Helicobacter pylori--the latest in diagnosis and treatment

European and North American guidelines on the management of Helicobacter pylori infection were updated in 2007. New diagnostic methods have been introduced and in Australia, the recommended therapy choices in cases of penicillin allergy and for second line treatment are only accessible through the Therapeutic Goods Administration Special Access Scheme.

The article aims to update general practitioners on recommendations for testing and treating H. pylori infection, practical aspects of diagnostic methods, proof of cure testing to prove eradication, and the management of eradication failure and recurrent infection.

Urea breath tests are the best way to diagnose current H. pylori infection. Serology should primarily be used when UBTs may be false negative, eg. current bleeding ulcer or H. pylori suppressing drugs. For children who cannot use UBTs, stool antigen tests may be useful. In case of eradication failure with standard clarithromycin based therapy, bismuth based quadruple therapy is the favoured second line therapy. Preparing the patient for possible side effects is important as poor compliance and antibiotic resistance are the main reasons for eradication failure.