Helicobacter pylori are Gram-negative, microaerophilic bacteria, and ubiquitous organisms, which are present in about 50% of the global population (1). Metaplastic changes in the stomach is a result of chronic infection with H. pylori infection, and can lead to peptic ulcer. The most common route of H. pylori infection is oral-to-oral or fecal-to-oral contact (2-4).
Generally, H. pylori is an asymptomatic disease with no specific clinical signs; possible symptoms, includes nausea, vomiting, abdominal pain, heartburn, diarrhea, hunger in the morning, and halitosis (5). Also, recent studies proved the role of H. pylori in the development of endocrinopathies (6). In the new guideline on the treatment of Helicobacter pylori by the Canadian association of gastroenterology and the Canadian Helicobacter study group, it is suggested that all H. pylori eradication regimens should be given for 14 days to replace the 10-day treatment (7).
Patient suspected of H. pylori, following laboratory study, should be done: first of all, fecal antigen test of H. pylori with 98% specificity and 94% sensitivity was performed, and in the next step, positive results obtained in the early stage of disease should be used in order to detect post-treatment eradication (7-9). Secondly, the Carbon 13 urea breath test should be done and when urease is present in the stomach, concentration of labeled carbon is high and will react with H. pylori infection (7, 9). Thirdly, although serology of H. pylori is not a good test for follow-up of treated patients, it has high specificity and sensitivity (> 90%), thus is useful for detecting new infected patients (10). Finally, anti-biogram is useful in geographic areas with a high resistance rate against metronidazole and clarithromycin (7).
Recommended first-line strategy include concomitant non-bismuth quadruple therapy (Proton Pump Inhibitor [PPI] + Amoxicillin + Metronidazole + Clarithromycin [PAMC]) and traditional bismuth quadruple therapy (PPI + Bismuth + Metronidazole + Tetracycline [PBMT]) (7).
Also, it is recommended that PPI triple therapy (PPI + clarithromycin + either amoxicillin or metronidazole) is restricted to areas with known low Clarithromycin resistance (< 15%) or high eradication success with these regimens (> 85%), and rescue therapies include PBMT and levofloxacin–containing therapy (PPI + amoxicillin + levofloxacin). Rifabutin regimes should be restricted to patients, who have failed to respond to at least three prior options (7).
In Iran, due to increasing demand of therapy of H. pylori with short course treatment, it is highly recommended for all H. pylori eradication regimens to now last for 14 days.
