What are the best treatment options for H. pylori-induced peptic ulcer disease?

Malcolm Robinson MD: Helicobacter pylori was discovered in my professional lifetime and its importance was elucidated. It has become recognized as a very important cause of gastric and duodenal ulcer disease, of MALT lymphoma, and in some countries and some settings, in the causation of adenocarcinoma of the stomach. However, at least in my opinion, Helicobacter pylori has in some respects been overrated, because in our society peptic ulcer disease is vanishing, as is Helicobacter pylori, and we see almost no H. pylori-related adenocarcinoma of the stomach. On the other hand, there have been tremendous advances in the therapy of Helicobacter pylori, and our current therapy is both more effective and more rapid in its effectiveness than any therapy previously available, and I think most physicians are very grateful for this. However, in the long run, I suspect we'll be treating less and less Helicobacter pylori, both because it's vanishing and because we realize that its treatment, for example, in non-ulcer dyspepsia and its treatment in other non-ulcer-related disorders probably is not nearly as beneficial as we had thought.

The treatment of Helicobacter pylori has been revolutionized in the past year in the United States by the development of a regimen that, unlike the previous regimens, which were 10 to 14 days in duration, is only seven days in duration. I believe this will be helpful to physicians and to their patients in terms of compliance, in terms of efficacy, in terms of avoiding the development of antibiotic resistance, and I think it will make it more palatable to treat Helicobacter pylori in those patients who need H. pylori eradication

The key to the development of seven-day eradication therapy in Helicobacter pylori was the understanding that proton pump inhibitors are not all alike, that proton pump inhibitors are variable in their potency, and most importantly that they are variable in the onset of their effects, and as a result of that it has been possible using rabeprazole triple therapy to achieve eradication levels in seven days that previously were available only with 10- and 14-day regimens.