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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 127-136
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.127
Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens
Shen-Shong Chang, Hsiao-Yun Hu
Shen-Shong Chang, Division of Gastroenterology, Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, School of Medicine, Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei 112, Taiwan
Hsiao-Yun Hu, Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei 112, Taiwan
Hsiao-Yun Hu, Department of Education and Research, Taipei City Hospital, Taipei 103, Taiwan
Author contributions: Chang SS and Hu HY contributed equally to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hsiao-Yun Hu, PhD, Department of Education and Research, Taipei City Hospital, No. 145 Zhengzhou Rd., Taipei 103, Taiwan. hyhu@ym.edu.tw
Telephone: +886-2-27093600-3816 Fax: +886-2-28261002
Received: April 27, 2015
Peer-review started: May 1, 2015
First decision: May 18, 2015
Revised: June 10, 2015
Accepted: September 14, 2015
Article in press: September 15, 2015
Published online: November 6, 2015
Abstract

The presence of concomitant diseases is an independent predictive factor for non-Helicobacter pylori (H. pylori) peptic ulcers. Patients contracting concomitant diseases have an increased risk of developing ulcer disease through pathogenic mechanisms distinct from those of H. pylori infections. Factors other than H. pylori seem critical in peptic ulcer recurrence in end stage renal disease (ESRD) and cirrhotic patients. However, early H. pylori eradication is associated with a reduced risk of recurrent complicated peptic ulcers in patients with ESRD and liver cirrhosis. Resistances to triple therapy are currently detected using culture-based and molecular methods. Culture susceptibility testing before first- or second-line therapy is unadvisable. Using highly effective empiric first-line and rescue regimens can yield acceptable results. Sequential therapy has been included in a recent consensus report as a valid first-line option for eradicating H. pylori in geographic regions with high clarithromycin resistance. Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective in patients with dual- (clarithromycin- and metronidazole-) resistant H. pylori strains. We aim to review the prevalence of and eradication therapy for H. pylori infection in patients with ESRD and cirrhosis. Moreover, we summarized the updated H. pylori eradication regimens.

Keywords: Concomitant diseases, Helicobacter pylori, Culture susceptibility, Concomitant therapy, Hybrid therapy

Core tip: The authors outline that patients contracting concomitant diseases have an increased risk of developing ulcer disease through pathogenic mechanisms distinct from those of Helicobacter pylori (H. pylori) infections. Early H. pylori eradication is associated with a reduced risk of recurrent complicated peptic ulcers in patients with end stage renal disease and liver cirrhosis. Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective in patients with dual resistant H. pylori strains. High-dose amoxicillin therapy is promising and superior to standard regimens. Finally, culture and susceptibility testing should be performed before third-line treatment.