Helicobacter pylori eradication protocols

Helicobacter pylori eradication protocols is a standard name for all treatment protocols for peptic ulcers and gastritis, which primary goal is not only temporary relief of symptoms, but total elimination of Helicobacter pylori infection instead.

Definition

A good, clinically useful H.pylori eradication protocol is a treatment protocol, which ensures at least 80% H. pylori eradication rate, is not longer than 14 days (preferably 7 or 10 days) and is not too toxic (side effects should occur in not more than 10-15% patients receiving treatment by this protocol, and should not be so severe to warrant treatment discontinuation).

The treatment regimen should also be easy to follow by the patient, to improve or maintain high rate of treatment compliance.

During last decades, several new eradication protocols have been developed. This allowed clinicians to target several goals:

* improved treatment compliance:
** no need to strictly follow the diet, due to new proton pump inhibitor efficacy;
** decreased duration of therapy: from 14 to 10 to 7 days;
** decreased number of different tablets to ingest, due to combined standard preparations;
** decreased number of daily tablets - moved from 4x daily to bid schemes;
* lessened toxicity and probability of side effects;
* improved clinical efficacy in terms of H. pylori eradication ratios;
* overcoming the problem of antibiotic resistance;
* satisfied the need for alternative protocols for those patients who are allergic to one of the standard antibiotics used in standard protocols.

History of H. pylori eradication protocols

One of the first "eradication protocols", if not the first, was the protocol used by Barry Marshall to treat his own gastritis, which developed following intentional ingestion of H. pylori culture. He used bismuth salt and metronidazole. This treatment effectively cured his gastritis and eliminated the H. pylori infection. But in terms of modern eradication protocol definition, which requires not only occasional ability to cure the infection, but at least 80% eradication rate, this protocol cannot be described as "eradication protocol" and is not clinically reasonable.

One of the first "modern" eradication protocols, which is still used today, is a one week "triple therapy". The Sydney gastroenterolgist Thomas Borody invented the first triple therapy in 1987.cite journal | last = Borody | first = Thomas J. | coauthors = | P. Cole, S. Noonan, A. Morgan, J. Lenne, L. Hyland, S. Brandl, E. G. Borody, and L. L. George | date = October 16, 1989 | title = Recurrence of duodenal ulcer and Campylobacter pylori infection after eradication | journal = Medical Journal of Australia | volume = 151 | issue = 8 | pages = 431–435 | pmid = 2687668 ] Today, the standard triple therapy is amoxicillin, clarithromycin and a proton pump inhibitor such as omeprazole.cite journal | last = Mirbagheri | first = Seyed Amir | coauthors = Mehrdad Hasibi, Mehdi Abouzari, and Armin Rashidi | date = August 14, 2006 | title = Triple, standard quadruple and ampicillin-sulbactam-based quadruple therapies for H pylori eradication: A comparative three-armed randomized clinical trial | journal = World Journal of Gastroenterology | volume = 12 | issue = 30 | pages = 4888–4891
pmid = 16937475 | url = http://www.wjgnet.com/1007-9327/12/4888.asp | accessdate = 2006-09-30]

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