Helicobacter Pylori Infection

Abstract

Background: Infection with Helicobacter pylori (H. pylori) is a major pathogenic factor for gastroduodenal ulcer disease and gastric carcinoma, as well as for other types of gastric and extragastric disease. As a result of changing epidemiologic conditions (e.g., immigration), changing resistance patterns with therapeutic implications, and new knowledge relating to the indications for pathogen eradication, the medical management of H. pylori is a dynamic process in need of periodic reassessment.

Methods: This review is based on pertinent publications retrieved by a selective search in PubMed and the Cochrane Database, with particular attention to three international consensus reports and the updated German S2k guideline.

Results: H. pylori is now dealt with as an infection, whether or not the infected individual has symptoms or suffers from and H.-pylori-induced illness. H.-pylori-associated dyspepsia and functional dyspepsia are distinct entities that can only be diagnosed when competing elements in the differential diagnosis have been ruled out. H. pylori can be detected with noninvasive methods (13C-urea breathing test, stool antigen detection) and with invasive methods (histology, culture, rapid urease test). An important consideration for treatment is that primary clarithromycin resistance is common in many groups of patients; in Germany, its prevalence is now 10.9%. Primary treatment can be with either standard triple therapy (clarithromycin and amoxicillin or metronidazole) or bismuth-containing quadruple therapy. Treatment for 10 to 14 days is more likely to eradicate the pathogen than treatment for 7 days. When H. pylori infection is initially diagnosed in a patient over age 50, gastritis risk stratification should be performed by means of endoscopic biopsy and histologic examination.

Conclusion: The new, clinically relevant developments that are presented and commented upon in this review now enable evidence-based management of H. pylori infection.

Figures

Figure 1

An algorithm for the diagnosis and treatment of H.-pylori-associated dyspepsia and functional dyspepsia. EGD, esophagogastroduodenoscopy.

Figure 2

The pathogenesis of gastric carcinoma (after [27]). Hp, Helicobacter pylori

Figure 3

Treatment algorithm for H. pylori eradication for patient groups wih low primary clarithromycin resistance. PAC, proton-pump inhibitor, amoxicillin, and clarithromycin; PMC, proton-pump inhibitor, metronidazole, and clarithromycin.

Figure 4

Treatment algorithm for H. pylori eradication in patient groups with a high rate of primary clarithromycin resistance.