The American Journal of Gastroenterology has released updated guidelines regarding the management of Helicobacter pylori (H. pylori) infection. For patients who have never undergone treatment, the top recommendation is bismuth quadruple therapy.
The American Journal of Gastroenterology has released updated guidelines for treating Helicobacter pylori (H. pylori) infections.
The lead author of these guidelines is Dr. William D. Chey, who is the chief of the Division of Gastroenterology and Hepatology at the University of Michigan.
H. pylori is a bacterium that affects over half of the global population, although most individuals do not show symptoms.
This bacterium can lead to issues like dyspepsia, peptic ulcers, and even gastric cancer.
According to the new clinical practice guidelines, while H. pylori prevalence is declining in North America, it still impacts 30-40% of the population.
A previous guideline was published in 2017, which recommended proton pump inhibitor (PPI) and clarithromycin triple therapy as the primary treatment option.
The updated guideline now identifies bismuth quadruple therapy as the foremost recommendation for patients who have never received treatment.
This therapy usually involves a PPI, tetracycline, bismuth, and a nitroimidazole over a period of 14 days.
“We advised healthcare professionals to move away from PPI triple therapy back in 2017 due to rising concerns regarding clarithromycin resistance in H. pylori strains within the U.S.,” said Chey.
“Nevertheless, PPI triple therapy remains the most prescribed first-line treatment for H. pylori in the United States. In this latest guideline update, we emphasize that PPI triple therapy should not be used in almost all cases; patients should instead receive bismuth quadruple therapy or other recommended treatment options.”
The guideline offers a total of 12 treatment recommendations for patients in various scenarios.
The second recommendation for treatment-naïve patients, after bismuth quadruple therapy, is rifabutin triple therapy, which includes a PPI, rifabutin, and amoxicillin.
A third option features a new, highly effective medication called vonoprazan that suppresses stomach acid production, combined with amoxicillin.
Another significant shift in this guideline compared to 2017 is the increased emphasis on the availability of molecular testing for antibiotic resistance.
“Molecular testing enables the broader use of antibiotic sensitivity testing, allowing tailored therapy based on the antibiotics that a specific H. pylori strain or infected individual can tolerate,” Chey noted.
Additionally, the guideline outlines priorities for future research, such as determining which patients would benefit most from H. pylori testing to avert gastric cancer and assessing new FDA-approved treatments for ongoing infections.
Additional authors: Colin W. Howden, M.D., Steven F. Moss, M.D., Douglas R. Morgan, M.D., M.P.H., Katarina B. Greer, M.D., M.S., Shilpa Grover, M.D., M.P.H., Shailja C. Shah, M.D., M.P.H.
