8%) achieving eradication [46]. As a third-line agent, bismuth also may be JQ1 in vivo useful. In one multicenter study from Spain published recently, an eradication rate of 65% was observed for third-line bismuth-based quadruple therapy when standard therapy with clarithromycin and levofloxacin

had failed [47]. Studies on the role of probiotics as an adjunct to H. pylori eradication treatment have again been somewhat equivocal this year. The most frequently studied agents have been Lactobacillus sp. strains. In one study where 70 naïve patients were treated, Lactobacillus reuteri increased eradication rate by 8.6% and reduced the reported side effects when compared with placebo-supplemented triple therapy [48]. A meta-analysis of nine studies on probiotic use as an adjunct to triple therapy found that when specific Lactobacillus strains were used, eradication rates raised significantly by 17%, but when multistrain probiotics were used, eradication rates enhanced Belnacasan purchase by

only 2.8% [49]. This also was reflected in two other trials from Iran and Brazil where multistrain probiotics as adjunct therapy failed to show a benefit for eradication [50, 51]. Another study examined the role of L. reuteri without antibiotic therapy, finding a cure rate of 13.6% (3/22) when it was used with PPI [52]. Bifidobacterium infantis has also been proposed as having anti-H. pylori activity, and in a study this year from 上海皓元 Asia, it was observed that adding it to standard triple therapy increased the cure rate from 68.9% to 83%, and when pretreatment with 2 weeks of B. infantis was given as well, the success rate of eradication increased to 90.5% [53]. There were many studies on H. pylori resistance levels in the last year. These studies on resistance over the last

year are summarized in Table 2 [54-62]. One of the most significant of these was a systematic review of studies on resistance in Latin American countries [54]. This found that antibiotic resistance rates varied significantly by drug and by country, but not by year of sample collection [54]. This was corroborated by a Brazilian study [56]. However, it was in contrast to other studies from outside the Latin America region that showed rising resistance rates to certain antibiotics over time, especially with regard to levofloxacin resistance [55, 57-60]. Regarding secondary resistance, a large German study of over 5000 strains found this to be also a major problem, especially with reference to fluoroquinolones. In this study, from 2006 onward, a steady annual increase was noted in the level of levofloxacin/ciprofloxacin, and triple resistance (quinolone, clarithromycin, and metronidazole) was noted, peaking in 2011 with 29.1% for fluoroquinolone resistance and 18.6% for triple resistance.