Treatment of Helicobacter pylori infection with intra-gastric violet light phototherapy: a pilot clinical trial.

For the most part, eradication of Helicobacter infection is a routine expectation after the appropriate antibiotic course is given. Sometimes, however, because of patient non-compliance, resistant strains, or patient allergies, we are faced with the problem of recurrent resistant Helicobacter infection. This paper offers a radically different approach to Helicobacter eradication therapy, which may be useful as adjunct therapy in patients who fail conventional eradication protocols. This was a pilot study, and the feasibility and practicality of applying this method of bacterial eradication to a wider population remains to be shown. I find it very exciting because it offers an entirely new target to be exploited for therapy.

Helicobacter infection is the leading cause of gastritis, gastric and duodenal ulcer disease, and gastric cancer. Helicobacter pylori is a class 1 carcinogen, and the recommendation is to eliminate the bacteria when they are detected. The current treatment for bacterial eradication is a combination of acid suppression and antibiotics over 7 to 14 days (depending on the country). The regimens have significant side effects, which many patients cannot tolerate. Even with adequate therapy, eradication rates vary. A serious concern is the selection for resistant organisms, which then make eradication using conventional therapies unlikely. Here, the investigators introduce us to a method to safely and effectively deliver violet light therapy to the entire stomach during a single endoscopy setting. They used intragastric ultraviolet light to dramatically reduce the Helicobacter pylori bacterial load within the gastric mucosa, with reductions as high as 97%. While not complete, reduction of bacterial numbers of this magnitude may allow conventional therapies to successfully eradicate remaining bacteria. This is a pilot study, and many aspects of the technique can likely be improved upon. These potential improvements include devices which are better tolerated, more evenly distribute light, and possibly decrease the treatment time. Despite the preliminary nature of this study, it offers a new and novel method for the treatment of recurrent and resistant Helicobacter infection.