INTRODUCTION: In randomized trials, early improvement with biologic therapy in Crohn's disease (CD) and ulcerative colitis (UC) is linked to better long-term outcomes. However, some patients may respond later (late remitters). The frequency of such late remitters, predictors of who may belong to this group, and the long-term outcome of such patients have not been examined robustly. METHODS: This prospective single-center study enrolled patients with moderate-to-severe CD or UC initiating biologic or small molecule therapy. Disease activity was assessed prospectively using Harvey Bradshaw Index (CD) and Simple Clinical Colitis Activity Index (UC). Patients were followed for 1 year. Early remitters achieved clinical remission (Harvey-Bradshaw Index <= 4, Simple Clinical Colitis Activity Index <= 2) by week 14. Late remitters did not achieve remission by week 14 but attained remission by week 30. Nonremitters failed to achieve remission by week 30. RESULTS: Our cohort included 596 patients (280 CD, 316 UC) initiating anti-tumor necrosis factor (n = 174), vedolizumab (n = 171), anti-interleukin (primarily ustekinumab, n = 116), or Janus kinase inhibitors (primarily tofacitinib, n = 135). Most (89%) had previous biologic exposure. Clinical remission at week 14 occurred in 37%; an additional 14% achieved remission between weeks 14 and 30 (late remitters). Late remitters had slightly shorter disease duration but comparable demographics and disease characteristics to early responders. Late remitters had similar rates of clinical (64% vs 63%) and endoscopic remission (43% vs 49%) at week 52 compared with early remitters, with superior outcomes compared with nonremitters (13% and 16%, respectively; P < 0.001). DISCUSSION: Approximately one-sixth of patients achieved delayed remission by week 30. They had comparable 1-year outcomes as early remitters. Identifying predictors of delayed remission could help prevent early therapy discontinuation without affecting long-term outcomes.
ABSTRACT Background Rising Helicobacter pylori antibiotic resistance compromises efficacy of empirical eradication therapies. This study aimed to provide updated, region‐specific resistance data in Eastern China to guide empirical treatment strategies. Methods A multicenter, cross‐sectional study was conducted across 30 institutions in Eastern China from 2022 to 2025. Susceptibility to six antibiotics was evaluated using the Kirby‐Bauer disk diffusion method. Results A total of 1088 H. pylori isolates from gastric biopsies were analyzed. Resistance rates were exceptionally high for metronidazole (93.8%), clarithromycin (71.0%), and levofloxacin (61.2%), whereas resistance to amoxicillin, furazolidone, and tetracycline remained universally low (< 1%). Multidrug resistance (MDR) was highly prevalent at 80.0%. However, resistance to metronidazole, levofloxacin, and clarithromycin showed decreasing trends over the study period. Interpretation Given the alarming resistance levels, empirical use of clarithromycin‐ and levofloxacin‐based regimens should be approached with caution in Eastern China. Where universal susceptibility testing is not accessible, there is an urgent need to explore and validate novel, effective empirical eradication regimens and to establish sustained regional resistance surveillance networks to dynamically refine H. pylori management strategies.
ABSTRACT The management strategies for Helicobacter pylori treatment are still diverse, especially because of the unequal availability of the drugs needed. In addition, the development of resistance to some antibiotics leads to unsatisfactory results. The role of H. pylori in gastric cancer, which allows the possibility of prevention in the general population by eradicating the bacteria, is a stimulus to have well‐established regimens. This article presents the antimicrobial stewardship principles that can guarantee appropriate treatment. The optimization of the clarithromycin‐based triple therapy includes antimicrobial susceptibility testing for clarithromycin, a higher dose of amoxicillin than in the original regimen, more than twice a day, and a proton pump inhibitor (PPI) like rabeprazole or esomeprazole, all administered for 2 weeks. The other regimen often used, the bismuth quadruple therapy, is optimal with the 3‐in‐1 capsule and a standard or high dose of PPI. In all cases, an eradication control must be performed after 4 to 6 weeks. The so‐called concomitant treatment does not meet stewardship principles. The availability of Potassium‐Competitive Acid Blockers (P‐CABs) in some countries could allow the use of a dual therapy with only amoxicillin, but it must be confirmed by proper trials in Western countries.
ABSTRACT Background and Aims Standard triple therapy (STT) for Helicobacter pylori ( H. pylori ) infection has become suboptimal. Atorvastatin may improve eradication rates by promoting autophagy and reducing inflammation. This study aimed to evaluate the efficacy and safety of adjuvant atorvastatin with STT compared to STT alone for H. pylori eradication. Methods In this randomized, placebo‐controlled trial, 138 treatment‐naïve patients with H. pylori infection were randomized to two groups. The intervention group ( n = 70) received a 14‐day regimen of omeprazole, amoxicillin, clarithromycin, and atorvastatin (40 mg once daily). The control group ( n = 68) received the same regimen with a matching placebo. The primary endpoint was H. pylori eradication, assessed by a urea breath test 4–6 weeks after treatment completion. Secondary endpoints included CYP2C19 and CYP3A4/5 genotypes, adverse events, and patient compliance. Results The eradication rate in the intervention group was significantly higher than in the control group in both the per‐protocol (97.1% vs. 85.3%) and intention‐to‐treat (ITT) analyses (95.7% vs. 85.3%). The absolute risk difference for the ITT analysis was 10.4% (95% CI, 0.75 to 20.1; p = 0.03). The distribution of CYP2C19 and CYP3A4/5 genotypes was similar between groups. No clinically significant differences in adverse events were observed. Conclusion Adjuvant therapy with atorvastatin combined with STT significantly improved H. pylori eradication rates without clinically significant adverse events. Further randomized controlled trials in diverse populations and with varying antibiotic resistance patterns are needed to better clarify the effects of statins on H. pylori treatment. Trial Registration Thai Clinical Trial Registry, No. TCTR20220201001
ABSTRACT Background The Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) systems stratify gastric cancer (GC) risk according to the extent of gastric atrophy and intestinal metaplasia. However, the clinical significance of intermediate stages remains uncertain. Objective To evaluate the association between OLGA/OLGIM stages and GC, with particular focus on the potential role of intermediate stages as early histological risk markers. Methods A systematic review and meta‐analysis (PROSPERO CRD42024549931) was conducted according to PRISMA 2020 guidelines. Cohort, case–control, and cross‐sectional studies reporting GC incidence or prevalence according to OLGA and/or OLGIM stage were included. Methodological quality was assessed using the Newcastle‐Ottawa Scale and certainty of evidence using GRADE. Random‐effects models were used to calculate pooled odds ratios (OR) and risk ratios (RR). Results Twenty‐eight studies involving 23,390 patients were included. Methodological quality was high and certainty of evidence was moderate. Advanced OLGA III–IV and OLGIM III–IV stages were strongly associated with GC (OR 6.49 and 7.76; RR 13.26 and 4.34, respectively). Intermediate stages were also associated with GC in observational studies: OLGA II (OR 2.77; 95% CI 1.83–4.20; I 2 = 71%) and OLGIM II (OR 3.63; 95% CI 2.90–4.55; I 2 = 0%). However, prospective cohort studies did not demonstrate a statistically significant increase in future GC incidence for OLGA II (RR 1.20; 95% CI 0.85–1.69). Conclusions Intermediate OLGA and OLGIM stages may represent early histological markers associated with gastric carcinogenesis. Prospective studies are required to determine their predictive value and potential implications for surveillance strategies, particularly in high‐incidence populations.
