Helicobacter Pylori (HP) is a human pathogen that is transmitted from human to human, producing active chronic gastritis in all colonized patients.
HP infection is known and accepted as a major etiologic factor in gastric cancer, being known that at least 90% of these are caused by Helicobacter pylori infection. It is established with no doubt that HP eradication is associated with reducing the incidence of gastric cancer.
Chronic gastritis with HP accounts for over 80% of all chronic gastritis. Symptomatology consists of pain or discomfort located in the upper abdomen.
Diagnosis is done using non-invasive tests. Any acid-resistant treatment should be discontinued 2 weeks before testing for HP infection.
For young patients, the "test and treat" strategy is preferred instead of prescribing a specific treatment or a superior digestive endoscopy, thus preventing high cost and discomfort to the patient.
In the case of elderly patients, where non-invasive tests are less relevant, a superior digestive endoscopy is preferred.
When alarm symptoms are present, such as weight loss, dysphagia, gastrointestinal bleeding or anemia, performing a superior digestive endoscopy is necessary.
In clinical practice, the rapid urination test, performed at endoscopy, is recommended as the first-line diagnostic test. If it is positive, it allows for the immediate start of the treatment.
In the treatment of Helicobacter pylori infection, the antibiotic resistance rate has increased in almost the entire world. A recent analysis of HP antibiotic resistance confirms that the eradication rate has dropped while the prevalence of antibiotic resistance is rising.
In areas with low resistance to clarithromycin, such as our country, triple therapy is recommended as the first line of treatment with proton pump inhibitor, clarithromycin, amoxicillin or metronidazole for a minimum of 7 days. Using proton pump inhibitor doses twice a day increases the effectiveness of triple therapy.
In areas with a high resistance to clarithromycin (> 15%), i.e. Central and South Europe, as well as in the United States, proton pump inhibitors, amoxicillin, metronidazole, with or without bismuth colloidal citrate are associated in the scheme. In areas with dual resistance to clarithromycin and metronidazole, the most relevant being China, bismuth quadrupole therapy, proton pump inhibitor, amoxicillin, tetracycline are recommended as the first line of treatment.
Ideally, clarithromycin can be replaced with drugs whose resistance has not become a problem, such as amoxicillin, tetracycline, furazolidone, rifabutin, or that can be successfully used at higher doses or longer.