Why should not we interrupt proton pump inhibitors and antibiotics-based eradication of Helicobacter pylori during the coronavirus COVID-19 pandemic? Review article
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Published:
Jun 30, 2020
Keywords:
Helicobacter pylori infection, peptic ulcer disease, gastric cancer, MALT lymphoma, eradication treatment, proton pump inhibitors
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Abstract
Helicobacter pylori infection is one of the most widespread infectious diseases in the world, but its prevalence varies depending on geographical region and economic and social condition. The percent of infected adult persons in Poland is 67, among younger population under 18 years being as high as about 32%. This infection in some number of the concerned persons can be associated with chronic gastritis, peptic gastric and duodenal ulcers, gastric mucosa-associated lymphoid tissue lymphoma (MALT) and gastric cancer. Extra-gastric manifestation of H. pylori infection are iron deficiency anemia, idiopathic thrombocytopenic purpura and significant B12 deficiency. According to the Maastricht V/Florence Consensus Report considering H. pylori infection a contagious disease that requires treatment in each case, indications for diagnostic evaluation to detect its presence are established, and then to its eradication. The treatment of H. pylori infection is complex and based on the combination of the following groups of medicines: proton pump inhibitors (PPI), antibiotics and anti-microbial nitroimidazoles and bismuth salts and probiotics. Currently, the main challenge in the field of H. pylori infection is antibiotic resistance, which influences the efficacy of eradication regiments. According to Maastricht V/Florence Consensus, in Poland where H. pylori resistance to clarithromycin is more than 15%, quadruple therapy with bismuth, PPI, tetracycline and metronidazole/tinidazole for 10–14 days should be used as first-line treatment. Triple therapy with fluoroquinolone is recommended as second-line treatment. After two unsuccessful attempts to eradicate, bacterial cultures should be should be performed to asses antibiotic sensitivity of the H. pylori strain. There are no reasons in front of pandaemia of COVID-19 to delay eradication of H. pylori infection, when the urgent indications: peptic ulcer complicated with haemorrhage, MALT lymphoma or early gastric cancer exists.
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Skrzydło-Radomańska, B. (2020). Why should not we interrupt proton pump inhibitors and antibiotics-based eradication of Helicobacter pylori during the coronavirus COVID-19 pandemic?. Medycyna Faktow (J EBM), 13(2(47), 198-207. https://doi.org/10.24292/01.MF.0220.9
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References
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18. Chey WD, Leontiadis GI, Howden CW et al. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017; 112(2): 212-39.
19. Qu XH, Huang X, Xiong P et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010; 16: 886-96.
20. George JN. Definition, diagnosis and treatment of immune thrombocytopenic purpyra. Haematologica. 2009; 94: 759-62.
21. Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013; 368: 2041-2.
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28. Fukase K, Kato M, Kikuchi S et al. Effect of eradication Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008; 372: 392-7.
29. Ma JL, Zhang L, Brown LM et al. Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatment on gastric cancer incidence and mortality. J Natl Cancer Inst. 2012; 104: 488-92.
30. Bartnik W, Celińska-Cedro D, Dzieniszewski J et al. Wytyczne Polskiego Towarzystwa Gastroenterologii dotyczące diagnostyki i leczenia zakażenia Helicobacter pylori. Med Prakt. 2014; 5: 46-50.
31. Vergara M, Catalan M, Gisberg JP et al. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther. 2005; 21: 1411-8.
32. Chan FKL, Ching J, Suen B et al. Effect of H. pylori eradication on the long-term incidence of reccurent ulcer bleeding in high-risk aspirin users: a 10 years prospective cohort study. Gastroenterology. 2011; 140(suppl 1): S173-S4.
33. Adrych K. Czy każdy chory z zakażeniem Helicobacter pylori powinien być leczony? Gastroenterol Klin. 2018; 10(1): 23-31.
34. Tepes B, Malfertheiner P, Labenz J et al. Modified Helicobacter pylori test using a new test meal and a C13-urea breath test in Helicobacter pylori positive and negative dyspepsia patients on proton pump inhibitors. World J Gastroenterol. 2017; 23(25): 1-8.
35. Scarpignato C. Towards the ideal regimen for Helicobacter pylori eradication: the search continues. Dig Liver Dis. 2004; 36: 243-7.
36. Gatta L, Vakil N, Vaira D et al. Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy. BMJ. 2013; 347: f4587.
37. Scarpignato C, Gatta L, Zullo A et al. Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression. BMC Medicine. 2016; 14(1): 179-209.
38. Lieber CS. Gastritis and Helicobacter pylori: forty years of antibiotic therapy. Digestion. 1997; 58: 203-10.
39. De Boer W, Driessen W, Jansz A et al. Effect of acid suppression on efficacy of treatment for Helicobacter pylori infection. Lancet. 1995; 345(8953): 806-20.
40. Gisberg JP. Rescue therapy for Helicobacter pylori infection 2012. Gastroenterol Res Pract. 2012; 974594.
41. Zullo A, Ridola L, Francesco VD et al. High-dose esomepazole and amoxicillin dual therapy for first-line Helicobacter pylori eradication: a proof of concept study. Ann Gastroenterol. 2015; 28: 448-51.
42. Tielemans MM, van Oijen MGH, Mulder CJJ. Esomeprazole relieves upper gastrointestinal symptoms in high-risk and average-risk NSAID users in daily clinical practice: results from an open-label study. Eur J Gastroenterol Hepatol. 2012; 24: 201-7.
43. Yeomans N, Lanas A, Labenz J et al. Efficacy of Esomeprazole (20 mg Once Daily) for Reducing the Risk of Gastroduodenal Ulcers Associated With Continuous Use of Low-Dose Aspirin. Am J Gastroenterol. 2008; 103: 2465-73.
44. Gąsiorowska A, Janiak M, Waśko-Czopnik D et al. Postępowanie u pacjentów z objawami choroby refluksowej – rekomendacje dla lekarzy rodzinnych. Lekarz POZ. 2019; 3-4: 245-65.
45. Wocial T. Czy jest nam potrzebny esomeprazol. Gastroenterol Klin. 2010; 2(2): 56-63.
46. Graham DY, Tansel A. Interchangeable use of proton pump inhibitors based on relative potency. Clin Gastroenterol Hepatol. 2018; 16: 800-8; e807.
47. Villoria A, Garcia P, Calvet X et al. Meta-analysis: high-dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2008; 28(7): 868-77.
48. Megraud F, Coenen S, Versporten A et al. Study Group participants. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013; 62(1): 34-42.
49. Dzierżanowska-Fangrat K, Rozynek E, Celińska-Cedro D et al. Antimicrobial resistance of Helicobacter pylori in Poland: a multicenter study. Int J Antimicrob Agents. 2005; 26(3): 230-4.
50. Hu Yi, Zhu Y, Nong-Hua L. Recent progress in Helicobacter pylori treatment. Chinese Med J. 2020; 133(3): 335-43.
51. Bartnik W. Zastosowanie bizmutu w leczeniu zakażenia Helicobacter pylori. Gastroenterol Klin. 2017; 9: 1-3.
52. Berrutti M, Pellicano R, Astegiano M et al. Helicobacter pylori eradication: metronidazole or tinidazole? Data from Turin, Italy. Minerva Gastroenterol Dietol. 2008; 54(4): 355-8.
53. Dzieniszewski J, Jarosz M. Wytyczne postępowania leczniczego w infekcji Helicobacter pylori. Med. po Dyplomie. 2006(suppl 13): 39-43.
54. Szajewska H, Horvath A, Piwowarczyk A. Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther. 2010; 32: 1069-79.
2. Zhu LR, Mao R, Fiorino G et al. 2nd Interview COVID-19 ECCO Taskforce. 2020.
3. Łodyga M, Eder P, Dobrowolska A et al. Stanowisko Polskiego Towarzystwa Gastroenterologii i Konsultanta Krajowego w Dziedzinie Gastroenterologii dotyczące postępowania z pacjentem z nieswoistą chorobą zapalną jelit w dobie pandemii COVID-19.
4. Rubin DT, Feuerstein JD, Wang AY et al. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology. 2020. https://doi.org/10.1053/j.gastro.2020.04.012.
5. Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983; 1(8336): 1273-5.
6. Hooi JKY, Lai WY, Ng WK et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017; 153(2): 420-9.
7. Perez-Perez GI, Rothenbacher D, Brenner H. Epidemiology of Helicobacter pylori infection. Helicobacter. 2004; 9(suppl 1): 1-6.
8. Peleteiro B, Bastos A, Ferro A et al. Prevalence of Helicobacter pylori infection worldwide: a systematic review of studies with national coverage. Dig Dis Sci. 2014; 59(8): 1698-709.
9. Matysiak-Budnik T, Knapik Z, Megraud F et al. Helicobacter pylori infection in Eastern Europe: seroprevalence in the polish population of Lower Silesia. Am J Gastroenterol. 1996; 12: 2513-5.
10. Bartnik W. Zastosowanie bizmutu w leczeniu zakażenia Helicobacter pylori. Gastroenterol Klin. 2017; 9(4): 17-20.
11. Cover TL, Blaser MJ. Helicobacter pylori in health and disease. Gastroenterology. 2009; 136: 1863-73.
12. Yamaoka Y. Mechanisms of disease: Helicobacter pylori virulence factors. Nat Rev Gastroenterol Hepatol. 2010; 7: 629-41.
13. Jodlowski TZ, Lam S, Ashby ChR. Emerging therapies for the treatment of Helcobacter pylori infections. Annals Pharmacother. 2008; 42(11): 1621-39.
14. Malfertheiner P, Megraud F, O’Morain CA et al. European Helicobacter and microbiota study group and consensus panel. Management of Helicobacter pylori infection – the Maastricht V/Florence Concensus Report. Gut. 2017; 66(1): 6-30.
15. Strzeszewski Ł. Postępowanie w przypadku zakażenia Helicobacter pylori. Podsumowanie raportu uzgodnieniowego MaastrichtV/Florencja. Med Prakt. 2017; 4: 14-23.
16. Sugano K, Tack J, Kuipers EJ et al. Faculty members of Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015; 64(9): 1353-67.
17. Fallone CA, Chiba N, van Zanten SV et al. The Toronto Consensus for the treatment of Helicobacter pylori consensus in adults. Gastroenterology. 2016; 151(1): 51-69.e14.
18. Chey WD, Leontiadis GI, Howden CW et al. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017; 112(2): 212-39.
19. Qu XH, Huang X, Xiong P et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010; 16: 886-96.
20. George JN. Definition, diagnosis and treatment of immune thrombocytopenic purpyra. Haematologica. 2009; 94: 759-62.
21. Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013; 368: 2041-2.
22. Franceschi F, Tortora A, Gasbarrini G et al. Helicobacter pylori and extragastric diseases. Helicobacter. 2014; 19(suppl 1): 52-8.
23. Lee YC, Chiang TH, Chou CK et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology. 2016; 150(5): 1113-24.
24. Hwang YJ, Kim N, Lee HS et al. Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication – a prospective study for up to 10 years. Aliment Pharmacol Ther. 2018; 47(3): 380-90.
25. Nakamura S, Sugiyama T, Matsumoto T et al. Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicenter cohort follow-up study of 420 patients in Japan. Gut. 2012; 61: 507-13.
26. Capelle LG, den Hoed CM, de Vries AC et al. Premalignant gastric lesions in patients with gastric mucosa-associated lymphoid tissue lymphoma and metachronous gastric adenocarcinoma: a case-control study. Eur J Gastroenterol Hepatol. 2012; 24: 42-7.
27. Dabrowski A. Choroba infekcyjna żołądka – Helicobacter pylori. W: Panasiuk A (ed). Choroby infekcyjne przewodu pokarmowego. Wydawnictwo Lekarskie PZWL, Warszawa 2018.
28. Fukase K, Kato M, Kikuchi S et al. Effect of eradication Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008; 372: 392-7.
29. Ma JL, Zhang L, Brown LM et al. Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatment on gastric cancer incidence and mortality. J Natl Cancer Inst. 2012; 104: 488-92.
30. Bartnik W, Celińska-Cedro D, Dzieniszewski J et al. Wytyczne Polskiego Towarzystwa Gastroenterologii dotyczące diagnostyki i leczenia zakażenia Helicobacter pylori. Med Prakt. 2014; 5: 46-50.
31. Vergara M, Catalan M, Gisberg JP et al. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther. 2005; 21: 1411-8.
32. Chan FKL, Ching J, Suen B et al. Effect of H. pylori eradication on the long-term incidence of reccurent ulcer bleeding in high-risk aspirin users: a 10 years prospective cohort study. Gastroenterology. 2011; 140(suppl 1): S173-S4.
33. Adrych K. Czy każdy chory z zakażeniem Helicobacter pylori powinien być leczony? Gastroenterol Klin. 2018; 10(1): 23-31.
34. Tepes B, Malfertheiner P, Labenz J et al. Modified Helicobacter pylori test using a new test meal and a C13-urea breath test in Helicobacter pylori positive and negative dyspepsia patients on proton pump inhibitors. World J Gastroenterol. 2017; 23(25): 1-8.
35. Scarpignato C. Towards the ideal regimen for Helicobacter pylori eradication: the search continues. Dig Liver Dis. 2004; 36: 243-7.
36. Gatta L, Vakil N, Vaira D et al. Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy. BMJ. 2013; 347: f4587.
37. Scarpignato C, Gatta L, Zullo A et al. Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression. BMC Medicine. 2016; 14(1): 179-209.
38. Lieber CS. Gastritis and Helicobacter pylori: forty years of antibiotic therapy. Digestion. 1997; 58: 203-10.
39. De Boer W, Driessen W, Jansz A et al. Effect of acid suppression on efficacy of treatment for Helicobacter pylori infection. Lancet. 1995; 345(8953): 806-20.
40. Gisberg JP. Rescue therapy for Helicobacter pylori infection 2012. Gastroenterol Res Pract. 2012; 974594.
41. Zullo A, Ridola L, Francesco VD et al. High-dose esomepazole and amoxicillin dual therapy for first-line Helicobacter pylori eradication: a proof of concept study. Ann Gastroenterol. 2015; 28: 448-51.
42. Tielemans MM, van Oijen MGH, Mulder CJJ. Esomeprazole relieves upper gastrointestinal symptoms in high-risk and average-risk NSAID users in daily clinical practice: results from an open-label study. Eur J Gastroenterol Hepatol. 2012; 24: 201-7.
43. Yeomans N, Lanas A, Labenz J et al. Efficacy of Esomeprazole (20 mg Once Daily) for Reducing the Risk of Gastroduodenal Ulcers Associated With Continuous Use of Low-Dose Aspirin. Am J Gastroenterol. 2008; 103: 2465-73.
44. Gąsiorowska A, Janiak M, Waśko-Czopnik D et al. Postępowanie u pacjentów z objawami choroby refluksowej – rekomendacje dla lekarzy rodzinnych. Lekarz POZ. 2019; 3-4: 245-65.
45. Wocial T. Czy jest nam potrzebny esomeprazol. Gastroenterol Klin. 2010; 2(2): 56-63.
46. Graham DY, Tansel A. Interchangeable use of proton pump inhibitors based on relative potency. Clin Gastroenterol Hepatol. 2018; 16: 800-8; e807.
47. Villoria A, Garcia P, Calvet X et al. Meta-analysis: high-dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2008; 28(7): 868-77.
48. Megraud F, Coenen S, Versporten A et al. Study Group participants. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013; 62(1): 34-42.
49. Dzierżanowska-Fangrat K, Rozynek E, Celińska-Cedro D et al. Antimicrobial resistance of Helicobacter pylori in Poland: a multicenter study. Int J Antimicrob Agents. 2005; 26(3): 230-4.
50. Hu Yi, Zhu Y, Nong-Hua L. Recent progress in Helicobacter pylori treatment. Chinese Med J. 2020; 133(3): 335-43.
51. Bartnik W. Zastosowanie bizmutu w leczeniu zakażenia Helicobacter pylori. Gastroenterol Klin. 2017; 9: 1-3.
52. Berrutti M, Pellicano R, Astegiano M et al. Helicobacter pylori eradication: metronidazole or tinidazole? Data from Turin, Italy. Minerva Gastroenterol Dietol. 2008; 54(4): 355-8.
53. Dzieniszewski J, Jarosz M. Wytyczne postępowania leczniczego w infekcji Helicobacter pylori. Med. po Dyplomie. 2006(suppl 13): 39-43.
54. Szajewska H, Horvath A, Piwowarczyk A. Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther. 2010; 32: 1069-79.