Helicobacter pylori: testing and treatment

Abstract

Helicobacter pylori is an important pathogen worldwide. Accurate diagnosis and appropriate therapy is important in clinical practice. Invasive tests that accurately identify current infection include the biopsy urease test and histology. The best noninvasive tests for diagnosis include the urea breath test and stool antigen testing. Proton pump inhibitor therapy can lead to false-negative H. pylori test results, and treatment should be stopped for 1–2 weeks prior to testing if possible. In the setting of bleeding peptic ulcer disease, urea breath testing is recommended to rule out a false-negative biopsy test result if needed. The current recommendations for when to test for H. pylori vary around the world. Well-accepted indications include active and past ulcer disease, and gastric-mucosa associated lymphoid tissue lymphoma. There is no universal agreement regarding whether all patients with functional dyspepsia should be tested and treated, although this is an evidence-based recommendation. There is also evidence that H. pylori eradication prevents peptic ulcer disease in those starting NSAIDs long term. Primary treatment remains triple therapy with 10–14 days probably being superior to shorter courses of therapy. Quadruple therapy is recommended if standard triple therapy fails. Salvage therapies with levofloxacin, rifabutin or furazolidone have been identified. Novel approaches to treatment include sequential therapy and use of adjuvants.

Keywords::

• bacterial resistance
• compliance
• diagnosis
• dyspepsia
• Helicobacter pylori
• nonsteroidal anti-inflammatory drugs
• peptic ulcer disease
• quadruple therapy
• sequential therapy
• triple therapy

Financial & competing interests disclosure

Nicholas J Talley works as a consultant for Altana, AstraZeneca, Axan, EBMed, Giaconda, Medscape, Solway, Theravance, Yamanouchi, Chugai, GlaxoSmithKline, Kosan, KV Pharmaceuticals, Renovis, Inc., Strategic Consultants Intl., Takeda Pharmaceuticals, TAP Pharmaceuticals, Therapeutic Gastrointestinal Group, ProEd Communications. He also receives grant and research support from Merck, Novartis, Tap Pharmaceuticals, Axcan, Bochringer-Ingelhein, Forest. 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.