CURRENT GUIDELINES FOR THE ERADICATION OF HELICOBACTER-PYLORI IN PEPTIC-ULCER DISEASE

Pharmacological suppression of gastric acid secretion has traditionall y been the most rational approach to healing ulcers successfully. Howe ver, ulcers initially healed using antisecretory therapy have a tenden cy to relapse after treatment is withdrawn. This tendency is altered d efinitively by eradication of Helicobacter pylori. Antimicrobial thera py should be given to all patients with documented duodenal and gastri c ulcer associated with H. pylori infection. The optimal therapeutic r egimen to eradicate H. pylori is still not completely clear. The requi rement for treatment to be effective in more than 90% of patients make s monotherapy and dual therapy inappropriate. Bismuth-based triple the rapy (bismuth, tetracycline and metronidazole) is highly efficacious i f the H. pylori strain is sensitive to metronidazole and the patient i s compliant, but adverse effects often occur. Triple therapy consistin g of omeprazole and 2 antimicrobials (clarithromycin and/or amoxicilli n and/or metronidazole) and quadruple therapy (bismuth-based triple th erapy plus omeprazole) are both very effective and patient compliance may be better because of the shortened (1 week) course. Preliminary da ta indicate that the efficacy of the regimen is not influenced by imid azole resistance. Eradication of H. pylori prevents complications and relapses of peptic ulcer disease and is a cost-effective option compar ed with maintenance acid-suppressive therapy.