Helicobacter pylori infection: diagnosis, treatment and risks of untreated infection

摘要

Helicobacter pylori infection is associated with various gastroduodenal pathologies ranging from gastritis and peptic ulcer disease to gastric cancer. The most current guidelines for the diagnosis, indications for therapy and treatment strategies of H, pylori are outlined in the third Maastricht Consensus conference which was convened by the European Helicobacter Study Group (EHSG). The diagnosis of H, pylori infection is established using invasive or non-invasive methods. Non-invasive tests are the urea-breath test, stool-antigen tests and serological kits with a high accuracy. Invasive tests include endoscopy with gaining of gastric biopsies for urea test (HUT~R, Helicobacter urease test) or histology (e.g. Whartin Starry silver staining). Eradication of H. pylori infection is recommended in patients with gastroduodenal pathologies such as peptic ulcer disease and low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, atrophic gastritis, first-degree relatives of gastric cancer patients, unexplained iron deficiency anaemia and chronic idiopathic thrombocytopenic purpura. Triple therapy using a proton pump inhibitor (PPI) with amoxicillin and clarithromycin or metronidazole given twice daily remains the recommended first-choice therapy. Bismuth containing quadruple therapy is also a first-choice treatment option. Rescue therapy should be based on antimicrobial susceptibility. The risk of untreated H. pylori infection appears to be highest in patients who require long-term treatment with non-steroidal anti-inflammatory agents. Untreated H. pylori infection also leads to precancerous and cancerous stomach lesions. Therefore, eradication of H. pylori has the potential to reduce the risk of gastric cancer development.