Diagnosis and Treatment of Helicobacter pylori Infection

The last 5 years have seen major shifts in defining whom to test and how to treat Helicobacter pylori infection. Peptic ulcer has changed from a chronic disease to a one-off condition, and countries with a high incidence of gastric cancer have begun implementing population-wide screening and treatment. A proactive approach to testing and treatment of H. pylori is now recommended, including outreach to family members of individuals diagnosed with active infection as well as high-risk local populations such as immigrants from high-risk countries. Increasing antimicrobial resistance has resulted in an overall decline in treatment success, causing a rethinking of the approach to development of treatment guidelines as well as the need to adopt the principles of antibiotic usage and antimicrobial stewardship. Required changes include abandoning empiric use of clarithromycin, metronidazole, and levofloxacin triple therapies. Here, we discuss these transformations and give guidance regarding testing and use of therapies that are effective when given empirically.

Automated summary

The past 5 years have witnessed significant changes in the testing and treatment of Helicobacter pylori infection. Peptic ulcer has transitioned from a chronic disease to an acute condition, and countries with high incidence of gastric cancer have started implementing population-wide screening and treatment. A proactive approach to testing and treatment, including outreach to family members and high-risk populations, is now recommended. The rise in antimicrobial resistance has led to a decline in treatment success, necessitating a reconsideration of treatment guidelines and adherence to principles of antibiotic usage and antimicrobial stewardship.