title: Helicobacter pylori:  clinical management.
abstract: OBJECTIVE
  Progress continues in our understanding of the role of Helicobacter pylori infection in gastroduodenal as well as extragastric disorders. This review gives an overview on selected areas of the H. pylori infection and their clinical implications.
  
  
  RESULTS
  Indications for therapy have been extended and now include idiopathic thrombocytopenic purpura, iron deficiency anemia, and vitamin B12 deficiency. New data are presented on the role of H. pylori in neurodegenerative disorders and in the metabolic syndrome. H. pylori is associated with a (small) increase in the risk for colorectal adenoma and colon cancer. The biggest challenge is the selection of new therapies and treatment strategies because of the increasing failure of standard triple therapies. The best option in high clarithromycin resistance areas is bismuth-based quadruple therapy. Probiotic bacteria and yeasts reduce adverse effects of standard H. pylori eradication regimens. In gastric cancer prevention, screening programs based on the serological detection of preneoplastic conditions may prove useful.
  
  
  CONCLUSIONS
  New algorithms for preventing H. pylori-induced disease and eradicating the organism should be individualized.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany. peter.malfertheiner@med.ovgu.de
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: Michael
authors.initials: M
authors.lastname: Selgrad
authors.forename: Jan
authors.initials: J
authors.lastname: Bornschein
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D016481:Helicobacter Infections / Q000188:drug therapy / Q000503:physiopathology*; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D019636:Neurodegenerative Diseases / Q000382:microbiology; D010437:Peptic Ulcer / Q000188:drug therapy / Q000382:microbiology; D019936:Probiotics / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents