{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:32:50Z","timestamp":1753878770364,"version":"3.41.2"},"reference-count":56,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":35,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Treatment of <jats:italic>Helicobacter pylori<\/jats:italic> gastric infection is complex and associated with increased rates of therapeutic failure. This research aimed to characterize the <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> infection status, strain resistance to antimicrobial agents, and the predominant lesion pattern in the gastroduodenal mucosa of patients with clinical suspicion of refractoriness to first\u2010 and second\u2010line treatment who were diagnosed and treated in a health center in Guayaquil, Ecuador.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 374 patients with upper gastrointestinal symptoms and <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> infection were preselected and prescribed one of three triple therapy regimens for primary infection, as judged by the treating physician. Subsequently, 121 patients who returned to the follow\u2010up visit with persistent symptoms after treatment were studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients had <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> infection. Histopathological examination diagnosed chronic active gastritis in 91.7% of cases; premalignant lesions were observed in 15.8%. The three triple therapy schemes applied showed suboptimal efficacy (between 47.6% and 77.2%), with the best performance corresponding to the scheme consisting of a proton pump inhibitor\u2009+\u2009amoxicillin\u2009+\u2009levofloxacin. Bacterial strains showed very high phenotypic resistance to all five antimicrobials tested: clarithromycin, 82.9%; metronidazole, 69.7%; amoxicillin and levofloxacin, almost 50%; tetracycline, 38.2%. Concurrent resistance to clarithromycin\u2013amoxicillin was 43.4%, to tetracycline\u2013metronidazole 30.3%, to amoxicillin\u2013levofloxacin 27.6%, and to clarithromycin\u2013metronidazole 59.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In vitro testing revealed resistance to all five antibiotics, indicating that <jats:italic>H<\/jats:italic>. <jats:italic>pylori<\/jats:italic> exhibited resistance phenotypes to these antibiotics. Consequently, the effectiveness of triple treatments may be compromised, and further studies are needed to assess refractoriness in quadruple and concomitant therapies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hel.13060","type":"journal-article","created":{"date-parts":[[2024,4,6]],"date-time":"2024-04-06T05:34:38Z","timestamp":1712381678000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refractoriness to anti\u2010<i>Helicobacter pylori<\/i> treatment attributed to phenotypic resistance patterns in patients with gastroduodenopathy in <scp>Guayaquil\u2010Ecuador<\/scp>"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1397-4915","authenticated-orcid":false,"given":"Javier David","family":"Lara\u00a0Icaza","sequence":"first","affiliation":[{"name":"Centro Cl\u00ednico Quir\u00fargico Ambulatorio (Hospital del D\u00eda) Efr\u00e9n Jurado L\u00f3pez  Guayaquil Ecuador"},{"name":"Universidad del Zulia (LUZ)  Maracaibo Venezuela"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8192-4930","authenticated-orcid":false,"given":"Rosalina Lara","family":"Tapia","sequence":"additional","affiliation":[{"name":"Centro Cl\u00ednico Quir\u00fargico Ambulatorio (Hospital del D\u00eda) Efr\u00e9n Jurado L\u00f3pez  Guayaquil Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6271-9761","authenticated-orcid":false,"given":"C\u00e1stula Tania Castro","family":"Triana","sequence":"additional","affiliation":[{"name":"Centro Cl\u00ednico Quir\u00fargico Ambulatorio (Hospital del D\u00eda) Efr\u00e9n Jurado L\u00f3pez  Guayaquil Ecuador"},{"name":"Universidad Cat\u00f3lica de Santiago de Guayaquil  Guayaquil Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3682-5394","authenticated-orcid":false,"given":"Laura Catalina Romero","family":"Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Centro Cl\u00ednico Quir\u00fargico Ambulatorio (Hospital del D\u00eda) Efr\u00e9n Jurado L\u00f3pez  Guayaquil Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12493"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.11.059"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i28.4076"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmclc.2015.09.004"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.26820\/recimundo\/3"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12557"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-018-5415-7"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12719"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i40.4548"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00253-020-10945-w"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.22516\/25007440.173"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11175077"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10070448"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.47892\/rgp.2020.403.1121"},{"key":"e_1_2_6_16_1","unstructured":"European Committee on Antimicrobial Susceptibility Testing (ECTS).Breakpoint tables for interpretation of MICs and zone diameters. 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