Eradication of Helicobacter pylori.

PURPOSE

To critically review current indications and therapies for Helicobacter pylori eradication.

DATA IDENTIFICATION

Studies selected for this review were identified from Medline and a manual search of the literature.

RESULTS OF DATA ANALYSIS

The clearest indication for H. pylori eradication is in the treatment of H. pylori-positive duodenal and gastric ulcer since eradication of the infection prevents ulcer relapse, effectively curing the disease. The use of anti-H. pylori therapy in non-ulcer dyspepsia remains controversial and further studies are required. Despite strong circumstantial evidence linking H. pylori and gastric cancer, it is premature to advocate H. pylori therapy for primary prevention of neoplasia. Triple therapy (bismuth, metronidazole, tetracycline) can eradicate H. pylori in over 90% of cases but this multidrug regimen is not ideal because of side effects, possible non-compliance and doubtful efficacy against metronidazole-resistant infection. Proton-pump inhibitor-antibiotic combinations are a promising alternative to triple therapy with few side effects and good compliance, but there is uncertainty about the most effective combination. H. pylori reinfection after successful eradication is unusual (< 1% per year).

CONCLUSIONS

H. pylori eradication is now the treatment of choice in H. pylori-positive peptic ulcer disease. The search continues for the ideal H. pylori treatment regimen which will combine high efficacy, safety and patient acceptability, with low cost.