Most straightforward cases can be managed in primary care with eradication treatment

Helicobacter pylori is the single most important pathogen in peptic ulcer disease since its eradication leads to cure.1 As a result, a National Institutes of Health consensus meeting in 1994 recommended giving anti- H pylori treatment to all patients with active peptic ulcer disease or a history of it and proved infection.2 In 1996 the consensus meeting of the European Helicobacter Study Group in 1996 made similar recommendations and added bleeding peptic ulcers and low grade MALT lymphoma to the list.3 Eradication for other indications remains more controversial. What therefore is the current best evidence on managing H pylori infection, and which is the best treatment?

Though the need for eradication in peptic ulcer disease is agreed, there is also evidence for eradicating H pylori in patients with advanced and progressively worsening forms of gastritis such as intestinal metaplasia, glandular atrophy, and erosive or hypertrophic forms of gastritis, and after resection for early gastric cancer.3 A recent prospective study, however, showed that the degree of intestinal metaplasia and atrophy remained unchanged despite successful eradication.4 This finding should temper the belief that …