H. pylori treatment

H. pylori treatment

Helicobacter pylori has been established as aetiologic agent of peptic ulcers and gastritis, and is a major risk factor for gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma (MALT). There is much debate on the role of H. pyloriin the pathogenesis of non-ulcer dyspepsia. Several large randomized trials have not provided evidence that H. pylori eradication is associated with symptomatic improvement in non-ulcer dyspeptics. On the other hand, it is generally agreed that H. pylorieradication is indicated in peptic ulcer disease and MALT lymphoma.

H. pylori is eradicated in over 90% of cases after administering triple therapy regimens that consist of

  1. a proton pump inhibitor (PPI)
  2. two anti-microbial agents: usually clarithromycin and amoxycillin.


Quadruple therapy consists of

  1. a proton pump inhibitor
  2. bismuth subcitrate
  3. tetracycline
  4. metronidazol

Antimicrobial resistance to metronidazol is a serious problem. Because of side effects (nausea), patient compliance is not optimal and 14-day regimens of triple or quadruple therapy are sometimes not completed.

Eradication of H. pylori results in healing of gastritis and cure of ulcer disease. Maintenance therapy with PPI or H2-receptor antagonists should be stopped. As the gastritis heals, acid production may increase and result in reflux disease. In fact, heartburn and reflux-oesophagitis are reported more frequently in patients who received eradication therapy.


Triple drug therapy results in eradication of H. pylori in what % of cases?


Possible triple therapy combinations do NOT include