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Treatment of Helicobacter pylori: an overview

Helicobacter pylori is recognized to be a serious pathogen, but there is still controversy as to who should be treated. There is consensus for treatment of Helicobacter‐positive peptic ulcer and B‐cell lymphoma. Lymphocytic gastritis and giant‐fold gastritis (Ménétrièr's disease) may also respond to treatment. Patients with func‐tional dyspepsia have a 20% placebo response with a 5–10% ‘eradication’ response, results not dissimilar from empirical treatment with a proton pump inhibitor. A ‘test and treat’ policy for patients with uninvesti‐gated dyspepsia remains controversial. Some have suggested that eradication may increase the risk of GERD, or predispose to adenocarcinoma at the gastro‐oesophageal junction. However, PPI treatment without Helicobacter eradication induces greater inflammation in the gastric corpus, the phenotype associated with non‐cardia gastric cancer. A minority believe that Helicobacter should be eradicated in all individuals.