Helicobacter pylori and peptic ulcer

Helicobacter pylori is an important pathogen causing both gastric and duodenal ulcer. The causal relationship is based on the strong association of peptic ulcer with H. pylori-induced gastritis, the improved rate of healing with H. pylori suppression, and markedly low recurrence rates for ulcer after H. pylori eradication. The ideal regimen for H. pylori eradication should be simple, inexpensive, free of side effects, and effective in at least 90% of patients. Triple therapy involving bismuth, metronidazole and tetracycline or amoxicillin results in the best and most consistent eradication data, but there is a significant incidence of side effects and problems with compliance. Acid suppression with ranitidine or omeprazole combined with antibiotics is effective but expensive with variable results in clinical trials. Sucralfate may also reduce H. pylori density and enhance the action of antibiotics used in eradication regimens. Studies reported in this Journal suggest that sucralfate can be successfully substituted for bismuth in triple therapy regimens with documented efficacy and few side effects. Considerable progress in developing newer regimens to eradicate H. pylori has been made. However, the development of an ideal drug or regimen remains a challenge.