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[Current therapy of Helicobacter pylori-induced chronic gastritis and/or peptic ulcer]
1I. Medizinische Abteilung, Hanusch-Krankenhaus, Wein.
Insights
Eradicating Helicobacter pylori (H.p.) is crucial for preventing peptic ulcer recurrence. While symptomatic benefits for gastritis remain unclear, H.p. eradication is essential for treating ulcers.
Area of Science:
- Gastroenterology
- Microbiology
Background:
- Helicobacter pylori (H.p.) infection is common.
- Its role in chronic gastritis and non-ulcer dyspepsia is debated.
- H.p. is a known cause of peptic ulcer disease.
Purpose of the Study:
- To evaluate the efficacy of H.p. eradication therapy.
- To determine the symptomatic benefit of H.p. eradication in gastritis.
- To assess the impact of H.p. eradication on peptic ulcer relapse rates.
Main Methods:
- Review of clinical trials on antimicrobial compounds for H.p. eradication.
- Analysis of symptomatic outcomes in patients with H.p.-positive gastritis and non-ulcer dyspepsia.
- Evaluation of H.p. eradication's effect on peptic ulcer recurrence.
Main Results:
- Antimicrobial therapy for H.p.-positive gastritis has not shown consistent symptomatic benefit.
- Longer follow-up may be needed to confirm symptomatic improvement in gastritis.
- H.p. eradication significantly reduces peptic ulcer relapse rates to near zero.
Conclusions:
- H.p. eradication is clearly indicated for chronic duodenal and gastric ulcers.
- Successful eradication obviates the need for maintenance therapy or surgery for ulcers.
- Combination therapies achieve high eradication rates (85-90%), with varying side effect profiles.
Abstract:
Helicobacter pylori (H.p.) induced chronic gastritis cannot at present be considered as an absolute indication for eradication therapy of H.p. Clinical trials with antimicrobial compounds, mainly bismuth, have not convincingly demonstrated appreciable symptomatic benefit for patients with H.p.-positive gastritis and non-ulcer dyspepsia. However, new results indicate that possibly a longer follow-up period may be necessary to prove a symptomatic improvement after H.p. eradication in patients with chronic gastritis. In contrast, eradication of H.p. reduces the relapse rates of recurrent non-iatrogenic peptic ulcer to virtually zero. Antimicrobial treatment of H.p. infection is, therefore, clearly indicated in chronic duodenal and gastric ulcers. In the case of success, drug maintenance therapy or operation becomes superfluous. The combination of amoxicillin plus metronidazole with ranitidine or of omeprazole with amoxicillin or clarithromycin results in eradication rates of about 85%. Triple therapy with bismuth, metronidazole, and amoxicillin or tetracycline is successful in about 90% of patients but the incidence of side effects is higher.