Tratamiento y manejo de la infección por Helicobacter pylori

Abstract

Helicobacterpylori infection is a global health problem. Its presence has been associated with the development of digestive diseases including peptic ulcer and gastric cancer, and extra-digestive diseases like thrombo- cytopenic purpura. There are different methods for its investigation, both invasive through a sample obtained by endoscopy; and non-invasive tests. There are specific conditions to indicate its eradication, but since it is considered a type I carcinogen by the WHO, it is currently being proposed to carry out massive eradication, in order to reduce gastric cancer mortality. There are different eradication regimens based on proton pump inhibitors combined with at least 2 antibiotics for at least 14 days, each with different efficacy. International consensus suggest using regimens that achieve an eradication rate greater than 90% and avoiding the use of clarithromycin in places with resistance greater than 15%. In Chile, the Ministry of Health ensures the free eradication of Helicobacter pylori to patients with peptic ulcers with standard triple therapy (amoxicillin, clarithromycin and omeprazole). National studies have shown that the eradication efficacy achieved with this regimen is 63% with 26% resistance to clarithromycin. This suggests that this scheme should be abandoned for other therapies that have shown a higher rate of eradication, such as dual therapy, concomitant quadruple therapy, and quadruple therapy with bismuth. This review addresses the rationale and up-to-date evidence behind the currently recommended eradication therapies and we will propose management algorithms in an attempt to homogenize the management of these patients.