Helicobacter pylori (H. pylori) infects approximately 50% of the adult population and is well
recognized as the main cause of gastritis, peptic ulcer disease and gastric cancer. The cure
of the H. pylori infection prevents recurrence of duodenal and gastric ulcer and improves
dyspepsia in a significant proportion of cases, so it is cost-effective.
Eradication therapy has changed over time. Recent meta-analyses have that the current global
eradication rate after standard triple therapy (STT) is less than 80%. Several European
studies have found even lower eradication rates, with 35-40% of cases resulting in treatment
failure, probably due to increased resistance to antibiotics in many geographical areas,
principally to clarithromycin. The usually recommended pattern in the American and European
(Maastricht III) consensus conferences from 2007 has traditionally been triple therapy,
composed by the combination of 2 antibiotics (clarithromycin plus amoxicillin or
metronidazole) and a proton pump inhibitor (PPI) for 7-14 days. However, triple therapy was
discouraged in settings with high rates of clarithromycin resistance (15-20%) and, as such,
new strategies in order to improve the efficacy of first-line treatments are required.
Treatment failure increases antibiotic resistant strains, leads to a second treatment and a
new diagnostic test to confirm eradication. Unfortunately, it remains unknown whether there
is room for improvement in these geographical areas using clarithromycin-containing therapies
or switching to bismuth quadruple therapy should be followed instead.