Helicobacter Pylori: Resistance and Treatment Results in Finland

................................................................................................................................. 5 List of abbreviations .............................................................................................................. 7 List of original publications................................................................................................... 8 Introduction ........................................................................................................................... 9 Review of the literature ....................................................................................................... 11 History ............................................................................................................................. 11 Helicobacter pylori infection .......................................................................................... 11 Bacteriology .................................................................................................................... 11 Epidemiology .................................................................................................................. 12 Antibiotic resistance ........................................................................................................ 12 Metronidazole.............................................................................................................. 12 Clarithromycin............................................................................................................. 14 Amoxicillin.................................................................................................................. 16 Tetracycline ................................................................................................................. 17 Fluoroquinolones ......................................................................................................... 17 Rifabutin ...................................................................................................................... 17 Dual resistance to both metronidazole and clarithromycin ......................................... 18 Secondary resistance.................................................................................................... 18 Helicobacter pylori and gastroduodenal diseases ........................................................... 18 Gastritis........................................................................................................................ 18 Peptic ulcer .................................................................................................................. 20 Malignancies................................................................................................................ 20 Dyspepsia .................................................................................................................... 21 Diagnosis of Helicobacter pylori infection ..................................................................... 22 Invasive tests ............................................................................................................... 22 Noninvasive tests......................................................................................................... 26 Clinical use of the tests................................................................................................ 28 Helicobacter pylori eradication therapy.......................................................................... 29 Challenges in the therapy ............................................................................................ 29 Indications for eradication therapy.............................................................................. 30 Test-and-treat............................................................................................................... 30 First-line therapy ......................................................................................................... 31 Rescue therapies after a failure.................................................................................... 33 Side effects of the eradication treatment ..................................................................... 34 Benefits from the eradication therapy ......................................................................... 34 Present study........................................................................................................................ 37 Aims of the present study ................................................................................................ 37 Patients ............................................................................................................................ 38 Methods ........................................................................................................................... 41 Culture ......................................................................................................................... 41 Antibiotic Resistance................................................................................................... 42 Serum Antibody determination ................................................................................... 42 Questionnaires ............................................................................................................. 42 Statistical analyses....................................................................................................... 43 Ethics ........................................................................................................................... 43 Results ............................................................................................................................. 44 Resistance .................................................................................................................... 44 Results of the eradication therapies ............................................................................. 46