Helicobacter pylori eradication: unravelling the facts

Recommendations for the choice, doses or duration of eradication therapy are still lacking. The purpose of this review was therefore to assess what conclusions could be drawn about eradication therapy, subsequent reinfection with Helicobacter pylori and ulcer recurrence.

Data were extracted from published papers and abstracts and entered into a dedicated database for appropriate subset analyses.

Despite problems of patient compliance and metronidazole resistance, triple therapy with either a bismuth salt or an antisecretory agent plus two antibiotics appears to provide the most effective eradication of H. pylori (< 80%). Dual therapies such as omeprazole plus amoxycillin are less effective (mean 59%, range 0-92%). Reinfection rates over one year vary between countries from 3% in Australia and the USA to 35% in Ireland. Reports of ulcer recurrence during the first year after successful eradication range from 0 to 27%.

There are insufficient data for particular doses and durations of eradication therapy from well designed controlled studies.