Helicobacter pylori therapy: a paradigm shift

ABSTRACT

Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when that is the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.

KEYWORDS:

• Helicobacter pylori
• therapy
• bismuth
• proton pump inhibitor
• clarithromycin
• amoxicillin
• metronidazole
• levofloxacin
• tetracycline

Financial & competing interests disclosure

DY Graham is supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs, National Institute of Health Public Health Service grant DK56338 which funds the Texas Medical Center Digestive Diseases Center. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the VA or NIH. Potential conflicts: Dr. Graham is a paid consultant for RedHill Biopharma regarding novel H pylori therapies and for BioGaia regarding use of probiotics for H pylori infections. M Dore receives research support from BioGaia. 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.