[Therapy of Helicobacter pylori infection: current status]

H. pylori is closely associated with gastritis, peptic ulcer disease and gastric cancer. A causative role of H. pylori is now established in type B gastritis, its role in non ulcer dyspepsia is unresolved. Eradication of H. pylori results in a marked decrease of peptic ulcer relapse rates. Gastric cancer risk is 2- to 8-fold increased if gastric mucosa is colonized by H. pylori. Treatment of H. pylori infection is difficult although the organism is highly sensitive to several antibiotics in vitro. Monotherapy with bismuth suppresses bacterial growth, but hardly ever eradicates the organism. Combination of amoxicillin with omeprazole may eradicate H. pylori in about 60-80% of patients and is well tolerated. Triple therapy (bismuth, amoxicillin, metronidazole) is the most effective treatment modality and results in eradication rates of 80% to 90%, however, side effects are noticed in 20%-30% of patients. Eradication of H. pylori should be considered under the following conditions: relapsing peptic ulcer, resistant peptic ulcer, break-through ulcer on maintenance treatment with H2-blockers, complicated ulcer. There is no indication for eradicating treatment in patients with simple H. pylori positive gastritis and NSAID-associated ulcer.