Retrospective Study
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World J Gastroenterol. Nov 21, 2014; 20(43): 16245-16251
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16245
Different antibiotic susceptibility between antrum and corpus of the stomach, a possible reason for treatment failure of Helicobacter pylori infection
Michael Selgrad, Ina Tammer, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Dirk Schlüter, Peter Malfertheiner
Michael Selgrad, Cosima Langner, Jan Bornschein, Julia Meißle, Arne Kandulski, Mariya Varbanova, Thomas Wex, Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany
Ina Tammer, Dirk Schlüter, Institute of Medical Microbiology, Otto-von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany
Author contributions: Selgrad M and Malfertheiner P designed the research; Selgrad M, Tammer I, Meißle J and Langner C performed the research; Selgrad M, Bornschein J, Kandulski A, Varbanova M, Wex T and Schlüter D analyzed the data; Selgrad M and Malfertheiner P wrote the paper.
Supported by In part supported by a grant from the BMBF, BMBF-0315905D in the frame of ERA-NET PathoGenoMics
Correspondence to: Michael Selgrad, MD, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany. michael.selgrad@med.ovgu.de
Telephone: +49-391-6713100 Fax: +49-391-6713105
Received: November 14, 2013
Revised: January 5, 2014
Accepted: April 21, 2014
Published online: November 21, 2014
Abstract

AIM: To assess whether antibiotic resistance varies between the antrum and corpus of the stomach of patients that are either Helicobacter pylori (H. pylori) therapy-naive or pre-treated.

METHODS: H. pylori strains were isolated from antrum and corpus biopsies from 66 patients that received a diagnostic gastroduodenoscopy for variant clinical indications. Antimicrobial susceptibility to amoxicillin, clarithromycin, tetracycline, metronidazole, levofloxacin and rifabutin was tested with the E-test method on Iso-Sensitest agar with 10 vol% defibrinated horse blood. In patients with a different antibiotic susceptibility pattern between the isolates from the antrum and corpus, DNA fingerprinting via random amplified polymorphic DNA analysis was performed to detect differences among DNA patterns of H. pylori isolates.

RESULTS: Primary, secondary and tertiary resistance to clarithromycin was 6.9%, 53.8% and 83.3%, retrospectively. Metronidazole and levofloxacin resistance also increased according to the number of previous treatments (17.2%, 69.2%, 83.3%; 13.8%, 23.1%, 33.3%). Tertiary resistance to rifabutin was detected in 12.5% of patients. In none of the 66 patients a resistance against amoxicillin or tetracycline was detectable. Discordant antibiotic susceptibility between antrum and corpus isolates for different antibiotics was seen in 15.2% (10/66) of the patients. Two out of those ten patients were naive to any H. pylori antibiotic treatment. The remaining eight patients previously received at least one eradication therapy. DNA fingerprinting analysis revealed no substantial differences among DNA patterns between antrum and corpus isolates in the majority of patients suggesting an infection with a single H. pylori strain.

CONCLUSION: Different antibiotic susceptibility between antrum and corpus biopsies is a common phenomenon and a possible explanation for treatment failure. Resistant H. pylori strains may be missed if just one biopsy from one anatomic site of the stomach is taken for H. pylori susceptibility testing.

Keywords: Helicobacter pylori treatment, Antibiotic susceptibility, Heteroresistance, Antibiotic susceptibility

Core tip: Different antibiotic susceptibility between antrum and corpus biopsies of the stomach represents a phenomenon and a possible explanation for treatment failure. Resistant Helicobacter pylori (H. pylori) strains, as a possible reason for treatment failure may be missed in a reasonable number if just one biopsy from one anatomic site of the stomach is taken for H. pylori susceptibility testing.