New American Guidelines for Helicobacter pylori Treatment

 
What is H. pylori?
Helicobacter pylori (H. pylori) is a spiral-shaped bacterium found in the stomach lining. This bacterium thrives in the acidic environment of the stomach. While many people may not show symptoms, H. pylori can cause serious health issues like chronic gastritis, peptic ulcers, and even gastric cancer.
 
Why is H. pylori a Health Risk?
H. pylori infection is common globally, especially in areas with poor sanitation. In North America, 30%-40% of people are affected. Those in crowded environments or immigrants from regions where H. pylori is widespread are at higher risk. Left untreated, H. pylori can lead to severe complications, including gastric cancer, making early detection and treatment critical.
 
New Guidelines for H. pylori Treatment
Recognizing the serious health risks of H. pylori, leading gastroenterology experts have released new treatment guidelines. These updates emphasize the importance of effective treatment protocols, especially in light of rising antibiotic resistance. Here is what you need to know to manage H. pylori infection effectively.
 
Diagnosing H. pylori: What to Expect
H. pylori can be diagnosed through non-invasive tests such as:

• Urea breath tests
• Stool antigen tests
• Blood tests

New guidelines also stress the importance of antibiotic sensitivity testing. This helps identify which antibiotics will be most effective, especially as resistance to common treatments increases.
 
 
Updated H. pylori Treatment Guidelines
The new guidelines provide different treatment options for first-time patients and those with persistent infections, aiming to improve effectiveness by overcoming antibiotic resistance.
 
First-Line Treatment for First-Time Patients:

1. Optimized Bismuth Quadruple Therapy (BQT):
   Combines a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. This is highly recommended for first-time patients due to its effectiveness.
2. Rifabutin Triple Therapy:
   A newer therapy combining rifabutin (a strong antibiotic), amoxicillin, and a PPI. It is a good alternative for patients needing a first-line treatment.
3. PCAB and Amoxicillin Dual Therapy:
   This combination of a potassium-competitive acid blocker (PCAB) and amoxicillin is another effective first-line treatment option, especially in cases where clarithromycin resistance is suspected.
4. PCAB-Clarithromycin Triple Therapy:
   For patients with unknown clarithromycin resistance, this therapy (PCAB, clarithromycin, and a PPI) is recommended over traditional PPI-based treatments.

 
Treatment for Patients with Persistent H. pylori Infections:
For patients whose first treatment did not work, the following options are recommended:

1. Bismuth Quadruple Therapy (BQT):
   This therapy is still the top recommendation for patients who did not respond to initial treatment. It is especially effective if the patient has not received BQT before.
2. Rifabutin Triple Therapy:
   Suggested for patients with persistent infections who have already undergone bismuth quadruple therapy. It provides another strong alternative.
3. Levofloxacin Triple Therapy:
   If your H. pylori strain is sensitive to levofloxacin, this therapy (levofloxacin, amoxicillin, and PPI) is recommended. It is useful if previous treatments, including BQT or rifabutin triple therapy, have failed.

 
Post-Treatment Testing: Why It’s Important
After completing treatment, it is critical to confirm the infection has been eradicated. Testing, usually done four weeks post-treatment, includes:

• Urea breath test
• Stool antigen test
• Biopsy-based tests

Ensuring the bacteria is eradicated helps prevent long-term complications, such as peptic ulcers or gastric cancer.
 
Who Should Be Tested for H. pylori?
Testing is recommended for high-risk individuals, including:

• People with a history of peptic ulcers or active ulcers.
• Those with unexplained iron deficiency anemia.
• Patients with a family history of gastric cancer or premalignant gastric conditions.
• Individuals on long-term NSAID use or experiencing functional dyspepsia.
• Adults living with someone who has tested positive for H. pylori.

 
Testing is also advisable for those in high-risk populations, particularly people from regions with a high incidence of gastric cancer or those with a family history of the disease.
 
The Future of H. pylori Treatment: Precision Medicine
As antibiotic resistance grows, treating H. pylori is evolving toward precision medicine. New therapies like rifabutin triple therapy and PCAB-amoxicillin dual therapy offer alternatives to traditional treatments. The guidelines also emphasize antibiotic susceptibility testing to personalize treatment and improve eradication rates.
 
Conclusion: Stay Informed About H. pylori Treatment
If you have been diagnosed with H. pylori or are at risk, it is essential to stay informed about the latest treatment options. The new guidelines provide updated, effective therapies to combat rising antibiotic resistance, helping patients reduce their risk of complications and ensuring they receive the best possible care.
 
Bumrungrad International Hospital: Experts in H. pylori Treatment
At Bumrungrad International Hospital, we provide cutting-edge care for patients with H. pylori infection. Our team of specialists uses the latest diagnostic tools and treatments to ensure the best outcomes for our patients. If you have any questions or need to schedule a consultation, contact us today to begin your path to better health.
 
Reference: Am J Gastroenterol 2024;119:1730–1753. https://doi.org/10.14309/ajg.0000000000002968; published online September 4, 2024
 

Tossapol Kerdsirichairat, MD, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital