Helicobacter pylori Diagnostics and Treatment: Could a Lack of Universal Consensus Be the Best Consensus?

Abstract

Helicobacter pylori testing and treatment has become a subject of intense debate and confusion worldwide in recent years, for both laboratory scientists and clinicians. The gastric pathogen H. pylori is believed to infect up to half of the world's population disproportionately, yet it remains a challenging diagnosis for many physicians worldwide. New testing mechanisms have been introduced, but no single universal approach for testing and treating H. pylori has been established to date. In effect, no population on earth has been spared from these chronic infections, but regional differences in prevalence and associated disease severity do exist. Not unexpectedly, there also exist regional approaches in the diagnosis, treatment, and management of these patients. This Q&A borrows the experience of 3 international experts in the field of H. pylori to reflect on the current status of H. pylori management and challenges on 3 separate continents, specifically Australia, Europe, and North America. Several different guidelines exist for the diagnosis/treatment of H. pylori infections. What controversy or challenges do you perceive with current guidelines? Barry Marshall: Guidelines for the treatment of H. pylori infections are aimed toward achieving a cure rate of at least 85%. In the past 10 years, because of gradually increasing resistance to macrolides, the very successful and popular combination treatment using a proton pump inhibitor (PPI),6 clarithromycin, and amoxicillin has declined in effectiveness from greater than an 85% cure rate originally, to the region of 70%–80% in some areas where long-acting macrolides have been used for 10 or more years. This has created research interest in the evaluation of newer and more intensive therapies, often with extra antibiotics added to hopefully eradicate the H. pylori without the emergence of resistant isolates. Over the years, shorter and more-intensive treatments for H. pylori infection have been tried, and these are …