This article summarizes the main conclusions drawn from the studies presented in Digestive Disease Week in 2012 on Helicobacter pylori
infection. In developed countries, the prevalence of this
infection has decreased, although it continues to be high. The prevalence in Spain is high (50%) and does not seem to be decreasing. There is an increase in antibiotic resistance, which is correlated with the frequency of prior
antibiotic prescription. H. pylori eradication improves the symptoms of "epigastric
pain syndrome" in functional
dyspepsia. The frequency of idiopathic
peptic ulcers seems to be increasing. To prevent the development of
gastric cancer, eradication
therapy should be administered early (before intestinal
metaplasia develops). H. pylori eradication in patients undergoing early endoscopic resection of
gastric cancer reduces the incidence of metachronous
tumors, although endoscopic follow-up should be performed periodically. H. pylori eradication induces
MALT lymphoma regression in most patients and tumoral recurrence in the long term is exceptional;
radiotherapy is an excellent second-line option; a watch and wait approach to histologic recurrence after initial
MALT lymphoma remission is a reasonable alternative.
Idiopathic thrombocytopenic purpura is an indication for eradication
therapy in children as well as adults. There are several diagnostic innovations, such as high-resolution endoscopy, narrow-band imaging, a method based on the electrochemical properties of H. pylori, and the cytosponge. Quadruple
therapy with
bismuth is at least as effective as standard triple
therapy. The superiority of "sequential"
therapy over standard triple
therapy should be confirmed in distinct settings. The efficacy of "concomitant"
therapy is similar -or even better- than that of "sequential"
therapy, but has the advantage of being simpler. A hybrid sequential-concomitant
therapy is highly effective. In patients allergic to
beta-lactams, the efficacy of treatment with a
proton pump inhibitor-
clarithromycin-
metronidazole is insufficient. When standard triple
therapy fails, the second-line option of a 10-day course of
levofloxacin is effective and is simpler and better tolerated than quadruple
therapy. Triple
therapy with
levofloxacin is also a promising alternative after failure of "sequential" and "concomitant"
therapy. New-generation
quinolones, such as
moxifloxacin and
sitafloxacin, could be useful as eradication
therapy, especially as rescue
therapy. When two eradication
therapies have failed, empirical administration of a third (e.g.
levofloxacin) is a valid option. Even after three eradication
therapies have failed, an empirical rescue
therapy (with
rifabutin) can be effective. H. pylori
reinfection is highly frequent in developing countries, probably due to intrafamilial transmission.