Helicobacter Pylori

It is a major challenge for guidelines to achieve relevance across a wide variety of populations with varying spectrums of disease and with vastly different resources with which to deal with it.

The major determinant of the prevalence of infection is socioeconomic status in childhood.

As with most endemic infectious diseases, a decline in prevalence has more to do with improvements in population hygiene and sanitation than with individual, case-by-case treatment, since in most countries, only a minority of infected individuals will ever receive therapy.

Eradication of H. pylori before the occurrence of adverse, precancerous histological changes has been shown to prevent gastric cancer and is the rationale for mass test-and-treat screening programs in young adults in countries with a high burden of disease and with sufficient resources to devote to this endeavor.

The decision to test for H. pylori should only be made with therapeutic intent.

The validation and implementation of rapid, inexpensive kit-based PCR diagnostic and antimicrobial resistance tests promises to be a major advance in management.

In resource-poor, high-prevalence regions in which diagnostic testing is not available, a history suggesting chronic ulcer disease—periodic upper gut pain and/or past or present melena—suggests a high likelihood of H. pylori ulcer disease and justifies empirical eradication therapy, especially in patients with no history or NSAID or aspirin use.

The major determinant of eradication success with PPI-AC is pretreatment clarithromycin resistance.

Patients should always be advised that successful eradication depends on compliance with the treatment. Time should be taken to counsel the patient, explaining how to take the multidrug therapy and anticipating adverse side effects. The need to complete the treatment should be emphasized. Written or pictorial information may also aid compliance.