What is the significance of Helicobacter pylori (H. pylori) infection?

From the Guidelines

H. pylori testing and eradication are crucial for preventing gastric cancer, and the most effective approach is to use a combination of screening tests and treatment, as recommended by the most recent guidelines 1. The most common tests for H. pylori infection include the urea breath test, stool antigen test, blood antibody test, and endoscopic biopsy.

• The urea breath test and stool antigen test are preferred non-invasive options with high accuracy (>90%) 1.
• For the breath test, patients ingest labeled urea, and if H. pylori is present, its urease enzyme breaks down the urea, releasing labeled carbon dioxide that's detected in breath samples.
• The stool antigen test directly detects H. pylori proteins in fecal samples.
• Blood antibody tests can indicate past infection but don't reliably confirm current infection.
• Endoscopic biopsy with rapid urease test, histology, or culture is the most definitive but invasive method. Testing should be done at least 2 weeks after stopping proton pump inhibitors and 4 weeks after antibiotics to avoid false negatives 1. Retesting to confirm eradication should occur 4-8 weeks after completing treatment, and the most effective treatment regimen is a 14-day bismuth quadruple therapy, as recommended by recent guidelines 1. In populations with high gastric cancer risk, an organized screening program with routine referral of those who test positive to receive eradication treatment is essential, as it can rapidly reduce the incidence rate of H. pylori infection and gastric cancer 1.
• The risk of gastric cancer depends on developing atrophic gastritis, and the prevalence of which varies geographically.
• Elimination of gastric cancer will require elimination of H. pylori infection, and this possibility has been the topic of consensus meetings that have recently updated the clinical recommendations 1. In summary, H. pylori testing and eradication are essential for preventing gastric cancer, and the most effective approach is to use a combination of screening tests and treatment, as recommended by the most recent guidelines 1.

From the Research

H. pylori Treatment

• The treatment of H. pylori infection typically involves a combination of antibiotics and a proton pump inhibitor (PPI) 2, 3, 4, 5, 6.
• The choice of antibiotics depends on various factors, including the patient's previous antibiotic exposure and the prevalence of antibiotic resistance in the region 4.
• Commonly used antibiotic regimens include clarithromycin, amoxicillin, and metronidazole, often in combination with a PPI such as omeprazole 2, 3, 5, 6.
• The duration of treatment can vary, but typically ranges from 7 to 14 days 2, 3, 5, 6.

Eradication Rates

• The eradication rates of H. pylori infection can vary depending on the treatment regimen and patient population 2, 3, 5, 6.
• Studies have reported eradication rates ranging from 70% to over 90% 2, 3, 5, 6.
• A study found that a 7-day course of omeprazole, clarithromycin, and amoxicillin was effective in eradicating H. pylori in about 89% of cases 3.
• Another study reported that a 1-week treatment with omeprazole, clarithromycin, and tinidazole or lansoprazole, amoxicillin, and metronidazole resulted in eradication rates of 91% and 87%, respectively 5.

Side Effects and Tolerability

• The side effects of H. pylori treatment are generally mild and well-tolerated 3, 5, 6.
• Common side effects include gastrointestinal disorders and taste disturbances 3, 5.
• Serious side effects, such as encephalopathy, can occur with certain medications, such as bismuth 2.