title: High Fluoroquinolone Resistant Strains of Helicobacter pylori in the Golden triangle
abstract: Background and aims: Helicobacter pylori (H. pylori) infections, associated with fatal GI diseases such as gastric
  cancer and MALT lymphoma, remain a major health problem in ASEAN countries. The Golden triangle has long been
  known as one of Asia’s main opium-producing areas. There have been no prior studies of H. pylori infection in this area.
  The major objectives of this project were therefore to establish prevalence, antibiotic resistance patterns and associated
  predictive in the Golden triangle. Methods: We recruited dyspeptic patients in Chiang khong and Chiang saen districts,
  Chiangrai province of Thailand. All subjects underwent gastroscopy, and 3 antral gastric biopsies were collected for
  rapid urease tests and H. pylori culture. E-tests were used to evaluate the MICs for metronidazole (MNZ), levofloxacin
  (LVX), ciprofloxacin (CIP), amoxicillin(AMX), tetracycline (TET) and clarithromycin (CLR). Results: Total of 148
  patients was included. H. pylori infection was present in 36.3%(37/102) of Chiang khong and 34.8 % (16/46) of Chiang
  saen subjects and the overall H. pylori infection rate was 35.8% (53/148). Antibiotic resistance was demonstrated in
  44%, including 2% for CLR and 26% for MNZ, whereas fluoroquinolone resistance was demonstrated to be as high
  as 25% in Chiang khong. Multi-drug resistant H. pylori was detected in 4%. There was no AMX and TET resistance
  in this study. The prevalence of CLR resistance on a background of gastritis was significantly higher than peptic ulcer
  disease in the golden triangle area (100%vs 0%: P= 0.04). Conclusions: H. pylori remains a common infection in the
  Golden triangle. MNZ resistance appears to be high, whereas fluoroquinolone resistance is prevalent and is becoming
  a significant problem in this area. Diagnosis of gastritis might be a predictor of CLR resistance in the Golden triangle.
  H. pylori eradication with an appropriate regimen by using the local antibiotic resistant pattern is a key important tool
  to reduce H. pylori associated GI diseases in this particular part of the world.
authors.affiliation: Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Pathumthani, Thailand|National Gastric Cancer and Gastrointestinal Diseases Research Center, Pathumthani, Thailand. Email:Vilaichone@hotmail.co.th
authors.forename: Ratha Korn
authors.initials: RK
authors.lastname: Vilaichone
authors.forename: Thawee
authors.initials: T
authors.lastname: Ratanachu ek
authors.forename: Pornpen
authors.initials: P
authors.lastname: Gamnarai
authors.forename: Phawinee
authors.initials: P
authors.lastname: Subsomwong
authors.forename: Tomahisa
authors.initials: T
authors.lastname: Uchida
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
keywords: Helicobacter pylori; antibiotic resistance; Golden triangle