Treatment of H. pylori infection: Current recommendations

Abstract

Helicobacter pylori (H. pylori) was isolated twenty years ago,
and since then a significant volume of literature concerning
it's significance for gastric and extragastric pathology has
been produced. The relevance of H. pylori infection and the
value of its eradication in disease areas and the resultant
statements with the corresponding level of recommendation,
have been discussed in various consensus meetings. The
recommendation to eradicate H. pylori in patients with
peptic ulcer disease includes active and inactive disease,
complicated disease and following gastric surgery for peptic
ulcer. H. pylori eradication is also strongly recommended
in H. pylori-positive patients with low-grade mucosa
associated lymphoid tissue lymphoma, although subsequent
lifelong surveillance is needed. Individual patients with H.
pylori-positive high-grade mucosa associated lymphoid
tissue lymphoma should undergo H. pylori eradication as
first-line treatment. Atrophic changes in the gastric mucosa
are associated with an increased risk for possible
progression to gastric cancer and therefore this condition
requires intervention by the eradication of H. pylori,
although there is no proof that progression to neoplasia
occurs. In addition, H. pylori eradication is now strongly
recommended in infected patients who are first-degree
relatives of gastric cancer patients, and in H. pylori positive
patients who wish to receive eradication therapy following
full consultation with their physician. The recommendation
to eradicate H. pylori in patients with functional dyspepsia
is made with the understanding that the likelihood of a
symptomatic benefit is likely to be modest, with the recent
meta-analysis indicating that 15 infected patients need to
be treated to cure one case of non-ulcer dyspepsia.
Key words: H. pylori, management.