REVIEW - ERADICATION OF HELICOBACTER-PYLORI - PROBLEMS AND RECOMMENDATIONS

The successful isolation of Helicobacter pylori from the stomachs of p atients with gastritis and peptic ulcer has revolutionized our concept s of the pathogenesis of gastritis, peptic ulcer, gastric cancer and g astric B cell lymphoma. Eradication of H. pylori heals gastritis and H . pylori-related peptic ulcer. After a successful cure of H. pylori in fection, virtually no recurrence of duodenal ulcer is seen. However, t reatment to curt: the infection has proved difficult. Numerous clinica l trials have been attempted, but as yet no ideal regimen has been ide ntified. Monotherapies have many drawbacks and should be avoided. Dual therapies combining a proton pump inhibitor (PPI) and an antimicrobia l agent provide higher eradication rates than those involving two anti microbial agents. Bismuth-based triple therapies are more effective th an dual therapies in eradicating H. pylori infection. However, poor co mpliance and frequent adverse effects have made these combinations les s favourable in clinical practice. Proton pump inhibitor-based triple therapies have shown more consistent and higher eradication rates with a short duration of treatment, good patient compliance, fewer side ef fects, prompt symptom relief and fast ulcer healing. Results from PPI- based quadruple therapies are promising; however, large multicentre cl inical trials are needed to confirm the effect and the complex regimen again may compromise compliance outside of the clinical trial setting . Eradication of H. pylori infection is cost-effective in the long-ter m management of peptic ulcer disease compared with maintenance therapy with antisecretory drugs.