ABSTRACT Background oipA , an outer membrane protein of Helicobacter pylori , is linked to IL‐8 induction and gastric inflammation, but its role is debated due to inconsistent findings. This study aims to explore the role of oipA phase variation in modulating the virulence traits of H. pylori , a bacterium strongly associated with the development of gastric cancer. Material and Methods American clinical isolate AH868 strain for naturally occurring phase variations of the oipA gene, and G27 strain for in vitro–induced phase variations were used to elucidate oipA 's impact on key virulence phenotypes, including cell elongation, CagA phosphorylation, and IL‐8 induction. Results Using AH868 strain, natural oipA phase variation does not affect cell elongation and IL‐8 induction. Interestingly, however, in vitro–induced oipA phase variations in G27 strain uncovered that 9.4% of oipA “Off” transformants exhibit reduced cell elongation while all maintaining consistent IL‐8 induction levels. Additionally, complementation of oipA “Off to On” status restores the cell elongation phenotype in 12.5% of transformants, highlighting the importance of oipA in maintaining normal cell morphology. Crucially, these variations in cell elongation are not linked to changes in bacterial adherence capabilities. Furthermore, the study shows a correlation among oipA phase variation, cell elongation, and CagA phosphorylation, suggesting that oipA influences the functionality of the Type IV secretion system. Whole‐genome sequencing of selected transformants reveals genetic variations in bab paralogue, cagY gene, and other genomic regions, underscoring the complex genetic interactions that shape H. pylori 's virulence. Conclusions Our research provides new insights into the subtle yet significant role of oipA phase variation in H. pylori pathogenicity, emphasizing the need for further studies to explore the intricate molecular mechanisms involved. This understanding could pave the way for targeted therapeutic strategies to mitigate the impact of H. pylori on human health.

Jing Lai

Sacheera Angulmaduwa

Myeong‐A Kim

Aeryun Kim

Kavinda Tissera

Yong‐Joon Cho

Jeong‐Heon Cha

Helicobacter

Influence of <scp>oipA</scp> Phase Variation on Virulence Phenotypes Related to Type <scp>IV</scp> Secretion System in Helicobacter pylori

oipA 相变对 Helicobacter pylori 中与IV型分泌系统相关的毒力表型的影响

ABSTRACT Background The eradication of Helicobacter pylori ( H. pylori ) is crucial due to its rising prevalence and increasing resistance. Bismuth‐containing quadruple therapies (BcQTs) have been proposed as a viable treatment option; however, the optimal duration for it remains contentious. This systematic review and meta‐analysis aimed to compare the clinical efficacy of short‐term BcQT (defined as 7 or 10 days) with a standard 14‐day course. Methods A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for randomized controlled trials published in English until June 20, 2024. Eligibility criteria were applied to identify relevant studies. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the included studies regarding eradication rates, adverse effects, and compliance. This systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement and was previously registered in PROSPERO under registration number CRD42024547773. Results This meta‐analysis finally included 15 trials involving a total of 4505 patients. The eradication rates for short courses of BcQT were lower than those for the 14‐day course (RR 0.96, 95% CI 0.93–0.99). However, the eradication rate for the 10‐day therapy was comparable to that of the 14‐day therapy (RR 0.98, 95% CI 0.95–1.00). Subgroup analyses of antibiotic combinations indicated that tetracycline and metronidazole combinations yielded similar H. pylori eradication rates in the 7‐day versus the 14‐day BcQT (RR 0.93, 95% CI 0.84–1.02). In the potassium‐competitive acid blocker subgroup, the eradication rates remained similar across the 14‐day group and the short‐course treatment groups, whether evaluating the short‐term treatment groups as a whole or the 7‐ and 10‐day subgroups separately. Additionally, the adverse effects and compliance associated with the short course of BcQT were comparable to those of the 14‐day therapy. Conclusion A 10‐day course of BcQT may represent the optimal treatment duration. Nevertheless, the choice of antibiotic combination should be guided by the regional antibiotic resistance patterns of H. pylori , as combinations with lower resistance rates are more effective. Trial Registration PROSPERO number: CRD42024547773

Miao Duan

Qingzhou Kong

Hui Wang

Yueyue Li

Optimal Duration of Bismuth‐Containing Quadruple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta‐Analysis

含铋四联疗法根除幽门螺杆菌的最佳疗程：一项系统综述和Meta分析

ABSTRACT Background Treatment with potassium‐competitive acid blockers has shown acceptable efficacy in Helicobacter pylori eradication. In regions like Korea, where the clarithromycin resistance rate is high, alternative combinations like non‐bismuth quadruple therapies have shown favorable results. This study compared the outcomes of sequential eradication therapy with new potassium‐competitive acid blocker tegoprazan and conventional esomeprazole‐containing sequential therapy. Materials and Methods Patients with Helicobacter pylori ( H. pylori ) infection were consecutively recruited. Patients were allocated to either an esomeprazole‐containing sequential or a tegoprazan‐containing sequential therapy group. Sequential therapy comprised esomeprazole (40 mg) or tegoprazan (50 mg) plus amoxicillin (1000 mg) twice daily for the initial 5 days, followed by esomeprazole (40 mg) or tegoprazan (50 mg) with clarithromycin (500 mg) and metronidazole (500 mg) twice daily for the remaining 5 days. Eradication rate, compliance, and adverse events were recorded. Results A total of 406 patients with H. pylori infection were enrolled in the trial and analyzed per protocol. Eradication rate by intention‐to‐treat and per‐protocol was 83.8% (95% confidence interval [CI]: 78.7–88.9) for esomeprazole‐containing sequential therapy, and 87.1% (95% CI: 82.5–91.8) for tegoprazan‐containing sequential therapy, with no statistical significance ( p = 0.399). Additionally, there was no statistically significant difference in treatment compliance between the two groups. Nausea was more prevalent (23.3%, 27/202) with sequential tegoprazans than with esomeprazole‐containing sequential therapy (14.2%, 29/204; p = 0.022). Conclusion Tegoprazan‐containing 10‐day sequential eradication treatment demonstrated similar eradication efficacy compared to esomeprazole‐containing treatment, even in regions with high antimicrobial resistance, such as Korea. Trial Registration ClinicalTrials.gov : NCT06382493

Jung Won Lee

Nayoung Kim

Jongchan Lee

So Young Jo

Dong Ho Lee

Efficacy of Tegoprazan‐Containing Sequential Eradication Treatment Compared to Esomeprazole‐Containing Sequential Eradication of Helicobacter pylori in South Korea, a Region With High Antimicrobial Resistance: A Prospective, Randomized, Single Tertiary Center Study

含泰妥拉唑序贯根除治疗与含埃索美拉唑序贯根除治疗在韩国的疗效比较：一项针对高耐药性地区的前瞻性、随机、单中心研究

In the eradication of Helicobacter pylori, the efficacy of bismuth remains inconclusive. We aimed to compare the efficacy of bismuth on various H. pylori eradication regimens.

A Reum Choe

Chung Hyun Tae

Miyoung Choi

Ki‐Nam Shim

Hye‐Kyung Jung

Systematic Review and Meta‐Analysis: Bismuth Enhances the Efficacy for Eradication of Helicobacter pylori

系统评价与荟萃分析：铋剂增强根除幽门螺杆菌的疗效

To evaluate the efficacy of colloidal bismuth subcitrate (CBS) therapy for the eradication of H. pylori in patients from a national pediatric registry of H. pylori infection.

Gonzalo Botija

Gonzalo Galicia

Beatriz Martínez

Carmen Cuadrado

Marta Soria

Sonia Fernández

Pedro Urruzuno

María‐Luz Cilleruelo

Efficacy of Bismuth Therapy in Eradicating Helicobacter pylori in Children—Data From the <scp>RENIHp</scp> Registry

铋剂疗法在儿童中根除幽门螺杆菌的有效性——来自<scp>RENIHp</scp>登记库的数据

ABSTRACT Background The Helicobacter pylori epidemic in China accounts for up to a third of gastric cancers worldwide. We aim to monitor the temporal and spatial dynamics of H . pylori infection in both adults and children across China. Materials and Methods We developed a surveillance system consisting of a data collection component that harnessed survey reports in natural populations and an analysis component that accounted for the differences in survey time and location, population age structure, and H . pylori detection method. System outputs were estimates of the prevalence of H . pylori in adults and children (aged ≤ 14 years) presented at three hierarchical levels (regional, provincial, and prefectural). Results The overall prevalence of H . pylori infection declined sharply in adults (63.3%, 52.5%, 43.4%, and 38.7%) and less sharply in children (23.1%, 26.1%, 16.0%, and 15.7%) in 1983–1999, 2000–2009, 2010–2014, and 2015–2019, respectively. The changes were asynchronous across regions, with the most marked declines in the Northwest, the Hong Kong‐Macao‐Taiwan region, and the East. We estimated that 457.6 million adults and 44.5 million children have been infected with H . pylori , with cross‐province disparities in prevalence ranging from 24.3% to 69.3% among adults and 2.9% to 46.3% among children. In general, the risk level of gastric cancer increased as the prevalence of H . pylori increased. The correlation was statistically significant for both adult men (Spearman coefficient of correlation: 0.393, p = 0.0146) and women (0.470, p = 0.0029). Conclusions The tracking system would be important for the continuous and stratified tracking of the Helicobacter pylori epidemic across China and can be used to furnish an evidence base for the formulation of tailored prevention strategies.

Zixing Wang

Yaoda Hu

Ran Fei

Wei Han

Xiaoxiao Wang

Dongbo Chen

Shaoping She

Tracking the Helicobacter pylori Epidemic in Adults and Children in China

追踪中国成人和儿童中幽门螺杆菌的流行情况

ABSTRACT Background The optimal dosage of minocycline remains unclear for Helicobacter pylori ( H. pylori ) eradication. We aimed to evaluate the efficacy and safety of four different regimens with minocycline and metronidazole compared to classical bismuth quadruple therapy for H. pylori rescue treatment. Materials and Methods From March 2021 to March 2024, refractory H. pylori ‐infected patients with at least two previous treatment failures who received 14‐day therapy with b.i.d. proton pump inhibitor 20 mg and bismuth 220 mg, plus tetracycline 400 mg q.i.d and metronidazole 400 mg q.i.d (BQT), or minocycline 50 mg q.i.d and metronidazole 400 mg q.i.d (PBMn 4 M 4 ), or minocycline 50 mg t.i.d and metronidazole 400 mg t.i.d (PBMn 3 M 3 ), or minocycline 50 mg b.i.d and metronidazole 400 mg q.i.d (PBMn 2 M 4 ), or minocycline 50 mg b.i.d and metronidazole 400 mg t.i.d (PBMn 2 M 3 ) were included in this retrospective study. H. pylori eradication was assessed by 13 C‐urea breath test at least 6 weeks after treatment. All adverse effects during treatment were recorded. Results Totally, 823 patients were enrolled: 251 with BQT, 97 with PBMn 4 M 4 , 191 with PBMn 3 M 3 , 108 with PBMn 2 M 4 , and 176 with PBMn 2 M 3 . The eradication rates of BQT, PBMn4M4, PBMn3M3, PBMn2M4, and PBMn2M3 were 89.2%, 87.6%, 91.6%, 88.0%, and 91.5%, respectively, by intention‐to‐treat analysis; 96.1%, 97.7%, 97.8%, 96.9%, and 97.6%, respectively, by modified intention‐to‐treat analysis; 97.1%, 97.5%, 97.7%, 96.8%, and 97.6%, respectively, by per‐protocol analysis. Metronidazole resistance did not affect the efficacy of all groups. PBMn 2 M 3 group achieved the greatest compliance and the fewest moderate and severe adverse events. Conclusions The novel bismuth‐containing quadruple therapy with a low dose of minocycline and metronidazole is an alternative to classical bismuth quadruple therapy for H. pylori rescue treatment with superior safety and compliance. Trial Registration ClinicalTrials.gov identifier: NCT06332599

Yu Huang

Shuhan Qiu

Yixian Guo

Jinnan Chen

Meixuan Li

Zhaohui Ding

Wei Zhang

Xiao Liang

Hong Lu

Optimization of Minocycline‐Containing Bismuth Quadruple Therapy for Helicobacter pylori Rescue Treatment: A Real‐World Evidence Study

含米诺环素的铋四联疗法优化用于幽门螺杆菌补救治疗：一项真实世界证据研究

ABSTRACT Background and Aims Physicians' knowledge and practices regarding the diagnosis, treatment, and follow‐up of Helicobacter pylori ( H. pylori ) infection can impact the effectiveness of eradication therapy. This study aimed to investigate the current state of knowledge and practices concerning H. pylori infection management among physicians in Gansu Province, northwest China. Materials and Methods From October to November 2023, 557 physicians from 14 cities and prefectures in Gansu Province participated in this multicenter cross‐sectional study and completed a survey questionnaire. Results A total of 519 valid questionnaires were collected. 43.2% of the physicians supported H. pylori screening for high‐risk populations or individuals with H. pylori –related diseases. The awareness of target screening populations varied among these physicians, ranging from 69.6% to 98.2%. Most physicians preferred the urea breath test (UBT) as the method for diagnosing H. pylori infection (98.3%) and for follow‐up after eradication therapy (98.5%). 89.6% of the physicians preferred bismuth‐containing quadruple therapy for initial eradication, with amoxicillin and clarithromycin being the most commonly used antibiotic combination (56.3%). In addition, 84.6% of the physicians indicated that they would inquire about the antibiotic usage history for most patients before treatment, 93.8% would ask patients about their previous eradication history, and 94.2% would inform patients about treatment‐related considerations. However, only 43.5%, 27.7%, and 29.7% of the physicians were aware of the high resistance rates of H. pylori to clarithromycin, levofloxacin, and metronidazole, respectively, in Gansu Province. Subgroup analysis revealed that the performance of gastroenterologists, nongastroenterologists, and physicians from different levels of hospitals differed in the diagnosis, treatment, and follow‐up of H. pylori infection. Conclusions Knowledge and practices regarding H. pylori infection management among physicians in Gansu Province, China, need further improvement. Strengthening targeted continuing education to increase the overall management level of H. pylori infection is recommended.

Na Liu

Qian Luo

Lingzhu Gou

Xiping Shen

Dekui Zhang

Knowledge and Practices of Helicobacter pylori Infection Management Among Physicians in Gansu Province, China: A Cross‐Sectional Study

甘肃省医务人员幽门螺杆菌感染管理知识与实践的横断面研究

ABSTRACT Background European and North‐American guidelines on management of H. pylori infection in children provide the option not to treat even if the infection is endoscopically confirmed. We used data from the EuroPed Hp Registry to identify factors associated with therapy decisions. Methods We included treatment‐naïve patients reported between 2017 and 2020 from 30 centers in 17 European countries. Multivariable logistic regression identified factors including comorbidities within and outside the gastrointestinal (GI) tract influencing the decision for or against therapy. Results Of 1165 patients (52% females, median age 12.8), 28% (321/1165) reported any alarm symptom, 26% (307/1165) comorbidities, and 16% (192/1165) did not receive eradication treatment. Therapy was initiated less often in children having any GI comorbidity (57%, n = 181), particularly in those with eosinophilic esophagitis (60%, n = 35), inflammatory bowel disease (54%, n = 28), and celiac disease (43%, n = 58), compared to those with non‐GI (86%, n = 126) or no comorbidity (89%, n = 858), despite similar frequencies of alarm and non‐alarm symptoms, ulcers, erosions, and nodular gastritis. Patients with GI and without comorbidities remained more likely untreated in high versus low H. pylori prevalence countries ( p &lt; 0.0001). In children without comorbidities, factors favoring therapy included older age, being overweight, having symptoms, erosions, antral nodularity, and available antibiotic susceptibility results. Conclusion In this cohort, H. pylori‐ infected children with GI comorbidities compared to no comorbidity showed 75% reduced chance of receiving eradication therapy. We found no evidence supporting different management strategies in infected patients with GI comorbidities compared to all pediatric patients with endoscopically proven H. pylori infection.

Thu Giang Le Thi

Katharina Werkstetter

Kallirroi Kotilea

Patrick Bontems

José Cabral

Maria Luz Cilleruelo

Michal Kori

Josefa Barrio

Matjaž Homan

Nicolas Kalach

Rosa Lima

Marta Tavares

Zrinjka Misak

Vaidotas Urbonas

Sibylle Koletzko

Factors Associated With Decision to Treat or Not to Treat Helicobacter pylori Infection in Children: Data From the <scp>EuroPedHp</scp> Registry

与儿童幽门螺杆菌感染治疗决策相关的因素：来自EuroPedHp登记库的数据

ABSTRACT Background and Aims Gastric cancer (GC) is the third cause of cancer mortality worldwide. A screening strategy that combines an upper gastrointestinal endoscopy (UGIE) with a screening colonoscopy may be cost‐effective in intermediate‐risk regions. This study aimed to evaluate the intention to adhere to combined endoscopic screening and assess knowledge of GC symptoms, risk factors, and barriers to screening. Methods Cross‐sectional study enrolling individuals eligible for CRC screening in northern Portugal, where a populational fecal occult blood test (FOBT) program is implemented. The validated PERCEPT‐PREVENT tool was applied across three groups: (a) not yet invited to CRC screening, (b) FOBT‐positive referred to colonoscopy, and (c) primary colonoscopy screening. Results A high acceptance rate was observed for combined endoscopic screening (94%; n = 264) [not yet invited to CRC screening 98% ( n = 90) vs. FOBT‐positive referred to colonoscopy 90% ( n = 103) vs. primary colonoscopy 97% ( n = 71); p = 0.017], with the vast majority reporting intention to adhere in the setting of full reimbursement (97%; n = 255). Most respondents were unaware of any possible GC symptom (76%; n = 213), risk factor (73%; n = 205), and UGIE‐related complication (85%; n = 237). Regular follow‐up with the primary care physician (Odds Ratio (OR) 27.59, 95% confidence interval (CI) 2.99–254.57), lower perceived negative health consequences of UGIE (OR 1.40, 95% CI 1.13–1.74), and lower perceived financial burden (OR 2.46, 95% CI 1.04–5.85) were the only factors independently associated with a higher intention to undergo combined screening. Conclusions Willingness to undergo combined endoscopic screening was notably high and positively impacted by lower perceived barriers. Additional efforts should be undertaken to improve levels of digestive health literacy.

João Carlos Silva

Mário Dinis‐Ribeiro

Fernando Tavares

Diogo Libânio

Gastric Cancer Screening: Intention to Adhere and Patients' Perspective

胃癌筛查：依从意愿与患者视角

HELICOBACTER 由 DAVID Y GRAHAM 教授编辑。编辑和同行评审过程是一个独立的过程。每当有利益冲突时，编辑和编辑委员会都会声明他们的利益和隶属关系。幽门螺杆菌认识到幽门螺杆菌在消化性溃疡、胃腺癌和原发性胃淋巴瘤中的关键作用。由于现在经常发现新的螺杆菌物种，螺杆菌涵盖了螺杆菌研究的整个范围，增加了胃肠病学领域之间的交流；微生物学;疫苗开发；实验动物科学。

The journal "Helicobacter" is edited by Professor David Y. Graham, and the editorial and peer review processes are conducted independently. Whenever there is a conflict of interest, the editors and editorial board declare their interests and affiliations. This journal recognizes the critical role of Helicobacter pylori in peptic ulcers, gastric adenocarcinoma, and primary gastric lymphoma. As new species of Helicobacter are frequently discovered, the journal covers the entire spectrum of Helicobacter research, enhancing communication between the fields of gastroenterology, microbiology, vaccine development, and experimental animal science.

《Helicobacter》期刊由大卫·Y·格雷厄姆教授主编，编辑和同行评审过程是独立进行的。每当出现利益冲突时，编辑和编辑委员会会公开声明他们的利益和隶属关系。该期刊专注于幽门螺杆菌在消化性溃疡、胃腺癌和原发性胃淋巴瘤中的重要作用。随着新螺杆菌物种的不断发现，期刊涵盖了螺杆菌研究的各个领域，促进了胃肠病学、微生物学、疫苗开发和实验动物科学之间的交流。

期刊	Helicobacter
ISSN	1083-4389, 1523-5378
h-index	90
Journal Impact	4.31
国际分区	MICROBIOLOGY(Q2)
国内分区	医学(2区)医学微生物学(2区)医学胃肠肝病学(3区)

Helicobacter

Influence of <scp><i>oipA</i></scp> Phase Variation on Virulence Phenotypes Related to Type <scp>IV</scp> Secretion System in <i>Helicobacter pylori</i>

Optimal Duration of Bismuth‐Containing Quadruple Therapy for <i>Helicobacter pylori</i> Eradication: A Systematic Review and Meta‐Analysis

Efficacy of Tegoprazan‐Containing Sequential Eradication Treatment Compared to Esomeprazole‐Containing Sequential Eradication of <i>Helicobacter pylori</i> in South Korea, a Region With High Antimicrobial Resistance: A Prospective, Randomized, Single Tertiary Center Study

Systematic Review and Meta‐Analysis: Bismuth Enhances the Efficacy for Eradication of <i>Helicobacter pylori</i>

Efficacy of Bismuth Therapy in Eradicating <i>Helicobacter pylori</i> in Children—Data From the <scp>RENIHp</scp> Registry

Tracking the <i>Helicobacter pylori</i> Epidemic in Adults and Children in China

Optimization of Minocycline‐Containing Bismuth Quadruple Therapy for <i>Helicobacter pylori</i> Rescue Treatment: A Real‐World Evidence Study

Knowledge and Practices of <i>Helicobacter pylori</i> Infection Management Among Physicians in Gansu Province, China: A Cross‐Sectional Study

Factors Associated With Decision to Treat or Not to Treat <i>Helicobacter pylori</i> Infection in Children: Data From the <scp>EuroPedHp</scp> Registry

Gastric Cancer Screening: Intention to Adhere and Patients' Perspective