Behandeling van helicobacter pylori-infecties: Een overzicht van indicaties en behandelingsvoimen

All patients with peptic ulcer disease should be screened for the presence of H. pylori infection. Succesful H. pylori eradication prevents the recurrence of peptic ulcers almost totally and maintenance therapy with antisecretory drugs is then no longer indicated. Currently, there is no indication for eradication therapy in patients with non ulcer dyspepsia. Persons with a strong family history of gastric cancer and patients with hypertrophic gastritis and mucosa-associated-lymphoid-tissue (MALT) B-cell lymphoma of the stomach may also benefit from H. pylori eradication therapy. Preliminary evidence suggests that maintenance therapy with antisecretory drugs may actually lead to an accelerated atrophy of stomach mucosa in the presence of H. pylori infection. Therefore, acid suppressive maintenance therapy will most probably become another indication for H. pylori eradication. Triple therapy lasting 1-2 weeks or quadruple therapy for 1 week are most effective eradication therapies for H. pylori at this moment. Triple therapy usually consists of a proton pump inhibitor or a bismuth salt with two antibiotics. H. pylori eradication rates of approximately 85-90% can be obtained with these combinations. Quadruple therapy, consisting of two antibiotics combined with both a proton pump inhibitor and a bismuth salt, achieves an eradication rate of more than 90%. This therapy regime is second line treatment at the moment.