Molecular characterization, antibiotic resistance profiling, and therapeutic evolution of Artemisia extract against Helicobacter pylori isolated from ulcerative colitis patients in Iraq

Background: Ulcerative colitis is a long-term inflammatory bowel disease with many causes. Helicobacter pylori infection may contribute to disease progression. This study sought to characterize H. pylori isolates from UC patients, ascertain their antibiotic resistance profiles, and assess the therapeutic potential of Artemisia annua extract as an alternative treatment. Methods: A cross-sectional study was executed from July 2024 to April 2025, including 132 biopsy samples from UC patients. H. pylori isolates were identified using polymerase chain reaction (PCR) targeting the 16S rRNA and CagA virulence genes. Antibiotic susceptibility was assessed by standard methods, and the antimicrobial efficacy of A. annua extract was evaluated at various concentrations. Results: Thirteen H. pylori isolates (9.85%) were successfully recovered from the 132 biopsy samples. All isolates (100%) tested positive for the 16S rRNA gene, and 92.3% tested positive for the CagA gene. High antibiotic resistance rates were observed: 92.3% of isolates were resistant to amoxicillin/clavulanic acid, clarithromycin, and trimethoprim–sulfamethoxazole, while 84.6% were resistant to metronidazole and gentamicin. Conversely, notable sensitivity was found to cefoxitin, ceftazidime, piperacillin/tazobactam, and imipenem. The A. annua extract had strong antimicrobial activity, killing all isolates at 40 mg/ml within 480 minutes of being exposed. Conclusions: Although the isolated H. pylori strains showed high resistance levels, the small sample size (n = 13) limits the generalizability of these findings. Thus, the observed resistance patterns apply to the studied isolates only. Nevertheless, A. annua extract showed promising antibacterial activity, indicating potential as a complementary therapy against H. pylori in UC. Larger studies are needed to confirm these results.