{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:53:42Z","timestamp":1781844822953,"version":"3.54.5"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      We sought to determine whether the endoscopic grade of gastric atrophy (according to Kimura-Takemoto) affects the likelihood of successful first-line\n                      <jats:italic>H. pylori<\/jats:italic>\n                      eradication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective analysis of consecutive patients hospitalized at Wuhan Fourth Hospital between November 2021 and November 2025. Eligible individuals had a positive urea breath test confirming\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection, were diagnosed with chronic atrophic gastritis via gastroscopy, received a bismuth-containing quadruple regimen as first-line therapy, and returned for a follow-up breath test at least 4 weeks post-treatment. Prior to therapy (within 28 days), each patient underwent high-definition white-light gastroscopy. Two independent endoscopists, unaware of patient allocation, retrospectively reviewed all images to grade atrophy using the Kimura-Takemoto system. Patients were assigned to either the closed-type (C-type) or open-type (O-type) atrophy group. The primary endpoint was eradication failure, defined as a positive follow-up breath test. Logistic regression (univariate and multivariate) was used to identify factors independently linked to treatment failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 154 patients completed follow-up and were included. The overall eradication rate was 76.6% (118\/154). In the open-type atrophy group (\n                      <jats:italic>n<\/jats:italic>\n                      = 26), the eradication rate was only 42.3% (11\/26), significantly lower than the 83.6% (107\/128) observed in the closed-type group (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). After adjusting for confounders such as body weight and age, multivariate analysis revealed that endoscopic open-type atrophy was independently associated with eradication failure (OR = 8.287, 95% CI: 3.150\u201321.804,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The extent of endoscopic gastric mucosal atrophy independently predicts a lower efficacy of first-line\n                      <jats:italic>H. pylori<\/jats:italic>\n                      eradication. For patients with Kimura-Takemoto open-type atrophy, clarithromycin-containing quadruple regimens should be used cautiously. Alternative clarithromycin-free regimens (e.g., tetracycline-, metronidazole-, or levofloxacin-based therapies, or high-dose amoxicillin with PPI\/vonoprazan) or susceptibility-guided individualized therapy are recommended in clinical practice.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1864653","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:28:57Z","timestamp":1781843337000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of kimura-takemoto atrophy classification on first-line H. pylori eradication: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dongchu","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Wuhan Fourth Hospital","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangwu","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Wuhan Fourth Hospital","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aixiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Wuhan Fourth Hospital","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13099-025-00715-2","article-title":"Prevalence of and risk factors for helicobacter pylori infection in children under 64 months in Thimphu, Bhutan, and introducing the new in-house immunochromatography test kit: a cross-sectional study","volume":"17","author":"Sherpa","year":"2025","journal-title":"Gut Pathog."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1128497","DOI":"10.3389\/fmicb.2023.1128497","article-title":"Multidrug resistance in helicobacter pylori infection","volume":"14","author":"Dasc\u0103lu","year":"2023","journal-title":"Front Microbiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/01.JAA.0000000000000154","article-title":"Vonoprazan: a novel agent used in eradicating helicobacter pylori infection","volume":"37","author":"Provenza","year":"2024","journal-title":"Jaapa."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.3390\/antibiotics12071184","article-title":"Epidemiology of helicobacter pylori resistance to antibiotics (a narrative review)","volume":"12","author":"Mladenova","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1186\/s12876-025-04366-0","article-title":"Health education based on precede-proceed model in eradication evaluation of helicobacter pylori infection: a retrospective cohort study","volume":"25","author":"Shang","year":"2025","journal-title":"BMC Gastroenterol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"44105","DOI":"10.1038\/s41598-025-27876-z","article-title":"Efficacy of fourteen-day once-daily vonoprazan-based quadruple therapy for helicobacter pylori in high clarithromycin-resistance regions (once-vono trial)","volume":"15","author":"Sukkamolsantiporn","year":"2025","journal-title":"Sci Rep."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e43080","DOI":"10.7759\/cureus.43080","article-title":"Unpacking the racial gap: helicobacter pylori infection clearance among different racial groups","volume":"15","author":"Rammohan","year":"2023","journal-title":"Cureus."},{"key":"B8","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1046\/j.1523-5378.1999.99299.x","article-title":"Effect of smoking and histological gastritis severity on the rate of h. 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