Categories: H. Pylori

April 2009 Volume 5, Issue 4 , Supplement 13

M. Brian Fennerty, MD, William D. Chey, MD, and Nimish Vakil, MD

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Helicobacter pylori infection remains a significant clinical issue, as it is associated with peptic ulcer disease, dyspepsia, and gastric cancer. H. pylori testing is the standard of care for patients with ulcers, and multiple treatment guidelines recommend H. pylori testing and treatment as a first-line management strategy in patients with dyspepsia. H. pylori is best diagnosed using a real-time test such as the stool antigen test or urea breath test. The most common treatment strategy for H. pylori in the United States is antimicrobial-based triple therapy with a proton pump inhibitor and two antibiotics, although bismuth-containing quadruple therapy should be considered an equivalent first-line treatment based on efficacy and tolerability. Alternative treatment strategies are becoming increasingly important given the rise in the prevalence of drug-resistant strains of H. pylori. Sequential therapy is promising but requires validation in different patient populations. Other treatment options include levofloxacin and rifabutin. Adherence is a key factor in optimizing treatment outcomes and avoiding resistance. Clinicians should therefore discuss issues of adherence, resistance, and side effects with patients at the beginning of treatment in order to maximize adherence and increase the likelihood of attaining H. pylori eradication.

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