Eradication, Strain Preservation, Strain Change — Outcomes of Helicobacter pylori Therapy

Abstract

Relevance. If we reduce the treatment exclusively to the eradication of Helicobacter pylori (Hp), the question of monitoring the results of anti-Hp therapy is controversial, given the widely known data on the detection of Hp, including virulent strains of Hp, in most healthy individuals. The aim of the study: to track the dynamics of stomach colonization with various Hp strains in patients with gastric ulcer and duodenal ulcer (PUD) immediately after the use of standard three-component anti-Hp therapy (AHT) and 1.5–2 months after AHT. Methods. Genotyping of Hp strains was carried out by the VNTR method together with the determination of the cagA gene. Results. Assessment of the results of AHT in the form of «eradication of Hp — re-detection of Hp» (i. e., without taking the determination of Hp strains into account) showed less reliability in the differences than the «eradication — preservation of the strain or change of the strain» score in patients with PUD; in addition, the differences between the initial bacteriological picture and that observed immediately after AHT were on the verge of reliability, while the differences between the initial bacteriological picture and that observed after 1.5–2 months had a high degree of reliability. The number of eradications increased (eradication achieved immediately after AHT was not preserved, except for one) and the number of cagA-containing strains decreased (due to new eradication detected at late follow-up periods and due to a change in strains) in long-term follow-up in patients with PUD. Conclusion. Since all patients with PUD achieved clinical remission, which lasted for the next 1.5–2 months, the success of AHT should not be unambiguously associated with the eradication of Hp; the restoration of the organism's colonization resistance to Hp after a course of therapy is more likely.