Search Results (1,533)

Introduction: The declining efficacy of standard triple therapy for Helicobacter pylori (H. pylori) eradication, largely driven by increasing antibiotic resistance, has highlighted the need for alternative treatment strategies. Vonoprazan–amoxicillin dual therapy (VDT) has emerged as a promising regimen due to the potent and sustained acid suppression provided by vonoprazan. This meta-analysis aims to compare the efficacy and safety of VDT versus clarithromycin-based standard triple therapy (STT) for H. pylori eradication in adults. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted from inception to 15 March 2026 for randomized controlled trials (RCTs) comparing VDT (vonoprazan plus amoxicillin) with STT (proton pump inhibitor, amoxicillin, and clarithromycin) for H. pylori eradication (PROSPERO “CRD420261357715”). Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel method within a restricted maximum-likelihood random-effects model. Results: Five RCTs were included with 1363 patients (VDT: 680, STT: 683). VDT demonstrated a significantly higher H. pylori eradication rate compared with STT (RR 1.17; 95% CI [1.07; 1.27]; p = 0.007; I² = 11%). Conclusions: This meta-analysis suggests that VDT may be associated with higher H. pylori eradication rates than clarithromycin-based STT. Further large, well-designed RCTs are needed before firm first-line recommendations can be made. Full article

Metronidazole is an antibiotic used to treat Helicobacter pylori, a bacterium responsible for chronic infections in humans that cause gastric inflammation, ulcers, and cancer. However, its long-term administration is limited by toxicity and increased resistance. In the search for more effective agents against H. pylori infection, molecular hybridization has now been applied to the synthesis of the new compound 3. Its structure connects the metronidazole moiety to pectolinarigenin, the latter obtained by acid hydrolysis of glycosylated flavonoids isolated from the plant Linaria reflexa Desf. The NOE effect supported the C-7 functionalization of 3, as evidenced by the energy-minimized DFT-calculated structure. The new molecule enriches the chemical space of known metronidazole–flavonoid analogs, among which the genistein derivative 2 was reported as the most active in inhibiting bacterial strains. The computational analysis of 2 and 3 compared with metronidazole as the reference has provided favorable data for both Absorption, Distribution, Metabolism, and Excretion (ADME) predictions and the probability of anti-H. pylori activity, besides rising docking evaluation on three specific targets and dynamics simulation as inhibitors of the flavodoxin enzyme. The results are promising for further in-depth biological investigation. Full article

Small intestinal bacterial overgrowth (SIBO) refers to an abnormal increase in the number of bacteria in the small intestine and is observed in various diseases. SIBO can also develop after long-term use of proton pump inhibitors (drug-induced SIBO), bariatric surgery, gastrectomy, and other surgeries (postoperative SIBO). The aim of this narrative review is to summarize all of the published information on the treatment of SIBO in as much detail as possible and present it separately for each specific disease and intervention associated with SIBO. The most extensively studied drug for the treatment of SIBO is rifaximin. It eliminates SIBO in 63% of cases; however, most studies lack a control group. Small RCTs assessing the effects of this antibiotic on SIBO have reported conflicting results, and a meta-analysis showed no effect. A large RCT is required to verify the results of uncontrolled studies. Neomycin and norfloxacin showed efficacy in the treatment of SIBO in single RCTs, with elimination rates of 20 and 100%, respectively. Ciprofloxacin, rifamycin, metronidazole, and other antibiotics, as well as ursodeoxycholic acid, showed positive effects for the treatment of SIBO, but only in uncontrolled studies or in comparison with rifaximin or other drugs. The reported elimination rates were 54%, 67%, 79%, and 75%, respectively. Eradication therapy for Helicobacter pylori infection eliminated SIBO at a rate of approximately 70%. Probiotics have been tested for treatment of SIBO in various diseases. VSL#3 and Saccharomyces boulardii CNCM I-745 were effective in RCTs, with elimination rates of 58% and 80%, respectively. In conclusion, when selecting SIBO treatment regimens, those that have demonstrated the greatest efficacy for a specific concomitant disease should be preferred, despite the generally low level of evidence supporting these approaches in most cases. Full article

Background and Aims: Helicobacter pylori is a major cause of chronic gastritis and peptic ulcer disease. The increasing global spread of antibiotic-resistant strains, particularly against amoxicillin and clarithromycin, poses a significant challenge to eradication therapies. Moreover, treatment-related adverse effects, often linked to antibiotic-induced intestinal dysbiosis, frequently lead to a poor patient compliance; this, in turn, promotes the persistence of resistant bacterial populations. Probiotics may mitigate these effects and improve treatment adherence. This study aimed to assess the genomic safety of new probiotics intended for adjuvant use in H. pylori eradication regimens. Methods: Whole-genome sequencing was performed on three probiotic strains: one of Lactobacillus acidophilus, and two of Bifidobacterium animalis subsp. lactis. Genomes were compared with corresponding wild-type reference strains to identify genetic variations and detect mobile genetic elements. Results: Comparative genomic analysis revealed differences between selected and wild-type strains. Importantly, no plasmids or transposons were identified, suggesting a reduced theoretical risk of horizontal transfer of antimicrobial resistance determinants. Genomic findings were consistent with in vitro phenotypic observations. Conclusions: Whole-genome sequencing provided a robust assessment of the safety profile of these strains. The absence of transferable resistance elements supports their potential use as probiotic candidates to improve tolerability and adherence to H. pylori eradication therapies, contributing to more effective treatment outcomes. Full article

Helicobacter pylori (H. pylori) infection is one of the major causes of gastric cancer and remains an important global health concern. However, the biological processes linking chronic infection to malignant transformation are still not fully understood. Unlike previous reviews that mainly emphasized oxidative injury or individual virulence factors, this review synthesizes current evidence into an integrated redox-centered framework for gastric carcinogenesis. This framework links signaling pathways, epithelial adaptation, diagnostic interpretation, and therapeutic stratification. Current evidence indicates that persistent redox imbalance interacts with inflammatory signaling, mitochondrial dysfunction, metabolic reprogramming, epigenetic alteration, microbiome disruption, and oncogenic pathway activation throughout disease progression. Particular attention is given to the coordinated roles of NF-κB, STAT3, PI3K/AKT, HIF-1α, β-catenin, and Hippo-YAP signaling pathways. These pathways contribute to epithelial survival, chronic inflammation, genomic instability, and malignant transformation. This review additionally introduces a conceptual threshold model describing the progression from early epithelial stress to increasingly stable oncogenic reprogramming during long-standing infection. In addition, the limitations of conventional infection-centered diagnostics and non-selective antioxidant therapies are critically discussed. Emerging diagnostic approaches include oxidative injury biomarkers, transcriptomic and epigenetic profiling, artificial intelligence-assisted pathology, and multi-parameter predictive models. These approaches may improve risk stratification and facilitate earlier identification of high-risk gastric states. The translational implications further emphasize the importance of stage-specific and compartment-directed therapeutic strategies, particularly selective redox modulation and precision-guided targeting. Overall, this review provides a multidimensional perspective on H. pylori-associated gastric carcinogenesis and highlights future directions for predictive diagnostics, mechanistic stratification, and precision-based therapeutic development. Full article

The incidence of levofloxacin and metronidazole resistance in H. pylori Indonesian strains is increasing. Conventional approaches to antibacterial discovery are often a protracted process. This study uses structure-based virtual screening to quickly discover anti-H. pylori. This study employed homology modeling, docking, ADMET prediction, and molecular dynamics simulation to evaluate phytochemicals against resistant H. pylori gyrA, gyrB, and rdxA structures from Indonesian strains. Three-dimensional structures were constructed from the amino acid sequences gyrA, gyrB, and rdxA of levofloxacin- and metronidazole-resistant H. pylori Indonesian strains. The results of redocking at the binding sites gyrA (0.13 Å), gyrB (0.0024 Å), and rdxA (0.5 Å) obtained a valid RMSD. Curcumin exhibited the lowest average binding scores across gyrA (−154.994 kcal/mol), gyrB (−159.2033 kcal/mol), and rdxA (−166.322 kcal/mol) compared to other compounds and standard therapies, including levofloxacin (−109.1553 and −122.5873 kcal/mol) and metronidazole (−85.6096 kcal/mol). Molecular dynamics simulation results revealed that the curcumin–gyrA complex exhibited comparatively more restrained fluctuation than the other complexes throughout the simulation, as indicated by a consistently low total RMSD value (4–7 Å). Curcumin demonstrated the most favorable computational interaction profile among the evaluated compounds. Full article

Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, with chronic inflammation playing a central role in its pathogenesis. While established risk factors such as Helicobacter pylori (Hp), diet, and lifestyle are well recognized, growing epidemiological evidence links airborne particulate matter (PM) exposure with increased GC incidence and mortality. However, the biological mechanisms underlying this association remain poorly understood. This review integrates epidemiological evidence associating elevated PM exposure with GC risk and summarizes current mechanistic knowledge regarding PM gastric translocation and retention. The influence of PM size, chemical composition, and surface reactivity on biological activity is also discussed, highlighting the stomach as a plausible yet understudied target organ. Additionally, we compiled evidence from studies published between 2010 and 2026 demonstrating the ability of PM to induce inflammatory responses through activation of NF-κB, MAPK, JAK/STAT, and COX-2 signaling pathways across diverse biological systems. Although PM-induced inflammation has been extensively characterized in respiratory and other tissues, its contribution to gastric carcinogenesis remains largely unexplored. We propose that PM exposure may exacerbate Hp-driven inflammation, promoting a persistent pro-inflammatory microenvironment conducive to tumor initiation and progression. Collectively, these findings position PM as a biologically plausible and potentially modifiable risk factor for GC. Full article

Background: Helicobacter pylori is a globally prevalent gastric pathogen associated with chronic gastritis, peptic ulcer disease, and gastric adenocarcinoma. Its persistence within the gastric niche is strongly linked to biofilm formation, contributing to immune evasion and antibiotic therapy resistance. Methodology: In the present study, we investigated the antibiofilm potential of capsaicin, a natural phytochemical derived from Capsicum species, against H. pylori using experimental and computational approaches. Results: Capsaicin treatment significantly reduced biofilm biomass (up to 75.66 ± 4.00%), metabolic activity (up to 61.23 ± 6.88%), and cell surface hydrophobicity in a dose-dependent manner. Microscopic analyses revealed disrupted biofilm architecture and diminished extracellular polymeric substance at higher concentrations. Molecular docking analysis revealed that capsaicin interacts with target H. pylori proteins (GTP cyclohydrolase II, α-carbonic anhydrase, and urease) through stable hydrogen bonds and hydrophobic contacts. Molecular dynamics simulations further supported the stability of these complexes and demonstrated reduced structural fluctuations upon ligand binding. Free energy landscape analysis suggested ligand-induced conformational alterations in α-carbonic anhydrase, indicating possible structural effects associated with capsaicin interaction. Conclusions: Overall, the findings provide insight into the antibiofilm activity of capsaicin against H. pylori and highlight its potential as a natural adjunct strategy for combating biofilm-associated persistence and antimicrobial resistance. Full article

It is crucial to consider newer antibiotics with activity against anaerobes and Helicobacter pylori, given their healthcare importance, and the constantly growing antibiotic resistance/multidrug resistance, which complicates the therapy. The aim of this review was to emphasize certain recently approved or still-under-investigation antibiotics with potential benefits for treating Clostridioides difficile infections (CDIs), other anaerobic infections, and those caused by H. pylori, covering recent data from articles published primarily in 2020–2026. Given the limited number of antibiotics for treating CDI and fidaxomicin nonavailability in many countries, it is necessary to conduct more extensive laboratory and clinical studies of promising antibiotics such as ibezapolstat, delafloxacin, lascufloxacin, omadacycline, eravacycline, ridinilazole, and CRS3123. Against Bacteroides fragilis group species, delafloxacin and eravacycline showed good activity. Research on rifasutenizol for bacterial vaginosis, sarecycline and nadifloxacin for acne vulgaris and amixicile for periodontal diseases needs to be expanded. For H. pylori infection, delafloxacin, sitafloxacin, nemonoxacin, zoliflodacin, and rifasutenizol may improve the suboptimal success of most eradication regimens. However, more efforts, in coordination between medical, scientific, manufacturing, and government representatives, should ensure wider access to and research on the newer antibacterials. Establishing more research groups, careful examination of market issues, and additional approaches, such as nanomaterials, efflux pump inhibitors, phage therapy, and CRISPR-Cas systems, should be beneficial. Notwithstanding the difficulties, there are many opportunities to promote research on and potential use of newer antibiotics which show advantages over the older antibacterials, and to make them available to numerous countries and patients worldwide. Full article

Helicobacter pylori (H. pylori) antimicrobial resistance is a key driver of eradication failure in children and adults. Recognizing factors associated with H. pylori antimicrobial resistance may help identify individuals at risk for treatment failure and tailor management. We conducted a retrospective cohort study of patients with H. pylori-positive gastric biopsy culture and available antimicrobial susceptibility data at a large pediatric tertiary care center between 2020 and 2025. Descriptive statistics and logistic regression models were used to assess associations among demographic characteristics, prior treatment history, and antimicrobial resistance. Of 174 patients (56.1% male, median 14 years), 50.3% were resistant to at least one antimicrobial. Resistance rates included metronidazole (28.3%), clarithromycin (18.5%), rifampin (12.7%), fluoroquinolones (11.6%), amoxicillin (4%), and tetracycline (0.6%). The multidrug resistance rate was 17.3%. Prior H. pylori treatment was the most consistent predictor of antimicrobial resistance on both bivariate and multivariable analyses. Race was independently associated with metronidazole resistance, with Black patients exhibiting the highest rates and significantly greater odds compared to White patients. Hispanic ethnicity was also independently associated with increased odds of metronidazole resistance. Careful consideration of prior treatment history, race, and ethnicity is warranted when managing pediatric H. pylori infection, given their association with increased antimicrobial resistance. Full article

Background/Objectives: In South Asia, the prevalence of Helicobacter pylori (H. pylori) infections may be as high as 60–80%, constituting a notable public health issue, with eradication strategies critical in reducing the H. pylori-associated disease burden. The aim of our study was to assess the knowledge, attitude, and practices (KAP) regarding the screening, treatment, and follow-up of H. pylori-induced gastric ulcers among physicians in Lahore, Pakistan. Methods: A self-administered, questionnaire-based cross-sectional study—including the development and validity assessment of a 24-item questionnaire—was carried out in two tertiary-care hospitals between January and May 2024. Statistical analyses (descriptive statistics, χ²-tests, binary logistic regression, and 95% confidence interval [95% CI]) were carried out using IBM SPSS 27.0. The study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Results: Among N = 385 participants, 57.9% were male, 60.0% were aged between 25 and 34 years, 59.5% worked in a public hospital, and 55.3% had <5 years of working experience. Of them, 32.9% had noted medical journals, while 27.0% reported online educational materials as their key sources of evidence-based information. Although 91.2% and 87.3% of physicians had good knowledge and attitude levels (≥50% score) pertaining to H. pylori-associated gastric ulcers, respectively. Participants aged 25–34 years (aOR: 0.217 [95% CI: 0.08–0.589]), who have <5 years of working experience (aOR: 0.328 [95% CI: 0.136–0.790]) and those working in public hospitals (aOR: 0.130 [95% CI: 0.048–0.352]) were less likely to show poor attitudes. Furthermore, 76.5% made it a routine to discuss the risk factors of H. pylori-induced ulcers with their patients, while 67.4% highlighted the importance of follow-up testing to confirm the eradication of H. pylori. Conclusions: Inconsistent and empirical treatment approaches, lack of routine screening, and inadequate follow-up practices may further compromise eradication efforts and contribute to antimicrobial resistance. Our findings emphasize the importance of targeted educational programs to address knowledge gaps, standardize practices, and enhance the appropriate management of H. pylori-induced gastric ulcers in Pakistan. Full article

Proton pump inhibitor (PPI)-containing regimens, including bismuth quadruple therapy, may perturb gut microbiota through combined exposure to acid suppression, antibiotics, bismuth, and underlying disease context. Herbal medicines and natural products have been proposed as adjunctive interventions to mitigate treatment-related microbiota perturbations; however, systematic synthesis of the clinical evidence remains limited. This systematic review and meta-analysis evaluated the effects of herbal and natural product interventions on gut microbiota and clinical outcomes in patients receiving PPI-containing therapy. Six databases (PubMed, EMBASE, Web of Science, Scopus, CENTRAL, and CNKI) were searched from their inception to March 2026. Risk of bias was assessed using RoB 2.0 and ROBINS-I. This review was prospectively registered in PROSPERO (CRD420261346672). Eighteen studies (17 randomized controlled trials, 1 observational study; n = 1984 participants) were included in the final analysis. Meta-analysis demonstrated significantly higher Helicobacter pylori eradication rates (pooled relative risk (RR) = 1.20, 95% confidence interval (CI) 1.14–1.27; I² = 33%). Chinese-style total effective rate was also higher in the herbal groups (RR = 1.19, 95% CI 1.14–1.25; I² = 0%), but this non-standardized outcome should be interpreted cautiously. Exploratory microbiome meta-analyses suggested higher post-treatment Bifidobacterium and Lactobacillus levels; however, substantial heterogeneity limited interpretability. Narrative synthesis revealed potential preservation of α-diversity and attenuation of pathobiont proliferation in herbal groups. Overall, herbal and natural product interventions may be associated with favorable clinical outcomes and potential microbiota-modulating effects in patients receiving PPI-containing therapy, but certainty remains limited due to methodological concerns, outcome indirectness, and heterogeneity. High-quality trials stratified by antibiotic exposure are warranted. Full article

Background: Gastroesophageal reflux symptoms (GERSs) represent the most prevalent phenotype of gastroesophageal reflux disease and frequently overlap with the symptoms of functional dyspepsia, posing diagnostic and therapeutic challenges. Limitations of long-term acid suppression have prompted interest in alternative mucosa-protective approaches. This study was conducted to evaluate the effectiveness of a novel multicomponent formulation (Tamacid-Pro^®) in patients with reflux-like symptoms and negative endoscopy. Methods: In this prospective observational study, consecutive adult patients undergoing upper gastrointestinal endoscopy at a tertiary centre between January 2025 and February 2026 were screened. Patients with upper gastrointestinal symptoms lasting ≥2 months, negative endoscopy, and no evidence of Helicobacter pylori infection were enrolled. Participants received Tamacid-Pro^® three times daily for 3 months. Symptom frequency and intensity were assessed at baseline and after treatment using the Reflux Disease Questionnaire (RDQ). Changes over time were analyzed using paired t-tests, and multivariable linear regression was performed to identify response predictors. Results: A total of 1035 patients were included. After 3 months of treatment, all RDQ items showed a statistically significant improvement in both frequency and intensity (p < 0.0001). Significant reductions were observed in the GERD composite score, as well as in heartburn, regurgitation, and dyspepsia dimensions (all p < 0.0001). In a multivariable analysis, female sex was independently associated with greater improvement across multiple symptom domains, whereas alcohol consumption was negatively associated with improvement in the heartburn dimension. Conclusions: In this large real-world cohort of endoscopy-negative patients, treatment with Tamacid-Pro^® was associated with significant improvement in both typical reflux and dyspeptic symptoms. These findings support the role of multicomponent, mucosa-protective formulations as a valuable therapeutic option in patients with GERSs and overlapping functional gastrointestinal disorders. Full article

Green synthesis of silver nanoparticles (CP-AgNPs) using Calotropis procera (CP) offers a sustainable approach to producing multifunctional therapeutic nanomaterials. This study aimed to synthesize CP-AgNPs and evaluate their antimicrobial, antioxidant, anti-inflammatory, and anticancer potential, with a focus on Helicobacter pylori and gastric cancer cells. CP-AgNPs were prepared by phytochemical reduction using CP leaf extract and characterized by UV–Vis, XRD, FTIR, SEM, EDX, TEM, and Zeta. Antibacterial activity against H. pylori, time-kill kinetics, and SEM imaging of membrane damage were performed. Antioxidant (DPPH, ABTS) and anti-inflammatory assays, together with cytotoxicity studies in AGS cells (DAPI, AO/EtBr, and SEM), were also conducted. CP-AgNPs exhibited an SPR peak at 432 nm, face-centered cubic crystallinity, and spherical morphology (8–32 nm). They showed strong, dose-dependent antibacterial activity against H. pylori, surpassing metronidazole at higher doses. Time-kill assays and SEM confirmed membrane disruption. Antioxidant activity was notable (IC₅₀: 40 µg/mL for DPPH; 60 µg/mL for ABTS). CP-AgNPs demonstrated significant anti-inflammatory effects and dose-dependent cytotoxicity in AGS cells, inducing apoptosis and morphological alterations. The broad biological activity of CP-AgNPs likely arises from the synergy between silver ions and CP phytochemicals. Their superior antibacterial effects, combined with antioxidant and anti-inflammatory properties, indicate strong therapeutic potential for gastric diseases. Anticancer activity in AGS cells suggests additional biomedical relevance, which may involve ROS-associated and apoptosis-related pathways, as suggested by previous studies. CP-AgNPs represent a promising natural nanoplatform for managing H. pylori infection, oxidative stress, inflammation, and gastric cancer, warranting further mechanistic and in vivo studies. Full article

Background: Otitis media with effusion (OME) is a highly prevalent pediatric condition and a leading cause of conductive hearing loss in children. Its pathogenesis remains uncertain, and diagnostic and therapeutic challenges make management difficult. Objectives: This review evaluates current evidence on the middle ear microbiome in pediatric OME, focusing on the diagnostic value of 16S ribosomal ribonucleic acid (16S rRNA) gene sequencing and its potential clinical implications. Methods: A literature review was conducted using the PubMed database, including studies published between 2006 and 2026. Eligible studies involved pediatric patients with OME and examined the sources and characteristics of microbiota potentially involved in disease pathogenesis. Microbiome analysis was performed using next-generation sequencing (NGS) techniques. Results: Growing evidence indicates that OME is associated with microbial dysbiosis and biofilm formation rather than a sterile inflammatory process. The most frequently detected genera include Haemophilus, Moraxella, Streptococcus, and Alloiococcus, although substantial variability exists between studies. Pathogens are believed to reach the middle ear through the Eustachian tube from two main reservoirs: the nasopharynx and the adenoids. The potential role of Helicobacter pylori infection and gastroesophageal reflux disease (GERD) in OME pathogenesis remains uncertain and requires further investigation. NGS methods, including 16S rRNA sequencing, demonstrate higher sensitivity than conventional culture techniques, enabling the detection of fastidious and previously unrecognized microorganisms. Evidence also highlights the limited effectiveness of antibiotic therapy in OME, the persistent issue of antibiotic overuse, and the relative advantages of conservative management and microbiome-modulating approaches compared with antibiotics and surgical interventions. Conclusions: Current evidence suggests that OME is closely associated with microbiota dysbiosis and bacterial biofilm formation. Given the limited efficacy of antibiotics, microbiome-focused strategies—particularly probiotics—should be further explored. Molecular diagnostic methods, especially NGS, show clear advantages over traditional culture-based techniques. Future research should further evaluate microbiome modulation as a potential adjunctive or preventive strategy. Full article