Helicobacter pylori: an update for primary care physicians

It is now widely accepted that H. pylori plays an important role in gastritis and PUD, and that eradication leads to a marked decrease in ulcer recurrence. H. pylori alone is not sufficient to cause ulcer disease. There is a complex interaction with acid production and mucosal protection. Treatment that is directed only at reducing acid production heals ulcers and is safe, but is temporary at best and does not address the underlying etiology. Currently treatment for H. pylori can only be recommended for patients with PUD confirmed to have H. pylori infection (Table 1). As further studies are done and more understanding is gained, these recommendations may be expanded. More research is needed with prospective studies to determine if eradication reduces the risk of gastric cancer. More research is also needed on shorter courses of treatment with fewer side effects, on the effectiveness of immunization against H. pylori, and on other innovative forms of treatment.