Slovenian society for gastroenterology and hepatology guidelines on the management of Helicobacter pylori infection

Abstract

Infection with Helicobacter pylori (Hp) is the most common infecion in the world. Half of the world population is infected. The prevalence of infection is declining in the developed world and also in Slovenia, because of better sanitation and eradication therapies. The prevalence of infection with Hp in Slovenia is 25.1 %. Only 20 % of the infected will develop a duodenal or gastric ulcer, ALT lymphoma or cancer in their lifetime. Hp infection is a risk factor for ulcer bleeding in patients on nonsteroidal antiinflammatory drugs and salicylates. Gastoenterologists diagnose the infection with Hp and prescribe therapy. A general practitioner can diagnose the infection by urea breath test or Hp stool test and prescribe therapy in cases of patients with a proven ulcer disease or in patients with first- degree relatives with gastric cancer. The guidelines on the management of Hp infection, published by the Slovenian Society for Gastroenterology and Hepatology (SZGH) in 2010, recommend one week therapy with proton pump inhibitor (PPI) bid, clarithromycin 500 mg bid and amoxiclline 1000 mg bid in patients without prior therapy with clarithromycin. In the case of prior therapy with macrolides, clarithromycin must be changed for metronidazole 400 mg bid. In the case of therapeutic failure second-line therapy should last 10 days. Secondline therapy can be based on Hp culture and bacterial resistance. The other possibility is PPI bid, colloidal bismuth subcitrate 120 mg qid, oxytetracycline 250 mg qid, metronidazole 400 mg qid; sequential therapy: PI bid 10 days, amoxicillin 1000 mg bid for first 5 days, clarithromycin 500 mg bid and metronidazole 400 mg bid for second 5 days; or PPI bid, amoxicilline 1000 mg bid and levofloxacin 500 mg bid. Hp is a group I human carcinogen responsible for 65 % of all gastric cancers. National screening for Hp infection in younger population without precancerous lesions in the stomach can reduce the incidence of gastric cancer for 45 %. SZGH recommends that a national Hp screening and therapeutic programme in Slovenia should be prepared.