Can the response to eradication therapy in Helicobacter pylori infection be predicted?

Abstract

The role of Helicobacter pylori infection in the production of mucosal damage has largely been considered within a simple infection paradigm, because to date eradication has appeared to be a predictable outcome of antibiotic therapy. Various antibiotic regimens claim eradication rates in excess of 90% and in vitro H. pylori is sensitive to many antibiotics. Eradication failure is discussed in terms of antibiotic resistance and poor compliance. However, it is now clear that the contemporary notion that H. pylori infection directly causes mucosal disease, and that a course of antibiotics to which the organism is sensitive will cure the disease, is too simplistic. Thus, in general clinical experience, a more realistic eradication rate is 60–70% and failure to attain mucosal sterility cannot be simply explained by patterns of antibiotic resistance¹. An increasingly large pool of patients with persistent infection due to failed therapy has become a significant medical problem, causing confusion in the minds of clinicians, which increases as the ‘easy-to-treat’ cases become less common.