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Eradication of Helicobacter pylori.

It has become clear over the past 10 years that Helicobacter pylori is responsible for two of the most common gastrointestinal diseases worldwide, gastric and duodenal ulcer, and that it plays an important role in the development of the second most common lethal malignancy affecting humankind, gastric cancer. At present eradication therapy is considered to be the most appropriate way of treating gastric and duodenal ulcer associated with infection. Treatment, however, remains a difficult area. Although the organism is sensitive to a wide variety of antibiotics in vitro, monotherapy in vivo is rarely successful. The first treatments used bismuth compounds, but results were variable and side-effects significant. When a single antibiotic, such as amoxycillin or clarithromycin, is combined with the proton pump inhibitor omeprazole, results are good but still with varied success and in the case of clarithromycin, the organism can develop resistance to macrolides. Triple therapy using omeprazole, 20 mg daily, in conjunction with clarithromycin, 250 mg twice daily, and tinidazole, 500 mg twice daily, and given for only one week, has had a 95% success rate. This regimen appears to be the most effective and acceptable combination described so far. However, the major difficulty facing most clinicians today is that even with the most effective therapies, infection in some patients would appear to be ineradicable, and this is an area in which further research is urgently required.