Control and management of H. Pylori - the state of the art

The recognition of Helicobacter pylori as a human pathogen was one of the most important discoveries in gastroenterology in recent decades. It is the primary cause of a range of gastric conditions, in particular chronic gastritis, peptic ulcer, gastric cancer, and gastric MALT lymphoma. H. pylori eradication can in part cure and prevent these conditions. Clinical therapy requires combination treatment. This is usually done by means of profound acid suppression and multiple antimicrobial drugs given for 7-14 days. Standard antimicrobials are bismuth compounds, amoxicillin, metronidazole, clarithromycin, and tetracyclin. Salvage antimicrobials are in particular levofloxacin, rifabutin, furazolidone, doxycycline, and nitrozoxanide. These are usually given in combinations of 3 (triple therapies) or 4 drugs (quadruple therapies). With respect to triple therapies, a range of studies have taught that double dose PPI, and longer treatment increase eradication rates, while probiotics may decrease side effects. Quadruple therapies are either bismuth-based (combined with 3 antimicrobials or a PPI plus two antimicrobials), or non- bismuth-based. The latter typically consist of a PPI with three antimicrobials. Depending on the dosing schedule, the latter are categorized as sequential, hybrid, and concomitant treatments. With the widespread occurrence of antimicrobial resistance, treatment in most parts of the world is shifting towards quadruple regimens as primary treatment for H. pylori infection, with the aim to achieve a > 90% eradication rate with the first treatment. The presentation will discuss the recent state-of-art in control and management of H. pylori infection and H. pylori -related clinical conditions, with focus on gastric neoplasia.