Treatment of Helicobacter pylori infection

It has been 2 decades since the rediscovery of Helicobacter pylori. Since that time, enormous advances have occurred: H. pylori is clearly felt to be a cause of peptic ulcer disease and gastric malignancies such as mucosa associated lymphoid tissue (MALT) lymphoma and a carcinogenic factor for gastric adenocarcinoma. These associations have led to clear indications for H. pylori treatment in certain conditions, but in other diseases where the associations are not as clear, the indications also remain relatively controversial. Clear indications for H. pylori treatment include patients with duodenal and gastric H. pylori associated ulcers and MALT lymphoma. In uninvestigated dyspepsia, there are also very clear benefits to H. pylori treatment whereas in non-ulcer dyspepsia, the benefits are controversial. H. pylori is certainly a risk factor for gastric adenocarcinoma but eradication of this infection has not yet been shown to reduce or eliminate the risk of developing this condition. The effect of H. pylori treatment in patients with gastroesophageal reflux disease is also unclear. There is a potential benefit in the prevention of atrophic gastritis but a potential disadvantage is the worsening of reflux disease, which has been suggested by certain studies. In addition, the interaction between H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) appears quite complicated. Although there have been several advances in the last 2 decades with regards to the treatment of H. pylori, several controversies still exist, attesting to the requirement for further research.