[Therapy of Helicobacter pylori infection: "Who to treat, how to treat?"].
Seventeen years after detection of Helicobacter pylori as the pathogenetic factor in a variety of gastroduodenal diseases, current treatment options are about 90% effective in eradicating the bacteria and thereby curing the affiliated disorders. In 1987 successful therapy has been shown to reduce relapse rates of duodenal and gastric ulcers dramatically and clinicians all over the world started to perform a still ongoing vast number of trials searching for the most effective first--and in case of failure, second line-treatment options. The results of these trials led to strictly evidence based and generally accepted guidelines formulated by Consensus Reports. The main questions "who to treat" and "how to treat" can be answered by using the categories "strongly recommended indications", "advisable indications" that leave some space for individual decisions, and consideration of first and second time eradication therapies together as a package. Treatment has become simple: three drugs, twice daily for one week. All available protone pump inhibitors (PPI) have been shown to be effective and presently there is only a few antibiotic agents used in combination and defined dose, proven to ensure treatment success. The future will encounter clinicians with problems concerning patient compliance, antibiotic resistance and more effective second and even third line therapies. This paper will focus on two subjects: indications ("who to treat") and evidence-based eradication regimens ("how to treat") in a reasonable setting close to everyday clinical practice.
Sebesta
Ch
Ch
I. Medizinische Abteilung, Krankenanstaltenverband Korneuburg-Stockerau, Landstrasse 18, A-2000 Stockerau.
Höller
E
E
Györög
M
M
Prenner
M
M
Trianto
Th
T
Klammer
Ina
I
Willmann
Andrea
A
Maderbacher
H
H
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D054328:Proton Pump Inhibitors; D013272:Stomach Diseases / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors