Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
Helicobacter. 2020 Oct;25(5):e12721. doi: 10.1111/hel.12721. Epub 2020 Jul 12.
Penicillin-allergic children who are infected with Helicobacter pylori constitute a relatively common subgroup. We aimed to study the short-term and long-term effects of bismuth quadruple therapy on gut microbiota in penicillin-allergic children.
We prospectively recruited treatment-naive children with H pylori infection and H pylori-negative asymptomatic children as healthy controls. Patients received 14-day bismuth quadruple therapy consisting of omeprazole, clarithromycin, metronidazole, and bismuth. Fecal samples were collected at weeks 0, 2, 6, and 52. Alterations in the gut microbiota were analyzed by 16S rRNA gene sequencing.
Twenty-two subjects (14 gastritis patients, 8 duodenal ulcer patients) and 23 controls participated in this study. At week 2, alpha diversity was reduced in both gastritis (P < .05) and ulcer (except P = .16 with Chao 1 index) patients compared with baseline. Some changes persisted at week 6, and all were restored at week 52. Beta diversity was significantly altered 2 weeks after treatment in the gastritis and duodenal ulcer groups (P = .001, P = .002, respectively) and restored at weeks 6 and 52. The mean relative abundance of Bacteroidetes (P < .001, P = .005, respectively) decreased and that of Proteobacteria increased (P < .001, P = .03, respectively). All alterations recovered at week 6 and 52. In both the gastritis and ulcer groups at week 2, some beneficial bacteria were decreased including Bacteroides (P < .001 and P = .003), Faecalibacterium (P < .001 and P = .02), Phascolarctobacterium (P = .002 and P = .004), Roseburia ( P < .001 and P = .13), Bifidobacterium (P = .08 and P = .04), and Blautia (P < .001 and P = .002). Some detrimental bacteria were increased including Escherichia-Shigella (P < .001 and P = .19), Klebsiella (P < .001, and P = .09), Enterococcus (P < .001 and P = .007), and Streptococcus (P = .002 and P = .004). The changes returned to almost the pre-eradication level 1 year after therapy.
Bismuth quadruple therapy causes short-term dysbiosis of the gut microbiota. Most changes recovered 1-year post-eradication, indicating the long-term safety of H pylori therapy.
青霉素过敏的儿童感染幽门螺杆菌构成了一个相对常见的亚组。我们旨在研究铋四联疗法对青霉素过敏儿童肠道微生物群的短期和长期影响。
我们前瞻性地招募了未经治疗的幽门螺杆菌感染儿童和无症状的幽门螺杆菌阴性儿童作为健康对照。患者接受了为期 14 天的铋四联疗法，包括奥美拉唑、克拉霉素、甲硝唑和铋。在第 0、2、6 和 52 周收集粪便样本。通过 16S rRNA 基因测序分析肠道微生物群的变化。
22 名受试者（14 名胃炎患者，8 名十二指肠溃疡患者）和 23 名对照者参加了这项研究。第 2 周，与基线相比，胃炎（P<.05）和溃疡（除 Chao 1 指数 P=.16 外）患者的 alpha 多样性均降低。一些变化持续到第 6 周，所有变化均在第 52 周恢复。治疗后 2 周，胃炎和十二指肠溃疡组的 beta 多样性发生显著改变（P=.001，P=.002），并在第 6 和 52 周恢复。厚壁菌门的平均相对丰度（P<.001，P=.005）降低，变形菌门的相对丰度增加（P<.001，P=.03）。所有变化在第 6 和 52 周恢复。在第 2 周的胃炎和溃疡组中，一些有益细菌减少，包括拟杆菌（P<.001 和 P=.003）、粪杆菌（P<.001 和 P=.02）、 Phascolarctobacterium（P=.002 和 P=.004）、罗斯伯里氏菌（P<.001 和 P=.13）、双歧杆菌（P=.08 和 P=.04）和布劳特氏菌（P<.001 和 P=.002）。一些有害细菌增加，包括大肠杆菌-志贺氏菌（P<.001 和 P=.19）、克雷伯氏菌（P<.001，P=.09）、肠球菌（P<.001 和 P=.007）和链球菌（P=.002 和 P=.004）。治疗 1 年后，这些变化几乎恢复到根除前的水平。
铋四联疗法导致肠道微生物群的短期失调。大多数变化在根除后 1 年内恢复，表明幽门螺杆菌治疗具有长期安全性。
