Helicobacter pylori is a Gram-negative bacterium responsible for chronic gastritis, peptic ulcers, and gastric adenocarcinoma, recognized as a class I carcinogen by the WHO. Worldwide prevalence is approximately 50%, with significant geographical variations. In Belgium, migrant populations present higher infection rates. Rising antibiotic resistance, particularly to clarithromycin (21%) and levofloxacin (24%), causes challenges for eradication protocols.
First-line therapies feature quadruple regimens with or without bismuth, personalized according to local resistance rates and antimicrobial susceptibility testing (AST) results, if possible. Specific management is recommended for refractory cases, children, and HIV patients. Esomeprazole 2 x 40mg and rabeprazole 2 x 20mg are more powerful than other proton pomp inhibitors (PPIs).
Diagnosis involves non-invasive methods (urea breath test, fecal antigen test) and invasive techniques (biopsies for histology and AST). Endoscopic diagnosis is based on the regular disposition of gastric collecting venules (RAC), determining the need for targeted biopsies for AST. Post-treatment eradication confirmation is critical, typically through a breath test conducted at least four weeks after antibiotic cessation and two weeks after PPI discontinuation
Keywords
Helicobacter pylori, gram-negative bacteria, carcinogen, gastritis, ulcer, adenocarcinoma