Helicobacter pylori

Treatment

Clinical practice guidelines by the American College of Gastroenterology guide treat. Regarding which patient to treat:

• "Testing is uncertain among patients with functional dyspepsia, gastroesophageal reflux disease (GERD), patients taking nonsteroidal antiinflammatory drugs, with iron deficiency anemia, or who are at risk of developing gastric cancer".

Regarding how to treat:

• "Eradication rates achieved by first-line treatment with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin have decreased to 70-85%, in part due to increasing clarithromycin resistance".
• "Eradication rates may also be lower with 7 versus 14-day regimens."

Regarding follow-up of treatment:

• "Testing to prove eradication should be performed in patients who receive treatment of H. pylori for peptic ulcer disease, individuals with persistent dyspeptic symptoms despite the test-and-treat strategy, those with H. pylori-associated MALT lymphoma, and individuals who have undergone resection of early gastric cancer".
• "For patients with persistent H. pylori consider bismuth quadruple therapy. A PPI, levofloxacin, and amoxicillin for 10 days is more effective and better tolerated than bismuth quadruple therapy for persistent H. pylori".