Intraluminal therapy for Helicobacter pylori infection

• Published in: Journal of gastroenterology and hepatology 2019-08, Vol.34 (8), p.1337-1343
• Main Authors: Liou, Tai‐Cherng, Liao, Po‐Hao, Lin, Yu‐Chun, Chu, Cheng‐Hsin, Shih, Shou‐Chuan
• Format: Article
• Language: English
• Subjects: Acetylcysteine - administration & dosage; Acetylcysteine - adverse effects; Adult; Aged; Amoxicillin - administration & dosage; Amoxicillin - adverse effects; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antibiotics; Antigens; Clarithromycin - administration & dosage; Clarithromycin - adverse effects; Clinical trials; disease eradication; Drug Administration Schedule; Drug Therapy, Combination; Endoscopy; Eradication; Expectorants - administration & dosage; Expectorants - adverse effects; Female; Gastric Acid - metabolism; Gastric Mucosa - drug effects; Gastric Mucosa - metabolism; Gastric Mucosa - microbiology; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter Infections - metabolism; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - drug effects; Helicobacter pylori - pathogenicity; Humans; Hydrogen-Ion Concentration; Lansoprazole - administration & dosage; Lansoprazole - adverse effects; Male; Metronidazole - administration & dosage; Metronidazole - adverse effects; Middle Aged; Mucosa; Pain; Pathogens; Patients; Powders; Prospective Studies; Proton Pump Inhibitors - administration & dosage; Remission Induction; Therapeutic Irrigation - adverse effects; Time Factors; Treatment Outcome; Urea; Young Adult
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.14627

Background and Aim Several strategies have been proposed to increase the eradication rate of Helicobacter pylori. However, the widespread increasing resistance rates to current multiple‐dose oral antibiotic therapies call for alternative therapeutic approaches. We aim to develop a novel intraluminal therapy for H. pylori infection (ILTHPI). Methods From April 2017 to December 2017, 100 H. pylori‐infected treatment‐naïve patients with upper abdominal pain or discomfort underwent endoscopic examinations and concomitant ILTHPI, which comprised the control of intragastric pH, the irrigation of gastric mucosal surface with a mucolytic agent, and the application of single‐dose medicaments containing antibiotic powders. The safety profiles while conducting ILTHPI and adverse events after ILTHPI were evaluated. The success of eradication was assessed based on the result of the 13C‐urea breath test 6 weeks after ILTHPI. In addition, a patient with successful ILTHPI was reconfirmed by a negative H. pylori stool antigen test four to 6 months after ILTHPI to exclude short‐term recurrence. Results All the 100 enrolled patients completed the ILTHPI with good safety profiles and mild adverse events (6%). Five patients dropped out, and 51 of 95 patients (53.7%) achieved successful eradication immediately after endoscopic examinations. All 51 patients revealed negative stool H. pylori antigen tests four to 6 months after successful ILTHPI. No short‐term recurrence was observed. Conclusions We have developed a novel therapeutic approach. With the ILTHPI, H. pylori can be eradicated immediately by administrating a single‐dose regimen while conducting an endoscopic examination. Clinical Trials Number NCT03124420