Author:

Abstract:

In the primary care setting, a "test-and-treat"-approach for Helicobacter pylori is recommended in adults below 45 years presenting with persistent dyspepsia and after exclusion of symptoms of gastro-oesophageal reflux, NSAID-use or alarm. The urea-breath test or alternatively the stool-antigen test are the detection methods of choice. In the secondary care setting, eradication of H. pylori is recommended in all patients with a peptic ulcer (with or without complications), a low-grade maltoma, atrophic gastritis or undergoing surgery for gastric carcinoma. Finally, eradication is also recommended in first degree relatives of gastric carcinoma patients and in patients who themselves request eradication (the latter only after a thorough consultation). First-line eradication therapy consists of triple therapy with protonpump inhibitors (PPIs), clarithromycine and amoxicilline. The second-line eradication scheme consists of quadruple-therapy with PPIs, bismuth salts, tetracycline and metronidazole. This combination offers the advantage of containing tetracycline for which no resistance has been observed, as well as metronidazole where resistance can be overcome and bismuth which carries synergistic effects with antibiotics. If second-line therapy fails, a number of basic criteria for efficacious eradication should be checked and individually corrected or adapted. Especially the compliance of the patient should be verified.