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World J Gastroenterol. Jan 21, 2014; 20(3): 699-705
Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.699
Helicobacter pylori: Future perspectives in therapy reflecting three decades of experience
Tajana Filipec Kanizaj, Nino Kunac
Tajana Filipec Kanizaj, Department of gastroenterology, University hospital Merkur, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Nino Kunac, University hospital Merkur, Zagreb 10000, Croatia
Author contributions: Kanizaj TF and Kunac N contributed equally to this work and wrote the paper; Kanizaj TF designed the theme topic; Kanizaj TF and Kunac N equally performed the research, analysis and interpretation of published data; Kunac N searched the relevant literature.
Correspondence to: Tajana Filipec Kanizaj, PhD, Assistant Professor, Department of gastroenterology, University hospital Merkur, School of Medicine, University of Zagreb, Zajceva 19, Zagreb 10000, Croatia.
Telephone: +385-98623903  Fax: +385-12431393
Received: September 28, 2013
Revised: December 5, 2013
Accepted: January 2, 2014
Published online: January 21, 2014

The rising prevalence of antibiotic resistance has created a need to reassess the established Helicobacter pylori (H. pylori) eradication protocols, and to develop new ones. Various bacterial and host factors are evaluated, and their contribution to eradication failure is estimated. For a long time being considered the cornerstone eradication scheme, the standard triple therapy has been replaced with novel, more efficient regimens, namely sequential and concomitant, along with the emergence of a new design of bismuth quadruple therapy. A rescue levofloxacin based regimen has overcome the fear of therapy failure due to higher prevalence of dual resistant (clarithromycin and metronidazole) H. pylori. Culture-free and efficient susceptibility test are reestablishing the concept of tailored therapy, making eradication success close to originally desirable rates. Alleviating therapy side effects and improving patient compliance are as important as choosing appropriate eradication schemes, so various probiotic compound supplements are taken into consideration. Finally, we summarize the emerging efforts and obstacles in creating efficient H. pylori vaccine.

Keywords: Helicobacter pylori, Eradication therapy, Antibiotic resistance, First line therapy, Rescue therapy, Sequential therapy, Bismuth-containing quadruple therapy, Concomitant quadruple therapy, Hybrid (dual-concomitant) therapy

Core tip: In this article the authors have made a review of the most important literature with knowledge of various factors affecting Helicobacter pylori eradication success. The paper presents an analysis of established and new eradication regimens, as well as factors affecting their performance. Since the last 3 decades many new developments appeared in the field of this intriguing infection, along with implementation of recently published guidelines. Authors made a new look to future perspectives in managing this complex infection.