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Hi there, this is Barry Marshall coming to you this morning from the H. pylori
research lab in Perth Western Australia at The University of Western Australia
and my first slide is just to show you a photograph of my colleagues who work
in the H. pylori Research Lab
and you can find our website
at hpylori.com.au
and of course I have quite a few
interesting websites helico.com
helicobacter.com
and even my own personal website barryjmarshall.com which you can find
if you do a search anytime
but to wind-up the conference for you
I thought I'd like to talk about important
issues with Helicobacter pylori right now
which might be not
addressed in some of the conferences
and then perhaps talk a little bit about the future and I'll tell you what I am doing
here at the University of Western Australia
so firstly in my next slide, I just make a couple points about diagnosis
you know in Western Australia we use all the available tests, so
you cant say one test is going to suit every person
we use carbon 14 breath test, we use the same one as the United States
PYtest, it's called
and I developed that in the US when I used to work there in the 90s
we also use serology. The advantage of serology is very sensitive so you can
exclude H. pylori if it is negative
and the carbon 14 breath test is very specific
so by combining the two you have almost a 100% accurate diagnosis
of H. pylori
of course you could use a carbon 13 breath test
and to a lesser degree not quite as accurate you could use a stool test
as a definite proof of helicobacter pylori infection
in Western Australia, we recommend that you always followup to patients after
treatment you will not not how accurate your
diagnosis is
you will not know
how successful your treatment is unless you follow up all your patients after treatment
and in every country if we find different patents of antibiotic resistance
so you cant necessarily rely on someone else's data
and assumed that a certain treatments is going to be successful in your area so i
encourage you
to use a definitive test proof or eradication with a breath test
a stool test or if you haven't got those or maybe even
endoscopy biopsy and in some patients
dont be trapped into using polymerase chain reaction. I know a lot of people
are writing papers about polymerase chain reaction as a diagnosis
but in my opinion polymerase chain reaction
alone is not to be recommended. It seems to produce a lot of false-positive
results so it's not properly validated
against gold standard such as culture
the treatment I'd say just remember that most treatment failures are cause
de-novo
resistance that's resistance the develops to Clarithromycin and Metronidazole
during the treatment
so although
resistance in the population to say Clarithromycin and macrolides are important
you should be aware that a lot of resistance does develop
during the treatments. So after your first treatment, you're going to use a
different combination of drugs
there is good news and we've just published a paper about this which I will show you a slide
that salvage regimens can cure more than 90% of patients
so it tell your patients and and doctors to
remain enthusiastic after treatment failures because
the second or third treatment is still very very successful and in Western Australia
in our recent paper, we found nearly 95% cure rate
even in patients who are alleged penicillin
so we're very optimistic that we tell patients don't be depressed when
the treatment fails
so in the next slide
you can see l strategies of treatments the first one of course would be
the standard maastricht treatment
proton pump inhibitor, amoxicillin and metronidazole. or
proton pump inhibitor, amoxicillin and clarithromycin
and in Western Australia, we give those for 7 days
and the treatment has a cure rate of about 85%
people who are allergic to penicillin of course can PPI
Clarithromycin and Metronidazole together which was Frank Bazzoli
original treatment
however when patients fail that treatment
well even without doing culture sensitivity test, she could go on to get a
treatment which we called PARC
Proton pump inhibitor
Amoxicillin
Rifabutin
and Ciprofloxacin. You could use any
quinolones, instead of Ciprofloxacin, you could use levofloxacin, whichever is
less expensive
but if you use a high dosage of proton pump inhibitor and helps any other works
and in our combinations, which is a kind of a sequential therapy
we give you Amoxicillin and the PPI for 10 days and we only give the
Rifabutin
and the Ciprofloxacin for the last 5 days for the treatment
and that saves a lot expense for the patient and in that treatment, we have a
cure rate
of about 95%. so it is quite a good treatment
of course if the patient is allergic to penicillin you're just going to replace
the Amoxicillin with bismuth. But anyway, have a read of our paper. It's in
Alimentary Pharmacology & Therapeutics August 2012
it's called Helicobacter pylori eradication
in western australia
using novel quadruple therapy combinations
and that treatment results in approximately 300 patients
so what about the future. I've got a few ideas for the future as I would like to see
people doing more research especially in South America
you need novel new treatments for H. pylori
new formulations of all antibiotics. So keep experimenting on those
different combinations
and you'll save your patience a lot of expense and probably come up with some
really interesting new treatments I really think there're still plenty of work
to be done evaluating bismuth
at in combinations with antibiotics
secondly, I hope that there are some natural products some
foods
or herbs
that can be used to inhibit H. pylori. A lot of people
very interested in that
and it could be used by itself maybe
or could be used to supplement an antibiotic treatment for H. pylori treatment and i think we're
going to see some interesting results in those kinds of studies in the future
and of course there is probiotics. Already a couple of
probiotics are on the market around the world to help suppress
H. pylori
but i would like to see stronger
probiotics enhanced probiotics in the future
now finally there are perhaps useful adaptations of H. pylori
so in my lab and in my company ONDEK. I would show you a slide in the second
we are evaluating helicobacter pylori is a vaccine delivery system
secondly
there's evidence that H. pylori can be used for immuno modulation and I
that there will be some publications from my lab
on that area very soon
and finally you theoretically you could deliver of small amounts of peptides
hormones and things
via H. pylori into the guy. maybe cytokines and maybe drugs
into the portal venous system through the gut wall
so finally, I just show you
the idea that we're working in my research company called ONDEK
biologic delivery systems and this is the concept what if pylori, live
H. pylori could be given to people to carry a vaccine and people
could be vaccinated with that single dose of H. pylori and carry
vaccination strain into your gut
the days, weeks
months or even permanently depending on which strain you chose and there is
evidence that a lot of H. pylori strains
do not cause many symptoms by themselves so they could be useful
to carry something else into the body
and potentially vaccines for
the common things such as tetanus, rubella
could be used in new pandemics, eg: SARS
bird flu and they might be the very difficult vaccinations could even
be attempted
well I guess we could dream of a vaccine for malaria hepatitis c
*** and even tuberculosis carried into the body by H. pylori
so I hope we'll see those developments on the next twenty of thirty years
and that you can help me
on this journey. Thank you.