Comparative molecular profiling of Helicobacter pylori infection and antibiotic genotypic resistance in paired gastric mucosa, gastric juice, and stool samples

作者：J. Cheng, Chanjuan Fan, Xiaolin Zhao, Zhen Li, Dongling Xie, Yong Cai, Kun Huang, Mengyuan Yang, Hui Wang · 发表于：Scientific Reports · 年份：2025 · DOI：10.1038/s41598-025-32968-x · 被引用次数：2 · 研究领域：Helicobacter pylori-related gastroenterology studies、Gastric Cancer Management and Outcomes、Clostridium difficile and Clostridium perfringens research

Increasing antibiotic resistance in Helicobacter pylori ( H. pylori ) is undermining empirical eradication therapies. Non-invasive methods for resistance profiling are urgently needed to guide precision treatment. This study aimed to compare the performance of paired gastric juice and stool samples against gastric mucosa for the detection of H. pylori infection and genotypic resistance to clarithromycin and levofloxacin. In this prospective study, patients with H. pylori infection confirmed through positive 13 C/ 14 C-urea breath test and histology (Warthin-Starry staining) provided matched gastric mucosal biopsies, gastric juice, and stool samples. Genotypic resistance to clarithromycin and levofloxacin was assessed via commercial quantitative PCR. Performance of gastric juice and stool samples were compared against gastric mucosa as the reference standard using sensitivity, specificity, predictive, and Cohen’s kappa values. Among 218 patients with confirmed H. pylori infection, gastric mucosa identified clarithromycin resistance in 56.9% and levofloxacin resistance in 33.0%. For detecting infection, gastric juice achieved higher sensitivity (97.6% vs. 91.3%, P = 0.003) and specificity (50.0% vs. 30.0%), with stronger reference agreement (kappa = 0.476 vs. kappa = 0.025). In resistance genes profiling, gastric juice exhibited superior sensitivity for both clarithromycin (87.1% vs. 72.6%, P = 0.001) and levofloxacin (70.8% vs. 61.1%, P = 0.049), while maintaining high specifi...