High prevalence of clarithromycin resistant Helicobacter pylori in Turkish children with gastric disorders
Introduction
Helicobacter pylori (H. pylori) is a Gram-negative microaerophilic spiral-shaped bacterium that is colonized in the gastric mucosa of almost 30%–50% of healthy individuals (Li et al., 2018). H. pylori infection is usually presented as dyspepsia, peptic ulcer disease, chronic gastritis, and sometimes stomach cancer and extragastric diseases (Take et al., 2015). It is essential, the eradication of H. pylori to control related infections (Zagari et al., 2018; Montazer-Saheb et al., 2011). PCR procedure through the detection of UreC (glmM) gene as a housekeeping gene is now known as an effective method to identify H. pylori infections independent of sample quality and culturing limitations (Shetty et al., 2017). In this respect, clarithromycin as a proton pump inhibitor (PPI) is often used to treat H. pylori infections (Malfertheiner et al., 2017). Clarithromycin by binding to bacterial 23S ribosomal subunit inhibits ribosome protein synthesis.
However, the spread of antibiotic-resistant H. pylori strains has limited the utilization of clarithromycin (Chey et al., 2017). Based on reports, the resistance rate to clarithromycin varies in different geographic areas, such as 37% in North America, 50% in China, 30% in Japan and Italy, and 17.5% to 23.4% in Europe and 40% in Turkey (Thung et al., 2016; Agudo et al., 2010).
In most cases, resistance to clarithromycin appears through point mutations in the domain V of 23SrRNA subunit of H. pylori. A conformation change occurs in the target site of clarithromycin so it can not stop the protein synthesis in the bacterial cell (Megraud et al., 2013). The most common mutations in the 23SrRNA gene are A-to-G transition at location 2142 (A2142G) and A-to-G transition at location 2143 (A2143G) (Kim et al., 2002). Restriction fragment length polymorphism (PCR- RFLP) is known as a fast and accurate method for detecting clarithromycin resistant H. pylori strains through the detection of the mutations in the 23S rRNA gene (Klesiewicz et al., 2014). The purpose of this study was to examine the prevalence rate of H. pylori and resistance to clarithromycin in pediatric patients by the PCR-RFLP technique.
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Subjects and samples
A cross-sectional study was performed from October 2015 to November 2016 in the Pediatric Center of the Balcali Hospital, Adana, Turkey. Each of the patient's parents signed an informed consent approved by the research ethics committee. The biopsy samples were obtained from the gastric antrum of patients with digestive disorders by esophagogastroduodenoscopy. Patients with gastritis, ulcer, nodular gastritis, pangastritis, and hyperemia were included in this study. In total, 110 patients
Results
The prevalence of H. pylori was examined in patients with gastric disorders. Based on the results, the prevalence of H. pylori was considerably associated with mild gastritis, pangastritis, and nodular gastritis (p < 0.05) (Table 1).
The prevalence rate of H. pylori infection was assessed based on three methods including RUT, PCR, and histopathological tests. Based on the RUT test, H. pylori bacteria were detected in 23.6% (26/110) of samples while 26.4% (29/110) of biopsy samples were positive
Discussion
In this study, the resistance to clarithromycin was evaluated in pediatric patients in the Adana city of Turkey. According to our results, 33.6% of the patients were positive for H. pylori which 56.75% of them were resistant to clarithromycin consistent with the previous study done in Turkey in 2003 (Bağlan and Özden, 2003). The prevalence of helicobacter in this study was more than the previous studies in Turkey (Maçin et al., 2015; Özçay et al., 2004; Kocazeybek et al., 2019). Despite this,
Conclusion
According to our data, clarithromycin may be unsuitable as the first-line antibiotic for the eradication of H. pylori in pediatric patients in the south of Turkey. Hence, it is essential to note other classes of antibiotics except clarithromycin for the effective treatment of H. pylori infection in children younger than 18 years in the study region.
Ethics committee approval
Tabriz University of Clinical Research Ethics Committee, (reference number: IR. TBZMED. REC.1396, 235).
CRediT authorship contribution statement
Ali Bahadori: Conceptualization. Tülin Güven Gökmen: Data curation. Fatih Köksal: Writing – original draft. Gökhan Tumgor: Visualization. Mehmet Agin: Investigation. Ali Sadighi: Software. Mojtaba Ziaee: Methodology. Leila Rahbarnia: Supervision, Writing – review & editing.
Declaration of competing interest
The authors have no conflict of interest.
Acknowledgment
This study was supported by the Department of Medical Microbiology, Cukurova University, Adana, Turkey, and Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. The authors are very grateful to the Balcali Hospital endoscopy unit staff for their valuable help and cooperation during this study.
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