Lactobacillus Reuteri: Innovación en el tratamiento de H. pylori.

Summary

The speaker discusses the global prevalence and challenges of treating Helicobacter pylori infection, which can lead to a significantly higher risk of cancer. They highlight the need for effective treatments, focusing on first-line therapies and the use of antibiotics based on bacterial resistance. The speaker also explores the growing issue of resistance, the potential of probiotics, particularly Lactobacillus reuteri, in enhancing eradication rates, and their role as an adjuvant therapy. The importance of tailored treatments and the need for ongoing research into new therapeutic approaches is emphasized.

Takeaways

• 😀 Helicobacter pylori is the most common infection globally and poses a significant risk for developing cancer, especially in areas with high prevalence like the one described in the script.
• 😀 Eradication of Helicobacter pylori is crucial for all infected patients, with initial first-line treatments recommended for most cases.
• 😀 Culturing and molecular testing (like PCR) for resistance are not cost-effective due to the high economic burden they represent.
• 😀 High doses of proton pump inhibitors (PPIs) are needed to aid bacterial replication by achieving profound acid inhibition, especially in regions with high cytochrome 2p 219 prevalence.
• 😀 There is a growing issue of resistance to antibiotics like metronidazole, clarithromycin, and levofloxacin in the treatment of Helicobacter pylori, but amoxicillin remains effective with low resistance.
• 😀 As resistance rates increase over time, longer treatments (14 days or more) are often required for better eradication outcomes.
• 😀 Second-line treatments involve using antibiotics not included in the first regimen, along with the addition of bismuth to enhance eradication rates.
• 😀 Probiotic therapies, particularly Lactobacillus reuteri, can act as adjuncts to standard treatments, showing promise in improving eradication rates and reducing side effects.
• 😀 Studies have demonstrated that Lactobacillus reuteri can physically bind to Helicobacter pylori and reduce bacterial density, aiding antibiotic treatment.
• 😀 The use of probiotics, particularly Lactobacillus reuteri, has shown improvements in eradication rates and may help reduce adverse effects when combined with conventional therapies.
• 😀 There is ongoing research into new therapeutic options for Helicobacter pylori, including probiotics and potential biofilm interventions, though more evidence is still required for broader implementation.

Q & A

What is Helicobacter pylori and why is it significant?

Helicobacter pylori is the most common bacterial infection in the world. It poses a significant risk, increasing the chances of gastric cancer, particularly in regions with a high prevalence (greater than 70%), where cancer incidence can be four times higher due to the infection.

What challenge does Helicobacter pylori re-infection present?

Re-infection with Helicobacter pylori is a major challenge due to its high prevalence and its association with gastric cancer. Managing and effectively treating the infection remains difficult, especially with rising antibiotic resistance rates.

What is the general consensus on treating Helicobacter pylori infection?

The consensus supports treating all patients diagnosed with Helicobacter pylori infection, aiming for eradication through appropriate therapy, typically starting with first-line treatment options.

Why are molecular tests and cultures not always used for Helicobacter pylori treatment?

Although molecular tests and cultures can help determine bacterial susceptibility and resistance, they are not cost-effective and impose a significant economic burden on healthcare systems, making them less commonly used.

How does cytochrome 2P219 affect the treatment of Helicobacter pylori?

A high prevalence of cytochrome 2P219, a cytochrome responsible for the rapid metabolism of certain drugs, can affect the metabolism of treatments like losartan. This necessitates the use of higher doses of medications, such as proton pump inhibitors, to effectively inhibit acid secretion and facilitate bacterial eradication.

What are the resistance patterns observed in the treatment of Helicobacter pylori?

Resistance to certain antibiotics, including metronidazole, clarithromycin, and levofloxacin, is rising, making treatment more difficult. However, resistance to amoxicillin remains low, allowing it to be used effectively in most treatment regimens.

What is the significance of resistance rates in Helicobacter pylori treatment?

As resistance rates to key antibiotics grow each year, the efficacy of current treatment regimens decreases, leading to more severe epidemiological issues and the need for alternative or extended treatments.

What is the role of bismuth in second-line treatment for Helicobacter pylori?

Bismuth has been shown to improve eradication rates when added to second-line treatment regimens, which may include antibiotics not used in the first-line regimen. It helps increase the effectiveness of treatment in difficult cases.

How effective are probiotics in improving Helicobacter pylori eradication rates?

Probiotics, particularly Lactobacillus reuteri, have been shown to improve eradication rates by 8-12% and reduce side effects of standard treatments. These probiotics work by binding to Helicobacter pylori, decreasing bacterial density and aiding antibiotic activity.

What are the current international perspectives on using probiotics for Helicobacter pylori treatment?

International consensus, including recommendations from the Colombian Gastroenterology Association, suggests probiotics as an adjuvant therapy that could enhance eradication rates and reduce adverse effects of the primary treatment regimen.