Management of Helicobacter pylori infection in paediatric patients in Europe
Management of Helicobacter pylori infection in paediatric patients in Europe
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欧洲儿童患者幽门螺杆菌感染的管理
DOI：
10.1007/s15010-022-01969-7
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发表时间：
2022
期刊：
影响因子：
7.5
通讯作者：
Kakiuchi T
中科院分区：
文献类型：
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作者：
柏木宏子;三浦健一郎;松本純弥;坂元竜馬;竹田康二;山田悠至;藤本美智子;安田由華;山森英長;池田学;平林直次;橋本亮太;Kakiuchi T
怀着极大的兴趣，我读了Le Thi等人的一篇研究文章。[1]提示采用质子泵抑制剂（PPI）、阿莫西林（AMPC）、克拉霉素（CAM）或甲硝唑（MTZ）进行2周标准三联疗法可达到根除原发性幽门螺杆菌（H. pylori）根除成功率≥ 90%，尽管有针对性的治疗，但单一耐药菌株的失败率较高，这表明忽略了CAM敏感和CAM耐药H. pylori菌株，因为采样错误。每个国家的H.幽门螺杆菌根除治疗[2]建议成功率≥ 90%。因此，进行微生物敏感性试验非常重要。马斯特里赫特V指南建议，当区域CAM耐药率> 15%时，应放弃既往未进行微生物敏感性试验的克拉霉素三联疗法[3]。在最近的指南中，非铋剂四联疗法、序贯或伴随治疗或铋剂四联疗法被推荐为CAM耐药> 15%的地区的一线治疗[3，4]。然而，抗生素的不适当使用会导致H.从适当使用抗生素的观点来看，幽门和微生物敏感性测试是非常重要的。在这里，我想提出一个关于微生物敏感性试验的问题和一个关于CAM敏感和CAM耐药的H。pylori菌株共感染。首先，我对H菌的微生物敏感性试验感到担忧。幽门。Le Thi等人报告称，微生物敏感性试验在欧洲广泛使用;然而，我认为这些试验在全球范围内并不容易获得。使用epsilometer试验或纸片扩散的基于培养的微生物敏感性试验耗时，并且在可以进行的设施中受到限制。此外，由于需要几天时间才能收到结果，因此无法立即开始根除治疗，这对医生和患者来说都是一种负担。在日本，微生物敏感性测试培养H。在某些地区，幽门螺杆菌不属于公共健康保险的范围。在儿童中，食管胃内窥镜检查用于收集标本，这是高度侵入性的，并且在可以进行的设施中可能具有技术限制。测定H.幽门螺杆菌的分子检测需要大型且昂贵的专用设备和专业技能。我担心进行微生物敏感性试验的困难是其结论的主要限制。因此，有必要进一步发展和推广简便、经济的H. pylori扩大针对H.根除幽门第二，错过了一个CAM敏感和CAM耐药的H。pylori菌株导致标准三联疗法失败，包括CAM。然而，关于其存在的信息有限。本研究对120名感染H。pylori感染者的粪便经PCR测序评价CAM抗性，12例（10%; 12/120）为混合感染[5]（表1）。混合感染率与Le Thi等人报告的相似。[1]的文件。12名混合感染的学生接受沃诺拉赞、AMPC和CAM治疗，8名学生（66.7%; 8/12）报告成功根除。在本研究中，沃诺拉赞、AMPC和CAM的非CAM耐药组和CAM耐药组的根除成功率分别为94.3%（33/35）和72.9%（35/48）。在我们的研究中，混合感染中基于CAM的治疗显示根除成功率低于非CAM耐药组。有人建议，误判混合...
With great interest, I read a research article by Le Thi et al.[1], suggesting that a 2-week standard triple therapy with a proton-pump inhibitor (PPI), amoxicillin (AMPC), clarithromycin (CAM) or metronidazole (MTZ) tailored to microbial sensitivity tests can achieve a primary Helicobacter pylori (H. pylori) eradication success rate of≥ 90%, and higher failure rates in single-resistant strains despite tailored treatment indicate overlooking a mixed infection of a CAM-susceptible and a CAM-resistant H. pylori strain due to a sampling error. Guidelines in each country for H. pylori eradication therapy [2] recommend a success rate of≥ 90%. Therefore, it is important to implement microbial sensitivity tests. The Maastricht V guidelines recommend that clarithromycinbased triple therapy without prior microbial sensitivity tests should be abandoned when the regional CAM resistance rate is> 15%[3]. In recent guidelines, nonbismuth quadruple therapy, sequential or concomitant treatment, or bismuth quadruple therapy is recommended as the first-line therapy in regions where CAM-resistance is> 15%[3, 4]. However, inappropriate use of antibiotics leads to resistance acquisition to H. pylori and microbial sensitivity tests are highly important from the viewpoint of appropriate use of antibiotics. Here, I want to present one concern regarding microbial sensitivity tests and one data regarding CAM-susceptible and a CAM-resistant H. pylori strain coinfection. First, I have a concern about microbial sensitivity tests for H. pylori. Le Thi et al. reported that microbial sensitivity tests are widely available in Europe; however, I believe that they are not readily available worldwide. Culture-based microbial sensitivity tests using epsilometer tests or disk diffusion are time-consuming and limited in facilities where they can be performed. Additionally, the fact that it takes several days to receive the results makes it impossible to start eradication treatment promptly, which is a burden for medical physicians and patients. In Japan, microbial sensitivity test cultures for H. pylori are not covered by public health insurance in some areas. In children, esophagogastroduodenoscopy is used to collect specimens, which is highly invasive and may be technically limiting in facilities where it can be performed. To measure microbial sensitivity tests for H. pylori, molecular detection requires large and expensive dedicated equipment and specialized skills. I fear that the difficulty in conducting microbial sensitivity tests is a major limitation with respect to their conclusions. It is essential to further develop and expand simple and economical methods that can test the microbial sensitivity tests for H. pylori to expand tailored therapies for H. pylori eradication. Second, missed coinfection detection of a CAM-susceptible and a CAM-resistant H. pylori strain led to standard triple-therapy failure, including CAM. However, there is limited information about its existence. In our study, in which 120 third-year junior high school students infected with H. pylori were evaluated for CAM resistance via PCR sequencing using stool, 12 (10%; 12/120) were mixed infected [5](Table 1). Mixed infection rates were similar to those reported by Le Thi et al.[1]. The 12 students with mixed infections were treated with vonoprazan, AMPC, and CAM, and eight students (66.7%; 8/12) reported successful eradication. In this study, the eradication success rate was 94.3%(33/35) in the non CAM-resistant group and 72.9%(35/48) in the CAM-resistant group with vonoprazan, AMPC, and CAM. In our study, CAM-based therapy in mixed infections showed a lower eradication success rate than the non CAM-resistant groups. It was suggested that misjudging mixed …
影响因子：
24.5
作者：
Malfertheiner, P.;Megraud, F.;El-Omar, E. M.
通讯作者：
El-Omar, E. M.