H. pylori Eradication Therapy

Copyright © 2013 P.-I Hsu and N.-J. Peng. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. As a general rule for the treatment of infectious diseases, clinicians should prescribe anti-H. pylori regimens that have a per-protocol eradication rate ≥90%. However, the eradi-cation rate of the standard triple therapy recommended by most guidelines has generally declined to unacceptable levels (i.e., 80% or less) recently. e reasons for this fall in efficacy with time are uncertain but may relate to the increasing incidence of clarithromycin-resistant strains of H. pylori, poor compliance, and rapid metabolism of proton pump inhibitor (PPI) [1, 2]. Recently, several treatment regimens have emerged to cure H. pylori infection. e novel �rst-line anti-H. pylori therapies include sequential therapy [3], con-comitant quadruple therapy [4], hybrid (dual-concomitant) therapy [5], and bismuth-containing quadruple therapy. Aer the failure of standard triple therapy, a bismuth-containing quadruple therapy regimen comprising a PPI, bismuth, metronidazole, and tetracycline as a second-line therapy is recommended. Recently, a triple therapy with the combination of a PPI, levo�oxacin, and amoxicillin has been proposed as an alternative to the standard rescue therapy and can achieve a higher eradication rate than a bismuth-containing quadruple therapy in some regions. Most guidelines suggest that patients requiring a third-line therapy should be referred to medical center and treated according to the antibiotic susceptibility test. However, it has been reported that the sensitivity of culture is less than 60%. Additionally, in vitro antimicrobial sensitivity does not necessarily lead to eradication in vivo and vice versa. e main focus of the special issue is on the recent advances in the treatment of H. pylori infection. is special issue reviews the novel �rst-line eradication regimens with a per-protocol eradication rate exceeding 90%. In addition, the emerging rescue therapies for the second-line and third-line therapies are also discussed. In the paper entitled " Pathogenesis of Helicobacter pylori-related gastroduodenal diseases from molecular epidemiological studies, " Y. Yamaoka presents African and Asian enigmas regarding high prevalence of H. pylori infection and low incidence of gastric cancer. is discrepancy could be explained in part by different types of H. pylori virulence factors, especially CagA, VacA, OipA, and DupA. In the paper entitled " Recent insights into antibiotic resistance in Helicobacter pylori eradication, " W. Wu et al. present the antibiotic …