Vonoprazan Helicobacter pylori eradication therapy: ethical and interpretation issues

We read with interest the important study on vonoprazan in Helicobacter pylori eradication therapy.1 Vonoprazan likely represents a significant advance in antisecretory and H. pylori eradication therapy. Despite being technically well done, several issues related to study conduct and interpretation remain. Their sample size was based on 90% success with lansoprazole, which has not been achieved in Japan for several decades. When the cure rates proved to be lower, the sample size was increased to ‘maintain the statistical power of the study’. We question whether this was ethical. It is generally considered unethical to randomise against a regimen that provides unacceptably low cure rates; many journals reject papers that do this.2 3 We believe the ethical response would be to stop the study. The study concluded that vonoprazan eradication therapy was superior. However, the cure rates of clarithromycin-susceptible infections with vonoprazan and lansoprazole...
Source: Gut - Category: Gastroenterology Authors: Tags: PostScript Source Type: research

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Approximately half of the world’s population is infected with the stomach pathogen Helicobacter pylori. Infection with H. pylori is the main risk factor for distal gastric cancer. Bacterial virulence factors, such as the oncoprotein CagA, augment cancer risk. Yet despite high infection rates, only a fraction of H. pylori–infected individuals develop gastric cancer. This raises the question of defining the specific host and bacterial factors responsible for gastric tumorigenesis. To investigate the tumorigenic determinants, we analyzed gastric tissues from human subjects and animals infected with H. pylori bacte...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Infection with the Gram-negative bacterium Helicobacter pylori remains the most important modifiable risk factor for the development of gastric cancer, a leading cause of cancer-related deaths worldwide. How the interactions between H. pylori and its host shape the gastric environment during chronic infection warrants further investigation. In this issue of the JCI, Palrasu et al. used human cell lines and mouse models to provide mechanistic insight into H. pylori’s ability to delay apoptosis in gastric epithelial cells by actively driving the degradation of a proapoptotic factor, SIVA1. Their findings suggest that p...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
In conclusion, anti-Hp Abs are neither more frequent nor elevated in SSc compared with healthy population, the only exception being the higher frequency and levels of anti-VacA Abs in pulmonary hypertension and lung fibrosis, respectively. These results suggest that Hp is unlikely to b e involved in the development of SSc.
Source: Immunologic Research - Category: Allergy & Immunology Source Type: research
Expert consensus mandates retesting for eradication of Helicobacter pylori infection after treatment, but it is not clear how many patients are actually retested. We evaluated factors associated with retesting for H pylori in a large, nationwide cohort.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Source Type: research
ilde;o Rasmussen Helicobacter pylori (H. pylori) is one of the main causes of gastric gancer. TNF-related apoptosis-inducing ligand (TRAIL) is a protein able to promote apoptosis in cancer cells, however not in gastric cancer, which presents resistance to apoptosis via TRAIL. It is believed that MicroRNA-106b-5p might be involved in this resistance, although its role in Gastric Cancer is unclear. We aimed to determine the expression of microRNA-106b-5p and TRAIL in patients with gastric diseases, infected by H. pylori, and understand the relationship between these genes and their role in apoptosis and the gastric ca...
Source: Genes - Category: Genetics & Stem Cells Authors: Tags: Article Source Type: research
Conclusions: H. pylori can affect a variety of TJPs, particularly claudin-4 and occludin. Claudin-2 is thought to be involved in FD irrespective of H. pylori status, especially in the pathophysiology of male FD. PMID: 32235032 [PubMed]
Source: Journal of Neurogastroenterology and Motility - Category: Gastroenterology Tags: J Neurogastroenterol Motil Source Type: research
Condition:   Helicobacter Pylori Infection Interventions:   Drug: ET;   Drug: SGT Sponsor:   National Taiwan University Hospital Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Source: Gastroenterology - Category: Gastroenterology Tags: Continuing Medical Education (CME)/MOC Activities Source Type: research
Conclusion: This study demonstrates the unequal manifestation of EOGC within the two ethnic groups of Han and Yi. However, familial clustering was infrequent. Further investigations are necessary to discover relevant risk factors apart from hereditary predisposition. PMID: 32231466 [PubMed - in process]
Source: The Scientific World Journal - Category: Science Tags: ScientificWorldJournal Source Type: research
CONCLUSION: These results suggested that rHP-NAP possesses the potential for use as an adjuvant of dendritic cell-based vaccine in anti-melanoma treatment. PMID: 32224538 [PubMed - in process]
Source: Iranian Journal of Immunology - Category: Allergy & Immunology Tags: Iran J Immunol Source Type: research
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