含替硝唑序贯疗法根除幽门螺杆菌62例

目的: 观察由泮托拉唑、替硝唑、阿莫西林、克拉霉素组成的10日序贯疗法根除幽门螺杆菌( H pylori)的疗效.方法: 将经胃镜检查确诊为慢性胃炎和消化性溃疡且H pylori阳性的患者120例随机分为两组, 治疗组(62例)方案为前5 d给予泮托拉唑+阿莫西林, 后5 d给予泮托拉唑+克拉霉素+替硝唑;对照组(58例)三联疗法为泮托拉唑+阿莫西林+克拉霉素, 疗程7 d. 比较治疗后两组患者H pylori根除率.结果: 治疗组和对照组H pylori ITT根除率分别为83.87%和67.24%, PP根除率分别为89.66%和72.22%, 两组分别有统计学意义( P<0.05).结论: 含替硝唑的10日序贯疗法治疗H pylori感染具有较高的根除率.     

以泮托拉唑为基础的三联和四联疗法根除幽门螺杆菌疗效比较——一项单中心、随机、开放、平行对照研究

背景：近年质子泵抑制剂（PPI）＋阿莫西林＋克拉霉素标准三联疗法对幽门螺杆菌（H.pylori）的根除率有所降低,PPI＋铋剂＋甲硝唑＋四环素的四联疗法能否成为一线治疗的首选以及适当延长疗程能否提高根除率尚有待明确。目的：比较以泮托拉唑为基础的7d标准三联疗法与7d、10d四联疗法根除H.pylori的疗效。方法：133例非溃疡性消化不良的H.pylori感染患者随机分配至7d三联组（45例,泮托拉唑40mgbid＋阿莫西林1.0gbid＋克拉霉素500mgbid,PAC方案）以及7d、10d四联组（43例和45例,泮托拉唑40mgbid＋枸橼酸铋钾220mgbid＋甲硝唑400mgtid＋四环素750mgbid,PBMT方案）。治疗结束后至少间隔4周行13C-尿素呼气试验复查H.pylori,评估治疗结果。结果：共129例患者按方案完成治疗。三组H.pylori根除率按意图治疗（ITT）分析分别为73.3%、79.1%和88.9%,按方案（PP）分析分别为75.0%、82.9%和90.9%。7dPAC方案的PP根除率显著低于10dPBMT方案（P〈0.05）。除四联组中有2例患者分别因头晕和腹泻而未完成治疗外,其余患者的不良反应相似且均能耐受。结论：在7d标准三联疗法H.pylori根除疗效降低的情况下,含泮托拉唑、铋剂、甲硝唑和四环素的10d四联疗法可考虑作为根除治疗的首选方案。     

粤东地区10日序贯疗法治疗幽门螺杆菌感染的临床观察

目的评价在粤东地区采用10d序贯疗法与传统三联疗法治疗幽门螺杆菌(Hp)感染的临床疗效。方法将汕头市、揭阳市、汕尾市经胃镜下胃黏膜Hp快速尿素酶试验阳性或者14C-尿素呼气试验阳性的患者132例,随机分为2组,治疗组67例,采用10d序贯疗法治疗,即前5d口服泮托拉唑20mg+阿莫西林1000mg,bid,后5d泮托拉唑20mg+克拉霉素500mg+甲硝唑400mg,bid。对照组65例,采用标准三联疗法:泮托拉唑20mg+甲硝唑400mg+阿莫西林1000mg,bid,疗程7d。疗程结束后4周行快速尿素酶试验或者14C-尿素呼气试验检测Hp。结果治疗组Hp根除率为94.03%,对照组73.85%,两组比较有显著性差异(P0.05)。结论在粤东地区采用10d序贯疗法对幽门螺杆菌感染的根除率高于传统的7d三联疗法。     

含铋剂四联疗法根除消化性溃疡幽门螺杆菌感染的疗效

目的:探讨含铋剂的四联疗法在根除幽门螺杆菌(Helicobacter pylori,H.pylori)感染的疗效研究.方法:将H.pylori感染的消化性溃疡病例288例,随机分为观察组和对照组各144例;观察组:胶体果胶铋+泮托拉唑+呋喃唑酮+阿莫西林四联疗法,疗程10 d;对照组:泮托拉唑+阿莫西林+克拉霉素标准三联疗法,疗程10 d.将两组溃疡总有效率、H.pylori根除率和不良反应进行比较.结果:观察组较对照组有较高的根除率,观察组分别为胃溃疡91.5%、十二指肠溃疡94.1%,对照组则分别为73.5%、71.1%,差异有统计学意义(P0.05).药物不良反应发生率差异无统计学意义(P0.05).结论:含铋剂四联疗法根除H.pylori感染根除率高、价廉,潜在的不良反应发生率低,是目前较为理想的根除H.pylori方案.     

兰索拉唑联合克拉霉素缓释胶囊阿莫西林胶囊三联治疗幽门螺杆菌疗效观察

目的兰索拉唑联合克拉霉素缓释胶囊阿莫西林胶囊三联治疗幽门螺杆菌(Helicobacter pylori,H.pylori)疗效观察。方法采用14C-尿素呼气试验阳性患者随机分为两组,观察组37例使用兰索拉唑片30 mg bid联合克拉霉素缓释胶囊250 mg bid、阿莫西林胶囊1 000 mg bid,对照组25例使用雷尼替丁胶囊150 mg bid联合甲硝唑片400 mg bid、阿莫西林胶囊1 000 mg bid:;连续服药2周,停药4周后,复测病人H.pylori、CPM变化及不良反应。结果观察组有效率100%,根除率91.89%;对照组有效率84.00%,根除率60.00%,观察组根除率高于对照组,两组比较差异有显著性(P0.05)。结论兰索拉唑联合克拉霉素缓释胶囊阿莫西林胶囊三联治疗H.pylori是有效安全的方法。     

胃溃疡合并糖尿病患者应用泮托拉唑治疗的有效性与作用机制分析

目的探究胃溃疡合并糖尿病患者接受泮托拉唑治疗的价值。方法选取该院2015年2月—2016年5月收治的胃溃疡合并糖尿病患者100例,根据其治疗方案分为两组,其均接受克拉霉素、阿莫西林、胰岛素等治疗,对照组同时接受奥美拉唑治疗,实验组则同时接受泮托拉唑治疗,对比2组胃溃疡合并糖尿病患者治疗疗效、不良反应、生活质量以及幽门螺杆菌根除情况的差异性。结果实验组总有效率(96.00%)、幽门螺杆菌转阴率(98.00%)明显高于对照组的总有效率(82.00%)、幽门螺杆菌转阴率(84.00%);实验组治疗后的生活质量改善程度优于对照组(P0.05);两组不良反应几率相比,差异无统计学意义(P0.05)。结论胃溃疡合并糖尿病患者接受泮托拉唑治疗,可较好促进其不良症状的改善,降低不良反应的几率,提高其生活质量。     

阿莫西林联合克拉霉素根治幽门螺杆菌临床观察

目的观察阿莫西林联合克拉霉素根治幽门螺杆菌的临床效果。方法 120例消化性溃疡并幽门螺杆菌阳性患者随机分为两组,对照组应用雷贝拉唑,阿莫西林加痢特灵,治疗组应用雷贝拉唑,阿莫西林加克拉霉素。结果治疗组有效率95%,对照组有效率80%,两组比较差异有统学意义(P<0.05)。结论阿莫西林联合克拉霉素根治幽门螺杆菌效果明显,不良反应少。     

三种3联抗生素治疗胃溃疡与幽门螺杆菌比较

目的提高治疗胃溃疡愈合率和根除幽门螺杆菌率而选择最好的药物及其配方.方法把经过内镜检查的胃溃疡合并幽门螺杆菌感染者54例,随机分为3组,每组18例,分别采用相应的A,B,C配方(A克拉霉素500mg+阿莫西林1000mg+甲硝唑400mg,2次/d;B克拉霉素250mg+阿莫西林1000mg+甲硝唑400mg,2次/d;C红霉素375mg+阿莫西林625mg+甲硝唑400mg,3次/d)再加奥美拉唑20mg,2次/d,连续治疗2wk,1mo后复查.结果溃疡愈合与根除幽门螺杆菌的关系为A和B配方的效果完全相同,即溃疡愈合18例,愈合率达100%,幽门螺杆菌根除18例,根除率达100%;C配方溃疡愈合17例,愈合率达94.4%,幽门螺杆菌根除16例,根除率88.8%.各方组间差异无显著性(P>0.05).结论幽门螺杆菌对克拉霉素高度敏感,奥美拉唑强大抑酸后可显著增强克拉霉素抗幽门螺杆菌效果.     

含左氧氟沙星的四联药物10日序贯疗法根除幽门螺杆菌疗效观察

目的 观察雷贝拉唑、克拉霉素、左氧氟沙星、阿莫西林(四联药物)10日序贯疗法根除幽门螺旋杆菌(HP)的疗效及安全性.方法 将经胃镜确诊的消化性溃疡和慢性胃炎伴胃黏膜萎缩或糜烂且幽门螺杆菌阳性的80例成人患者随机分成治疗组和对照组各40例.治疗组前5d口服雷贝拉唑10 mg、阿莫西林1 000 mg,2次/d;后5d口服雷贝拉唑10 mg、克拉霉素500 mg,2次/d;左氧氟沙星500 mg,1次/d.对照组采用传统的三联疗法(雷贝拉唑10 mg、阿莫西林1 000mg、克拉霉素500 mg,2次/d,共10 d).结果 治疗组及对照组HP根除率分别为92.5％(37/40)、75％(30/40),P＜O.05;不良反应发生率分别为7.5％、10％,两组相比差异无统计学意义.结论 四联药物10日序贯疗法对成人HP的根除率明显优于传统三联疗法,且较为安全.     

改良型三联疗法治疗幽门螺杆菌感染相关性消化性溃疡的疗效观察

[目的]探讨改良型三联疗法（泮托拉唑、阿莫西林和甲硝唑维B6）治疗幽门螺杆菌（Hp）感染相关性消化性溃疡（PU）的临床疗效及安全性。[方法]156例Hp阳性PU患者,随机分为观察组80例和对照组76例,观察组予以泮托拉唑、阿莫西林和甲硝唑维B6,对照组予以奥美拉唑、阿莫西林和甲硝唑,均按药物推荐剂量使用,连续服用2周。观察2组临床总有效率、Hp根除率及不良反应。[结果]观察组与对照组临床总有效率分别为93.75%、82.89%,症状缓解率分别为93.75%、81.58%,溃疡愈合率分别为91.25%、80.26%,Hp根除率分别为95.00%、85.53%,不良反应发生率分别为3.75%、13.16%;2组各指标比较,差异均有统计学意义（均P〈0.05）。[结论]以泮托拉唑、阿莫西林和甲硝唑维B6的改良型三联疗法抗Hp感染相关性PU,具有溃疡愈合迅速、Hp清除率和临床有效率高、不良反应轻微的特点,是一种较为理想的治疗方案,适合基层医院使用。     

Incidence of secondary Helicobacter pylori resistance to antibiotics in treatment failures after 1-week proton pump inhibitor-based triple therapies: a prospective study

BACKGROUND: Antibiotic-resistant Helicobacter pylori strains are becoming increasingly prevalent, although it is not clear to what extent the new resistant organisms will spread. AIM: To evaluate the incidence of secondary Helicobacter pylori resistance to metronidazole, clarithromycin and/or amoxycillin after one-week proton pump inhibitor based triple therapy failure in patients who were, before therapy infected with Helicobacter pylori strains susceptible to these antibiotics. PATIENTS AND METHODS: Enrolled in the study were 97 consecutive Helicobacter pylori-positive subjects infected by Helicobacter pylori strains susceptible to metronidazole, clarithromycin and amoxycillin. Activity of tested antibiotics was determined by means of the E-test. Patients were treated for seven days with a proton pump inhibitor, omeprazole 20 mg twice daily or pantoprazole 40 mg once daily, plus clarithromycin 250 mg twice daily and metronidazole 250 mg four times daily; or with a proton pump inhibitor plus amoxycillin 1 g twice daily and clarithromycin 500 mg twice daily. Two months after completion of therapy, endoscopy and gastric biopsies for histology, rapid urease test and culture were repeated. RESULTS: Four patients were dropped from the study Overall Helicobacter pylori cure rates expressed as both intention-to-treat and per-protocol analyses, were, respectively 80% (40/50) and 81.6% (40/49) with proton pump inhibitor, clarithromycin and metronidazole and 76.6% (36/47) and 81.8% (36/44) with proton pump inhibitor amoxycillin and clarithromycin. No significant differences were observed between the two treatments. Subjects in whom treatment failed were significantly younger and had less active ulcer than cured patients. Of treatment failures, 70.6% (12 out of 17 subjects) de veloped a secondary resistance to metronidazole (35.33% and/or clarithromycin (64.7%). Secondary antibiotic resistance occurred in 77. 8% of treatment failures treated with proton pump inhibitor, clarithromycin and metronidazole and in 62.5% of those treated with proton pump inhibitor, amoxycillin and clarithromycin. Considering all patients treated, the overall incidence of secondary metronidazole and/or clarithromycin resistance after therapy was reported in 12.9% of subjects (12 out of 93 treated patients). CONCLUSIONS: Secondary Helicobacter pylori resistances to metronidazole and/or clarithromycin occurred in large percentages in patients with treatment failure after the one-week proton pump inhibitor-based triple therapies, proton pump inhibitor, clarithromycin and metronidazole and proton pump inhibitor, amoxycillin and clarithromycin. It is likely that new antibiotics or treatment strategies will be needed in the near future to successfully treat Helicobacter pylori infection.     

泮托拉唑四联5d疗法与7d疗法随机对照研究

目的:比较泮妥拉唑四联5d疗法和7d疗法的Hpylori根除率和症状缓解率.方法:H pylori阳性的胃炎、胃溃疡或十二指肠患者70例随机接受5d(34例)或7d(36例)泮妥拉唑四联疗法:泮妥拉唑40mg、克拉霉素250mg、阿莫西林1.0g和胶体枸橼酸铋钾220 mg,均为2次/d.根除治疗后第4周复查H pylori是否根除,了解症状缓解情况.结果:5d组H pylori根除率为84.8%(PP)和82.4%(ITT),7d组H pylori根除率为88.2%(PP)和83.3%(ITT),5d组疼痛缓解率为72.0%(PP)和69.2%(ITT),7d组疼痛缓解率为83.9%(ITT)和89.7%(PP).按PP及ITT组群分析,两组方案H pylori根除率及疼痛缓解率无明显差异,两组患者均未出现严重不良反应.结论:泮妥拉唑四联5d疗法可以获得较高的H pylori根除率和疼痛缓解率,可以作为H pylori根除治疗的一线治疗方案.     

Recent success of pantoprazole -or lansoprazole- based clarithromycin plus amoxicillin treatment in the eradication of Helicobacter pylori.

BACKGROUND/AIMS: There are some reports showing that resistance of Helicobacter pylori (H. pylori) to clarithromycin has increased in recent years. We aimed to investigate the current success of a most popular first-line eradication regimen by using two different proton pump inhibitors: lansoprazole and pantoprazole. METHODS: Ninety patients with H. pylori-positive functional dyspepsia were randomized to receive pantoprazole 40 mg b.i.d. or lansoprazole 30 mg b.i.d. in addition to amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 14 days in a multicenter study. H. pylori infection was determined by histological examination and a rapid urease test. A follow-up endoscopy was performed to assess the H. pylori eradication six weeks after the end of therapy. RESULTS: Seventy-nine patients completed the study protocol properly. The H. pylori eradication rates according to per protocol analysis were 70% in group pantoprazole, amoxicillin and clarithromycin (28/40) and 69.2% in group pantoprazole, amoxicillin and clarithromycin (27/39). The eradication rates according to intention to treat analysis were 62.2% and 60% in lansoprazole, amoxicillin, clarithromycin, pantoprazole, amoxicillin, clarithromycin groups, respectively. The eradication rates were similar in both protocols (p>0.05). CONCLUSIONS: The most popular first-line eradication protocols of H. pylori achieved only a moderate success in the current study. Alternative therapy options are needed instead of clarithromycin-based triple treatment for eradication of H. pylori. The choice of proton pump inhibitor is not important in the eradication rate of H. pylori.     

The impact of Helicobacter pylori resistance on the efficacy of a short course pantoprazole based triple therapy

BACKGROUND: Many of the currently used Helicobacter pylori eradication regimens fail to cure the infection due to either antimicrobial resistance or poor patient compliance. Those patients will remain at risk of developing potentially severe complications of peptic ulcer disease. AIM: We studied the impact of the antimicrobial resistance on the efficacy of a short course pantoprazole based triple therapy in a single-center pilot study. METHODS: Forty previously untreated adult patients (age range 20 to 75 years, 14 males) infected with Helicobacter pylori and with inactive or healing duodenal ulcer disease were assigned in this open cohort study to 1 week twice daily treatment with pantoprazole 40 mg, plus clarithromycin 250 mg and metronidazole 400 mg. Helicobacter pylori was assessed at entry and 50 3 days after the end of treatment by rapid urease test, culture and histology of gastric biopsies. The criteria for eradication was a negative result in the tests. Susceptibility of Helicobacter pylori to clarithromycin and metronidazole was determined before treatment with the disk diffusion test. RESULTS: One week treatment and follow up were complete in all patients. Eradication of Helicobacter pylori was achieved in 35/40 patients (87.5%) and was higher in patients with nitroimidazole-susceptible strains [susceptible: 20/20 (100%), resistant: 10/15 (67%)]. There were six (15%) mild adverse events reports. CONCLUSIONS: A short course of pantoprazole-based triple therapy is well tolerated and effective in eradicating Helicobacter pylori. The baseline metronidazole resistance may be a significant limiting factor in treatment success.     

Morphometric estimation of acid output in duodenal ulcer associated with Helicobacter pylori infection.

OBJECTIVE: to determine the changes in acid output before and after eradication therapy in patients with duodenal ulcer associated with Helicobacter pylori infection. METHOD: the subjects of this prospective study were 16 patients with acute duodenal ulcer at endoscopy and H. pylori infection determined by rapid urease test and histology. They were randomly assigned to receive treatment with pantoprazole 40 mg b.i.d., clarithromycin 500 mg b.i.d. and amoxicillin 1 g b.i.d. during 7 or 14 days. Endoscopic examination and biopsy were repeated 4 weeks after treatment ended. The changes in acid output before and after treatment were calculated by the morphometric quantification of parietal cell canaliculi from the gastric corpus. To this end 20 parietal cells from the medial glandular zone were selected and canalicular index was calculated, before and after eradication therapy, with a morphometric method based on automatic analysis of histological images. RESULTS: canalicular index was 26.4 +/- 1.4 (mean +/- standard error of the mean) before treatment, and 20.5 +/- 1 (p < 0.01) after therapy. CONCLUSIONS: morphometric analysis showed a decrease in acid output in patients with duodenal ulcer associated with H. pylori infection 4 weeks after eradication therapy with clarithromycin, amoxicillin and pantoprazole.     

Cure of Helicobacter pylori infection and healing of duodenal ulcer: comparison of pantoprazole-based one-week modified triple therapy versus two-week dual therapy

Objective: Eradication of Helicobacter pylori ( H. pylori ) is recommended as the first-line therapeutic concept for reliable long-term prevention of duodenal ulcer (DU) relapse. Current treatment regimens vary in efficacy, complexity, and compliance. To assess the efficacy of pantoprazole in H. pylori eradication in parallel groups of patients using two eradication regimens.
Methods: Patients, (18–85 yr old; intention-to-treat,  n = 286  ) with proven DU, positive rapid urease test (biopsy), and ¹³C-urea breath test (UBT) were included in a prospective, randomized, multicenter study. Modified triple therapy consisted of 40 mg pantoprazole b.i.d ., 500 mg clarithromycin t.i.d ., and 500 mg metronidazole t.i.d . for 7 days (PCM therapy); dual therapy consisted of 40 mg pantoprazole b.i.d . and 500 mg clarithromycin t.i.d . for 14 days (PC therapy). In both groups 40 mg pantoprazole o.d . was given until day 28 when healing of DU was evaluated endoscopically; H. pylori status was assessed by UBT on day 56.
Results: H. pylori eradication rate was 95% in PCM versus 60% in PC therapy groups (per-protocol population,   p < 0.001  ), and 82% in PCM versus 50% in PC therapy in the intention-to-treat patient population (   p < 0.001  ). The DU healing rate was 98% in the PCM and 95% in the PC therapy groups (per-protocol population). Both regimens were similarly well tolerated. Adverse events in both regimens included taste disturbance, diarrhea, and increased serum concentration of liver enzymes, at an incidence of < 10%.
Conclusions: Compared to 2-wk PC therapy (pantoprazole and clarithromycin), the 1-wk PCM therapy (pantoprazole, clarithromycin, and metronidazole) is a significantly superior and highly promising strategy for eradication of H. pylori .     

Comparative study of modified-release clarithromycin and immediate-release clarithromycin in the treatment of Helicobacter pylori-associated peptic ulcer disease

BACKGROUND/AIMS: Proton pump inhibitor-based triple therapy containing immediate-release clarithromycin is an important regimen for the eradication of Helicobacter pylori (H. pylori). However, the efficacy of modified-release clarithromycin for the treatment of H. pylori-associated peptic ulcer disease is still unknown. The aims of the study were to compare the efficacy of modified-release clarithromycin and immediate-release clarithromycin on the rates of ulcer healing and eradication of H. pylori. METHODOLOGY: One hundred and sixty-one patients with Helicobacter pylori-associated peptic ulcer were randomized to receive one-week triple therapy with either modified-release clarithromycin 1000mg once daily (AECMR) or immediate-release clarithromycin 500mg twice daily (AECIR) in combination with amoxicillin 1,000mg twice daily (A) and esomeprazole 40mg once daily (E). Post-treatment ulcer healing status and Helicobacter pylori status was determined by endoscopy and 13C urea-breath test at 16 weeks and 8 weeks after completion of triple therapy, respectively. RESULTS: Helicobacter pylori eradication rates were 87.5% and 87.7% for AECMR and AECIR, respectively, in the intent-to-treat analysis. Eradication rates in the per-protocol groups were 90.3% and 91.4% for AECMR and AECIR, respectively. In both the intent-to-treat and per-protocol analyses, the eradication rates were comparable in the AECMR and AECIR groups (p= 1.0 and 1.0, respectively). Ulcer healing rates in the intention-to-treat analysis were 81.3% and 77.8% for AECMR and AECIR, respectively. Ulcer healing rates in the per-protocol analysis were 90.3% and 90.0% for AECMR and AECIR groups, respectively. In both the intention-to-treat and per-protocol analyses, the ulcer healing rates were comparable in the AECMR and AECIR groups (p=0.645 and 0.584, respectively). CONCLUSIONS: Modified-release clarithromycin 1000mg once daily can be used as an alternative to immediate-release clarithromycin 500mg twice daily for the treatment of Helicobacter pylori-associated peptic ulcer disease.     

Efficacy of the dosing regimen of pantoprazole 40 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily for 7 days, in the eradication of Helicobacter pylori in patients with peptic ulcer

AIM: This is an open label, multicenter trial to determine the efficacy of the association of pantoprazole, clarithromycin and amoxicillin to eradicate Helicobacter pylori in patients with peptic ulcer. MATERIAL AND METHODS: Seventy-one patients (36 females, 35 males, average age 41.9 years) from three Brazilian university centers (located in the cities of Belo Horizonte and Porto Alegre), with peptic ulcers confirmed by endoscopy, and infections by H. pylori proven by at least two diagnostic testings were admitted in the trial. An association of pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1.0 g was administered to patients twice daily for 7 days. RESULTS: By the end of treatment all patients were examined for digestive symptoms, presence of adverse events, and treatment adherence. Sixty days after the end of the treatment a new endoscopy with biopsies and respiratory function testing with 13C-urea breath test was performed in order to determine the eradication rates of that microorganism. Patients showing negative results at least in the 13C-urea breath test and in one other test (urease or histology) were considered H. pylori-negative. By the end of the trial, 60/69 (87%, CI 95% = 78.9-94.8) patients had the H. pylori eradicated in the per protocol analysis and 60/71 (84.5%, CI 95% = 76-92.9) in the intention-to-treat analysis. One patient was withdrawn from the trial due to a diarrhea. Twelve (16.9%) patients showed adverse symptoms that were deemed as mild symptoms. CONCLUSION: Our conclusion is that the association of pantoprazole, amoxicillin and clarithromycin administered during 7 days is an effective and well-tolerated alternative as regards the eradication of H. pylori in patients with peptic ulcer in Brazil.     

Canadian Helicobacter pylori Consensus Conference update: infections in adults. Canadian Helicobacter Study Group.

The first Canadian Helicobacter pylori Consensus Conference took place in April 1997. The initial recommendations of the conference were published in early 1998. An update meeting was held in June 1998, and the present paper updates and complements the earlier recommendations. Key changes included the following: the recommendation for testing and treating H pylori infection in patients with known peptic ulcer disease was extended to testing and treating patients with ulcer-like dyspepsia; it was decided that the urea breath test (not serology) should be used for routine diagnosis of H pylori infection unless endoscopy is indicated for another reason; and recommended therapies were a twice daily, seven-day regimen of a proton pump inhibitor (omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg) or ranitidine bismuth citrate 400 mg, plus clarithromycin 500 mg and amoxicillin 1000 mg, or plus clarithromycin 500 or 250 mg and metronidazole 500 mg. The need was reiterated to have funding for readily accessible, accurate testing for H pylori infection with the urea breath test. It was strongly recommended that regional centres be established to monitor the prevalence of antibiotic-resistant H pylori infections. The initial consensus document referred to pediatric issues that were not addressed in this update but were the subject of a subsequent Canadian Helicobacter Study Group meeting, and will be published later in 1999.