Search Results (270)

Helicobacter pylori infection is associated with severe gastroduodenal pathologies. This study evaluated the bactericidal and antibiofilm activities of eudesmin, a furanofuran lignan from Araucaria araucana, and its acid-induced epimer, epieudesmin, against clinical isolates and the H. pylori ATCC 43504 strain. Virulence profiles and antibiotic susceptibility (CLSI/EUCAST) were determined. Antibacterial effects were assessed via minimum inhibitory concentration (MIC), checkerboard assays, time-kill kinetics, and urease activity. Biofilm reduction and morphological alterations were analyzed using crystal violet staining and scanning electron microscopy, respectively. Cytotoxicity was evaluated in HepG2 cells. Clinical strains exhibited distinct virulence and multidrug-resistance patterns. Both lignans displayed rapid antibacterial activity (MIC: 0.78–3.12 µg/mL) without antagonistic interactions with co-administered antibiotics and significantly reduced biofilm biomass (p < 0.0001). Eudesmin and epieudesmin effectively inhibit H. pylori growth and biofilm formation, while sublethal concentrations disrupted biofilm integrity and induced a bacillary-to-coccoid transition. Toxicity of both compounds was evaluated in HepG2 cells till 50 µg/mL showing a similar pattern, reducing cell viability up to 30% at almost 25 µg/mL, highlighting its potential as a non-antibiotic complementary therapeutic agent, although further in vivo and clinical studies are warranted to confirm its therapeutic applicability. Full article

Background and Objective: Helicobacter pylori infection remains a major cause of chronic gastritis, dyspepsia, and peptic ulcer disease worldwide. Increasing antibiotic resistance, particularly to clarithromycin, has reduced the effectiveness of standard eradication therapies. The aim of this study was to compare the effectiveness of two triple therapy regimens for Helicobacter pylori eradication in patients presenting with dyspepsia in primary care and to evaluate the influence of demographic, clinical, and lifestyle factors on treatment outcomes. Methods: This retrospective study included 1800 adult patients with dyspeptic symptoms and confirmed Helicobacter pylori infection who received triple therapy between January 2023 and early 2026 in a primary care setting. Patients were treated with either clarithromycin 500 mg, amoxicillin 1000 mg, and pantoprazole 20 mg, or levofloxacin 500 mg, amoxicillin 1000 mg, and pantoprazole 20 mg. Clinical reassessment and therapy review were performed after 21 days. Eradication status was evaluated using stool antigen testing after completion of therapy. Data extracted from medical records included age, sex, body mass index, smoking status, alcohol consumption, obesity, diabetes mellitus, history of gastroduodenal disease, and chronic use of non-steroidal anti-inflammatory drugs. Statistical analysis included descriptive statistics, chi-square testing, and multivariable logistic regression to identify factors associated with eradication success. Statistical significance was considered at p < 0.05. Results: Among 1800 patients, 52 percent were male and the mean age was 47 years. The levofloxacin-based regimen achieved a significantly higher eradication rate compared with the clarithromycin-based regimen, 82.9 percent versus 71.8 percent, p < 0.001. Treatment failure was more frequent among active smokers, obese patients, alcohol consumers, and individuals with diabetes mellitus. In multivariable analysis, treatment with a levofloxacin-based regimen remained an independent predictor of successful eradication with an odds ratio of 1.88 and p < 0.001. Smoking, obesity, and diabetes were independently associated with lower eradication success. Adverse effects were reported in 13.9 percent of patients receiving clarithromycin and 9.1 percent of those receiving levofloxacin, with a statistically significant difference between the groups, p = 0.002. Conclusions: Levofloxacin-based triple therapy demonstrated superior effectiveness compared with the clarithromycin-based regimen for Helicobacter pylori eradication in patients with dyspepsia in primary care. Lifestyle factors and metabolic comorbidities appear to influence treatment outcomes and should be considered when selecting eradication strategies in routine clinical practice. Full article

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, largely due to late-stage diagnosis and the limited sensitivity of current screening approaches for early lesions. In recent years, the gut microbiota has emerged as a key factor in colorectal carcinogenesis, offering promising opportunities for the development of novel, non-invasive diagnostic and therapeutic strategies. Specific bacterial species and microbial metabolites have been implicated in colorectal carcinogenesis and are under investigation as potential biomarkers for CRC detection. However, despite growing evidence of association, most remain investigational and require further clinical validation before routine implementation. Among the proposed bacterial biomarkers, Fusobacterium nucleatum is one of the most promising candidates for clinical implementation, with encouraging evidence supporting its use in non-invasive stool-based CRC detection. Streptococcus gallolyticus subsp. gallolyticus and Clostridium septicum currently serve primarily as clinical warning markers due to their well-established association with occult colorectal malignancy rather than as screening biomarkers. In contrast, pks⁺Escherichia coli, enterotoxigenic Bacteroides fragilis, Enterococcus faecalis, and Peptostreptococcus anaerobius remain investigational. Helicobacter pylori has limited value for CRC detection because of its inconsistent association and low specificity. Overall, this review summarizes the most extensively studied bacterial species and microbial metabolites involved in colorectal cancer development, with particular emphasis on their underlying pathogenic mechanisms and highlighting their potential value as diagnostic biomarkers and therapeutic targets. It also highlights emerging bacterial taxa and microbial signatures that have been associated with early tumorigenesis in recent studies. Full article

Background: Rosacea is a chronic inflammatory dermatosis characterized by vascular dysregulation, immune dysfunction, neurovascular alterations, and microbial involvement. Recent advances in understanding its pathophysiology have led to the development of targeted therapeutic strategies addressing multiple disease mechanisms. This systematic review aimed to evaluate contemporary evidence regarding emerging and established treatment approaches for rosacea. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2016 and 2025. Original human studies evaluating therapeutic interventions for rosacea were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate for each study design. Results: Fifteen studies involving 537 patients with rosacea and 77 controls (614 participants in total) met the eligibility criteria. Evaluated interventions included vascular-targeted therapies, topical anti-inflammatory agents, systemic and immunomodulatory treatments, and microbiome-oriented approaches. Oxymetazoline, pulsed-dye laser, platelet-rich plasma, ivermectin, azelaic acid, dapsone, sulfur preparations, and metronidazole demonstrated clinical benefits in reducing erythema, inflammatory lesions, or overall disease severity. Emerging therapies, including tofacitinib and oral ivermectin, showed promising results in refractory disease. Microbiome-related interventions, particularly Demodex-targeted therapies and Helicobacter pylori eradication, were also associated with clinical improvement. Risk-of-bias assessment identified two studies with low risk of bias, twelve with moderate risk of bias, and one study with high risk of bias. Conclusions: Current evidence supports a multimodal and mechanism-based approach to rosacea management, integrating vascular, inflammatory, immunological, and microbiological targets. However, the available evidence remains limited by small sample sizes, heterogeneous methodologies, short follow-up periods, and a predominance of non-randomized study designs. Large, well-designed randomized controlled trials are needed to establish optimal evidence-based treatment strategies and define the long-term efficacy and safety of emerging therapies. 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

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: The optimal ¹³C-urea breath test (UBT) dosage for diagnosing Helicobacter pylori remains debated. We compared the accuracy and agreement of a low-dose 45 mg tablet (without citric acid) versus the standard 75 mg granule (with citric acid) protocol. Methods: In this prospective, randomized crossover trial, adults underwent both a 45 mg and a 75 mg ¹³C-UBT on the same day. Breath samples were collected at 15 and 30 min. The primary outcome was diagnostic agreement at 30 min. Secondary outcomes included diagnostic performance against a composite reference standard, wherein concordant 45 mg and 75 mg UBT results were presumed to represent true H. pylori status, while discordant cases underwent endoscopic reference testing (rapid urease test and histology, with immunohistochemistry where required), stratified by age and BMI. Results: For the 431 participants included, the 45 mg and 75 mg tests showed substantial agreement at 30 min (90.3%; κ = 0.766). The 30 min sampling time yielded significantly better accuracy than 15 min for both doses. The 45 mg protocol achieved excellent accuracy (AUC 0.953), statistically non-inferior to the 75 mg protocol (AUC 0.966; p = 0.50). Notably, in participants aged <40 years or with BMI < 25.0 kg/m², the 45 mg protocol demonstrated robust performance (AUC 0.977 and 0.966, respectively), comparable to the 75 mg standard (p > 0.05). No adverse events occurred. Conclusions: The low-dose 45 mg ¹³C-UBT provides high diagnostic agreement and comparable clinical performance to the standard 75 mg protocol without requiring citric acid acidification. Its robust performance in younger, lower-BMI individuals shows clinical promise. However, because diagnostic accuracy analyses partly relied on a composite reference assumption, further externally validated studies are required before broad screening-policy claims can be made. Full article

Background: The clinical significance of Helicobacter pylori (H. pylori) infection in acute non-variceal upper gastrointestinal bleeding (NVUGIB) remains uncertain, particularly regarding short-term outcomes beyond rebleeding. Methods: We conducted a single-center retrospective cohort study of consecutive adults admitted with acute NVUGIB to Hatyai Hospital, Thailand, between January 2016 and December 2020. H. pylori status was determined during the index hospitalization using rapid urease testing and/or histopathologic examination of gastric biopsy specimens obtained during upper gastrointestinal endoscopy. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, rebleeding, requirement of packed red blood cell transfusion, and length of hospital stay. Multivariable regression analyses were performed to adjust for potential confounders. Results: Among 933 patients, 289 (31.0%) were H. pylori-positive and 644 (69.0%) were H. pylori-negative. The H. pylori-positive group was younger, predominantly male, and had lower rates of cirrhosis and prior proton pump inhibitor use. They also more often had peptic ulcer bleeding and underwent earlier endoscopy. H. pylori positivity was independently associated with lower 30-day mortality (adjusted odds ratio 0.39, 95% confidence interval 0.18–0.84), but not with rebleeding, requirement of transfusion, or length of stay. Conclusions: H. pylori positivity was associated with lower short-term mortality in acute NVUGIB, although this finding may reflect baseline clinical differences rather than a direct effect on bleeding severity. Full article

The rise in global consumption of fresh vegetables is a response to their nutrient-dense composition and low caloric content—key factors for optimising human metabolic health. This study evaluated the Quantitative Microbial Risk Assessment (QMRA) of Helicobacter pylori and enteric pathogens in fresh vegetables within the central highlands of Peru. The research integrated conventional microbiology, qPCR, and Monte Carlo simulations. The results revealed a high prevalence of Escherichia coli (83.7%), with a heterogeneous distribution where Huancayo presented the highest prevalence (95.5%) and Chupaca the lowest (68.2%). In contrast, pathogens such as H. pylori and Campylobacter jejuni showed marginal prevalences of 2.33% and 3.49%, respectively, with detections restricted to leafy and root vegetables at specific points of sale. Although biochemical tests indicated the presumptive presence of Helicobacter pylori, the qPCR results were negative, possibly due to the bacteria’s viable but non-culturable (VBNC) state. The QMRA model showed a highly skewed annual infection risk distribution, with E. coli presenting the highest risk: median Pann = 1.000 and 84.3% of simulations exceeding the WHO tolerable threshold of 10⁻⁴. For Salmonella Typhimurium and Shigella flexneri, 22.4% and 9.1% of simulations exceeded the same threshold, respectively. The results underscore the urgent need to implement traceability programs and improve agricultural practices across the evaluated provinces. Full article

Background: Helicobacter pylori remains a major cause of chronic active gastritis and a clinically relevant precursor of peptic ulcer disease and gastric neoplasia. Host-derived non-invasive biomarkers that reflect infection-related gastric inflammation are still insufficiently developed. This study evaluated the clinical relevance of fecal miR-146a in patients with H. pylori-associated gastritis. Methods: We conducted a prospective study over a 3-year period (2023–2025) at the County Clinical Emergency Hospital Sibiu, Romania. The study included 85 adults: 45 patients with confirmed H. pylori-associated gastritis and 40 controls. Demographic, clinical, inflammatory, endoscopic, histopathological, and molecular data were analyzed. Continuous variables were compared using the Mann–Whitney U test and categorical variables using the chi-square or Fisher’s exact test. Multivariable analysis was performed using Firth’s penalized logistic regression. Results: Patients with H. pylori-associated gastritis showed significantly higher fecal miR-146a expression than controls (2.05 [1.77–2.37] vs. 0.88 [0.77–0.99], p < 0.001). They also had higher CRP, ESR, WBC, abdominal pain scores, and a greater burden of endoscopic and histopathological abnormalities. In both multivariable models, fecal miR-146a remained the only significant variable associated with disease status. Conclusions: Fecal miR-146a is markedly elevated in H. pylori-associated gastritis and may represent a promising non-invasive biomarker of infection-related gastric inflammation. Larger prospective studies are needed for validation. Full article

Helicobacter pylori is the leading cause of chronic gastrointestinal tract diseases, with a worldwide prevalence of around 50%. For identification in medical practice, non-invasive methods such as the immunochromatographic test for antigen in stool (SAT) and the urease breath test (UBT) are widely used. Recently, we developed a highly sensitive and specific nested PCR (NPCR) that involves two amplification reactions and uses primers designed to target the variable regions of the 16S rRNA gene to amplify a short 148 bp amplicon. The aim of this study was to compare two classical methods, SAT and UBT, with the 148 bp amplicon NPCR. We examined samples from 137 volunteers, and found 46 positives with NPCR using stool samples, 34 with UBT, and only 24 with SAT. H. pylori origin of the 148 bp amplicons was confirmed by sequencing. NPCR had the highest detection rate in this cohort, suggesting that a portion of the population may be misdiagnosed, particularly by SAT. Due to the cost and simple performance in practice, SAT is a method of choice for initial screening. However, in cases of negative results and persistent digestive problems, we recommend the more sensitive UBT. NPCR may be a useful complementary method, especially in discordant or clinically suspicious cases. Full article

Anemia is a major global public health problem and is most commonly associated with iron deficiency; however, deficiencies in other micronutrients, including vitamin B₁₂, may also contribute to its development. Increasing evidence suggests that Helicobacter pylori infection may influence the occurrence of anemia through several mechanisms related to alterations in the gastric environment. Chronic gastric inflammation and increased gastric pH associated with H. pylori infection may impair the absorption of non-heme iron and reduce the concentration of vitamin C in gastric juice. Since vitamin C enhances iron bioavailability by reducing ferric iron (Fe³⁺) to the more absorbable ferrous form (Fe²⁺), decreased levels of this vitamin may further limit iron absorption. At the same time, the increase in gastric pH may hinder the release of vitamin B₁₂ from food proteins, potentially contributing to disturbances in its absorption. This review aimed to present an integrated overview of the relationships between H. pylori infection, alterations in the gastric environment, and mechanisms that may contribute to the development of anemia, including disturbances in vitamin B₁₂ absorption, with particular emphasis on the potential role of vitamin C. Full article

Objective: This umbrella review synthesizes and critically appraises the evidence on the efficacy and safety of tegoprazan-based versus proton pump inhibitor (PPI)-based regimens for Helicobacter pylori (H. pylori) eradication. Methods: This umbrella review was pre-registered in PROSPERO (CRD420251271120). Systematic reviews and meta-analyses published between 1 January 2018 and 10 December 2025 were identified through MEDLINE/PubMed, EMBASE, and the Cochrane Library. Reviews comparing tegoprazan-based and PPI-based eradication regimens in adult patients were included. Methodological quality was assessed using AMSTAR-2, risk of bias with ROBIS, and certainty of evidence with GRADE. Pooled relative risks (RRs) were calculated, with subgroup analyses by study design, treatment duration, and therapeutic regimen. Results: Eight systematic reviews and meta-analyses encompassing 17 primary studies and 12,714 participants were included. Tegoprazan-based regimens were associated with a statistically significant improvement in eradication efficacy compared with PPI-based therapies (RR = 1.019; 95% CI: 1.003–1.035; p = 0.021). In randomized controlled trials, the benefit was more pronounced (RR = 1.037; 95% CI: 1.015–1.061; p = 0.001), whereas no statistically significant benefit was observed in non-randomized studies (RR = 1.014; 95% CI: 0.991–1.037; p = 0.235). The efficacy advantage was mainly confined to quadruple therapy regimens (RR = 1.044; 95% CI: 1.002–1.088; p = 0.038). Tegoprazan-based regimens were associated with a lower incidence of overall adverse events compared with the PPI group (RR = 0.930; 95% CI: 0.885–0.976; p = 0.003). Conclusions: Tegoprazan-containing regimens were associated with a modest but statistically significant improvement in H. pylori eradication compared with PPI-containing regimens, particularly in randomized controlled trials and quadruple therapy regimens. Full article

Background: Helicobacter pylori is a well-established risk factor for gastric carcinogenesis. Increasing evidence suggests that the oral cavity may serve as an extragastric reservoir for the bacterium, potentially contributing to persistent infection and reinfection. Orthodontic appliances can modify oral biofilm ecology and may facilitate bacterial colonization. This study aimed to investigate the association between oral H. pylori colonization and gastric cancer, while exploring the potential modifying role of fixed orthodontic appliances. Materials and Methods: In this cross-sectional observational study, 212 participants were recruited from gastroenterology and dental clinics between January 2023 and March 2025. Oral samples were collected and analyzed for H. pylori DNA using polymerase chain reaction (PCR). Gastric diagnoses were established through endoscopic examination and histopathological evaluation, classifying participants into gastric cancer, precancerous gastric lesions, non-atrophic gastritis, and control groups. Demographic, clinical, and oral health variables were recorded. Multivariable logistic regression models were used to evaluate the association between oral H. pylori detection and gastric cancer while adjusting for potential confounders, including age, sex, smoking status, oral hygiene indicators, and socioeconomic factors. Results: Oral Helicobacter pylori DNA was detected in 35/54 (64.8%) patients with gastric cancer, 30/56 (53.6%) with precancerous lesions, 21/52 (40.4%) with non-atrophic gastritis, and 15/50 (30.0%) controls. Gastric H. pylori infection was identified in 41/54 (75.9%) gastric cancer cases compared with 18/50 (36.0%) controls. Oral H. pylori positivity was more frequent among patients undergoing active orthodontic treatment (22/36, 61.1%) than among those without orthodontic appliances (79/188, 42.0%). In multivariable analysis, oral H. pylori positivity remained independently associated with gastric cancer (adjusted OR 3.02, 95% CI 1.51–6.03, p = 0.002). Conclusions: Our findings support an association between oral–gastric microbial interactions and H. pylori–associated disease, and suggest that the oral cavity may serve as a potential reservoir for gastric infection dynamics. The presence of orthodontic appliances may be associated with altered oral microbial ecology and could be linked to sustained H. pylori colonization. Full article

Background: Helicobacter pylori (H. pylori) infection is an established risk factor for gastric cancer. However, treatment efficacy and the underlying mechanisms in elderly patients with H. pylori infection remain incompletely characterised. This study aimed to compare the eradication efficacy and safety of four amoxicillin-containing regimens for H. pylori infection in elderly patients. Methods: Elderly patients (age ≥ 60 years) with Helicobacter pylori infection treated at five hospitals in Beijing between January 2018 and June 2025 were enrolled. Participants were stratified into four groups according to the prescribed regimen: vonoprazan–amoxicillin (VA) dual therapy, rabeprazole–amoxicillin (RA) dual therapy, rabeprazole–Jinghua Weikang (a Chinese herbal medicine, granules)–amoxicillin–furazolidone (RJAF) quadruple therapy, and rabeprazole–bismuth–amoxicillin–furazolidone (RBAF) quadruple therapy. The primary endpoint was the eradication rate for each regimen. Secondary outcomes included the incidence of adverse events (AEs) and data on comorbidities. In addition, serological testing for H. pylori virulence-associated antibodies (CagA, VacA, UreA, and UreB) was performed in 32 patients at baseline, prior to treatment initiation. Results: A total of 312 patients were screened. The eradication rates with VA, RA, RJAF, and RBAF were 96.3%, 94.0%, 86.8%, and 86.6%, respectively (χ² = 6.92, p = 0.075). The incidence of AEs was 13.8%, 15.5%, 17.9%, and 19.1% in the VA, RA, RJAF, and RBAF groups, respectively (p = 0.391). Conclusions: In elderly patients with Helicobacter pylori infection, dual therapy demonstrates non-inferior efficacy compared with triple therapy and conventional quadruple therapy. More complex regimens do not confer additional clinical benefit. Among the two dual-therapy regimens, VA dual therapy shows superior overall performance and is therefore recommended as the first-line treatment of choice. Full article