Eradication of Helicobacter pylori: Which patients, which drugs?

Helicobacter pylori, first detected in gastritis patients a decade ago, has now been shown to be the major cause of active chronic gastritis, and the evidence that it plays a major role in the pathophysiology of duodenal ulcers and possibly gastric ulcers is compelling. The infection is generally diagnosed at the initial endoscopy by means of a rapid urease test, but it may be detected by serologic testing in patients not undergoing endoscopy. Treatment of the infection should be reserved for patients with duodenal ulcer disease that presents a significant management problem. The recommended therapy, commonly referred to as triple therapy, consists of bismuth subsalicylate, tetracycline, and metronidazole and has an 80% to 90% eradication success rate.