University of Zambia School of Health Sciences, Lusaka, Zambia.
Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia.
Dig Dis. 2024;42(2):154-160. doi: 10.1159/000535454. Epub 2024 Jan 5.
Helicobacter pylori (H. pylori) is one of the most important infections globally, affecting more than 50% of the human population. Clarithromycin (CLA)-containing regimens are recommended for empirical eradication of H. pylori in populations with less than 15% resistance. The aim of this study was to estimate the prevalence of CLA resistance in samples collected from Zambian patients to determine if CLA is suitable for first-line H. pylori empirical treatment.
We used archival biopsy samples collected from dyspeptic patients undergoing endoscopy. The samples had been snap-frozen immediately after collection and stored at -80°C. We performed multiplex real-time PCR using Bosphore Helicobacter pylori Genotyping Kits v1, Istanbul, Turkey, to determine the presence of wild-type H. pylori and three mutations, A2142G, A2142C, and A2143G, of domain V in 23s rRNA gene.
We tested 259 gastric biopsy samples from patients with dyspepsia, of which 136 (53%) were from females. The median age was 48 years (IQR 40-61 years). Endoscopically, most of the patients, 164 (63%), had a normal gastric mucosa. CLA resistance was found in 48 (28%) samples, with A2142G mutation in 23 (13%), A2143G mutation in 32 (18%), and double mutations A2142C and A2143G in 6 (3%).
The presence of significant levels of CLA resistance in Zambia suggests that it should not be used as first-line empirical treatment for H. pylori infection. However, with a limitation of suitable alternatives, there is an urgent need to formulate new treatment approaches.
幽门螺杆菌（H. pylori）是全球最重要的感染之一，影响了超过 50%的人口。在耐药率低于 15%的人群中，推荐使用包含克拉霉素（CLA）的方案进行经验性幽门螺杆菌根除。本研究旨在评估从赞比亚患者样本中采集的 CLA 耐药率，以确定 CLA 是否适合作为一线经验性幽门螺杆菌治疗。
我们使用从接受内镜检查的消化不良患者中收集的存档活检样本。这些样本在收集后立即进行冷冻，并储存在-80°C。我们使用 Bosphore 幽门螺杆菌基因分型试剂盒 v1（土耳其伊斯坦布尔）进行多重实时 PCR，以确定野生型 H. pylori 以及 23s rRNA 基因中域 V 的三个突变 A2142G、A2142C 和 A2143G 的存在。
我们测试了 259 份来自消化不良患者的胃活检样本，其中 136 份（53%）来自女性。中位年龄为 48 岁（IQR 40-61 岁）。内镜下，大多数患者（63%）有正常的胃黏膜。48 份（28%）样本中发现 CLA 耐药，其中 23 份（13%）存在 A2142G 突变，32 份（18%）存在 A2143G 突变，6 份（3%）存在双重突变 A2142C 和 A2143G。
在赞比亚存在显著水平的 CLA 耐药表明，不应该将其作为幽门螺杆菌感染的一线经验性治疗。然而，由于合适的替代方案有限，迫切需要制定新的治疗方法。
