, Volume 50, Issue 6, pp 984–990 | Cite as

Current Guidelines for the Eradication of Helicobacter pylori in Peptic Ulcer Disease

  • Erik A. J. Rauws
  • René W. M. van der Hulst
Practical Therapeutics


Pharmacological suppression of gastric acid secretion has traditionally been the most rational approach to healing ulcers successfully. However, ulcers initially healed using antisecretory therapy have a tendency to relapse after treatment is withdrawn. This tendency is altered definitively by eradication of Helicobacter pylori. Antimicrobial therapy should be given to all patients with documented duodenal and gastric ulcer associated with H. pylori infection.

The optimal therapeutic regimen to eradicate, H. pylori is still not completely clear. The requirement for treatment to be effective in more than 90% of patients makes monotherapy and dual therapy inappropriate. Bismuth-based triple therapy (bismuth, tetracycline and metronidazole) is highly efficacious if the H. pylori strain is sensitive to metronidazole and the patient is compliant, but adverse effects often occur. Triple therapy consisting of omeprazole and 2 antimicrobials (clarithromycin and/or amoxicillin and/or metronidazole) and quadruple therapy (bismuth-based triple therapy plus omeprazole) are both very effective and patient compliance may be better because of the shortened (1 week) course. Preliminary data indicate that the efficacy of the regimen is not influenced by imidazole resistance.

Eradication of H. pylori prevents complications and relapses of peptic ulcer disease and is a cost-effective option compared with maintenance acid-suppressive therapy.


Omeprazole Metronidazole Duodenal Ulcer Pylorus Infection Clarithromycin 
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  1. 1.
    Rauws EAJ, Langenberg W, Houthoff HJ, et al. Campylobacter pyloritis-associated chronic active antral gastritis: a prospective study of its prevalence and the effects of antimicrobial and antiulcer treatment. Gastroenterology 1988; 94: 33–401..PubMedGoogle Scholar
  2. 2.
    McColl KEL, El-Nyim AM, Chittajallu RS, et al. A study of the pathogenesis of Helicobacter pylori negative duodenal ulceration. Gut 1993; 34: 762–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Borody TJ, George LL, Brandi S, et al. Helicobacter pylori negative duodenal ulcer. Am J Gastroenterol 1991; 86: 1154–7.PubMedGoogle Scholar
  4. 4.
    Taha AS, Nakashabendi I, Lee FD, et al. Chemical gastritis and Helicobacter pylori related gastritis in patients receiving non-steroidal anti-inflammatory drugs: comparison and correlation with peptic ulceration. J Clin Pathol 1992; 45: 135–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Heresbach D, Raoul JL, Bretagne JF, et al. Helicobacter pylori: a risk and severity factor of non-steroidal anti-inflammatory drug-induced gastropathy. Gut 1992; 33 (12): 1608–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Martin DF, Montgomery E, Dobek AS, et al. Campylobacter pylori, NSAIDs, and smoking: risk factors for peptic ulcer disease. Am J Gastroenterol 1989; 84 (10): 1268–72.PubMedGoogle Scholar
  7. 7.
    NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease. Helicobacter pylori in peptic ulcer disease. JAMA 1994; 272: 65–9.CrossRefGoogle Scholar
  8. 8.
    Marshall BJ, Armstrong JA, Francis GJ, et al. Antibacterial action of bismuth in relation to Campylobacter pyloridis colonization and gastritis. Digestion 1987; 37: 16–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Rauws EAJ. Therapeutic attempts at eradication of Campylobacter pylori. Eur J Gastroenterol Hepatol 1989; 1: 34–41.Google Scholar
  10. 10.
    Glupczsynski J, Burette A. Drug therapy for Helicobacter-pylori infection: problems and pitfalls. Am J Gastroenterol 1990; 85: 1545–1551.Google Scholar
  11. 11.
    Noach LA. Helicobacter pylori infection: Aspects of pathogenesis and therapy. Academic thesis.Google Scholar
  12. 12.
    Glupczsynski J, Burette A. Failure of azitromycin to eradicate Campylobacter pylori from the stomach because of required resistance during treatment. Am J Gastroenterol 1990; 85: 98–9.Google Scholar
  13. 13.
    Lambert JR, Lin SK, Schembri M, et al. Helicobacter pylori therapy randomized study of denol/antibiotic combination. Rev Esp Enferm Dig 1990; 78(S): 115–6.Google Scholar
  14. 14.
    Goodwin CS, Marshall BJ, Blincow ED, et al. Prevention of nitroimidazole resistance in Campylobacter pylori by coadministration of colloidal bismuth subcitrate: clinical and in vitro studies. J Clin Pathol 1988; 41: 207–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Mégraud F, Cayla R, Lamouliatte H, et al. Surveillance of Helicobacter pylori resistance to macrolides and nitro-imidazoles compounds at a national level [abstract no. 334]. Am J Gastroenterol 1994; 89: 1368.Google Scholar
  16. 16.
    Labenz J, Leverkus F, Bozsch G, et al. Omeprazole plus amoxicillin for cure of H. Pylori infection. Factors influencing the treatment success. Scand. J. Gastroenterol 1994; 29: 1070–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Unge P, Gad A, Eriksson K, et al. Amoxicillin added to omeprazole prevents relapse in the treatment of duodenal ulcer patients. Eur J Gastroenterol Hepatol 1993; 5: 325–31.CrossRefGoogle Scholar
  18. 18.
    Logan RPH, Walker MM, Misiewicz JJ, et al. Changes in the intragastric distribution of H.pylori during treatment with omeprazole. Gut 1995; 36: 12–6.PubMedCrossRefGoogle Scholar
  19. 19.
    van der Hulst RWM, Tytgat GNJ. Helicobacter pylori and peptic ulcer disease. Scand. J. Gastroenterol 1995; (in press).Google Scholar
  20. 20.
    Penston JG. Review article: Helicobacter pylori eradication — understandable caution but no excuse for inertia. Aliment Pharmacol Ther 1994; 8: 369–89.PubMedCrossRefGoogle Scholar
  21. 21.
    de Boer WA, Driessen WMM, Potters VPJ, et al. Randomized study comparing 1 with 2 weeks of quadruple therapy for eradicating Helicobacter pylori. Am J Gastroenterol 1994; 89; 11: 1993–7.PubMedGoogle Scholar
  22. 22.
    Thijs JC, van Zwet AA, Oey HB. Efficacy and side effects of a triple drug regimen for the eradication of Helicobacter pylori. Scand J Gastroenterol 1993; 28: 934–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Hentschel E, Brandstatter G, Dragosics B, et al. Effect of ranitidine and amoxycillin plus metronidazole on the eradication of H. pylori and the recurrence of duodenal ulcer. N Engl J Med 1993; 326: 308–12.CrossRefGoogle Scholar
  24. 24.
    Bazzoli F, Gullini S, Zagari RM, et al. Effect of omeprazole and clarythromycin plus timidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer [abstract]. Am J Gastroenterol 1994 Aug; 89: 1364.Google Scholar
  25. 25.
    Bell GD, Powell KU, Burridge SM, et al. Helicobacter pylori eradication: efficacy and side-effect profile of a combination of omeprazole, amoxycillin and metronidazole compared with four alternative regimens. Q J Med 1993; 86: 743–50.PubMedGoogle Scholar
  26. 26.
    Borody TJ, Andrews P, Shortis NP, et al. Optimal H. pylori therapy: a combination of omeprazole and triple therapy [abstract]. Gastroenterology 1994 Apr; 106 Suppl.: 55.Google Scholar
  27. 27.
    de Boer WA, Driessen W, Tytgat GNJ. Effect of acid suppression on efficacy of treatment for Helicobacter pylori infection. Lancet 1995; 345: 817–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Mannes GA, Bayerdörffer E, Hochter W, et al. Early relapse rate after healing of C. pylori-positive duodenal ulcers [abstract]. Klin Wochenschr 1989; 67 Suppl. 18: 44.Google Scholar
  29. 29.
    o’Riordan T, Mathai E, Tobui E, et al. Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate. Gut 1990; 31: 999–1002.PubMedCrossRefGoogle Scholar
  30. 30.
    Weil J, Bell GD, Jones PH, Gant P, et al. Eradication of Campylobacter pylori: are we being misled? [letter]. Lancet 1988; 2: 1245.PubMedCrossRefGoogle Scholar
  31. 31.
    Noach LA, Langenberg WL, Bertola MA, et al. Impact of metronidazole resistance on the eradication of Helicobacter pylori. Scand J Infect Dis 1994; 26: 3: 321–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Neri M, Susi D, Bovani I, et al. Omeprazole, bismuth and clarithromycin: a new approach to the treatment of Helicobacter pylori (HP)-related gastritis [abstract]. Gastroenterology 1992; 102: A134.Google Scholar
  33. 33.
    Bell GD, Powell KU, Burridge SM, et al. Short report: omeprazole plus antibiotic combinations for the eradication of metronidazole-resistant Helicobacter pylori. Aliment Pharmacol 1992; 6: 751–8.CrossRefGoogle Scholar
  34. 34.
    Bayerdörffer E, Mannes GA, Sommer A, et al. High dose omeprazole treatment combined with amoxicillin eradicates Helicobacter pylori. Eur J Gastroenterol Hepatol 1992; 4: 697–702.Google Scholar
  35. 35.
    Labenz J, Gyenes E, Rühl GH, et al. Amoxicillin plus omeprazole versus triple therapy for eradication of Helicobacter pylori in duodenal ulcer disease: a prospective, randomized, and controlled study. Gut 1993; 34: 1167–70.PubMedCrossRefGoogle Scholar
  36. 36.
    Logan RPH, Gummett PA, Misiewicz J, et al. One weeks’s anti-Helicobacter pylori treatment for duodenal ulcer. Gut 1994; 35: 15–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Cayla R, Zerbib F, De Mascarel A, et al. Dual therapy with high dose of omeprazole versus triple therapy using omeprazole in combination with two antibiotics for H. pylori eradication [abstract]. Am J Gastroenterol 1994 Aug; 89: 1366.Google Scholar
  38. 38.
    George LL, Borody TJ, Andrews P, et al. Cure of duodenal ulcer after eradication of Helicobacter pylori. Med J Aust 1990; 153: 145–9.PubMedGoogle Scholar
  39. 39.
    Sobala GM, George R, Tomkins D, et al. Spontaneous healing of duodenal ulcers after eradication H. pylori [abstract]. Ir J Med Sci 1992; 161 Suppl. 10: 5.Google Scholar
  40. 40.
    De Koster E, Nyst JF, Deprez C, et al. Helicobacter pylori treatment: double vs. triple therapy: who needs bismuth? [abstract]. Gastroenterology 1992; 102: A58.Google Scholar
  41. 41.
    Labenz J, Stolte M, Ruhl GH, et al. One-week low dose triple therapy for the eradication of Helicobacter pylori infection. Eur J Gastroenterol Hepatol 1995; 7: 9–11.PubMedGoogle Scholar
  42. 42.
    Logan RPH, Gummett PA, Schaufelberger HD, et al. Eradication of Helicobacter pylori with clarithromycin and omeprazole. Gut 1994; 35: 323–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Hosking SW, Ling TWK, Chung SCS, et al. Duodenal ulcer healing by eradication of Helicobacter pylori without anti-acid treatment: randomized controlled trial. Lancet 1994; 343: 508–10.PubMedCrossRefGoogle Scholar
  44. 44.
    Labenz J, Rühl GH, Bertrams J, et al. Clinical course of duodenal ulcer disease: one year after omeprazole plus amoxycillin or triple therapy plus ranitidine for cure of Helicobacter pylori infection. Eur J Gastroenterol Hepatol 1994; 6 (4): 293–7.Google Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Erik A. J. Rauws
    • 1
  • René W. M. van der Hulst
    • 1
  1. 1.Department of Gastroenterology & HepatologyAcademic Medical CenterAmsterdamThe Netherlands

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