Current indications for Helicobacter pylori eradication therapy

Two questions need to be answered before the eradication of Helicobacter pylori infection can be discussed. Firstly, can the infection be cured, and if so, is the cure permanent or transient? Secondly, what is the long-term clinical outcome of H. pylori infection? Current indications for the eradication of H. pylori infection can be divided into three categories: well-established, equivocal and experimental. Peptic ulcer disease in patients positive for H. pylori is a well-established indication for eradication of the organism. H. pylori-positive dyspepsia and the need for prolonged treatment with non-steroidal anti-inflammatory drugs are equivocal indications. MALT (mucosa-associated lymphoid tissue)-lymphoma, hypertrophic/hyperplastic gastritis, atrophic gastritis with or without premalignant mucosal alterations, and the need for prolonged powerful acid-suppressive therapy, in patients positive for H. pylori are all experimental indications. The decision to recommend H. pylori eradication therapy should not be taken lightly. Despite the risks associated with antimicrobial therapy, however, the benefits from cure of the infection are such that antimicrobial therapy is being increasingly favoured, and the reasoning behind withholding eradication therapy is becoming more difficult to understand in the light of current knowledge.