The role of acid inhibition in the treatment of Helicobacter pylori infection.

The recognition that Helicobacter pylori is a causal factor in the development of most peptic ulcers (and may play a role in the pathogenesis of gastric cancer) has provided an impetus to the search for a suitable regimen that will eradicate the organism. Combinations of antibiotics with bismuth (triple therapy) eradicate the organism in around 90% of cases, but the regimens are complicated, and poor compliance and significant side effects are frequently seen. The observation that omeprazole in combination with a single antibiotic provides eradication rates of over 80% is an important advance, as this combination is a simple regimen and is well tolerated. In this article, the role of omeprazole in eradication therapy is discussed, the published data are reviewed and hypotheses relating to the mode of action of omeprazole are presented. Although the optimum therapy has yet to be identified, acceptable results should be obtained by using omeprazole, 40 mg twice daily, plus amoxycillin, 500 mg four times daily, for 2 weeks.