How to Achieve a Near 100% Cure Rate for H. Pylori Infection in Peptic Ulcer Patients

Abstract

Infection with Helicobacter pylori is the main etiological factor in duodenal and gastric ulcer disease, and eradication of the organism cures peptic ulcer disease. Cure of the infection therefore has become the ultimate treatment goal in ulcer patients. Only therapies that achieve a > 90% cure rate should be used in clinical practice and, as in any other disease, the therapy with the highest cure rates should be used. Bismuth-based triple therapy is considered the gold standard; it has been used successfully in many studies, usually with good tolerability on the part of patients. Many physicians have been hesitant to prescribe this therapy. The regimen is complex, and it is thought to have many side effects. Several groups have shown that concomitant therapy with a proton pump inhibitor increases efficacy and lessens side effects. Moreover, it has become clear that the duration of treatment can be decreased to just 7 days. With this adjustment it now seems sensible to use this short 7-day quadruple therapy, which at present has superior cure rates when compared with any other anti-Helicobacter therapy. This article is a plea for the use of this regimen and gives practical advice about how to employ therapy in general practice. Suggestions are made about how to motivate a patient to comply with the therapy prescribed. If these suggestions are followed, good compliance seems possible, and a near 100% cure rate will be within reach.

Bismuth, lansoprazole, amoxicillin and metronidazole or clarithromycin as first-lineHelicobacter pyloritherapy

“…The adherence to both regimens was excellent (92.6% vs 94.4%, p=0.593). Our results are consistent with the notion that pretreatment counselling is very important for good success in H. pylori eradication 26 27…”

Advantages of Moxifloxacin and Levofloxacin-based triple therapy for second-line treatments of persistent Helicobacter pylori infection: a meta analysis

“…It has been reported that quadruple therapy consisting of a similar combination of antibiotics and a proton-pump inhibitor has repeatedly been shown to be equally eff ective in spite of the presence of metronidazole resistance when the attention was given to the dose of metronidazole (e.g. 400 or 500 mg three times daily) and duration of therapy of approximately 14 days [47][48][49][50][51][52]. So, metronidazole-containing quadruple therapy may have overcome metronidazole resistance to some degree in our studies.…”

How to Effectively Use Bismuth Quadruple Therapy

“…de Boer who performed many of the initial Dutch trials examining dose, duration and the use of PPI's, used a 7-point approach of patient education/motivation starting with taking time to talk to the patient and explain the rationale. He then went on to explain the potential difficulties and side effects that might occur and provided details about how to take the medications 45 . He and Borody had good but not perfect adherence.…”