The first-line regimens of Helicobacter pylori eradication in Korea

Approximately half of the world’s population is infected by Helicobacter pylori [1], which causes various gastrointestinal diseases including gastritis, peptic ulcer, gastric mucosaassociated lymphoid tissue lymphoma, and gastric cancer [2,3]. Korean guidelines, which were revised in 2013, by the Korean College of Helicobacter and Upper Gastrointestinal Research strongly recommend that H. pylori should be eradicated in patients with peptic ulcer disease, gastric MALT lymphoma, endoscopically treated early gastric cancer, and immune thrombocytopenic purpura [4]. Identification of optimal regimen of H. pylori eradication has been a challenge for gastroenterologists. Twenty years ago, one comparative study showed that proton pump inhibitor (PPI)based triple therapy, that consisted of PPI, amoxicillin, and metronidazole, had superior efficacy for H. pylori eradication among various regimens based on PPI, bismuth, amoxicillin, and metronidazole [5]. In addition, conventional triple therapy, that consists of PPI, amoxicillin, and clarithromycin, has been widely used in Korea because of the high resistance rate of H. pylori against metronidazole [4,6,7]. This conventional triple therapy for 7-14 days is also a world-wide choice for H. pylori eradication [8,9]. However, eradication of conventional triple therapy has decreased over the past 10 years [10,11], caused by resistance against clarithromycin [12]. Alternatively, many eradication regimens including sequential therapy, concomitant therapy, and hybrid therapy have been suggested [4]. Despite of the insufficient eradication rate of the conventional triple therapy, the current Korean guideline still recommends conventional triple therapy as a first-line therapy for H. pylori infection because superior efficacy of alternative regimens over the conventional triple therapy has not been fully evaluated [4]. Recently, however, the Maastricht V/Florence Consensus Report stated that PPI-clarithromycin-containing triple therapy without prior susceptibility testing should be abandoned Corresponding Author: Chan Hyuk Park Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri, 11923, Korea. Tel: +82-31-560-2230 Fax: +82-31-553-7369 E-mail: yesable7@gmail.com