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Helicobacter pylori is a pathogenic microorganism that successfully inhabits the human stomach, colonizing it by producing several virulence factors responsible for preventing host self-defense mechanisms. The adherence mechanism to gastric mucosal tissue is one of the most important processes for effective colonization in the stomach. The blood group antigen-binding adhesion (BabA) and sialic acid-binding adherence (SabA) are two H. pylori outer membrane proteins able to interact with antigens in the gastroduodenal tract. H. pylori possesses several mechanisms to control the regulation of both BabA and SabA in either the transcriptional or translational level. BabA is believed to be the most important protein in the early infection phase due to its ability to interact with various Lewis antigens, whereas SabA interaction with sialylated Lewis antigens may prove important for the adherence process in the inflamed gastric mucosal tissue in the ongoing-infection phase. The adherence mechanisms of BabA and SabA allow H. pylori to anchor in the gastric mucosa and begin the colonization process.

Helicobacter pylori infection is a severe global health problem that is closely associated with acid-related diseases and gastric malignancies. Eradicating H. pylori is strongly recommended for lowering peptic ulcer recurrence and preventing gastric cancer. The current approved H. pylori eradication regimen combines a proton pump inhibitor (PPI) with two antibiotics. Unfortunately, this regimen failed to meet expectations mostly due to antibiotic resistance and insufficient gastric acid suppression. Vonoprazan, a novel potassium-competitive acid blocker, showed promising results as a PPI replacement. Vonoprazan inhibits gastric acid secretion by acting as a reversible competitive inhibitor against potassium ions and forming disulfide bonds with the cysteine molecule of H+/K+-ATPase. Vonoprazan has superior pharmacological characteristics over PPI, such as no requirement for acid activation, stability in acidic conditions, shorter optimum acid suppression period, and resistance to cytochrome P (CYP)2C19 polymorphism. Several comparative randomized controlled trials and meta-analyses revealed the superiority of vonoprazan in eradicating H. pylori, notably the resistant strains. The adverse effect caused by vonoprazan is long-term acid suppression that may induce elevated gastrin serum, hypochlorhydria, and malabsorption. All vonoprazan studies have only been conducted in Japan. Further studies outside Japan are necessary for universally conclusive results.

Background Gastric cancer remains the fourth leading cause of cancer-related death worldwide. Significant number of gastric cancer patients presented with bleeding. Objective This study aimed to identify risk factors and overall survival rates of bleeding gastric cancer patients. Methods This retrospective cohort study was conducted between 2007–2022 at tertiary care center in Thailand. Clinical information, endoscopic findings and histological type were extensively reviewed and were compared between bleeders and non-bleeders. Patients were monitored for at least 5 years. Results There were 20,981 patients who underwent upper gastrointestinal endoscopy during study period. Total of 201 gastric cancer patients were included in this study, 21 were excluded due to incomplete medical records. 180 gastric cancer patients were included with mean age of 60.5±14.3 years. There were 65 (36.1%) patients with gastrointestinal bleeding. Hypertension and chronic kidney disease were significantly more common in bleeders than non-bleeders (43.1% vs 23.5%, OR2.51, 95%CI 1.14.-5.52, p = 0.022; and 16.9% vs 5.2%, OR2.00, 95%CI 1.56–6.63, p = 0.025, respectively). current H. pylori infection was also significantly more common in bleeders than non-bleeders (84.6% vs. 55.7%, OR 4.39, 95%CI 1.90–10.12, p<0.001). Median overall survival of bleeders was significantly lower than non-bleeders (7±0.93 vs 10±2.10 months, p = 0.001). Conclusions Bleeding gastric cancer was not an uncommon condition. Majority of patients presented at advanced stage with grave prognosis. Male gender, hypertension, chronic kidney disease, and current H. pylori infection were reliable predictors for bleeding. Early diagnosis and prompt treatment are the key to improve clinical outcome.

Immunological non-response (INR) to antiretroviral therapy (ART) is a critical concern for PLHIV, characterized by inadequate CD4 T-cell recovery despite virological suppression. This retrospective study analyzed medical records of virologically suppressed adult PLHIV on ART (2004-2024) at two hospitals in Surabaya, Indonesia, using four operational categories to identify clinical and demographic determinants of INR. Patients were classified as immunological responders (IRs) or non-responders (INRs) based on four definitions: INR1 (CD4 gain < 100 cells/mm ), INR2 (CD4 < 350 cells/mm ), INR3 (meeting of either criterion), and INR4 (meeting of both criteria). Of 464 patients, 382 were analyzed. Baseline CD4 < 200 cells/mm strongly predicted INR2 (aOR = 5.60, 95% CI: 2.95-10.62) and INR3 (aOR = 4.46, 95% CI: 2.39-8.29), while anal sexual transmission was protective against INR2 (aOR = 0.42, 95% CI: 0.19-0.92) and INR3 (aOR = 0.41, 95% CI: 0.19-0.89). By month 12, IR groups had over 350 CD4 cells/mm , with faster recovery slopes in months 0-6 (IR: >20 vs. INR: <10 cells/mm /month). INR1 and INR4 had flat or negative slopes at 12-24 months, while IR groups had positive slopes. Baseline CD4 was the strongest INR predictor, suggesting the value of early ART and individualized care for Indonesian PLHIV.

IntroductionThe surgical safety checklist (SSC) is designed to improve the safety of surgical procedures, reduce avoidable complications and deaths and foster better communication and collaboration among healthcare providers. Despite the global acceptance of the initiative, there is limited comprehensive research on the challenges, success factors, impact and the role of professional organisations in SSC implementation in Indonesia. This study aimed to explore the implementation of SSC in Indonesia by investigating the challenges, success factors, impact and role of professional organisations in SSC implementation in Indonesia based on the perspective of the surgical team.MethodThis descriptive qualitative study, part of a larger research project, employed purposive sampling to select 13 interview participants from surgical teams across hospitals with varying ownership structures, as well as members of surgical-related professional organisations. Data were collected through in-depth interviews and analysed using thematic analysis.ResultsParticipants acknowledged the positive impact of SSC on patient safety; however, challenges such as compliance issues, teamwork dynamics and unsafe behaviour persisted. Key success factors included strong organisational and policy support at the institutional level, including hospital accreditation, educational programmes, safety and quality committees, regular audits and workload management. However, professional organisations in Indonesia have not played a significant role in promoting SSC.ConclusionEffective SSC implementation strategies must target the micro, meso and macro levels for comprehensive success. Future research should prioritise overcoming barriers and harnessing the influence of professional organisations to standardise SSC practices, ultimately enhancing patient safety across healthcare settings.

ObjectiveTo assess the efficacy, safety and compliance with dual, triple and quadruple therapy first-line regimens for Helicobacter pylori eradication.DesignA systematic review and network meta-analysis (NMA) reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses NMA guidance.Data sourcesPubMed, Cochrane Library, ProQuest and Scopus were searched until 12 October 2025.Eligibility criteriaRandomised controlled trials (RCTs) published in English that measured the eradication rate, adverse events and compliance rates of dual therapy compared with triple or quadruple therapy for H. pylori first-line treatment.Data extraction and synthesisData extraction and risk-of-bias assessment were performed by two independent reviewers. The data were analysed and represented as pooled ORs. Heterogeneity was assessed using meta-regression and trim-and-fill analyses.ResultsPairwise meta-analysis of 56 RCTs showed that dual therapy had no different eradication rates than triple therapy (intention-to-treat (ITT): OR 0.88, 95% CI 0.60 to 1.29; per-protocol (PP): OR 0.76, 95% CI 0.46 to 1.25). Dual therapy outperformed quadruple therapy (OR 1.20, 95% CI 1.04 to 1.39) with fewer adverse events (OR 0.32, 95% CI 0.28 to 0.38) and higher compliance rates (OR: 1.49, 95% CI 1.26 to 1.76). Based on the NMA, RAC-7 has the highest probability of effective treatment for both ITT (P-score=0.9436) and PP (P-score=0.9545).ConclusionDual therapy represents a promising first-line option, demonstrating comparable efficacy and adverse event rates with higher compliance, although triple therapy showed the highest probability of being the most effective first-line regimen in the NMA, followed by quadruple therapy. Further studies in non-Asian populations, along with resistance-guided treatment approaches, are needed to refine global eradication strategies.