J Dig Dis. 2022 Nov 2. doi: 10.1111/1751-2980.13142. Online ahead of print.
ABSTRACT
AIMS: Guidelines suggest bismuth-containing quadruple (BQT) or concomitant regimens (CT) as first line therapy in our geographic area. Both schedules contain metronidazole.
METHODS: We recruited naïve subjects with H. pylori infection in the period January 2020-December 2021, receiving either CT or BQT. Before therapy, patients collected a fecal sample using the THD fecal test device. H. pylori DNA was extracted and mutations rdxA/frxA and A2143G in genes for metronidazole and clarithromycin resistance were respectively investigated using RT-PCR with high resolution melting curve.
RESULTS: Ninety-six patients were enrolled: 29 received BQT and 67 CT. The overall eradication rate was 94.8%, in detail 100% for BQT and 92.5% for CT, respectively. Metronidazole resistance was found in 18 subjects (18.8%), while clarithromycin resistance in 19 (19.8%). All 18 patients with metronidazole resistance experienced eradication. Five had assumed BQT and 13 CT. The eradication rate in metronidazole-sensitive strains was 93.6%. Of these, 24 received BQT with 100% success, and 54 had CT with 5 failures (success 90.7%). Two failing patients were resistant to clarithromycin, and the remaining 3 were susceptible to both clarithromycin and metronidazole. We did not observe any statistical significance in the eradication rate between metronidazole-resistant and sensitive strains (100% versus 93.6%, respectively, p = 0.58).
CONCLUSIONS: Our results suggest that metronidazole resistance does not influence the eradication rate of BQT and CT regimens in our geographical area, even if such result needs to confirmed in a larger sample.
PMID:36321440 | DOI:10.1111/1751-2980.13142
