Enfermedades relacionadas con Helicobacter pylori: dispepsia, úlcera y cáncer gástrico

Abstract

This article summarizes the main conclusions drawn from the presentations on Helicobacter pylori infection at Digestive Disease Week 2010. Antibiotic resistance is increasing in several countries. There is an inverse relationship between H. pylori and gastroesophageal reflux disease (GERD), although this association does not imply that H. pylori eradication favors the development of GERD. The benefit of eradication therapy in uninvestigated dyspepsia seems to be confirmed in the long term. H. pylori eradication improves symptoms in a subgroup of patients with functional dyspepsia. The frequency of idiopathic peptic ulcers seems to be increasing. H. pylori eradication eliminates almost all episodes of peptic ulcer rebleeding; nevertheless, the use of non-steroidal anti-inflammatory drugs (NSAIDS) or H. pylori reinfection can lead to bleeding recurrence. Diagnostic methods for H. pylori based on gastric biopsy have reduced sensitivity in patients with gastrointestinal bleeding. Even patients showing gastrointestinal hemorrhage while receiving NSAIDs are frequently infected. The phylogenetic origin of the H. pylori strain predicts the development of preneoplastic gastric lesions. The electrochemical properties of H. pylori allow these lesions to be rapidly and accurately detected in gastric biopsies. The rapid urease test, including biopsies from both antrum and body, increases sensitivity and allows results to be obtained more quickly. Although confirmation of H. pylori eradication is recommended, in clinical practice, this recommendation is frequently not carried out. Narrow-band imaging allows the change in mucous and vascular pattern after eradication to be confirmed. An association between H. pylori infection and iron deficiency anemia, arteriosclerosis, obesity and adenomas/colorectal tumors has been suggested but remains to be confirmed. The efficacy of “traditional” triple therapies currently leaves much to be desired but could be increased by the use of high-dose proton pump inhibitors and antibiotics and/or increased duration of therapy. The new single-capsule preparation combining bismuth, tetracycline and metronidazole simplifies administration of quadruple therapy. The superiority of “sequential” therapy over the standard triple therapy should be confirmed in different environments. A hybrid sequential-concomitant therapy is a potentially useful alternative. The new sustainedrelease formulation antibiotics have shown promising results. Second-line rescue therapy with levofloxacin is effective and is also simpler and better tolerated than quadruple therapy. In patients allergic to penicillin, a combination with levofloxacin and clarithromycin is a promising rescue alternative. The new-generation quinolones, such as sitafloxacin, could be useful in third-line eradication therapy. Because H. pylori infection does not confer protection, reinfection can occur more than once with the same strain, which could allow the use of this bacterium as a vector for the administration of various vaccines on multiple occasions.