Advances in the Diagnosis and Therapy of Helicobacter pylori - Abstract
Background: Helicobacter pylori infection infects approximately 50% of the
world’s population, and is associated with significant morbidity and mortality. H. pylori
infection is associated with large expenditures for diagnostic testing and prescription
medication.
Summary: The C13-urea breath test remains the non-invasive test with the highest
sensitivity and specificity, and is the test-of-choice to confirm eradication following
treatment. Although the stool antigen test is an acceptable alternative, care should
be taken to only use kits with a documented accuracy >90%. Due to the increasing
resistance to clarithromycin, the efficacy of standard clarithromycin-based triple
therapy is now below 75%. Current guidelines recommend that such treatment only be
used in regions where H. pylori resistance to clarithromycin is below 20%. Concomitant
therapy and bismuth-based quadruple therapy yield superior eradication rates
compared to standard triple therapy and sequential therapy. First line therapy tailored
to cytochrome P450 2C19 (CYP2C19) phenotype and clarithromycin susceptibility may
increase treatment success, however large, randomized controlled trials are lacking.
Salvage therapy with fluoroquinalones is effective in about three quarters of patients,
and is superior to bismuth-based quadruple therapy in this setting.
Key messages: Clinicians must consider local antibiotic resistance patterns before
choosing a particular regimen. In the absence of such information, clinicians should
balance the need for a prolonged four-drug regimen against adverse effects and
costs.