This article evaluates the epidemiology and eradication of H. pylori in dyspepsia patients and other special populations using short-course treatments.
Ables, Simon & Melton, (2007) state that ‘one half of the world’s population has Helicobacter pylori infection with an estimated prevalence of 30 percent in North America’. It is now evident that Helicobacter pylori is a contributing agent of peptic ulcer disease.With this information at hand, it is now possible for patients with this condition to be treated. Successful studies show that H. pylori eradication notably reduces the risk of ulcer recurrence and bleeding in these patients; and is less expensive than chronic antisecretory therapy. In contrast, H. pylori eradication demonstrates little or no improvements in nonulcer dyspepsia and GERD patients.
In addition, according to Ables et al., it is not recommended that H. pylori be eradicated to prevent gastric cancer in asymptomatic patients because of the lack of guidelines and good-quality clinical trials. In other populations, such as patients with undifferentiated dyspepsia and children, special considerations need to be taken to detect the cause of symptoms and underlying pathophysiology. It is suggested by most national guidelines that patients with undifferentiated dyspepsia undergo a ‘test-and-treat’strategy. Research illustrates that this strategy is noninvasive, cost-effective, and reduces endoscopies and the use of antisecretory medications. In children with suspected H. pylori infection, reliable noninvasive tests for cure include: the urea breath and stool antigen test over and above the serology for immunoglobulin G test. Moreover, it is important to note that endoscopy with biopsy, is still the diagnostic strategy of choice in children with severe upper abdominal pain.
Another option for eradication in adults and children who are H. pylori positive; is short course drug therapy – consisting of various dosages of bismuth salts and antibiotics along with proton pump inhibitors- ranging from one-, five-, and seven-day regimens (Ables, et al.). This gives rise to the thesis of evaluating H. pylori eradication using short-duration treatments. The authors further support this thesis by suggesting the potential benefits of shorter regimens such as fewer adverse drug effects, better compliance, and reduced cost to patients.
On the flipside, there is growing concern about the antibiotic resistance of H.pylori specifically in patients at high risk for complications of H.pylori infection and uncertainty as to whether shorter courses of eradication will be associated with a higher resistance rate.
In response to the above-stated problem. The article outlines that it is too early too know whether short courses of eradication therapy will be associated with a higher resistance rate and uses one small trial and a meta-analysis of current literature on treatment of resistant H. pylori. The data shows failings in one or more regimens and some benefits in triple- and quadruple-drug therapy
Reference:
Ables, A.Z., Simon, I., Melton, E.R. (2007). Update on Helicobacter pylori Treatment. American Family Physician, 75(3), 351-358
