Update on the Role ofH pyloriInfection in Gastrointestinal Disorders

Abstract

Infection withHelicobacter pyloriis accepted as the primary cause of peptic ulcer disease, and there is evidence to suggest its role in other gastrointestinal disorders. An estimated 20% to 40% of the Canadian population is infected withH pylori; however, clinically relevant disease is present in only approximately 10% to 20% of these individuals. Therefore, it is crucial to identify the diseases for which eradication ofH pyloriis beneficial to ensure that patients do not receive unnecessary treatment. In patients with ulcers induced by long term treatment with nonsteroidal anti-inflammatory drugs, preliminary results suggest that eradication ofH pylorimay reduce the risk of peptic ulcer bleeding. Furthermore, a benefit has been observed for the eradication ofH pyloribefore patients commence therapy with a nonsteroidal anti-inflammatory drug. An association between the presence ofH pyloriand specific dyspeptic symptoms has yet to be established; however, there may be a subset of patients with functional dyspepsia who benefit from the eradication ofH pylori. The relationship between gastroesophageal reflux disorder andH pyloriinfection remains unclear. In Canada, the recommended therapy for the eradication ofH pyloriis seven days of twice-daily treatment with a proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole. Although the proton pump inhibitors are treated as a class for use in these regimens, there is suggestion that a faster onset of action may lead to a higher rate of eradication.