Treatment of Helicobacter pylori infection

Treatment of H. pylori infection, will remain an expanding topic in gastroenterology in the new millennium. A total of 582 full papers were published on this aspect last year alone. Proton pump inhibitors (PPI) are an essential component of triple therapy regimens. There are now four PPIs available and the effect on H. pylori is class-specific. Ranitidine-bismuth citrate (RBC) is an alternative to PPI in triple therapy regimens. Risk factors for failure include antibiotic resistance, compliance and duration of therapy. Second-line therapy for eradication failure includes quadruple therapy, a combination of bismuth-based triple therapy and a PPI or RBC and two antibiotics. Treatment of the infection in the young and elderly are new treatment areas of interest. New antibiotics are needed, but old antibiotics rifabutin and furazolidone are a welcome addition to established treatments. New formulation of a single capsule containing the three components of bismuth-based triple therapy is currently being investigated. A new formulation to deliver antibiotics to the stomach via specific delivery system shows some promise. A novel H2 receptor antagonist group shows some encouraging results. However in vitro results do not always correlate to the in vivo situation. There are still challenges to find better treatments to eradicate H. pylori. Curr Opin Gastroenterol 16 (suppl 1):S44-S51 (C) 2000 Lippincott Williams & Wilkins.