[Helicobacter pylori - 2012]

György Miklós Buzás
Orvosi Hetilap 2012 September 9, 153 (36): 1407-18
The author overviews some aspects of literature data of the past 2 years. Genetic research has identified polymorphisms of Helicobacter pylori virulence factors and the host which could play a role in the clinical outcome of the infection (peptic ulcer or gastric cancer). So far they have been performed in research centers but with a decrease of costs, they will take their place in diagnosing the diseases and tailoring the treatment. Antibiotic resistance is still growing in Southern European countries and is decreasing in Belgium and Scandinavia. Currently, the clarithromycin resistance rate is of 17-33% in Budapest and levofloxacin resistance achieved 27%. With careful assessment of former antibiotic use the resistance to certain antibiotics can be avoided and the rates of eradication improved. Immigration is a growing problem worldwide: according to Australian, Canadian and Texan studies, the prevalence of Helicobacter pylori is much higher in the immigrant groups than in the local population. An Italian study showed that the eradication rate of triple therapy is significantly lower in the Eastern European immigrants than in the Italians. A recent research has suggested a link between female/male infertility, habitual abortion and Helicobacter pylori infection. However, there are no published data or personal experience to show whether successful eradication of the virus in these cases is followed by successful pregnancies or not. The author overviews the Maastricht process and analyzes the provisions of the Maastricht IV/Florence consensus, in which the new diagnostic algorithms and indications of eradication therapy are reformulated according to the latest levels of evidence and recommendation grading. According to the "test and treat" strategy, either the urea breath test or the stool monoclonal antigen test are recommended as a non-invasive diagnostic method in primary care. Endoscopy is still recommended in case of alarm symptoms, complicated ulcer, or if there is a suspicion of malignancy or MALT lymphoma. Local resistance to clarithromycin and levofloxacin should be considered in the choice of first-line therapy, in case of levels >15-20% these compounds should not be used. In regions with low resistance rates, classical triple therapy remains the regimen of choice; its alternative is the bismuth-based quadruple therapy. Determining antimicrobial resistance is justified after failed second- or third-line therapies; where available, molecular methods (fluorescence in situ hybridization, polymerase chain reaction) should be used. As second/third line treatments, the sequential, bismuth-based quadruple, concomitant quadruple regimens, hybrid are all possible alternatives. The Hungarian diagnostic and therapeutic approach in practice is different in some aspects from the provisions of the European consensus. Orv. Hetil., 2012, 153, 1407-1418.

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