Current guidelines for the eradication of Helicobacter pylori in peptic ulcer disease

Pharmacological suppression of gastric acid secretion has traditionally been the most rational approach to healing ulcers successfully. However, ulcers initially healed using antisecretory therapy have a tendency to relapse after treatment is withdrawn. This tendency is altered definitively by eradication of Helicobacter pylori. Antimicrobial therapy should be given to all patients with documented duodenal and gastric ulcer associated with H. pylori infection. The optimal therapeutic regimen to eradicate H. pylori is still not completely clear. The requirement for treatment to be effective in more than 90% of patients makes monotherapy and dual therapy inappropriate. Bismuth-based triple therapy (bismuth, tetracycline and metronidazole) is highly efficacious if the H. pylori strain is sensitive to metronidazole and the patient is compliant, but adverse effects often occur. Triple therapy consisting of omeprazole and 2 antimicrobials (clarithromycin and/or amoxicillin and/or metronidazole) and quadruple therapy (bismuth-based triple therapy plus omeprazole) are both very effective and patient compliance may be better because of the shortened (1 week) course. Preliminary data indicate that the efficacy of the regimen is not influenced by imidazole resistance. Eradication of H. pylori prevents complications and relapse of peptic ulcer disease and is a cost-effective option compared with maintenance acid-suppressive therapy.