Helicobacter pylori and peptic ulcer disease. Current evidence for management strategies.
OBJECTIVE
To review current evidence for primary care physicians who manage Helicobacter pylori in peptic ulcer disease.


METHODS
MEDLINE was searched to August 1997 for randomized controlled trials, systematic overviews, and consensus reports. High-quality recent reviews were often found. Randomized controlled trials presented as abstracts at recent meetings were reviewed.


RESULTS
Helicobacter pylori is found in most case of duodental and gastric ulcer, and eradication of H pylori leads to "cure" of ulcer disease and prevention of ulcer complications. Eradication of H pylori is not indicated for gastroesophageal reflux disease. No evidence indicates that screening asymptomatic individuals for H pylori infection reduces the risk of subsequent development of gastric cancer. Controversial areas are the role of H pylori in functional dyspepsia and screening for H pylori before initiating nonsteroidal anti-inflammatory drugs. In primary care, H pylori can be detected using serologic tests or urea breath tests (UBT), but only UBTs can be used to confirm eradication. Whether patients suspected of having ulcers can be managed with an H pylori test-and-treat strategy without initial investigation is controversial. The first-line recommended treatment is 1 week of twice daily triple therapy with a proton pump inhibitor, clarithromycin (Biaxin), and amoxicillin (e.g., Amoxil), or metronidazole (Flagyl).


CONCLUSIONS
Helicobacter pylori eradication should be first-line therapy in primary care for infected patients with peptic ulcers. Effective H pylori testing methods and treatments are now available.
Division of Gastroenterology at McMaster University in Hamilton, Ont., Surrey GI Clinic, Guelph, ON. chiban@fhs.mcmaster.ca
N
N
Chiba
R
R
Lahaie
R N
RN
Fedorak
R
R
Bailey
S J
SJ
Veldhuyzen van Zanten
B
B
Bernucci
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005194:Family Practice; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016480:Helicobacter pylori; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008795:Metronidazole / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole