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Accurate evaluation of pediatric Helicobacter pylori heteroresistance contributes to further improving the quality of tailored therapy

Pediatric Research (2024)Cite this article

Increasing antibiotic resistance for Helicobacter pylori (H. pylori) has been observed worldwide, especially in Southeast Asia which exhibited a significant increase in resistance to all antibiotics. Kotilea et al.1 published an important original article for tailored therapy of H. pylori, which offers recommendations for recognizing the presence of H. pylori heteroresistance and performing routine biopsies from the antrum and corpus. It was also important that the possibility that the reported heteroresistance rate is underestimated by conventional microbiologic techniques relying on culture, compared with polymerase chain reaction (PCR) or fluorescence in situ hybridization (FISH). This report about H. pylori heteroresistance in adults is limited, even more so in children,2 In ESPGHAN/NASPGHAN guidelines for H. pylori in children and adolescents, at least one biopsy specimen of the antrum and one from the corpus should be obtained for culture; however, there is no mention of whether it is to definitively diagnose H. pylori infection or determine H. pylori heteroresistance. H. pylori heteroresistance is a significant clinical issue that is rarely discussed in main treatment guidelines.3 Here, I want to present our data regarding clarithromycin (CAM)-susceptible and CAM-resistant H. pylori strains heteroresistance infection in adolescents.

In 2020, we conducted a study involving individuals from the Saga H. pylori Testing and Treatment Project.4 Submitted stool samples were evaluated using real-time PCR and Sanger sequence analysis for the H. pylori gene and CAM resistance mutations at positions 2142 and 2143 of H. pylori’s 23 S rRNA. If there were two peaks at the same location in the sequence analysis, it was considered to be H. pylori heteroresistance infection. This study is part of the research conducted for the Smart GeneTM performance evaluation test. Smart Gene™ was developed based on the concept of point-of-care genetic testing. We have developed a reagent for evaluating H. pylori CAM resistance mutations exclusively for Smart Gene™.5

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The authors did not receive a specific grant from any funding agency in the public, commercial, or non-profit sectors for this research.

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  1. Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan

    Toshihiko Kakiuchi

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  1. Toshihiko Kakiuchi
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Toshihiko Kakiuchi: Conceptualization, writing—original draft, writing—review & editing.

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Correspondence to Toshihiko Kakiuchi.

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Kakiuchi, T. Accurate evaluation of pediatric Helicobacter pylori heteroresistance contributes to further improving the quality of tailored therapy. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03072-z

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