Treatment of Helicobacter pylori

Helicobacter pylori is the most common infection in the world and is associated with some of the most prevalent gastroduodenal pathologies. There is now considerable evidence that H. pylori eradication not only heals duodenal ulcer, but also prevents ulcer recurrences and probably ulcer complication. It is, therefore, universally accepted that all patients with duodenal ulcers should receive eradication therapy. This review represents an attempt to summarize and analyse all the studies published from March 1997 to March 1998, in which different anti-H. pylori regimens have been used. Despite a large number of clinical trials (51), no significant advances have been made in H. pylori therapy, so the optimal eradication treatment still remains a matter of debate. More than 6000 patients were treated in these studies and most (around 5000) were found to have a peptic ulcer disease; this represents no more than 10-15% of our endoscopic findings. Eleven studies addressed the non-ulcer dyspepsia debate (less than 1000 patients). These studies did not define the best therapy or the benefit of treatment. The proton pump inhibitor regimens are definitely the most representative drug policy to have appeared in the literature; despite several attempts (proton pump inhibitor treatment given for less than 1 week, for 1 week, or for more than 1 week) the short 1-week regimen recommendation has been recognized as the most promising treatment. What has been highlighted is the importance of imidazole-resistant and -sensitive strains when considering the eradication rate.