Eradication Therapy For Helicobacter Pylori

Eradication of Helicobacter pylori, the causative agents of a number of gastrointestinal disorders including peptic ulcer disease, using combinations of antisecretory drugs and/or antibiotics is now approaching fairly high levels. However, there is still a significant degree of disagreement regarding the best combination to use.

In a situation reminiscent of the elucidation of the best combinations of drugs to use in congestive heart failure, gastroenterologists around the world are now compiling data on several combinations of drugs which may satisfy the fundamental requirements of an H pylori eradication regimen; a 90% or greater efficacy rate, a short-course of therapy using a simple regimen and a low rate of side effects. David Graham of Baylor College of Medicine, speaking at a satellite symposium to the 10th World Congress of Gastroenterology in Los Angeles, USA, last week, commented that "we're still at the stage of doing recipes."

There is a general consensus that eradication of H pylori is the treatment of choice in peptic ulcer disease, reflected by the US National Institutes of Health consensus recommendation earlier this year (a view which is reinforced by the announcement last week that the World Health Organization has classified the organism as a class 1 carcinogen). However, controversy still exists over the other acid-related diseases such as reflux esophagitis and non-ulcer dyspepsia. Unfortunately eradication has proved to be surprisingly difficult; despite being sensitive to many antibiotics in vitro, the in vivo eradication efficacy for H pylori is often disappointing. Nevertheless, a great many papers and abstracts have been presented at the WCG which indicate that a regimen conforming to the ideal described above may not be too far off.