Editing Helicobacter pylori (section)

=== Antibiotic resistance ===
Increasing [[antibiotic resistance]] is the main cause of initial treatment failure. Factors linked to resistance include mutations, [[efflux pump]]s, and the formation of [[biofilm]]s.<ref name="Soto">{{cite journal |vauthors=Soto SM |title=Role of efflux pumps in the antibiotic resistance of bacteria embedded in a biofilm |journal=Virulence |volume=4 |issue=3 |pages=223–9 |date=April 2013 |pmid=23380871 |pmc=3711980 |doi=10.4161/viru.23724 |url=}}</ref><ref name="Cai">{{cite journal |last1=Cai |first1=Yuying |last2=Wang |first2=Caixia |last3=Chen |first3=Zhenghong |last4=Xu |first4=Zhengzheng |last5=Li |first5=Huanjie |last6=Li |first6=Wenjuan |last7=Sun |first7=Yundong |title=Transporters HP0939, HP0497, and HP0471 participate in intrinsic multidrug resistance and biofilm formation in Helicobacter pylori by enhancing drug efflux |url=https://onlinelibrary.wiley.com/doi/10.1111/hel.12715 |journal=Helicobacter |access-date=15 February 2024 |language=en |doi=10.1111/hel.12715 |date=August 2020 |volume=25 |issue=4 |pages=e12715 |pmid=32548895 |s2cid=219726485 |archive-date=15 February 2024 |archive-url=https://web.archive.org/web/20240215084607/https://onlinelibrary.wiley.com/doi/10.1111/hel.12715 |url-status=live }}</ref> One of the main [[antibiotic]]s used in eradication therapies is [[clarithromycin]], but clarithromycin-resistant strains have become well-established and the use of alternative antibiotics needs to be considered. Fortunately, non-invasive stool tests for clarithromycin have become available that allow selection of patients that are likely to respond to the therapy.<ref>{{cite journal | vauthors = Mommersteeg MC, Nieuwenburg SA, Wolters LM, Roovers BH, van Vuuren HA, Verhaar AP, Bruno MJ, Kuipers EJ, Peppelenbosch MP, Spaander MC, Fuhler GM | title =  The use of non-invasive stool tests for verification of Helicobacter pylori eradication and clarithromycin resistance. | journal =  United European Gastroenterol J | volume = 11 | issue = 9 | pages = e894-903| date = November 2023 | pmid = 37854002 | pmc = 10637120 | doi = 10.1002/ueg2.12473 | doi-access = free}}</ref> Multidrug resistance has also increased.<ref name="Cai"/> Additional rounds of antibiotics or other therapies may be used.<ref name="Stenström B, Mendis A, Marshall B 2008 608–12">{{cite journal | vauthors = Stenström B, Mendis A, Marshall B | title = Helicobacter pylori--the latest in diagnosis and treatment | journal = Australian Family Physician | volume = 37 | issue = 8 | pages = 608–12 | date = August 2008 | pmid = 18704207 }}</ref><ref>{{cite journal | vauthors = Fischbach L, Evans EL | title = Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori | journal = Alimentary Pharmacology & Therapeutics | volume = 26 | issue = 3 | pages = 343–57 | date = August 2007 | pmid = 17635369 | doi = 10.1111/j.1365-2036.2007.03386.x | s2cid = 20973127 | type = Meta-analysis }}</ref><ref>{{cite journal | vauthors = Graham DY, Shiotani A | title = New concepts of resistance in the treatment of Helicobacter pylori infections | journal = Nature Clinical Practice. Gastroenterology & Hepatology | volume = 5 | issue = 6 | pages = 321–31 | date = June 2008 | pmid = 18446147 | pmc = 2841357 | doi = 10.1038/ncpgasthep1138 }}</ref> [[Next generation sequencing]] is looked to for identifying initial specific antibiotic resistances that will help in targeting more effective treatment.<ref name="Pohl">{{cite journal |vauthors=Pohl D, Keller PM, Bordier V, Wagner K |title=Review of current diagnostic methods and advances in Helicobacter pylori diagnostics in the era of next generation sequencing |journal=World J Gastroenterol |volume=25 |issue=32 |pages=4629–4660 |date=August 2019 |pmid=31528091 |pmc=6718044 |doi=10.3748/wjg.v25.i32.4629 |doi-access=free |url=}}</ref>

In 2018, the [[WHO]] listed ''H. pylori'' as a high priority pathogen for the research and [[Drug discovery|discovery of new drugs]] and treatments.<ref name="Sukri">{{cite journal |vauthors=Sukri A, Hanafiah A, Patil S, Lopes BS |title=The Potential of Alternative Therapies and Vaccine Candidates against Helicobacter pylori |journal=Pharmaceuticals |volume=16 |issue=4 |date=April 2023 |page=552 |pmid=37111309 |pmc=10141204 |doi=10.3390/ph16040552 |doi-access=free |url=}}</ref> The increasing antibiotic resistance encountered has spurred interest in developing alternative therapies using a number of plant compounds.<ref name="Vaou">{{cite journal |vauthors=Vaou N, Stavropoulou E, Voidarou C, Tsigalou C, Bezirtzoglou E |title=Towards Advances in Medicinal Plant Antimicrobial Activity: A Review Study on Challenges and Future Perspectives |journal=Microorganisms |volume=9 |issue=10 |date=September 2021 |page=2041 |pmid=34683362 |pmc=8541629 |doi=10.3390/microorganisms9102041 |doi-access=free }}</ref><ref name="pmid20459098">{{cite journal | vauthors = Moon JK, Kim JR, Ahn YJ, Shibamoto T | title = Analysis and anti-Helicobacter activity of sulforaphane and related compounds present in broccoli ( Brassica oleracea L.) sprouts | journal = Journal of Agricultural and Food Chemistry | volume = 58 | issue = 11 | pages = 6672–7 | date = June 2010 | pmid = 20459098 | doi = 10.1021/jf1003573 | bibcode = 2010JAFC...58.6672M }}</ref> Plant compounds have fewer side effects than synthetic drugs. Most plant extracts contain a complex mix of components that may not act on their own as antimicrobials but can work together with antibiotics to enhance treatment and work towards overcoming resistance.<ref name="Vaou"/> Plant compounds have a different mechanism of action that has proved useful in fighting antimicrobial resistance. For example, various compounds can act by inhibiting enzymes such as urease, and weakening adhesions to the mucous membrane.<ref name="Sathianarayanan">{{cite journal |vauthors=Sathianarayanan S, Ammanath AV, Biswas R, B A, Sukumaran S, Venkidasamy B |title=A new approach against Helicobacter pylori using plants and its constituents: A review study |journal=Microb Pathog |volume=168 |issue= |pages=105594 |date=July 2022 |pmid=35605740 |doi=10.1016/j.micpath.2022.105594 |s2cid=248975163 |url=}}</ref> Sulfur-containing compounds from plants with high concentrations of polysulfides, [[coumarin]]s, and [[terpene]]s have all been shown to be effective against ''H. pylori''.<ref name="Vaou"/>

''H. pylori'' is found in saliva and [[dental plaque]]. Its transmission is known to include oral-oral, suggesting that the dental plaque biofilm may act as a reservoir for the bacteria. Periodontal therapy or [[scaling and root planing]] has therefore been suggested as an additional treatment to enhance eradication rates, but more research is needed.<ref name="Rahat">{{cite journal |vauthors=Rahat M, Saqib M, Ahmed M, Suleman M, Ismail SM, Mumtaz H, Khalid H |title=Use of eradication therapy in adjunction to periodontal therapy versus alone for treatment of Helicobacter pylori infections: a mini review |journal=Ann Med Surg (Lond) |volume=85 |issue=6 |pages=2756–2760 |date=June 2023 |pmid=37363585 |pmc=10289787 |doi=10.1097/MS9.0000000000000741 |url=}}</ref><ref name="BMC2023">{{cite journal |vauthors=Moradi Y, Majidi L, Khateri S, Azh N, Gheshlagh RG, Saniee N, Zarei M, Moradpour F |title=The association between periodontal diseases and helicobacter pylori: an updated meta-analysis of observational studies |journal=BMC Oral Health |volume=23 |issue=1 |pages=523 |date=July 2023 |pmid=37496045 |pmc=10369707 |doi=10.1186/s12903-023-03232-3 |doi-access=free |url=}}</ref>