The potential value of lansoprazole in Helicobacter pylori eradication

Most anti-Helicobacter pylori (Hp) regimens available have drawbacks. Standard triple therapy using bismuth, metronidazole, and tetracycline gives good eradication rates but at the expense of a long, complicated regimen associated with significant side effects, and results are not as good in areas where there is a high resistance to nitroimidazoles. The introduction of eradication regimens based on acid suppression in combination with antibiotics has yielded promising results. Dual therapy using a proton pump inhibitor (PPI) with either amoxicillin or clarithromycin has yielded eradication rates above 80% with relatively few side effects, but results have been somewhat inconsistent from center to center. The combination of acid suppression with two antibiotics has provided better results, with centers achieving eradication rates of over 90%. The new PPI lansoprazole possesses some theoretical advantages as an acid-suppressing drug, and its preliminary use in a number of studies suggests that it may have an important role to play in Hp eradication regimens. Considerably more work, however, is required to identify the ideal dosage and combination that will give the best eradication rates with the simplest regimen and fewest side effects.