What is Helicobacter pylori (H. pylori) infection?

From the Guidelines

Helicobacter pylori infection should be treated with a combination therapy, prioritizing the most recent and effective treatment regimens, to reduce the risk of peptic ulcers, gastritis, and gastric cancer, as supported by the most recent study from 2022 1. The treatment of Helicobacter pylori infection typically involves a combination of two antibiotics and a proton pump inhibitor, with the specific regimen depending on factors such as antibiotic resistance and previous treatment failure.

• The most effective treatment regimens may vary depending on the population and the prevalence of antibiotic resistance, as noted in a study from 2019 1.
• Diagnosis of H. pylori infection can be confirmed through various tests, including breath tests, stool antigen tests, blood antibody tests, or endoscopic biopsy, as discussed in a review from 2022 1.
• Eradication of the infection should be confirmed 4-8 weeks after treatment completion, typically using a urea breath test or stool antigen test.
• The infection is typically acquired in childhood and can persist for decades if untreated, highlighting the importance of early diagnosis and treatment, as noted in a study from 2022 1.
• Successful eradication of H. pylori infection significantly reduces the risk of ulcer recurrence and may help prevent gastric cancer in high-risk populations, as supported by the most recent evidence 1. Key considerations in the treatment of H. pylori infection include:
• The use of effective antibiotic regimens, taking into account the increasing problem of antibiotic resistance, as discussed in a study from 2019 1.
• The importance of confirming eradication of the infection after treatment, to ensure that the treatment has been effective, as noted in a review from 2022 1.
• The need for a proactive approach to testing and treatment, including outreach to high-risk populations, such as immigrants from countries with high prevalence of H. pylori infection, as recommended in a study from 2022 1.

From the Research

Helicobacter pylori Infection Treatment

• The treatment of Helicobacter pylori infection typically involves a combination of antibiotics and a proton pump inhibitor (PPI) 2, 3, 4.
• First-line treatment usually consists of a PPI, amoxicillin, and clarithromycin, with eradication rates ranging from 80-90% 2, 3, 4.
• Second-line treatment options include bismuth-based quadruple therapies and levofloxacin-based regimens, which have been shown to be effective in patients who do not respond to first-line treatment 3, 5.
• Sequential therapy, which involves a combination of antibiotics and a PPI, has also been proposed as a potential treatment option, but requires further study and validation 4.

Treatment Efficacy and Safety

• Studies have shown that the efficacy of Helicobacter pylori treatment regimens can vary depending on the specific combination of antibiotics and PPI used, as well as patient compliance 2, 3, 5.
• Side effects during eradicative treatments are relatively rare, occurring in 15-30% of patients 2.
• The use of azithromycin, ofloxacin, bismuth, and omeprazole as a second-line therapy has been shown to be effective and safe, with an eradication rate of 77.3% in one study 5.

Treatment Recommendations

• The "test and treat" strategy is recommended for undiagnosed dyspepsia, which involves non-invasive testing for H. pylori infection 2.
• Endoscopy is recommended for patients over 45 years of age with first symptoms of dyspepsia, as well as for patients with "alarming" symptoms such as weight loss, anemia, or bloody vomiting 2.
• An individual approach to eradication is proposed for patients with gastroesophageal reflux disease and those using non-steroid anti-inflammatory drugs 2.