Management

The antimicrobial treatment of Helicobacter pylori is an important component of the treatment of peptic ulceration. H. pylori is associated with duodenal ulceration in nearly 100% of cases and with gastric ulceration in about 60% of cases. Helicobacter infection should be considered when patients experience ulcer recurrence on maintenance medical therapy or when peptic ulcers fail to heal.

Multiple medical regimens exist consisting of some combination of clarithromycin, metronidazole, bismuth, and/or tetracycline. Triple therapy is becoming more popular with use of a PPI and two antibiotics (i.e., omeprazole, clarithromycin and metrinidazole). Regardless of the exact regimen used, a 10-14 day course leads to eradication of H. pylori in approximately 90% of cases. This results in a decreased rate of recurrence in ulcer disease (6-25% compared to 70-80% without eradication).

References

1. Greenfield LJ, Mulholland M, Oldham KT et al. Surgery scientific principals and practice. 2nd ed. Philadelphia: Lippincott-Raven, 1997.

2. Sabiston DC, Lyerly HK. Textbook of surgery. 15th ed. Philadelphia: W.B. Saunders Co., 1997.

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