New Published Guidelines For Helicobacter Pylori Suggest Change to Treatment Recommendations
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The American Journal of Gastroenterology has published a new guideline on the treatment of Helicobacter pylori (H. pylori) infection.
H. pylori is a bacterium that infects over half the people in the world, though most are asymptomatic. It can cause dyspepsia, peptic ulcer disease and gastric cancer.
A previous guideline was published in 2017. It had maintained the recommendation of a proton pump inhibitor-clarithromycin triple therapy as the primary treatment option.
In the new guideline, the number one recommendation for treatment-naïve patients is bismuth quadruple therapy. That treatment typically includes a PPI, tetracycline, bismuth and nitroimidazole for 14 days.
“We were already recommending that healthcare providers move away from PPI triple therapy in 2017 because of increasing problems with chloromycetin resistance amongst H. pylori strains in the United States,” corresponding author of the guideline, William D. Chey said.
“Despite that recommendation, PPI triple therapy still dominates first-line therapy prescriptions for H. pylori patients in the United States. In this newest iteration of the guideline, we are very clear to say that in essentially all circumstances you should not be prescribing PPI triple therapy, and you should be instead using bismuth quadruple therapy or one of the other suggested treatment options.”
A third option consists of a new, highly potent drug which blocks stomach acid production called vonoprazan combined with the antibiotic amoxicillin.
The guideline makes 12 total treatment suggestions for patients in a variety of different situations. The number two recommendation for treatment-naïve patients—after bismuth quadruple therapy—is rifabutin triple therapy (a PPI, rifabutin and amoxicillin.)
Besides the move away from PPI triple therapy, another change from the 2017 guideline is the discussion of increasingly available molecular testing for antibiotic susceptibility.
The guideline also outlines future research priorities, such as identifying which individuals would most benefit from H. pylori testing to prevent gastric cancer and evaluating newly FDA-approved regimens for persistent infections.
Reference: Chey, W. D., Howden, C. W., Moss, S. F., Morgan, D. R., Greer, K. B., Grover, S., & Shah, S. C. (2024). ACG clinical guideline: Treatment of Helicobacter pylori infection. The American Journal of Gastroenterology, 119(9), 1730-1753. https://doi.org/10.14309/ajg.0000000000002968
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