Treatment strategies for Helicobacter pylori infection.
Peptic ulcer disease is strongly associated with infection by Helicobacter pylori, a spiral-shaped, flagellated organism found predominantly in the gastric antrum. More than 90 percent of duodenal ulcers and adenocarcinomas of the distal stomach are associated with H. pylori infection. Eradication of the organism effectively prevents relapses of gastroduodenal ulcers associated with H. pylori. In patients undergoing endoscopy, the rapid urease test is highly sensitive and specific in diagnosing H. pylori infection. Noninvasive diagnostic methods include serologic antibody measurements and urea breath testing. Empiric therapy may be tried if the diagnosis is suspected on a clinical basis. Traditional 14-day "triple therapy" with bismuth, metronidazole and either amoxicillin or tetracycline has consistently produced eradication rates of approximately 90 percent. Newer combination regimens have shown promise in a smaller number of studies. No single agent given as monotherapy has proved to be acceptably effective in clinical studies.
Damianos
A J
AJ
Pennsylvania State University College of Medicine, Hershey, USA.
McGarrity
T J
TJ
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D011500:Protein Synthesis Inhibitors / Q000627:therapeutic use; D012459:Salicylates / Q000627:therapeutic use; D013752:Tetracycline / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D010406:Penicillins; D011500:Protein Synthesis Inhibitors; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth