Advertisement

Current Treatment Options in Gastroenterology

, Volume 15, Issue 4, pp 648–659 | Cite as

Best Practice Recommendations for Diagnosis and Management of Helicobacter pylori—Synthesizing the Guidelines

  • David J. Bjorkman
  • Matthew Steenblik
Stomach (DA Johnson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stomach

Abstract

Purpose of review Three guidelines on Helicobacter pylori have been published recently with recommendations that differ from past guidelines. In this review, we summarize the Toronto consensus statement, the Maastricht V/Florence consensus report and the American College of Gastroenterology guidelines on H. pylori, comparing and contrasting the recommendations. We also provide a proposed approach integrating the information from all three guidelines.

Findings Increasing antibiotic resistance has decreased the effectiveness of past treatment regimens for H. pylori. The recommended treatment approach should be based on local and individual antibiotic resistance patterns. Empiric first-line therapy should be a 14-day course of bismuth- or antibiotic-based quadruple therapy. Clarithromycin triple therapy is not recommended unless the local clarithromycin resistance rate is less than 15%. Second-line therapy should be influenced by the failed first-line therapy. Quadruple bismuth-based therapy or levofloxacin-based therapy are suggested regimens. Testing for antibiotic resistance is recommended after multiple failed treatments.

Summary Therapy of H. pylori should be based on the knowledge of local antibiotic resistance patterns. Unfortunately, these are often not available. Additional efforts are needed to define local antibiotic resistance to allow susceptibility-based treatment. In the meantime, 14-day quadruple therapy with bismuth or concomitant antibiotics is the recommended as an empiric first-line treatment approach.

Keywords

Helicobacter pylori Dyspepsia Peptic ulcer disease Gastric cancer Antibiotic resistance 

Notes

Compliance with ethical standards

Conflict of interest

David J. Bjorkman declares that he has no conflict of interest.

Matthew Steenblik declares that he has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212–39. The most recent update of ACG guidelines on H. pylori , updating the prior guideline of 2007. The recommendations focus only on North America. CrossRefPubMedGoogle Scholar
  2. 2.
    Hooi JKY, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153:420–9.CrossRefPubMedGoogle Scholar
  3. 3.
    •• Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology. 2016;151:51–69. A new guideline from the Canadian Association for Gastroenterology and the Canadian Helicobacter Study Group. The recommendations focus only on treatment and literature is reviewed only after 2008. CrossRefPubMedGoogle Scholar
  4. 4.
    •• Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacer pylori infection-the Maastricht V/Florence consensus report. Gut. 2017;66:6–30. Most recent guideline from the long-standing Maaschrict/Florence group on H. pylori . The prior guideline was published in 2012. This is the broadest of the new guidelines covering disease association, diagnosis, treatment, prevention and the role of the gut microbiome. CrossRefPubMedGoogle Scholar
  5. 5.
    Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection—the Maastricht IV/ Florence consensus report. Gut. 2012;61:646–64.CrossRefPubMedGoogle Scholar
  6. 6.
    • Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64:1353–67. International consensus report on the role of H. pylori in gastric disorders. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chey WD, Wong BC. Practice parameters committee of the American College of Gastroenterology American College of Gastroenterology guideline on the management of Helicobacter pylori. Am J Gastroenterol. 2007;102:1808–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    • Gisbert JP, Molina-Infante J, Amador J, Bermejo F, Bujanda L, Calvet X, et al. IV Spanish consensus conference on Helicobacter pylori infection treatment. Gastroenterol Hepatol. 2016;39:697–721. Spanish consensus guidelines for H. pylori . Published during the same time period as those reviewed here. The recommendations are similar to the other guidelines. CrossRefPubMedGoogle Scholar
  10. 10.
    Thung I, Aramin H, Vavinskaya V, Gupta S, Park JY, Crowe SE, et al. Review article: the global emergence of Helicobacter pylori antibiotic resistance. Aliment Pharmacol Ther. 2016;43:514–33.CrossRefPubMedGoogle Scholar
  11. 11.
    • Graham DY, Laine L. Toronto H. pylori consensus recommendations in context. Gastroenterology. 2016;151:9–12. Editorial accompanying the Toronto guidelines putting the guidelines in perspective, noting that resistance patterns are not often known and the pitfalls of multidrug therapy in creating more resistance. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and NutritionUniversity of Utah School of MedicineSalt Lake CityUSA

Personalised recommendations