Introduction: Helicobacter pylori eradication is increasingly challenged, due to high antibiotic resistance rates in H. pylori and treatment failure. Consequently, new treatment regimens are needed. Probiotic and gastrointestinal bacteria exert anti-H. pylori activity in vivo, thus being potential add-on candidates for future eradication strategies. Methods: In this review we summarized the currently available literature for in vivo inhibition of H. pylori. Included studies address anti-H. pylori effects in mouse and rat models caused by potentially beneficial bacteria. Research on literature was further extended to clinical eradication studies in humans. Results: Several bacterial strains, mainly belonging to the Lactobacillus-genus, inhibited H. pylori in vivo. In animal studies probiotic bacteria and commensals reduced H. pylori colonisation and the inflammatory response. Certain probiotic species lead to a decrease of H. pylori colonisation. However, H. pylori eradication with current probiotic therapy is not obtained. Conclusion: Probiotic and gastrointestinal commensals are beneficial in H. pylori eradication therapy. Their current role is the reduction of adverse events and H. pylori load.

Chronic atrophic gastritis and intestinal metaplasia (IM) are gastric precancerous conditions (GPCs) associated with an increased risk of gastric cancer. Early detection and accurate characterization of GPC are therefore crucial for risk stratification and the implementation of preventive strategies. In the absence of clear mucosal changes observed through white-light imaging (WLI) or virtual chromoendoscopy, endocytoscopy can help unveil the presence of GPC by enabling in vivo assessment of nuclear and cellular structures at ultra-high magnification. Endocytoscopy is typically performed using WLI following dye-based staining of the mucosa. In this case, we demonstrate that combining endocytoscopy with the texture and color enhancement imaging (TXI) mode substantially improves the assessment of the gastric mucosa. In a 61-year-old man undergoing esophagogastroduodenoscopy, WLI showed multifocal erythema in the stomach, without clearly visible lesions on either WLI or narrow-band imaging. Conventional endocytoscopy revealed multiple small spots of IM with characteristic changes in glandular structures, which were even more evident when using the TXI mode. Histological analysis of targeted biopsies confirmed small foci of IM in both the antrum and corpus. The patient was enrolled in a surveillance program because of his clinical background. The combination of endocytoscopy with the TXI mode significantly enhances the delineation of mucosal and cellular architecture, supporting a more accurate optical diagnosis.

Background: The miniaturization of ureterorenoscopes increasingly enables atraumatic primary ureteroscopy, without ureteral dilation or presenting. This study aims to evaluate the feasibility and safety of primary ureteroscopy using the HU30M (6.3 Fr, HugeMed, Shenzhen HugeMed Medical Technical Development Co., Ltd., Shenzhen, China), the smallest currently available ureteroscope. Methods: We analyzed consecutive patients in whom primary ureteroscopy using the HU30M was performed or attempted, using prospectively collected in-hospital and 30-day follow-up data for retrospective evaluation. The primary outcome was the success rate of primary ostial intubation. Secondary outcomes included the stone-free rate (SFR) in patients with urolithiasis, incidence of in-hospital complications (Clavien–Dindo classification) and 30-day emergency readmission. Additionally, we conducted a propensity score-matched comparative analysis of the HU30M versus a contemporary 7.5 Fr digital single-use ureteroscope (PUSEN PU3033AH, Zhuhai Pusen Medical Technology Co., Ltd., Jinhua, China). Results: Between January and April 2025, primary ureteroscopy using the HU30M was performed or attempted in 34 patients, including four bilateral procedures. Primary ureteroscopy was defined as ureteroscopic access without prior stenting or dilation. Indications were diagnostic evaluation in 15 patients (44%), uretreroscopic stone treatment in 10 patients (29%) and endoscopic combined intrarenal surgery (ECIRS) in 9 patients (27%). Successful primary ostial intubation was achieved in 36 of 38 renal units (95%). Among urolithiasis cases, SFR was 17/19 (90%) in-hospital complications were limited to postoperative fever in two patients (6%) and no procedure-related 30-day emergency readmission occurred. In matched analyses, HU30M demonstrated significantly shorter operative times compared with the 7.5 Fr ureteroscope, while postoperative hemoglobin drop, inflammatory parameters and renal function were comparable. Conclusions: Primary ureteroscopy with HU30M is feasible and safe across diverse indications, achieving high success of atraumatic ostial access. Comparative analyses suggest procedural efficiency advantages and overall safety comparable to the current digital single-use ureteroscope standard.

Introduction: Helicobacter pylori is a highly prevalent pathogen affecting approximately 50% of the world population, causing chronic gastritis and subsequently adenocarcinoma. Antibiotic resistance rates in H. pylori are increasing, thus demanding alternative treatment options. Some beneficial bacteria, including probiotics and gastrointestinal commensals, were shown to inhibit H. pylori growth, viability, and initial attachment to the gastric epithelium. Methods: In this review, we systematically summarized the currently available literature for in vitro inhibition of H. pylori through beneficial bacteria from the Lactobacillales order. We performed research on PubMed and Google Scholar in accordance with the PRISMA guidelines. Results: A multitude of species were shown to possess anti-H. pylori activity, although the majority of investigated bacteria belonged to only one bacterial genus: Lactobacillus. Anti-H. pylori activity was mediated through transcriptional modulation of virulence factors, competition for binding sites, the induction of a dormancy state of H. pylori, and the secretion of anti-H. pylori compounds. Conclusion: Many bacterial compounds that show probiotic properties are capable of inhibiting H. pylori in in vitro experiments. However, a huge variety of test methods to detect anti-H. pylori effects demands standardization.

Background and Aims: Helicobacter pylori (H. pylori) is an obligate pathogen affecting approximately 50% of the world population. With rising antibiotic resistance rates in H. pylori and increasing dropout rates from eradication therapies due to adverse effects, H. pylori treatment is increasingly challenged. Saccharomyces boulardii (S. boulardii), a probiotic yeast, was shown to reduce infection- and therapy-associated adverse events and increase H. pylori eradication rates. Our meta-analysis summarizes the beneficial effects of S. boulardii supplementation on H. pylori eradication and therapy-associated side effects. Methods: We conducted a systematic literature review and meta-analysis on PubMed, Cochrane Library, and Google Scholar from inception (1993) to October 24, 2024. Research and analysis were performed in accordance with the ‘Preferred Reporting Items of Systematic Reviews and Meta-Analyses’ (PRISMA) guidelines. Results: The supplementation of S. boulardii to H. pylori therapy caused a significant increase in overall eradication rates and a significant decrease in overall diarrhea, nausea, and epigastric pain rates. Subgroup analysis showed that S. boulardii supplementation also decreased taste disturbance rates in patients receiving triple therapy. Symptoms, such as meteorism, vomiting, and urticaria/rash, were not significantly reduced through the supplementation of S. boulardii. Conclusions: S. boulardii was shown to be an effective add-on to H. pylori eradication therapy. Significant improvements in eradication and frequency of the most common adverse events were observed. However, more studies are needed to validate those findings for patients receiving bismuth-based quadruple therapy.

Early detection of gastric preneoplastic lesions (GPL) is essential to prevent gastric cancer. Endocytoscopy may improve optical diagnosis through in vivo histologic assessment of mucosa. We assessed diagnostic performance of endocytoscopy and interobserver agreement for GPL diagnosis compared with reference histopathology.Eighty gastric areas (36 antrum, 44 corpus) from 25 prospectively recruited patients were assessed by endocytoscopy and classified as non-preneoplastic, preneoplastic, or dysplastic/neoplastic by an expert endoscopist. Targeted biopsies from each area served for histopathological assessment. High-quality images/videos were recorded for independent review by three additional observers (1 expert, 2 non-experts), blinded to endoscopic and histological findings.Histologically, 25 gastric areas (31.3%) showed GPL, 14 (17.5%) atrophic gastritis, and 11 (13.8%) intestinal metaplasia. Gastric cancer was found in three cases (3.8%). Combined sensitivity, specificity, and accuracy for endocytoscopic diagnosis of GPL or dysplasia were 89.3%, 94.2%, and 92.5% among expert endocytoscopists and 85.7%, 68.3%, and 74.4%, among non-experts, respectively. Interobserver agreement was substantial (κ-value 0.79) between experts and fair (κ-value 0.30) between non-experts.New-generation endocytoscopy has potential to identify GPL with high diagnostic accuracy, reliability, and reproducibility. Training and clinical experience with endocytoscopy are required to maximize diagnostic performance.