Treatment of Helicobacter pylori: an overview

Helicobacter pylori is recognized to be a serious pathogen, but there is st ill controversy as to who should be treated. There is consensus for treatme nt of Helicobacter-positive peptic ulcer and B-cell lymphoma. Lymphocytic g astritis and giant-fold gastritis (Menetrier's disease) may also respond to treatment. Patients with functional dyspepsia have a 20% placebo response with a 5-10% 'eradication' response, results not dissimilar from empirical treatment with a proton pump inhibitor. A 'test and treat' policy for patie nts with uninvestigated dyspepsia remains controversial. Some have suggeste d that eradication may increase the risk of GERD, or predispose to adenocar cinoma at the gastro-oesophageal junction. However, PPI treatment without H elicobacter eradication induces greater inflammation in the gastric corpus, the phenotype associated with non-cardia gastric cancer. A minority believ e that Helicobacter should be eradicated in all individuals. When choosing treatment it is logical to start with a combination of antibi otics that, in the event of failure, will allow a second combination to be used without overlap.