Management of Helicobacter pylori infection

Abstract

Helicobacter pylori is the cause of peptic ulcer, gastric cancer and gastric lymphoma. Diagnosis of H. pylori infection can be made using invasive and noninvasive tests. Invasive tests based on endoscopy, such as histology, are recommended when a gastric malignancy is suspected. Alternatively, noninvasive tests, such as the urea breath test and stool tests are useful for H. pylori diagnosis and follow-up. Triple therapy with either amoxicillin or metronidazole, clarithromycin and proton pump inhibitor given twice daily for 7–14 days is the recommended first-line treatment, after having checked the individual clarithromycin antimicrobial susceptibility. A triple therapy with levofloxacin, amoxicillin and proton pump inhibitor for 10–14 days should be used as second-line treatment, where the strains are susceptible to fluoroquinolone. Alternatively, bismuth-based quadruple therapy is recommended.

Keywords::

• antibacterials
• antibiotics
• diagnostic test
• endoscopy
• gastric cancer
• gastric lymphoma
• Helicobacter pylori
• peptic ulcer
• urea breath test
• vaccine

Acknowledgements

The authors wish to thank the Italian Ministry of University and Research for supporting their studies.

Financial & competing interests disclosure

Mario M D’Elios is an applicant of the EU Patent 05425666.4 for HP-NAP as a potential therapeutic agent in cancer, asthma, and allergic and infectious diseases. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

b.i.d.: Twice daily; PPI: Proton pump inhibitor.