Update on the Management of Helicobacter pylori Infection
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Update on the Management of Helicobacter pylori Infection Nasir Saleem Colin W. Howden* Address * Division of Gastroenterology, University of Tennessee College of Medicine, 956 Court Avenue, Suite H210, Memphis, TN, 38163, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords H. pylori I Antibiotics I Antibiotic resistance I Clarithromycin I Rifabutin I Vonoprazan
Abstract Purpose of review Our purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities. Recent findings Increasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. Molecular-based genotypic testing for antibiotic resistance and an effective H. pylori vaccine remain under development. Summary Inability to test for antibiotic resistance renders treatment selection empiric. However, resistance to rifabutin and amoxicillin remains rare. Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing.
Introduction Helicobacter pylori (H. pylori) infection is one of the most common chronic bacterial infections in humans affecting approximately 4.4 billion people worldwide, with a prevalence of 28 to 84% in different populations [1, 2]. The incidence and prevalence of H. pylori infection are higher among people born outside North America compared with those among people born here. However, the prevalence is high within certain communities in North America and varies with socioeconomic status and race/ethnicity [3–6]. In general, the prevalence is lower
among non-Hispanic whites compared with other groups such as African Americans, Hispanics, Native Americans, Alaska Natives, and Americans of Korean or Chinese ancestry [7, 8]. H. pylori infection is implicated in the pathogenesis of gastritis, gastric and duodenal ulcers, gastric cancer, and gastric mucosa‑associated lymphoid tissue (MALT) lymphoma [9–12]; its eradication is recommended in the treatment and/or prevention of these conditions [13, 14]. Treatment has also been
Hot Topic recommended for patients with uninvestigated dyspepsia in the absence of alarm features, and for those with functional dyspepsia. Importantly, all patients with a positive test of active infection should be offered treatment [3, 15, 16]. However, H. pylori treatment has been complicated and has required 10 or 14 days of multiple daily doses of three or four different medicines. Furthermore, the effect
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