The best and worst treatments for Helicobacter pylori

Since the isolation and identification of Helicobacter pylori by the consequently Nobel prize winning pathologist Barry Marshall and gastroenterologist Robin Warren in 1982,1 it quickly became evident that half of the world’s population is infected with this organism.2 The scientific and medical community soon realised that H pylori infection does not always cause clinical disease but strongly affects the relative risk of various disorders in the upper gastrointestinal tract (gastritis, peptic ulcer disease, gastric cancer, mucosa associated lymphoid tissue lymphoma) and sometimes beyond (idiopathic thrombocytopenic purpura, idiopathic iron deficient anaemia).

The number of guidelines for the management of H pylori infection from various societies (including the American College of Gastroenterology, Maastricht IV Consensus Report, Japanese Society for Helicobacter Research, Second Asia-Pacific Consensus Guidelines, National Institute for Health and Care Excellence) attests to the difficulty in achieving successful eradication of this highly adaptive pathogen. For effective treatment, complex multidrug regimens are required. High bacterial load, high gastric acidity, type of Helicobacter strain, low compliance, and smoking are associated with treatment failure, but growing antibiotic resistance—in particular …