Helicobacter pylori eradication: a critical appraisal and current concerns

Helicobacter pylori is now well recognized as a critical factor in the majority of patients with peptic ulcer disease and successful treatment of the infection results in cure of the disease. However, treatment of this infection has proved difficult, involving a combination of drugs, and has usually involved complex treatment regimens. Triple therapy involving a bismuth compound in combination with metronidazole and tetracycline or amoxicillin have been most widely used and achieve successful cure of the infection in about 90% of cases when the tetracycline combination is used. More recently, the use of the proton-pump inhibitors in combination with amoxicillin have been widely advocated to combine effective symptom relief with high ulcer healing rates and an opportunity to cure the disease. However, all these treatments have some disadvantages due to unpredictability, adverse events, complex regimens making compliance difficult, or cost. This article reviews the results of current treatments for the eradication of H. pylori infection and identifies opportunities for the development of optimal approaches to the cure of this infection.