title: Extremely High Prevalence of Metronidazole-Resistant Helicobacter pylori Strains in Mountain People (Karen and Hmong) in Thailand.
abstract: This study aimed to survey the prevalence, patterns of antibiotic resistance, and clinical factors associated with antibiotic resistance in Helicobacter pylori among the Karen and Hmong mountain people of Thailand. We recruited dyspeptic patients in the Maesod district, Tak Province, Thailand. All subjects underwent upper gastrointestinal endoscopy, and three antral gastric biopsies were obtained for rapid urease tests and culture. An epsilometer was used to determine the minimum inhibitory concentrations of amoxicillin (AMX), clarithromycin (CLR), metronidazole (MNZ), levofloxacin (LVX), ciprofloxacin (CIP), and tetracycline (TET). A total of 291 subjects were enrolled; 149 (51.2%) were infected with H. pylori. Helicobacter pylori infection was present in 47.1% of Thai, 51.7% of Karen, and 58.7% of Hmong subjects. Antibiotic resistance was present in 75.8% including AMX (0.8%), TET (0%), CLR (5.6%), MNZ (71.8%), CIP (19.4%), LVX (19.4%), and multidrug resistance in 21.8%. Karen subjects had the highest prevalence of MNZ resistance (84.6%), and Hmong subjects had the highest prevalence of fluoroquinolone (27.3%) and multidrug (34.1%) resistance. MNZ plus fluoroquinolone (14.5%) was the most common multidrug resistance. There was no association between clinical factors and antibiotic resistance. MNZ resistance was prevalent, whereas fluoroquinolone- and multidrug-resistant H. pylori infections are important problems in mountain people of Thailand.
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand vilaichone@hotmail.co.th yyamaoka@bcm.edu.
authors.forename: Ratha-korn
authors.initials: RK
authors.lastname: Vilaichone
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand.
authors.forename: Thawee
authors.initials: T
authors.lastname: Ratanachu-Ek
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand.
authors.forename: Pornpen
authors.initials: P
authors.lastname: Gamnarai
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand.
authors.forename: Supakarn
authors.initials: S
authors.lastname: Chaithongrat
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand.
authors.forename: Tomahisa
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand vilaichone@hotmail.co.th yyamaoka@bcm.edu.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Biochemistry, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand; Division of Gastroenterology, Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan; Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Gastrointestinal & Liver Center, Bangkok Hospital Medical Center (BMC), Bangkok, Thailand; National Gastric Cancer and Helicobacter pylori Research Center, Bangkok, Thailand.
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D024881:Drug Resistance, Bacterial; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole