Helicobacter pylori

Abstract

The Helicobacter pylori is a gram-negative bacterium, which is well adapted to live in the gastric mucosa. Sixty percent of the adult population in the world is thought to be infected by this bacterium. The prevalence depends on the social-economical class, and whether the patient lives in a developing country. The Helicobacter pylori can be detected through several invasive tests (urease, tissue culture or histological test) and non-invasive tests (respiratory or breath test, stool or serological tests). Currently, patients who present active or healed peptic ulcer are candidates to Helicobacter pylori detection and eradication. However, a consensus is yet to be defined regarding the need for its eradication in patients with functional dyspepsia, gastroesophagical reflux disease or those under the use of non-steroidal anti-inflammatory drugs (NSAIDs). Although there are no indications for the eradication of H. pylori as a preventive measure for gastric cancer, this subject has been under intense investigation. It is probable that, with the development of a vaccine, this becomes the most practical approach. The current eradication treatments include anti-secretory drugs, bismuth and antibiotics. Complex and poorly-tolerated therapeutic regimen should be avoided; the simplest therapeutic regimens currently under use, which present fewer side effects and good compliance by most of the patients, is the association of a protonpump inhibitor (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole) at the usual dose, clarithromycin 500 mg and amoxicilline 1000 mg, b.i.d. for 7 days. Regarding retreatment regimens, the association of four drugs and a longer period of treatment are indicated.