H. pylori Eradication Therapy

Initial Management Approach

• Patients with a positive H. pylori stool test should receive eradication therapy regardless of symptoms, as H. pylori infection always implies gastritis, which is a risk factor for further gastrointestinal disease 2, 3

First-Line Treatment Options

• The American Gastroenterological Association recommends a proton pump inhibitor (PPI) plus two antibiotics for 14 days to prevent peptic ulcer disease, gastric cancer, and other H. pylori-related complications 1

Post-Treatment Follow-up

• Confirmation of H. pylori eradication is strongly recommended in complicated peptic ulcer disease, gastric ulcer, and low-grade gastric MALT lymphoma 2, 4
• Follow-up testing should be performed no earlier than 4 weeks after cessation of treatment, using either the 13C-urea breath test 1, stool antigen test 3, or endoscopy with biopsy 4, 3

Special Considerations

• Patients under 45 years without alarm symptoms can be treated by primary care physicians without further investigations 2, 5
• Patients over 45 years with severe dyspeptic symptoms or any patient with alarm symptoms should be referred to a specialist for endoscopy 5, 6
• The European Helicobacter Study Group recommends stopping antibiotics, bismuth, or PPIs at least 2 weeks before testing to avoid false negative test results 3

Common Pitfalls to Avoid

• Mono-antibiotic therapy increases the risk of antibiotic resistance and should be avoided 4
• Poor patient compliance can lead to treatment failure, and patients should be educated on the importance of completing the full course of treatment 4
• Failure to confirm eradication is particularly important in high-risk cases, and should be pursued in all patients with confirmed infection 4, 3