Eradication of Helicobacter pylori in routine clinical practice: Doubts and uncertainties

BACKGROUND/AIMS: The aim of this study was to evaluate the overall efficacy of Helicobacter pylori (H. pylori) infection treatment in our routine clinical practice. As proton pump inhibitor-containing regimens offer the advantage of rapid symptom relief and the highest rates of duodenal ulcer healing, we decided to prescribe these regimens to treat H. pylori infection in our daily practice. METHODOLOGY: We prospectively carried out a study of unselected outpatients who were referred to our practices to undergo gastroscopy. The patients assessed as H. pylori-positive (by means of Giemsa stain and rapid urease test) were randomly assigned to one of the following four treatment schedules: omeprazole plus amoxycillin plus tinidazole (OAT) for 2 weeks; omeprazole plus amoxycillin (OA) for 2 weeks; omeprazole plus clarithromycin plus tinidazole (OCT) for 1 week; and, omeprazole plus clarithromycin plus amoxycillin (OCA) for 1 week. H. pylori status was re-assessed at least 2 months time after the end of the therapy when the patients were re-endoscoped. RESULTS: Out of a total of 200 patients returning for a follow-up visit and included in our study, 143 were H. pylori-eradicated, with an inclusive rate of 71.5% only. Side effects occurred in 37 (18%) patients. CONCLUSIONS: In our routine clinical practice, the overall eradication rate of H. pylori infection resulted in a little more than 70% of patients treated. Considering that more and more physicians routinely treat H. pylori infection, and that more and more patients require treatment, the management of this worldwide infection remains problematic.