Ir para o menu de navegação principal Ir para o conteúdo principal Ir para o rodapé
##common.pageHeaderLogo.altText##

Controle e gestão de riscos para saúde e emergências

v. 28 n. 1 (2026)

Análise do resistoma de Helicobacter pylori na Colômbia

DOI
https://doi.org/10.22267/rus.262801.352
Enviado
junho 7, 2025
Publicado
2026-01-01

Resumo

Introdução: Helicobacter pylori é uma bactéria intimamente associada à gastrite crônica e ao câncer gástrico. Na Colômbia, sua alta prevalência, juntamente com marcantes diferenças geográficas na incidência de câncer gástrico, motivou estudos focados na resistência antimicrobiana dessa bactéria. Objetivo: Caracterizar o resistoma do Helicobacter pylori na Colômbia por meio da análise de estudos fenotípicos e genotípicos, a fim de avaliar os padrões de resistência. Materiais e métodos: Foi realizada uma revisão da literatura em bases de dados científicas, selecionando-se 21 estudos originais. Foram avaliadas mutações em genes associados à resistência e realizada uma análise estatística descritiva utilizando o software R. Resultados: Foram identificadas alta resistência ao metronidazol, resistência variável à claritromicina e tetraciclina, resistência moderada à amoxicilina e levofloxacina e baixa resistência à furazolidona e rifampicina. Conclusão: A alta resistência ao metronidazol o descarta como uma opção confiável de primeira linha. A resistência variável à claritromicina e à tetraciclina exige testes de suscetibilidade regionais. A amoxicilina e a levofloxacina mantêm eficácia moderada, enquanto a furazolidona e a rifampicina se destacam como alternativas promissoras. É essencial implementar testes fenotípicos ou genotípicos antes do tratamento e atualizar as diretrizes empíricas com base na vigilância local.

Referências

  1. Malfertheiner P, Camargo MC, El-Omar E, Liou JM, Peek R, Schulz C, et al. Helicobacter pylori infection. Nat Rev Dis Primers [Internet]. 2023; 9:19. DOI: 10.1038/s41572-023-00431-8
  2. Crowe SE. Helicobacter pylori infection. N Engl J Med [Internet]. 2019; 380(12):1158-1165. DOI: 10.1056/nejmcp1710945
  3. Correa P, Piazuelo MB. The gastric precancerous cascade. J Dig Dis [Internet]. 2012; 13(1):2-9. DOI: 10.1111/j.1751-2980.2011.00550.x
  4. Cheng HC, Yang YJ, Yang HB, Tsai YC, Chang WL, Wu CT, et al. Evolution of the Correa's cascade steps: A long-term endoscopic surveillance among non-ulcer dyspepsia and gastric ulcer after H. pylori eradication. J Formos Med Assoc [Internet]. 2023; 122(5):400-410. DOI: 10.1016/j.jfma.2022.11.008
  5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Infection with Helicobacter pylori. In: Schistosomes, liver flukes and Helicobacter pylori. Lyon (FRA): IARC; 1994. Disponible en: h ps://www.ncbi.nlm.nih.gov/books/NBK487782
  6. Moodley Y, Linz B, Bond RP, Nieuwoudt M, Soodyall H, Schlebusch CM, et al. Age of the association between Helicobacter pylori and man. PLoS Pathog [Internet]. 2012; 8(5):e1002693. DOI: 10.1371/journal.ppat.1002693
  7. Linz B, Balloux F, Moodley Y, Manica A, Liu H, Roumagnac P, et al. An African origin for the intimate association between humans and Helicobacter pylori. Nature [Internet]. 2007; 445(7130):915-918. DOI: 10.1038/nature05562
  8. Guzman KA, Daza AP, Gomez RV, Montenegro LM, Pazos A. Whole-genome sequences of Helicobacter pylori isolated from patients with high risk of gastric cancer in the Andes of Nariño, Colombia. Microbiol Resour Announc [Internet]. 2024; 13(8):e01232-23. DOI: 10.1128/mra.01232-23
  9. Guzmán KA, Pazos A. Helicobacter pylori: Microorganismo patógeno o mutualista en poblaciones colombianas. Univ Salud [Internet]. 2023; 25(1):1-6. DOI: 10.22267/rus.232501.292
  10. Wang H, Zhao M, Shi F, Zheng S, Xiong L, Zheng L. A review of signal pathway induced by virulent protein CagA of Helicobacter pylori. Front Cell Infect Microbiol [Internet]. 2023; 13:1062803. DOI: 10.3389/fcimb.2023.1062803
  11. Al-Ouqaili MTS, Hussein RA, Majeed YH, Al-Marzooq F. Study of vacuolating cytotoxin A (vacA) genotypes of ulcerogenic and non-ulcerogenic strains of Helicobacter pylori and its association with gastric disease. Saudi J Biol Sci [Internet]. 2023; 30(12):103867. DOI: 10.1016/j.sjbs.2023.103867
  12. Yang L, Ying X, Liu S, Lyu G, Xu Z, Zhang X, et al. Gastric cancer: Epidemiology, risk factors and prevention strategies. Chin J Cancer Res [Internet]. 2020; 32(6):695-704. DOI: 10.21147/j.issn.1000-9604.2020.06.03
  13. Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric cancer: Epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int J Mol Sci [Internet]. 2020; 21(11):4012. DOI: 10.3390/ijms21114012
  14. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2024; 74(3):229-263. DOI: 10.3322/caac.21834
  15. Morgan E, Arnold M, Camargo MC, Gini A, Kunzmann AT, Matsuda T, et al. The current and future incidence and mortality of gastric cancer in 185 countries, 2020-40: A population-based modelling study. EClinicalMedicine [Internet]. 2022; 47:101404. DOI: 10.1016/j.eclinm.2022.101404
  16. GBD 2017 Stomach Cancer Collaborators. The global, regional, and national burden of stomach cancer in 195 countries, 1990-2017: A systematic analysis for the Global Burden of Disease study 2017. Lancet Gastroenterol Hepatol [Internet]. 2020; 5(1):42-54. DOI: 10.1016/S2468-1253(19)30328-0
  17. Li Y, Choi H, Leung K, Jiang F, Graham DY, Leung WK. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol [Internet]. 2023; 8(6):553-564. DOI: h ps://doi.org/10.1016/s2468-1253(23)00070-5
  18. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut [Internet]. 2022. DOI: 10.1136/gutjnl-2022-327745
  19. Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut [Internet]. 2017; 66(1):6-30. DOI: 10.1136/gutjnl-2016-312288
  20. Guzman K, Montenegro L, Pazos A. The Helicobacter pylori single nucleotide polymorphisms SNPs associated with multiple therapy resistance in Colombia. Front Microbiol [Internet]. 2023; 14:1198325.
  21. Tshibangu-Kabamba E, Yamaoka Y. Helicobacter pylori infection and antibiotic resistance - from biology to clinical implications. Nat Rev Gastroenterol Hepatol [Internet]. 2021; 18(9):613-629. DOI: 10.1038/s41575-021-00449-x
  22. Liou JM, Jiang XT, Chen CC, Luo JC, Bair MJ, Chen PY, et al. Second-line levofloxacin-based quadruple therapy versus bismuth-based quadruple therapy for Helicobacter pylori eradication: and long-term changes to the gut microbiota and antibiotic resistome: A multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol [Internet]. 2023; 8(3):228-241. DOI: 10.1016/S2468-1253(22)00384-3
  23. Álvarez A, Moncayo JI, Santacruz JJ, Corredor LF, Reinosa E, Martínez JW, et al. Resistencia a metronidazol y claritromicina en aislamientos de Helicobacter pylori de pacientes dispépticos en Colombia. Rev Med Chile [Internet]. 2009; 137(10):1309-1314. DOI: 10.4067/S0034-98872009001000005
  24. Bedoya-Gómez IJ, Alvarez-Aldana A, Moncayo-Ortiz JI, Guaca-González YM, Santacruz-Ibarra JJ, Arturo-Arias BL, et al. Surveillance of the antimicrobial resistance rates of Helicobacter pylori ten years later in the Western Central Region, Colombia. Dig Dis [Internet]. 2020; 38(3):196-203. DOI: 10.1159/000503381
  25. Trespalacios AA, Otero W, Caminos JE, Mercado MM, Ávila J, Rosero LE, et al. Phenotypic and genotypic analysis of clarithromycin-resistant Helicobacter pylori from Bogotá DC, Colombia. J Microbiol [Internet]. 2013; 51(4):448-452. DOI: 10.1007/s12275-013-2465-6
  26. Henao-Riveros SC, Quiroga A, Martínez-Marín JD, Otero-Regino W. Resistencia primaria a la claritromicina en aislamientos de Helicobacter pylori. Rev Colomb Gastroenterol [Internet]. 2009; 24(2):110-114. Disponible en: h p://www.scielo.org.co/scielo.php?script=sci_ar ext&pid=S0120-99572009000200004
  27. Trespalacios AA, Otero Regino W, Mercado Reyes M. Resistencia de Helicobacter pylori a metronidazol, claritromicina y amoxicilina en pacientes colombianos. Rev Colomb Gastroenterol [Internet]. 2010; 25(1):31-38. Disponible en: h p://www.scielo.org.co/scielo.php?script=sci_ar ext&pid=S0120-99572010000100009
  28. Arévalo-Jaimes BV, Rojas-Rengifo DF, Jaramillo CA, de Molano BM, Vera-Chamorro JF, Delgado MP. Genotypic determination of resistance and heteroresistance to clarithromycin in Helicobacter pylori isolates. BMC Infect Dis [Internet]. 2019; 19(1):546. DOI: 10.1186/s12879-019-4178-x
  29. Yepes CA, Rodríguez-Varón A, Ruiz-Morales Á, Ariza B. Resistencia antibiótica del Helicobacter pylori en el Hospital Universitario San Ignacio de Bogotá. Acta Med Colomb [Internet]. 2008; 33(1):11-14. Disponible en: h ps://www.actamedicacolombiana.com/ojs/index.php/actamed/article/view/1746
  30. Acosta CP, Hurtado FA, Trespalacios AA. Determinación de mutaciones de un solo nucleótido en el gen 23S rRNA de Helicobacter pylori relacionadas con resistencia a la claritromicina en una población del departamento del Cauca, Colombia. Biomédica [Internet]. 2014; 34:156-162. DOI: 10.7705/biomedica.v34i0.1649
  31. Roldán IJ, Castaño R, Navas MC. Mutaciones del gen ARN ribosómico 23S de Helicobacter pylori asociadas con resistencia a claritromicina en pacientes atendidos en una unidad de endoscopia de Medellín, Colombia. Biomédica [Internet]. 2019; 39:117-129. DOI: 10.7705/biomedica.v39i4.4377
  32. Figueroa M, Cortés A, Pazos Á, Bravo LE. Sensibilidad in vitro a amoxicilina y claritromicina de Helicobacter pylori obtenido de biopsias gástricas de pacientes en zona de bajo riesgo para cáncer gástrico. Biomédica [Internet]. 2012; 32(1):32-42. DOI: 10.7705/biomedica.v32i1.454
  33. Muñoz AB, Stepanian J, Solano-Gutierrez JS, Vale FF, Trespalacios-Rangel AA. Helicobacter pylori infection in Colombia: Phylogeny, resistome, and virulome. APMIS [Internet]. 2025; 133(2):e70003. DOI: 10.1111/apm.70003
  34. Mannion A, Dzink-Fox J, Shen Z, Piazuelo MB, Wilson KT, Correa P, et al. Helicobacter pylori antimicrobial resistance and gene variants in high- and low-gastric-cancer-risk populations. J Clin Microbiol [Internet]. 2021; 59(5):e03203-20. DOI: 10.1128/JCM.03203-20
  35. Trespalacios-Rangél AA, Otero W, Arévalo-Galvis A, Poutou-Piñales RA, Rimbara E, Graham DY. Surveillance of Levofloxacin Resistance in Helicobacter pylori Isolates in Bogotá-Colombia (2009-2014). PLoS One [Internet]. 2016 Jul 25; 11(7):e0160007. DOI: 10.1371/journal.pone.0160007
  36. Roberts LT, Issa PP, Sinnathamby ES, Granier M, Mayeux H, Eubanks TN, et al. Helicobacter pylori: A review of current treatment options in clinical practice. Life (Basel) [Internet]. 2022; 12(12):2038. DOI: 10.3390/life12122038
  37. Ma a AJ, Zambrano DC, Martínez YC, Fernández FF. Mutaciones puntuales en el dominio transglicosilasa del gen pbp1a en aislados de Helicobacter pylori resistentes a amoxisilina. Rev Gastroenterol Méx [Internet]. 2023; 88(2):100-106. DOI: 10.1016/j.rgmx.2021.05.008
  38. Hernández-Ceruelos A, Romero-Quezada LC, Ruvalcaba-Ledezma JC, López-Contreras L. Therapeutic uses of metronidazole and its side effects: An update. Eur Rev Med Pharmacol Sci [Internet]. 2019; 23:397-401. DOI: 10.26355/eurrev_201901_16788
  39. Henao SC, Otero W, Ángel LA, Martínez JD. Resistencia primaria a metronidazol en pacientes adultos de Bogotá. Rev Colomb Gastroenterol [Internet]. 2009; 24(1):10-15. Disponible en: h p://www.scielo.org.co/scielo.php?script=sci_ar ext&pid=S0120-99572009000100005
  40. Acosta CP, Quiroga AJ, Sierra-Torres CH, Trespalacios AA. Frecuencia de mutaciones de la nitrorreductasa RdxA en Helicobacter pylori para la activación del metronidazol en una población del departamento del Cauca, Colombia. Biomédica [Internet]. 2017; 37(2):191-199. DOI: 10.7705/biomedica.v37i2.3007
  41. Elbaiomy RG, Luo X, Guo R, Deng S, Du M, El-Sappah AH, et al. Antibiotic resistance in Helicobacter pylori: A genetic and physiological perspective. Gut Pathog [Internet]. 2025; 17(1):35. DOI: 10.1186/s13099-025-00704-5
  42. Graham DY, Lee SY. How to Effectively Use Bismuth Quadruple Therapy: The good, the bad, and the ugly. Gastroenterol Clin North Am [Internet]. 2015 Sep; 44(3):537-563. DOI: 10.1016/j.gtc.2015.05.003
  43. Cho JH, Jin SY. Current guidelines for Helicobacter pylori treatment in East Asia 2022: Differences among China, Japan, and South Korea. World J Clin Cases [Internet]. 2022 Jul 6; 10(19):6349-6359. DOI: 10.12998/wjcc.v10.i19.6349
  44. Sun Y, Zhu M, Yue L, Hu W. Multiple Bismuth Quadruple Therapy Containing Tetracyclines Combined with Other Antibiotics and Helicobacter pylori Eradication Therapy. J Clin Med [Internet]. 2022 Nov 28; 11(23):7040. DOI: 10.3390/jcm11237040
  45. Alavinejad P, Nayebi M, Parsi A, Abdelsameea E, Ahmed MH, Hormati A, et al. Levofloxacin+Tetracycline Quadruple Regimen for Eradication of Helicobacter pylori: A Multicenter Multinational Randomized Controlled Trial. Middle East J Dig Dis [Internet]. 2023 Jan; 15(1):12-18. DOI: 10.34172/mejdd.2023.314
  46. Guzman KA, Hidalgo A, Pazos AJ. Point mutations in furazolidone and rifampicin resistance genes in Helicobacter pylori strains from Colombia. Antibiotics (Basel) [Internet]. 2024; 13(7):643. DOI: 10.3390/antibiotics13070643
  47. Lopera B, Lemos K, Atehortúa JD, Valencia-Cárdenas J, Vélez-Gómez D, Martinez A, et al. Furazolidone susceptibility of Helicobacter pylori isolated from patients with gastroduodenal diseases in Colombia. Rev Inst Med Trop Sao Paulo [Internet]. 2025; 67:e20. DOI: 10.1590/S1678-9946202567020
  48. Barreda-Costa CS, Piccini-Larco JR, Chu-Revollar LD, Salazar-Muente F, Barriga-Briceño JA, Herrera-Alzamora MA. Tratamiento cuádruple con doxiciclina, furazolidona, bismuto e inhibidor de bomba de protones sigue siendo efectivo frente al Helicobacter pylori en nuestra población. Rev Gastroenterol Perú [Internet]. 2023; 43(2):116-119. DOI: 10.47892/rgp.2023.432.1458
  49. Prasad R, Gupta N, Banka A. Multidrug-resistant tuberculosis/rifampicin-resistant tuberculosis: Principles of management. Lung India [Internet]. 2018; 35(1):78-81. DOI: 10.4103/lungindia.lungindia_98_17
  50. Zuluaga-Arbeláez N, Sierra EC, Guevara LG, Pérez-Viana S. Estrategias terapéuticas para Helicobacter pylori en Colombia. CES medicina [Internet]. 2021; 35(3):244-256. DOI: 10.21615/cesmedicina.6224
  51. Montes A, Santacruz A, Sañudo J, Pazos A. Efecto in vitro de Lactobacillus casei subsp rhamnosus sobre el crecimiento de un aislado de Helicobacter pylori. Universidad y Salud [Internet]. 2003; 1(4):5-12. Disponible en: h ps://revistas.udenar.edu.co/index.php/usalud/article/view/302
  52. Homan M, Orel R. Are probiotics useful in Helicobacter pylori eradication? World J Gastroenterol [Internet]. 2015 Oct 7; 21(37):10644-10653. DOI: 10.3748/wjg.v21.i37.10644
  53. Burbano-Vasquez DM, López-Miramag CD, Maigual-Enríquez LC, Legarda-Nastul YB, Arango-Bedoya O, Hurtado-Benavides AMH, et al. Estudio de biomoléculas con actividad inhibitoria sobre helicobacter pylori en pacientes colombianos con alto riesgo de cáncer gástrico. NOVA [Internet]. 2025; 23(44):35-49. DOI: 10.22490/24629448.9981
  54. Pazos AJ, Guzman K. Sa1194: Evolution of Helicobacter pylori and its relationship with mortality in colombian popul+ations with different risk of gastric cancer. Gastroenterology [Internet]. 2025; 169(Suppl 1):S-393. DOI: 10.1016/S0016-5085(25)01844-X
  55. Tamariz-Ortiz JH, Capcha-Mendoza R, Palomino-Cadenas EJ, Aguilar-Olano J. Actividad antibacteriana de la Sangre de Grado (Croton lechleri) frente al Helicobacter pylori. Rev Med Hered [Internet]. 2003; 14(2):81-88. Disponible en: h p://www.scielo.org.pe/scielo.php?script=sci_ar ext&pid=S1018-130X2003000200008
  56. Ramírez G. Sangre de drago (Croton lechleri Muell. Arg). Natura Medicatrix [Internet]. 2003; 21(4):213-217. Disponible en: h ps://dialnet.unirioja.es/servlet/articulo?codigo=4956317
  57. Tian YY, Yang AL, Chen XN, Li JQ, Tang LM, Huang HM, et al. Research progress on anti-tumor effect of Chinese Dragon’s blood. Zhongguo Zhong Yao Za Zhi [Internet]. 2021; 46(8):2037-2044. Disponible en: h ps://pubmed.ncbi.nlm.nih.gov/33982517
  58. Gupta D, Gupta RK. Bioprotective properties of Dragon’s blood resin: In vitro evaluation of antioxidant activity and antimicrobial activity. BMC Complement Altern Med [Internet]. 2011; 11:13. DOI: 10.1186/1472-6882-11-13

Downloads

Não há dados estatísticos.