Helicobacter pylori: Diagnosis and Treatment
Helicobacter pylori: Diagnosis and Treatment
Purpose of review Multiple diagnostic methods and treatment strategies have been developed to detect and treat the Helicobacter pylori infection. Many of them have stood the test of time; others lost their value with the introduction of new test and treatment modalities. This review focuses on the current diagnostic methods and their clinical implications, as well as on established and novel treatment strategies.
Recent findings The increasing antimicrobial resistance has resulted in a decline of the success rate of recommended eradication regimens. The current guidelines recommend as first-line treatment clarithromycin, amoxicillin or metronidazole, and proton pump inhibitor twice daily, but recent studies have demonstrated an increasing eradication failure with these regimens. Several treatment modifications have been adopted regarding duration and combination of substances.
Summary The currently recommended first-line treatments are effective and well tolerated. In areas with high antimicrobial resistance rates, new antibiotic combinations and modifications in the sequence of drug administration are proposed as alternative treatment options to standard triple therapy. Future treatment strategies have to focus on regional antimicrobial resistance adopted treatment selection and the development of new antibiotics.
The discovery of Helicobacter pylori in 1982 was the starting point of an immense change in the management of gastroduodenal diseases. At present, H. pylori is well recognized as the main pathogenic factor for chronic gastritis, peptic ulcer disease, and gastric cancer. Eradication therapy cures low-grade gastric-mucosa-associated lymphoid tissue (MALT) lymphomas, H. pylori-positive peptic ulcer disease and is beneficial in the therapy of H. pylori-related dyspeptic symptoms. Furthermore H. pylori eradication has the potential to prevent gastric cancer. The current recommended H. pylori eradication therapy contains a proton pump inhibitor (PPI) and the combination of two antibiotics. However, the widespread use of antibiotics has resulted in declining eradication rates with a demand for new treatment modalities. In this article, we review diagnostic methods for the detection of H. pylori and focus on treatment options in times of decreasing eradication rates.
Abstract and Introduction
Abstract
Purpose of review Multiple diagnostic methods and treatment strategies have been developed to detect and treat the Helicobacter pylori infection. Many of them have stood the test of time; others lost their value with the introduction of new test and treatment modalities. This review focuses on the current diagnostic methods and their clinical implications, as well as on established and novel treatment strategies.
Recent findings The increasing antimicrobial resistance has resulted in a decline of the success rate of recommended eradication regimens. The current guidelines recommend as first-line treatment clarithromycin, amoxicillin or metronidazole, and proton pump inhibitor twice daily, but recent studies have demonstrated an increasing eradication failure with these regimens. Several treatment modifications have been adopted regarding duration and combination of substances.
Summary The currently recommended first-line treatments are effective and well tolerated. In areas with high antimicrobial resistance rates, new antibiotic combinations and modifications in the sequence of drug administration are proposed as alternative treatment options to standard triple therapy. Future treatment strategies have to focus on regional antimicrobial resistance adopted treatment selection and the development of new antibiotics.
Introduction
The discovery of Helicobacter pylori in 1982 was the starting point of an immense change in the management of gastroduodenal diseases. At present, H. pylori is well recognized as the main pathogenic factor for chronic gastritis, peptic ulcer disease, and gastric cancer. Eradication therapy cures low-grade gastric-mucosa-associated lymphoid tissue (MALT) lymphomas, H. pylori-positive peptic ulcer disease and is beneficial in the therapy of H. pylori-related dyspeptic symptoms. Furthermore H. pylori eradication has the potential to prevent gastric cancer. The current recommended H. pylori eradication therapy contains a proton pump inhibitor (PPI) and the combination of two antibiotics. However, the widespread use of antibiotics has resulted in declining eradication rates with a demand for new treatment modalities. In this article, we review diagnostic methods for the detection of H. pylori and focus on treatment options in times of decreasing eradication rates.
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