| [ Summary ] |
Helicobacter pylori eradication has been recognized as a standard treatment for gastro-duodenal ulcers. Recently, proton pump inhibitor (PPI) based triple therapy, that combines PPI, clarithromycin and amoxicillin has become widely accepted throughout the world, and shows high eradication rates ranging from about 80-90%. In Japan, one week triple therapy is recommended for the treatment of gastro-duodenal ulcers. It is expected that there will be improvements in treatments for recurrent gastro-duodenal ulcers. Several studies revealed that one week eradication therapy and four week PPI therapy exhibited no statistical differences for gastro-duodenal ulcer healing ratios. Though, these studies strongly suggest that post eradication therapy is unnecessary for H.pylori negative ulcers, there is thought to be some relation to NSAIDs, along with other factors, such as increase in gastric juice, smoking, etc. Cases involving factors other than H.pylori, may require maintenance therapy with PPI or H2 receptor antagonists.
The rate of clarithromycin resistant strains has gradually been increasing, and this fact may lead to the eventual failure of PPI based triple therapy. Though the existence or recurrence of H.pylori plays a major role in the recurrence of gastro-duodenal ulcers, second line therapies, including of metronidazole or PPM+classical triple therapy, need to be expanded. In addition, another problem suggested by several studies is, that gastro-esophageal reflux disease (GERD) may increase after successful eradication of H.pylori, therefore, long term observation is necessary to clarify the efficacy of H.pylori eradication. |