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World J Gastroenterol. Aug 14, 2014; 20(30): 10355-10367
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10355
Helicobacter pylori eradication in West Asia: A review
Hafez Fakheri, Zohreh Bari, Mohsen Aarabi, Reza Malekzadeh
Hafez Fakheri, Inflammatory Diseases of the Upper Gastrointestinal Tract Research Center, Mazandaran University of Medical Sciences, 4816633131 Sari, Iran
Zohreh Bari, Mazandaran University of Medical Sciences, 4816976676 Sari, Iran
Mohsen Aarabi, Health Sciences Research Center, 4817844718 Sari, Iran
Reza Malekzadeh, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Kargar Shomali Avenue, 14117 Tehran, Iran
Author contributions: Malekzadeh R, Fakheri H and Bari Z and Aarabi M designed research; Fakheri H and Bari Z performed research; Aarabi M contributed analytic tools; Aarabi M analyzed data; Malekzadeh R, Fakheri H, Bari Z and Aarabi M wrote the paper.
Correspondence to: Reza Malekzadeh, MD, AGAF, Professor of Medicine, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital,Kargar Shomali Avenue,14117 Tehran, Iran. malek@tums.ac.ir
Telephone: +98-21-82415104 Fax: +98-21-82415400
Received: September 29, 2013
Revised: January 8, 2014
Accepted: April 1, 2014
Published online: August 14, 2014
Abstract

The efficacy of first- and second-line Helicobacter pylori (H. pylori) eradication regimens varies considerably in West Asian countries, mainly due to the variable prevalence of resistant organisms. However, no review article has yet evaluated and compared the efficacy of different regimens among different countries of this region. Therefore, we conducted a review to select the best options and provide recommendations for H. pylori treatment in this geographic region. A search through PubMed was carried out to obtain relevant randomized clinical trials published in English language up to June 2013. According to the results, among different therapeutic regimens used as the first-line protocols, 10-d Bismuth-Furazolidone/Metronidazole quadruple therapy, 14-d Clarithromycin-containing hybrid therapy and 14-d quadruple therapy including a proton pump inhibitor + Bismuth + Tetracycline (500 mg QID) + Metronidazole (500 mg TDS) seemed to be appropriate options. Among second-line therapeutic regimens, Bismuth-based quadruple therapies containing Tetracycline and Furazolidone/Metronidazole, triple therapy containing Amoxicillin and Gatifloxacin and Quadruple therapy including Bismuth + Azithromycin and Ofloxacin seemed to be effective options. Third-line therapies were not evaluated in West Asia; most guidelines, however, recommend choosing optimal eradication regimen according to the pattern of antibiotic susceptibility of H. pylori. Although we limited our investigation to H. pylori eradication regimens in West Asia, the clinical significance of the results goes beyond the countries situated in this geographic region. In fact, the results are transferrable to any region as long as the patterns of resistance are the same.

Keywords: Helicobacter pylori, Eradication, West Asia, Resistance, Recurrence

Core tip: The efficacy of first- and second-line Helicobacter pylori (H. pylori) eradication regimens varies considerably in West Asian countries, mainly due to the variable prevalence of resistant organisms. The present study evaluates and compares the efficacy of different regimens among different countries of this region. Although we limited our investigation to H. pylori eradication regimens in West Asia, the clinical significance of the results goes beyond the countries situated in this geographic region. In fact, the results are transferrable to any region as long as the patterns of resistance are the same.