Top

Current Treatment Options in Gastroenterology

Published in:

01-12-2018 | Stomach (P Malfertheiner, Section Editor)

Helicobacter pylori Infection: New Facts in Clinical Management

Authors: Peter Malfertheiner, MD, Marino Venerito, Christian Schulz

Published in: Current Treatment Options in Gastroenterology | Issue 4/2018

Abstract

Purpose

The global prevalence of Helicobacter pylori remains high in spite of its significant downwards trajectory in many regions. The clinical management of H. pylori infection merits guidance to meet ongoing challenges on whom and how to test, prevent, and cure related diseases.

Recent findings

Several international guidelines and consensus reports have updated the management strategies for cure of the H. pylori infection. The definition of H. pylori gastritis as an infectious disease independent of whether or not presenting with clinical manifestations and symptoms has broadened the use of the test and treat strategy. Patients on selected long-term medications, such as aspirin, other anti-platelet agents, NSAIDs, and PPIs should be considered for H. pylori test and treat. Important progress is made with initiatives in primary and secondary gastric cancer prevention. Uncertainties persist in the interpretation of the role of H. pylori in association with extragastric diseases. Selection of therapies needs to address individual antibiotic resistance and regional surveillance of resistance for the adoption of an effective treatment algorithm.

Conclusion

Clinical aspects of H. pylori infection have evolved over time and the therapeutic management requires continuous adaptation. A vaccine is still a non-fulfilled promise. The future will tell us more about the role of H. pylori in interactions with the gut microbiome.

Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420–9. https://doi.org/10.1053/j.gastro.2017.04.022.CrossRefPubMed

Franck C, Hoffmann A, Link A, et al. Prevalence of Helicobacter pylori infection among blood donors in Saxony-Anhalt, Germany - a region at intermediate risk for gastric Cancer. Z Gastroenterol. 2017;55 (7) ,653-656.CrossRefPubMed

Venneman K, Huybrechts I, Gunter MJ, Vandendaele L, Herrero R, Van Herck K. The epidemiology of Helicobacter pylori infection in Europe and the impact of lifestyle on its natural evolution toward stomach cancer after infection: a systematic review. Helicobacter. 2018;23(3):e12483. https://doi.org/10.1111/hel.12483.CrossRefPubMed

Wang C, Nishiyama T, Kikuchi S, et al. Changing trends in the prevalence of H. pylori infection in Japan (1908–2003): a systematic review and meta-regression analysis of 170,752 individuals. Sci Rep. 2017;7(1):1–12. https://doi.org/10.1038/s41598-017-15490-7.CrossRefPubMedPubMedCentral

• Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212–39. https://doi.org/10.1038/ajg.2016.563 Provides a comprehensive insight in clinical developments of H. pylori infection with recommendations for management with focus on practice in US.CrossRefPubMed

• Fallone CA, Chiba N, van Zanten SV, et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology. 2016;151(1):51–69.e14. https://doi.org/10.1053/j.gastro.2016.04.006 Thourough assessment of available and recommended eradication therapies.CrossRefPubMed

• Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence consensus report. Gut. 2016;66(1):6–30. https://doi.org/10.1136/gutjnl-2016-312288 Update on all clinical aspects related to H. pylori infection includung future directions concerning screen and treat strategies, update on treatment recommendations and adressing the new focus on gastric microbiota beyond H. pylori.CrossRefPubMed

• Mahachai V, Vilaichone R, Pittayanon R, et al. Helicobacter pylori management in ASEAN: The Bangkok consensus report. J Gastroenterol Hepatol. 2018;33(1):37–56. https://doi.org/10.1111/jgh.13911 Focus on clinical aspects of H. pylori infection in Asia and recommendations for clinical managment.CrossRefPubMed

Ražuka-Ebela D, Bianca Giupponi FF. The year in Helicobacter. Helicobacter. 2018.

10.

Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JP. Rosacea and gastrointestinal disorders: a population-based cohort study. Br J Dermatol. 2017;176(1):100–6. https://doi.org/10.1111/bjd.14930.CrossRefPubMed

11.

Hou Y, Sun W, Zhang C, et al. Meta-analysis of the correlation between Helicobacter pylori infection and autoimmune thyroid diseases. Oncotarget. 2017;8(70):115691–700. https://doi.org/10.18632/oncotarget.22929.CrossRefPubMedPubMedCentral

12.

Von Arnim U, Wex T, Link A, et al. Helicobacter pylori infection is associated with a reduced risk of developing eosinophilic oesophagitis. Aliment Pharmacol Ther. 2016;43(7). https://doi.org/10.1111/apt.13560.CrossRef

13.

Molina-Infante J, Gutierrez-Junquera C, Savarino E, et al. Helicobacter pylori infection does not protect against eosinophilic esophagitis: results from a large multicenter case-control study. Am J Gastroenterol. 2018;113(7):972–9. https://doi.org/10.1038/s41395-018-0035-6.CrossRefPubMed

14.

Arnold IC, Hitzler I, Müller A. The immunomodulatory properties of Helicobacter pylori confer protection against allergic and chronic inflammatory disorders. Front Cell Infect Microbiol. 2012;2:10. https://doi.org/10.3389/fcimb.2012.00010.CrossRefPubMedPubMedCentral

15.

Lionetti E, Leonardi S, Lanzafame A, Garozzo MT, Filippelli M, Tomarchio S, et al. Helicobacter pylori infection and atopic diseases: is there a relationship? A systematic review and meta-analysis. World J Gastroenterol. 2014;20(46):17635–47. https://doi.org/10.3748/wjg.v20.i46.17635.CrossRefPubMedPubMedCentral

16.

den Hollander WJ, Sonnenschein-van der Voort AMM, Holster IL, et al. Helicobacter pylori in children with asthmatic conditions at school age, and their mothers. Aliment Pharmacol Ther. 2016;43(8):933–43. https://doi.org/10.1111/apt.13572.CrossRef

17.

Aniwan S, Tremaine WJ, Raffals LE, Kane SV, Loftus EV. Antibiotic use and new-onset inflammatory bowel disease in Olmsted county, Minnesota: a population-based case-control study. J Crohn’s Colitis. 2018;12(2):137–44. https://doi.org/10.1093/ecco-jcc/jjx135.CrossRef

18.

Rosania R, Arnim UV, Link A, et al. Helicobacter pylori eradication therapy is not associated with the onset of inflammatory bowel diseases. A case-control study. J Gastrointest Liver Dis. 2018;27(2). https://doi.org/10.15403/jgld.2014.1121.272.hpy.

19.

Sung JJ, Chiu PC, Chan FKL, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018;67:1757–68. https://doi.org/10.1136/gutjnl-2018-316276.CrossRefPubMed

20.

Chan FKL, Ching JYL, Suen BY, Tse YK, Wu JCY, Sung JJY. Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology. 2013;144(3):528–35. https://doi.org/10.1053/j.gastro.2012.12.038.CrossRefPubMed

21.

Sostres C, Carrera-Lasfuentes P, Benito R, et al. Peptic ulcer bleeding risk. The role of Helicobacter pylori infection in NSAID/low-dose aspirin users. Am J Gastroenterol. 2015;110(5):684–9. https://doi.org/10.1038/ajg.2015.98.CrossRefPubMed

22.

Venerito M, Schneider C, Costanzo R, Breja R, Röhl FW, Malfertheiner P. Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti-inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors. Aliment Pharmacol Ther. 2018;(December 2017). https://doi.org/10.1111/apt.14652 CrossRef

23.

Scally B, Emberson JR, Spata E, et al. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. Lancet Gastroenterol Hepatol. 2018;3(4):231–41. https://doi.org/10.1016/S2468-1253(18)30037-2.CrossRefPubMedPubMedCentral

24.

Gyawali CP, Fass R. Management of gastroesophageal reflux disease. Gastroenterology. 2018;154(2):302–18. https://doi.org/10.1053/j.gastro.2017.07.049.CrossRefPubMed

25.

Malfertheiner P, Kandulski A, Venerito M. Proton-pump inhibitors: understanding the complications and risks. Nat Rev Gastroenterol Hepatol. 2017;14(12):697–710. https://doi.org/10.1038/nrgastro.2017.117.CrossRefPubMed

26.

Poulsen AH, Christensen S, McLaughlin JK, et al. Proton pump inhibitors and risk of gastric cancer: a population-based cohort study. Br J Cancer. 2009;100(9):1503–7. https://doi.org/10.1038/sj.bjc.6605024.CrossRefPubMedPubMedCentral

27.

Tran-Duy A, Spaetgens B, Hoes AW, de Wit NJ, Stehouwer CDA. Use of proton pump inhibitors and risks of fundic gland polyps and gastric cancer: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(12):1706–1719.e5. https://doi.org/10.1016/j.cgh.2016.05.018.CrossRefPubMed

28.

Cheung KS, Chan EW, Wong AYS, Chen L, Wong ICK, Leung WK. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori : a population-based study. Gut. 2017;gutjnl-2017-314605. https://doi.org/10.1136/gutjnl-2017-314605 CrossRefPubMed

29.

Ferreira RM, Pereira-Marques J, Pinto-Ribeiro I, Costa JL, Carneiro F, Machado JC, et al. Gastric microbial community profiling reveals a dysbiotic cancer-associated microbiota. Gut. 2018;67(2):226–36. https://doi.org/10.1136/gutjnl-2017-314205.CrossRefPubMed

30.

Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353–67. https://doi.org/10.1136/gutjnl-2015-309252.CrossRefPubMed

31.

Lee Y-C, Chiang T-H, Chou C-K, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology. 2016;150(5):1113–1124.e5. https://doi.org/10.1053/j.gastro.2016.01.028.CrossRefPubMed

32.

Seta T, Takahashi Y, Noguchi Y, et al. Effectiveness of Helicobacter pylori eradication in the prevention of primary gastric cancer in healthy asymptomatic people: A systematic review and meta-analysis comparing risk ratio with risk difference. Katoh M, ed. PLoS One. 2017;12(8):e0183321. https://doi.org/10.1371/journal.pone.0183321.CrossRefPubMedPubMedCentral

33.

Doorakkers E, Lagergren J, Engstrand L, Brusselaers N. Helicobacter pylori eradication treatment and the risk of gastric adenocarcinoma in a Western population. Gut. 2018;gutjnl-2017-315363. https://doi.org/10.1136/gutjnl-2017-315363 CrossRefPubMed

34.

•• Choi IJ, Kook M-C, Kim Y-I, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med. 2018;378(12):1085–95. https://doi.org/10.1056/NEJMoa1708423 First randomized prospective controlled trial providing evidence that H. pylori eradication prevents the development of metachronous gastric cancer following the endoscopic removal of early gastic cancer in a significant proportion of patients; suggests that H. pylori eradication will always remain beneficial although less effective in advanced stage of chronic atrophic gastritis.CrossRefPubMed

35.

Venerito M, Goni E, Malfertheiner P. Helicobacter pylori screening: options and challenges. Expert Rev Gastroenterol Hepatol. 2016;10(4). https://doi.org/10.1586/17474124.2016.1126507 CrossRef

36.

Malfertheiner P. Helicobacter pylori treatment for gastric cancer prevention. N Engl J Med. 2018;378(12):1154–6. https://doi.org/10.1056/NEJMe1800147.CrossRefPubMed

37.

Zagari RM, Rabitti S, Greenwood DC, Eusebi LH, Vestito A, Bazzoli F. Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis. Aliment Pharmacol Ther. 2017;46(7):657–67. https://doi.org/10.1111/apt.14248.CrossRefPubMed

38.

Malfertheiner P. Editorial: the non-invasive diagnosis of atrophic gastritis. Aliment Pharmacol Ther. 2017;46(11–12):1112–3. https://doi.org/10.1111/apt.14340.CrossRefPubMed

39.

Hamashima C, Shabana M, Okada K, Okamoto M, Osaki Y. Mortality reduction from gastric cancer by endoscopic and radiographic screening. Cancer Sci. 2015;106(12):1744–9. https://doi.org/10.1111/cas.12829.CrossRefPubMedPubMedCentral

40.

Jun JK, Choi KS, Lee H-Y, et al. Effectiveness of the Korean National Cancer Screening Program in Reducing Gastric Cancer Mortality. Gastroenterology. 2017;152(6):1319–1328.e7. https://doi.org/10.1053/j.gastro.2017.01.029.CrossRefPubMed

41.

Song M, Camargo MC, Weinstein SJ, Murphy G, Freedman ND, Koshiol J, et al. Serum pepsinogen 1 and anti-Helicobacter pylori IgG antibodies as predictors of gastric cancer risk in Finnish males. Aliment Pharmacol Ther. 2018;47(4):494–503. https://doi.org/10.1111/apt.14471.CrossRefPubMed

42.

Venerito M, Vasapolli R, Theodoros Rokkas PM. Gastric cancer: epidemiology, prevention and therapy. Helicobacter. 2018;suppl.1 e12518.

43.

Kagami T, Sahara S, Ichikawa H, Uotani T, Yamade M, Sugimoto M, et al. Potent acid inhibition by vonoprazan in comparison with esomeprazole, with reference to CYP2C19 genotype. Aliment Pharmacol Ther. 2016;43(10):1048–59. https://doi.org/10.1111/apt.13588.CrossRefPubMed

44.

Li M, Oshima T, Horikawa T, Tozawa K, Tomita T, Fukui H, et al. Systematic review with meta-analysis: vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter. 2018;23(4):e12495. https://doi.org/10.1111/hel.12495.CrossRefPubMed

45.

Graham DY, Dore MP, Lu H. Understanding treatment guidelines with bismuth and non-bismuth quadruple Helicobacter pylori eradication therapies. Expert Rev Anti-Infect Ther. 2018;16:1–9. https://doi.org/10.1080/14787210.2018.1511427.CrossRef

46.

Malfertheiner P, Chan FK, EL McColl K. Peptic ulcer disease. Lancet. 2009;374(9699):1449–61. https://doi.org/10.1016/S0140-6736(09)60938-7.CrossRefPubMed

47.

Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P. Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. Digestion. 2013;88(1). https://doi.org/10.1159/000350719 CrossRefPubMed

48.

Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18(3):318–27. https://doi.org/10.1016/S1473-3099(17)30753-3.CrossRefPubMed

49.

Gatta L, Scarpignato C, Fiorini G, Belsey J, Saracino IM, Ricci C, et al. Impact of primary antibiotic resistance on the effectiveness of sequential therapy for Helicobacter pylori infection: lessons from a 5-year study on a large number of strains. Aliment Pharmacol Ther. 2018;47(9):1261–9. https://doi.org/10.1111/apt.14597.CrossRefPubMed

50.

Thung I, Aramin H, Vavinskaya V, Gupta S, Park JY, Crowe SE, et al. Review article: the global emergence of Helicobacter pylori antibiotic resistance. Aliment Pharmacol Ther. 2016;43(4):514–33. https://doi.org/10.1111/apt.13497.CrossRefPubMed

51.

Ierardi E, Giorgio F, Iannone A, Losurdo G, Principi M, Barone M, et al. Noninvasive molecular analysis of Helicobacter pylori : is it time for tailored first-line therapy? World J Gastroenterol. 2017;23(14):2453–8. https://doi.org/10.3748/wjg.v23.i14.2453.CrossRefPubMedPubMedCentral

52.

Pastukh N, Binyamin D, On A, Paritsky M, Peretz A. GenoType® HelicoDR test in comparison with histology and culture for Helicobacter pylori detection and identification of resistance mutations to clarithromycin and fluoroquinolones. Helicobacter. 2017;22(6):e12447.https://doi.org/10.1111/hel.12447.CrossRef

53.

Skrebinska S, Megraud F, Bessede F. Diagnosis of H.pylori. Helicobacter. 2018;23 suppl 1. https://doi.org/10.1111/hel.12515 CrossRefPubMed

54.

Lv Z, Wang B, Zhou X, et al. Efficacy and safety of probiotics as adjuvant agents for Helicobacter pylori infection: a meta-analysis. Exp Ther Med. 2015;9(3):707–16. https://doi.org/10.3892/etm.2015.2174.CrossRefPubMedPubMedCentral

55.

Dang Y, Reinhardt JD, Zhou X, Zhang G. The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: a meta-analysis. PLoS One. 2014;9(11):e111030. https://doi.org/10.1371/journal.pone.0111030.CrossRefPubMedPubMedCentral

56.

McFarland LV, Huang Y, Wang L, Malfertheiner P. Systematic review and meta-analysis: multi-strain probiotics as adjunct therapy for Helicobacter pylori eradication and prevention of adverse events. United Eur Gastroenterol J. 2016;4(4):546–61. https://doi.org/10.1177/2050640615617358.CrossRef

57.

Szajewska H, Shamir R, Chmielewska A, et al. Systematic review with meta-analysis: early infant feeding and coeliac disease–update 2015. Aliment Pharmacol Ther. 2015;41(11):1038–54. https://doi.org/10.1111/apt.13163.CrossRefPubMed

58.

McNicholl AG, Molina-Infante J, Lucendo AJ, et al. Probiotic supplementation with Lactobacillus plantarum and Pediococcus acidilactici for Helicobacter pylori therapy: a randomized, double-blind, placebo-controlled trial. Helicobacter. 2018;23:e12529. https://doi.org/10.1111/hel.12529.CrossRefPubMed

Title: Helicobacter pylori Infection: New Facts in Clinical Management
Authors: Peter Malfertheiner, MD
Marino Venerito
Christian Schulz
Publication date: 01-12-2018
Publisher: Springer US
Published in: Current Treatment Options in Gastroenterology / Issue 4/2018
Print ISSN: 1092-8472
Electronic ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-018-0209-8

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Recent findings

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2018

Gastroduodenal “Dysbiosis”: a New Clinical Entity

Pancreatic Cancer and Diabetes Mellitus

Timing of Endoscopic Necrosectomy Following Transmural Stent Placement for Pancreatic Necrosis

The Role of Botox in Colorectal Disorders

Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders

The Role of Botulinum Toxin Injections for Esophageal Motility Disorders

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage