Helicobacter pylori therapy: a paradigm shift

Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease,
including gastric cancer. H. pylori eradication therapies and their efficacy are
summarized. A number of current treatment regimens will reliably yield >90% or
95% cure rates with susceptible strains. None has proven to be superior. We show
how to predict the efficacy of a regimen in any population provided one knows the
prevalence of antibiotic resistance. As with other infectious diseases, therapy
should always be susceptibility-based. Susceptibility testing should be demanded.
We provide recommendations for empiric therapies when that is the only option and
describe how to distinguish studies providing misinformation from those providing
reliable and interpretable data. When treated as an infectious disease, high H.
pylori cure rates are relatively simple to reliably achieve.