Current status of Helicobacter pylori in peptic ulcer disease

All patients with documented, past or present gastric or duodenal ulcers and who are infected with Helicobacter pylori should undergo antimicrobial therapy to eradicate it. Data do not yet support giving antimicrobial therapy to treat nonulcer dyspepsia or to prevent gastric neoplasia. H pylori infection is the main cause of chronic superficial gastritis and is associated with both gastric and duodenal ulcers. However, it has no proven relationship with nonulcer dyspepsia. H pylori infection is currently diagnosed by either endoscopic biopsy or serologic titers for a specific immunoglobulin (IgG) antibody. No noninvasive technique is available to document eradication of infection, although urea breath tests will soon simplify both the diagnosis of infection and documentation of eradication. Eradicating H pylori infection decreases the rate of ulcer recurrence. Treatment currently involves a 2-week, three-drug regimen of bismuth subsalicylate, tetracycline, and metronidazole, or a two-drug regimen of omeprazole and amoxicillin; other, simpler regimens are under investigation.