) published after 2010, involving patients with previous H. pylori treatment failure and interventions with vonoprazan-based therapy, high-dose PPI-amoxicillin dual therapy (HDDT), or rifabutin-containing triple therapy. 10 RCTs were included. HDDT demonstrated high eradication rates (81.3% to 89.2%), particularly when combined with metronidazole (92.6%), although at an increased frequency of adverse events. Vonoprazan-based regimens achieved comparable or higher era

Helicobacter pylori Infection and atherosclerosis: a systematic review.

Karbasi-Afshar R, Khedmat H, Izadi M · Acta medica Iranica · 2015

Helicobacter pylori (H. pylori) is a spiral-shaped gram negative bacterium that naturally colonizes the human gastric epithelium. In recent years, large evidence has come to the literature strongly proposing causal link between H. pylori and extra gastric disorders. Cardiovascular system is one of the extra gastric organs that can be affected by H. pylori infection. The first evidence suggestive of such an association comes from seroepidemiological evaluations, but histopathological and eradication studies have strongly confirmed existence of a causal association between H. pylori infection and cardiovascular events.

H. pylori infection: antimicrobial prescribing

NICE

This guideline covers antimicrobial prescribing for H. pylori infection. It aims to optimize antibiotic use and reduce antimicrobial resistance.

Effects of amoxicillin dosage on cure rate, gut microbiota, and antibiotic resistome in vonoprazan and amoxicillin dual therapy for Helicobacter pylori: a multicentre, open-label, non-inferiority randomised controlled trial.

Hu Y, Zhang ZY, Wang F, Zhuang K, Xu X, Liu DS · The Lancet. Microbe · 2025 · n=252

Vonoprazan and amoxicillin (VA) dual therapy as a mainstream Helicobacter pylori regimen has gained momentum worldwide, but the optimum dosages remain unclear. We aimed to compare the efficacy and safety of VA dual therapy with 2 g amoxicillin or 3 g amoxicillin, and to assess the short-term effects of therapy on the gut microbiota and antibiotic resistome. We conducted an open-label, non-inferiority randomised controlled trial at 12 centres in China. Individuals infected with H pylori, aged 18-70 years, and without previous eradication therapy were recruited. Participants were randomly assigned at a 1:1 ratio (block size of six) to receive vonoprazan (20 mg twice a day) with either low-dose amoxicillin (1 g twice a day; LVA therapy) or high-dose amoxicillin (1 g three times a day; HVA therapy) for 14 days. Gastric biopsies were collected before treatment for detection of antibiotic resistance. Stool samples were collected at baseline, week 2, and we

Simplified Helicobacter pylori therapy for patients with penicillin allergy: a randomised controlled trial of vonoprazan-tetracycline dual therapy.

Gao W, Liu J, Wang X, Li J, Zhang X, Ye H · Gut · 2024 · n=300

This study aimed to evaluate the efficacy and safety of vonoprazan and tetracycline (VT) dual therapy as first-line treatment for Helicobacter pylori infection in patients with penicillin allergy. In this randomised controlled trial, treatment-naïve adults with H. pylori infection and penicillin allergy were randomised 1:1 to receive either open-label VT dual therapy (vonoprazan 20 mg two times per day+tetracycline 500 mg three times a day) or bismuth quadruple therapy (BQT; lansoprazole 30 mg two times per day+colloidal bismuth 150 mg three times a day+tetracycline 500 mg three times a day+metronidazole 400 mg three times a day) for 14 days. The primary outcome was non-inferiority in eradication rates in the VT dual group compared with the BQT group. Secondary outcomes included assessing adverse effects. 300 patients were randomised. The eradication rates in the VT group and the BQT group were: 92.0% (138/150, 95% CI 86.1% to 95.6%) and 89.3% (134/150, 95% CI 83.0% to 93.6%) in

Bismuth-Containing Quadruple Therapy for Helicobacter pylori Eradication: A Randomized Clinical Trial of 10 and 14 Days.

Ding YM, Duan M, Han ZX, Song XH, Zhang FL, Wang Z · Digestive diseases and sciences · 2024

Bismuth-containing quadruple therapy is the first-line treatment for eradicating Helicobacter pylori (H. pylori). The optimal duration for H. pylori eradication using bismuth-containing quadruple therapy remains controversial. Therefore, we aimed to compare the clinical effects of the 10- and 14-day bismuth-containing quadruple treatment regimen to eradicate H. pylori. Treatment-naïve patients with H. pylori infection (n = 1300) were enrolled in this multicenter randomized controlled study across five hospitals in China. They were randomized into 10- or 14-day treatment groups to receive bismuth-containing quadruple therapy as follows: vonoprazan 20 mg twice daily; bismuth 220 mg twice daily; amoxicillin 1000 mg twice daily; and either clarithromycin 500 mg twice daily or tetracycline 500 mg four times daily. At least 6 weeks after treatment, we performed a 13C-urea breath test to evaluate H. pylori eradication. The per-protocol eradic

Comparative Efficacy and Safety of Potassium-Competitive Acid Blocker-Based Dual, Triple, and Quadruple Regimens for First-Line Helicobacter pylori Infection Treatment: A Systematic Review and Network Meta-Analysis.

Rokkas T, Ekmektzoglou K, Niv Y, Graham DY · The American journal of gastroenterology · 2025 · n=605

In the last few years, numerous new potassium-competitive acid blocker (P-CAB)-based randomized controlled trials (RCTs) concerning the first-line regimens for Helicobacter pylori infection treatment from various countries have been published. However, no network meta-analysis (NWM) exists, which examines the comparative efficacy and safety of P-CAB-based dual, triple, and quadruple treatments, and, therefore, in this NWM, we examined this matter comparing efficacy and safety of these P-CAB-based regimens. Databases were searched for identification, screening, eligibility, and inclusion of relevant RCTs. Extracted data were entered into a Bayesian NWM, and the ranking order for each regimen was evaluated by means of the surface under the cumulative ranking area values. Twenty-five eligible RCTs were included with 7,605 patients randomized to 6 first-line regimens, i.e. P-CAB dual therapy, P-CAB triple therapy, P-CAB quadruple therapy, PPI dual therapy, PPI triple therapy, and PPI qua

Use of bidirectional Mendelian randomization to unveil the association of Helicobacter pylori infection and autoimmune thyroid diseases.

Wang K, Zhang Q, Zhang P, Yang Q, Pan F, Zha B · Science advances · 2024

Previous observational studies found associations between Helicobacter pylori infection and autoimmune thyroid diseases (AITDs), but the causal nature of this association is still uncertain. We investigated the causal effect of six crucial antibodies against H. pylori on AITDs using a bidirectional Mendelian randomization (MR). We found that anti-H. pylori outer membrane protein (OMP) significantly increased the risk of hyperthyroidism and Graves' disease (GD). In addition, our reverse MR analysis indicated that hyperthyroidism could increase the levels of cytotoxin-associated gene A and OMP antibodies. We also observed causal roles of GD on anti-H. pylori OMP. Our analyses indicate the mutual effects of H. pylori infection and AITDs, suggesting the existence of a gut-thyroid axis. These results also provide evidence of the bidirectional causal association between anti-H. pylori OMP with hyperthyroidism and GD, resulting in a vicious circle.

Revaluation of Helicobacter pylori's role in esophageal carcinoma: A call for comprehensive research.

Omer JI, Habtemariam AH · World journal of gastroenterology · 2024

The study by López-Gómez et al, reports a significantly low prevalence (4.5%) of Helicobacter pylori (H. pylori) infection in esophageal cancer patients, contrasting sharply with the general population's infection rate. This finding challenges the established negative association between H. pylori and gastric malignancies, suggesting a potential protective role of H. pylori against esophageal carcinoma, particularly in the context of widespread proton pump inhibitor use. However, the study's retrospective nature, single-center design, and small sample size limit the generalizability of the findings and raise concerns about selection bias and statistical power. Diagnostic methods primarily based on histology may not detect all cases, especially those with prior antibiotic or proton pump inhibitor use. Additionally, the study does not account for various confounding factors such as dietary habits, socio-economic status, and genetic predispositions that could affect the associat

Effect of Saccaromyces Boulardii CNCM I-745 Supplementation on the Fecal Resistome of Patients Treated Against Helicobacter Pylori Infection

n=72 · NCT04786938 · COMPLETED · COMPLETED

Eradication therapy against Helicobacter pylori (Hp) carries adverse effects, such as altering the intestinal microbiota's structure and function and selecting commensals and pathogens resistant to antibiotics. This last undesirable effect turns the microbiota into a reservoir of resistance genes. Saccharomyces boulardii CNCM I-745 (Sb) can improve dysbiosis and reduce the abundance of multi-resistant bacteria. The objective of the current project is to characterize the resistome of individuals treated with anti-H. pylori therapy in the presence or absence of Sb in fecal samples. Applying metagenomics and using next-generation sequencing tools, the investigators seek to demonstrate the beneficial effect of Sb on the gut microbiota by reducing the abundance of resistance genes and characterizing bacteria modulated by this probiotic-yeast. The investigators expect to find an increase in the diversity and relative abundance of antibiotic resistance genes (ARGs) in the intestine of participants who did not receive Sb during Hp eradication therapy and one month after completing treatment. The increase in ARGs is probably correlated with the presence of Clostridia and Bacteroides.

The Study About the Selection of Time for Retreatment of Helicobacter Pylori After Eradication Failure

n=670 · NCT05173493 · COMPLETED · COMPLETED

The patients who accepted the quadruple eradication program of the helicobacter pylori but failed to eradicate helicobacter pylori will be assessed the most suitable re-eradication time of helicobacter pylori.

Lacidophilin Tablets in Combination With Vonorazan and Amoxicillin Dual Therapy for Eradicating Helicobacter Pylori Infection: a Prospective, Multi-centers, Superiority, Double-blind, Randomized Clinical Study

n=324 · NCT05749081 · ACTIVE_NOT_RECRUITING · ACTIVE_NOT_RECRUITING

Our previous study included 119 Helicobacter pylori(H. pylori)-infected Chinese patients without previous eradication history who were randomized to low-or high-dose amoxicillin-vonoprazan regimens consisting of amoxicillin 1 gram either b.i.d. or t.i.d plus vonoprazan 20 mg b.i.d for 7 or 10 days. Neither 7-or 10-day VA dual therapy with either b.i.d. or t.i.d. amoxicillin achieved satisfied efficacy (i.e., \<90%) when given as first-line treatment for H. pylori infection. Lacidophilin tablets have been reported to increase the eradication rate of H. pylori while reducing the incidence of adverse effects.This study evaluated the efficacy and safety of lacidophilin tablets in combination with amoxicillin-vonoprazan dual therapy for 10 days as first-line treatment for H. pylori in China.

Cochrane Library: Helicobacter pylori

Cochrane

The Cochrane Library provides a collection of systematic reviews and meta-analyses related to Helicobacter pylori infection. It offers high-quality evidence on interventions, diagnostics, and prognostics.

Cochrane reviews related to Helicobacter pylori infection

Cochrane

The Cochrane Library provides systematic reviews and meta-analyses on various aspects of H. pylori infection, including diagnostic methods, treatment efficacy, and prevention strategies.

TRIP Database search for Helicobacter pylori

The TRIP Database

TRIP Database is a clinical search engine that allows users to quickly find high-quality clinical evidence, including guidelines, systematic reviews, and primary research related to H. pylori infection.