H. pylori eradication therapy: impact of gastric mucosa atrophy on transport of amoxicillin to H. pylori colonization area

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Abstract

AIM: The aim was to assess systemic transport of amoxicillin, the most common antibiotic in H. pylori eradication regimens to the gastric in atrophic gastritis.

MATERIALS AND METHODS: Systemic transport of amoxicillin to the gastric lumen of rats was evaluated in washes from the gastric mucosa in the model of atrophic gastritis after intravenous drug infusion. Transport of amoxicillin from bloodstream to the gastric lumen was also assessed in patients with atrophic and non-atrophic gastritis in aspirated via nasogastric probe gastric juice after oral drug administration. Amoxicillin concentration was measured in samples using liquid chromatography-mass spectrometry.

RESULTS: In rats with induced atrophic gastritis, hyperemia and acute erosions of the gastric mucosa, as well as microscopic signs of non-active chronic body gastritis and non-active antral atrophic gastritis were found. Amoxicillin concentration in washes from the gastric mucosa was significantly (p < 0.01) higher in rats of experimental group than in control group at all time points (30, 60, 120, 240 min after drug infusion). The lowest mean amoxicillin concentration in gastric juice was observed in patients with antral atrophy (p < 0.01). The maximum amoxicillin concentration in gastric secretion was found at the 180th min of aspiration in patients with atrophy of gastric mucosa, while in patients of the group of comparison it was found at 30-120th min of aspiration.

CONCLUSIONS: Acute gastric mucosa erosions enhance amoxicillin delivery to gastric lumen in rats. Atrophy of antral mucosa more than in the corpus is characterized by decreased amoxicillin transfer from systemic bloodstream to gastric lumen in patients after oral amoxicillin intake. The gastric mucosa atrophy should be taken into consideration while predicting the efficacy of H. pylori eradication therapy in patients with chronic gastritis.

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About the authors

Anastasiya O. Sablina

Nikiforov Russian Center of Emergency and Radiation Medicine

Author for correspondence.
Email: a.o.sablina@mail.ru
ORCID iD: 0000-0002-0337-453X
SPIN-code: 1044-8392
Scopus Author ID: 57216203494

MD, PhD student

Russian Federation, 4/2 Academica Lebedeva str., Saint Petersburg, 194044

Oleg A. Sablin

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: gastroleg@yandex.ru
ORCID iD: 0000-0002-2597-1220
SPIN-code: 5446-2329
Scopus Author ID: 6508192177
ResearcherId: U-1854-2017

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4/2 Academica Lebedeva str., Saint Petersburg, 194044

Julia V. Andreeva

Pavlov Institute of Physiology

Email: jandreeva@mail.ru
ORCID iD: 0000-0002-7360-9306
SPIN-code: 5122-4026
Scopus Author ID: 42960935800
ResearcherId: AAO-9573-2021

Cand. Sci. (Biol.)

Russian Federation, Saint Petersburg

Gennadii G. Rodionov

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: rodgengeor@yandex.ru
ORCID iD: 0000-0001-6237-7848
SPIN-code: 6471-3933
Scopus Author ID: 57220177362
ResearcherId: AAQ-5773-2021

MD, Dr. Sci. (Med.), Assistant Professor

Russian Federation, 4/2 Academica Lebedeva str., Saint Petersburg, 194044

I. I. Shantyr

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: shantyr@arcerm.spb.ru
ORCID iD: 0000-0003-1840-5770
SPIN-code: 8038-2999
Scopus Author ID: 57216182544

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4/2 Academica Lebedeva str., Saint Petersburg, 194044

Inna E. Ushal

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: innaushal@mail.ru
ORCID iD: 0000-0001-5857-3627
SPIN-code: 4726-8832
Scopus Author ID: 23111545700

Cand. Sci. (Biol.)

Russian Federation, 4/2 Academica Lebedeva str., Saint Petersburg, 194044

Igor A. Samusenko

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: egors_2000@mail.ru
ORCID iD: 0000-0003-0622-3515
SPIN-code: 6669-5602
Scopus Author ID: 14020322000

Cand. Sci. (Med.)

Russian Federation, 4/2 Academica Lebedeva str., Saint Petersburg, 194044

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Supplementary files

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1. Fig. 1. Control group rat. Gastric body mucosa. In the pictures 1–4 histology slides stained with hematoxylin and eosin with alcian blue additional staining, ×200 magnification

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2. Fig. 2. Control group rat. Gastric antrum mucosa with focal production of glycosaminoglycans in the area of the glands

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3. Fig. 3. Rat with atrophic gastritis modeling. Gastric body mucosa with enhanced glycosaminoglycans production in superficial epithelium

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4. Fig. 4. Rat with atrophic gastritis modeling. Gastric antrum mucosa with atrophy and moderate glycosaminoglycans production in the area of the glands

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5. Fig. 5. Amoxicillin concentration in washes from the gastric mucosa of rats from both groups at different time points, Me. * p < 0.01

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6. Fig. 6. Amoxicillin mean concentration in gastric secretion samples in patients of different groups in different time points. ABG — atrophic body gastritis, AAG — atrophic antral gastritis

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Copyright (c) 2021 Sablina A.O., Sablin O.A., Andreeva J.V., Rodionov G.G., Shantyr I.I., Ushal I.E., Samusenko I.A.

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