title: Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens.
abstract: The presence of concomitant diseases is an independent predictive factor for non-Helicobacter pylori (H. pylori) peptic ulcers. Patients contracting concomitant diseases have an increased risk of developing ulcer disease through pathogenic mechanisms distinct from those of H. pylori infections. Factors other than H. pylori seem critical in peptic ulcer recurrence in end stage renal disease (ESRD) and cirrhotic patients. However, early H. pylori eradication is associated with a reduced risk of recurrent complicated peptic ulcers in patients with ESRD and liver cirrhosis. Resistances to triple therapy are currently detected using culture-based and molecular methods. Culture susceptibility testing before first- or second-line therapy is unadvisable. Using highly effective empiric first-line and rescue regimens can yield acceptable results. Sequential therapy has been included in a recent consensus report as a valid first-line option for eradicating H. pylori in geographic regions with high clarithromycin resistance. Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective in patients with dual- (clarithromycin- and metronidazole-) resistant H. pylori strains. We aim to review the prevalence of and eradication therapy for H. pylori infection in patients with ESRD and cirrhosis. Moreover, we summarized the updated H. pylori eradication regimens.
authors.affiliation: Shen-Shong Chang, Division of Gastroenterology, Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, School of Medicine, Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei 112, Taiwan.
authors.forename: Shen-Shong
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Shen-Shong Chang, Division of Gastroenterology, Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, School of Medicine, Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei 112, Taiwan.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hu
keywords: Concomitant diseases; Concomitant therapy; Culture susceptibility; Helicobacter pylori; Hybrid therapy