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Revision as of 13:23, 6 November 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Eradication of Helicobacter pylori with antimicrobial agents is indicated for patients with gastric or duodenal peptic ulceration, who are colonized with H. pylori, and patients with MALT lymphoma. Eradication therapy should also be considered in patients with immune thrombocytopenic purpura who are H. pylori-positive and patients who have undergone resection for early-stage gastric cancer. Pharmacologic therapies for peptic ulcer disease due to H. pylori is either triple or quadruple pharmacologic agents that include a Proton pump inhibitors plus a combination of antimicrobial agents. The use of antimicrobial therapy is discouraged among asymptomatic carriers.

Medical Therapy

The mainstay of treatment for peptic ulcer disease is pharmacotherapy. Pharmacotherapy for peptic ulcer disease can be discussed under Helicobacter pylori-associated peptic ulcer and Non- Helicobacter pylori-associated peptic ulcer disease.

Eradication Therapy for Helicobacter pylori Infection

The ACG’s 2007 treatment guideline on the management of H. pylori infection listed the following as established indications for diagnosis and treatment:

Indications^[1]

Active PUD (gastric or duodenal).
Confirmed history of PUD (not previously treated for H. pylori)
Gastric MALT lymphoma (low grade)
After endoscopic resection of EGC
Depending upon exposure of antibiotics and allergy to antibiotics ,following treatments regimen are being used^[2]^[3] :

Triple Therapy

Triple therapy consisting of a PPI and 2 antibiotics for 14 days remains a recommended treatment in regions where H. pylori clarithromycin resistance is known to be <15% and in patients with no previous history of macrolide exposure .^[4]^[5]^[6]
PCA regimen

Preferred regimen (1):Proton pump inhibitor (standard dose twice daily) for 7–14 days AND
Note: Lansoprazole 30 mg q12h, or Omeprazole 20 mg q12h, or Esomeprazole 40 mg q24h, or Rabeprazole 20 mg q12h
Preferred regimen (2):Clarithromycin (500 mg twice daily) for 7–14 days AND
Preferred regimen (3):Amoxicillin (1 g twice daily) for 7–14 days OR Metronidazole (250 mg four times daily) for 7–14 days

PCM regimen

Alternative regimen (1): Proton pump inhibitor (standard dose twice daily) for 7–14 days AND
Alternative regimen (2): Clarithromycin (500 mg twice daily) for 7–14 days AND
Alternative regimen (3): Metronidazole (250 mg four times daily) for 7–14 days

PLA regimen

Alternative regimen (1): Proton pump inhibitor (standard dose twice daily) for 10 days AND
Alternative regimen (2): Levofloxacin (500 mg twice daily) for 10 days AND
Alternative regimen (3): Amoxicillin (1 g twice daily) for 10 days

PMA regimen

Alternative regimen (1): Proton pump inhibitor (standard dose twice daily) for 7–14 days AND
Alternative regimen (1): Metronidazole (250 mg four times daily) for 7–14 days AND
Alternative regimen (1): Amoxicillin (1 g twice daily) for 7–14 days

PRA regimen

Alternative regimen (1): Proton pump inhibitor (standard dose twice daily) for 10 days AND
Alternative regimen (1): Rifabutin (150–300 mg/day) for 10 days AND
Alternative regimen (1): Amoxicillin (1 g twice daily) for 10 days

Bismuth quadruple therapy

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily) for 10–14 days AND
Preferred regimen (1): Metronidazole (250 mg four times daily) for 10–14 days AND
Preferred regimen (1): Tetracycline (500 mg four times daily) for 10–14 days AND
Preferred regimen (1): Bismuth (dose depends on preparation) for 10–14 days

Bismuth-Containing Quadruple Therapy

Bismuth quadruple therapy particularly advised in patients with any previous macrolide exposure or clarithromycin resistance is known to be high or who are allergic to penicillin ^[7]

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily) for 10–14 days AND
Preferred regimen (2): Metronidazole (250 mg four times daily) for 10–14 days AND
Preferred regimen (3): Tetracycline (500 mg four times daily) for 10–14 days AND
Preferred regimen (4): Bismuth (dose depends on preparation) for 10–14 day

Non–Bismuth-Containing Quadruple Therapy

Concomitant therapy^[8]^[9].

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily) for 10–14 days AND
Preferred regimen (2): Clarithromycin (500 mg twice daily) for 10–14 days AND
Preferred regimen (3): Amoxicillin (1 g twice daily) for 10-14 days AND
Preferred regimen (4): Nitroimidazole (250 mg four times daily) for 10–14 days

Sequential therapy^[10]^[11]^[12].:

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily) for 5-7 days AND
Preferred regimen (2): Amoxicillin (1 g twice times daily) for 5-7 days
FOLLOWED BY
Preferred regimen (3): Proton pump inhibitor (standard dose twice daily) for another 5-7days AND
Preferred regimen (4): Clarithromycin (500 mg twice daily) for another 5-7 days AND
Preferred regimen (5): Tinidazole (500 mg twice daily) for another 5-7 days

Hybrid therapy:

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily) for 7 days
Preferred regimen (2): Amoxicillin (1 g twice times daily) for 7 days AND FOLLOWED BY

Preferred regimen (3): Proton pump inhibitor (standard dose twice daily) for 5-7 days AND
Preferred regimen (4): Amoxicillin (1 g twice times daily)for 7 days AND
Preferred regimen (5): Clarithromycin (500 mg twice daily)for 7 days AND
Preferred regimen (6): Nitroimidazole (250 mg four times dailyfor 7 days

Levofloxacin triple therapy^[13]^[10]^[14]^[15]:

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily) for 10-14 days AND
Preferred regimen (2): levofloxacin for 10–14 days AND
Preferred regimen (3): Amoxicillin(1 g twice times daily) for 10-14 days^[13]^[10]^[14]^[15]

Fluoroquinolone sequential therapy

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily)for 5 -7 days AND
Preferred regimen (2): Amoxicillin(1 g twice times daily) AND FOLLOWED

Preferred regimen (1): Proton pump inhibitor (standard dose twice daily)for 5–7 days AND
Preferred regimen (1): Fluoroquinolonefor 5–7 days AND
Preferred regimen (1): Nitroimidazolefor 5–7 days

After failure of second-line treatment, treatment should be guided by antimicrobial susceptibility testing whenever possible.The urea breath test or a laboratory based validated monoclonal stool test are both recommended as non-invasive tests for determining the success of eradication treatment.^[16]

Selection of a first-line H. pylori treatment regimen.

•Key questions?
• Is there a penicillin (PCN) allergy?
•Previous macrolide (MCL) exposure for any reason ?

•PCN allergy: No
•MCL exposure: No

•PCN allergy: No
•MCL exposure: Yes

•PCN allergy: Yes
•MCL exposure: No

•PCN allergy: Yes
•MCL exposure: Yes

Recomended treatment:
•Bismuth quadruple
•Clarithromycin triple with amoxicillin
Other options:
•Sequential
•HYBRID
•Levofloxacin triple
•Levofloxacin sequential
•LOAD

Recomended treatment:
•Bismuth quadruple
•Levofloxacin sequential
Other options:
•Concomitant therapy
•Sequential therapy
• HYBRID
•LOAD

Recomended treatment:
•Bismuth quadruple
•Clarithromycin triple
with metronidazole
•Bismuth quadruple

Recomended treatment:
•Bismuth quadruple
•Clarithromycin triple with metronidazole
•Bismuth quadruple

Recommended first-line therapies for H pylori infection:

Regimen	Drug dose	Dosing frequency	Duration(days)	FDA approval
Clarithromycin triple	PPI(standard or double dose Clarithromycin(500mg) Amoxicillin(1gm)or Metronidazole(500mg TID)	BID	14 days	YES^†
Bismuth Quadruple	PPI(standard dose) Bismuth subcitrate (120-300mg)or Subsalicylate (300mg) Tetracyclin(500mg) Metronidazole(250-500mg)	BID QID QID TID to QID (500mg)	10-14 days	NO^‡
Concomitant	PPI (standard dose) Clarithromycin (500mg) Amoxicillin(1gm) Nitroimidazole(500mg)^c	BID	10 -14 days	NO
Sequential	PPI(standard dose)+Amoxicillin(1gm) PPI,Clarithromycin(500mg)+Nitroimidazole(500mg)^c	BID BID	5-7 days 5-7 days	NO
Hybrid	PPI(standard)+Amoxicillin(1gm) PPI,Amoxicillin,Clarithromycin(500mg),Nitroimidazole(500mg)^c	BID BID	7 days 7 days	NO
Levofloxacin triple	PPI(standard dose) Levofloxacin(500mg) Amoxicillin(1gm)	BID QID BID	10-14 days	NO
Levofloxacin sequential	PPI(standard or double dose)+Amoxicillin(1 gm) PPI,Amoxicillin,Levofloxacin(500mg QD),Nitroimidazole(500mg)^c	BID BID	5-7 days	NO
LOAD	Levofloxacin(250mg) PPI(double dose) Nitazoxanide(500mg)^c Doxycycline(100mg)	QD QD BID QD	7-10 days	NO
	†: Several PPI, Clarithromycin, and Amoxicillin combinations have achieved FDA approval, PPI, Clarithromycin, Metronidazole are not an FDA approved treatment regimen. ‡: PPI, Bismuth, Tetracycline, and metronidazole prescribed separately are not an FDA approved treatment regimen. However, Pylera, a combination product containing Bismuth subcitrate, Tetracycline, Metronidazole combination with PPI for 10 days is an FDA approved regimen. BID, twice daily; FDA, Food and Drug Administration; PPI, proton pump inhibitor; TID, three times daily; QD, once daily; QID, four times daily. c:Metronidazole or Tinidazole^[1]

Persistent Helicobacter Pylori infection

With declining success rates for H. pylori eradication therapy, many patients will be persistently infected after treatment and will therefore remain at risk for the complications of H. pylori-related disease, such as peptic ulceration and gastric malignancy, testing to prove eradication should be performed using a urea breath test, fecal antigen test or biopsy-based testing at least 4 weeks after the completion of antibiotic therapy and after PPI therapy has been withheld for 1–2 weeks.In patients with persistent H. pylori infection, every effort should be made to avoid antibiotics that have been previously taken by the patient^[1]^[17].

Persistent Helicobacter Pylori infection

Patient recieved clarithromycin triple therapy

Patient received Bismuth quadriple therapy

•No previous Quinolone exposure
•No PCN allergy
Recomended treatment:
•Bismuth quadruple
•Levofloxacin
•Rifabutin triple
•High dose dual

•Previous Quinolone exposure
•No PCN Allergy
Recomended treatment:
•Bismuth quadruple therapy
•Rifabutin triple
•High dose dual

•No previous Quinolone exposure
•PCN Allergy
Recomended treatment:
•Bismuth quadruple

•Previous Quinolone exposure
•PCN Allergy
Recomended treatment:
•Bismuth quadruple

•No previous Quinolone exposure
•No PCN allergy
Recomended treatment:
•Levofloxacin triple concomitant
•Rifabutin triple
•High dose triple

•Previous Quinolone exposure
•No PCN Allergy
Recomended treatment:
•Concomitant Rifabutin triple
•High dose dual

•No previous Quinolone
exposure
•PCN Allergy
Recomended treatment:
•PPI,Clarithromycin
,Metronidazole
•PPI,Levofloxacin,
Metronidazole

•Previous Quinolone exposure
•No PCN Allergy
Recomended treatment:
•PPI,Clarithromycin,
Metronidazole
•Bismuth quadruple

Salvage treatment

After the failure of first-line therapy, such patients should be considered for referral for salvage treatment.

Salvage therapies for Helicobacter pylori infection
Regimen	Drugs(doses)	Dosing frequency	Duration(days)	FDA approval
Bismuth quadruple	PPI(standard dose) Bismuth subciitrate(120-300mg or sub salicylate(300mg) Tetracycline(500mg) Metronidazole(500mg)	BID QID QID TID or QID	14	NO^(a)
Levofloxacin triple	PPI(standard dose) Levofloxacin (500mg) Amoxicillin(1gm)	BID QD BID	14	NO
Concomitant	PPI(standard dose) Clarithromycin(500mg) Amoxicillin(1gm) Nitroimidazole(500mg)	BID BID BID BID or TID	10-14	NO
Rifabutin triple	PPI(standard dose) Rifabutin(300mg) Amoxicillin(1gm)	BID QD BID	10	NO
High-dose dual	PPI(standard to double dose) Amoxicillin(1gm TID or 750mg QID)	TID or QID TID or QID	14	NO

(a)PPI,Bismuth,tetracyclin and metronidazole prescribed separately is not an FDA-approved treatment regimen.However,Pylera,a combination product containing bimuth subcitrate,tetracyclin and metronidazole combined with a PPI for 10 days is an FDA-approved treatment regimen.

BID, twice daily; FDA, Food and Drug Administration; PPI, proton pump inhibitor; TID, three times daily; QD, once daily; QID, four times daily^[1].

Medical therapy for Non Helicobacter pylori-associated Peptic ulcer disease:

NSAIDs is most common cause of non-helicobacter pylori associated peptic ulcer disease. First step in management is to stop taking NSAIDs. Medical treatment for NSAIDs associated peptic ulcer : H2- receptor Antagonist

Cimetidine 800 mg
Ranitidine/nizatidine 300 mg
Famotidine 40 mg

Proton pump inhibitors

Omeprazole 20 mg
Lansoprazole 30 mg
Rabeprazole 20 mg
Pantoprazole 40 mg

Prevention of NSAID-induced ulcers
Drug	Dose
Misoprostol	200 μg 3 times/day
Drug	Dose
Misoprostol	200 μg 3 times/day
Proton pump inhibitors Omeprazole 20 mg Lansoprazole 30 mg Rabeprazole 20 mg Pantoprazole 40 mg	Once daily (empty stomach)

Active Ulcer
Drug	Dose
H2- receptor Antagonist Cimetidine 800 mg Ranitidine/nizatidine 300 mg Famotidine 40 mg	Once daily (at night)
Proton pump inhibitors Omeprazole 20 mg Lansoprazole 30 mg Rabeprazole 20 mg Pantoprazole 40 mg	Once daily (empty stomach)
Maintenance therapy
H2-receptor antagonists Cimetidine 400 mg Ranitidine/nizatidine 150 mg Famotidine 20 mg	Once daily (at night)
Proton pump inhibitors Omeprazole 20 mg Lansoprazole 30 mg Rabeprazole 20 mg Pantoprazole 40 mg	Once daily (empty stomach)

Contraindicated Medications

Bleeding peptic ulcer is considered an absolute contraindication to the use of the following medications:

Guidelines and Resources

American College of Gastroenterology (ACG) – Guidelines for the management of dyspepsia.^[18]
American Society for Gastrointestinal Endoscopy (ASGE) – The role of endoscopy in dyspepsia.^[19]
American Society for Gastrointestinal Endoscopy (ASGE) – The role of endoscopy in gastroduodenal obstruction and gastroparesis.^[20]
American College of Cardiology Foundation/American College of Gastroenterology/American Heart Association (ACCF/ACG/AHA) – Reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.^[21]
The European Helicobacter Study Group (EHSG) – Management of Helicobacter pylori infection.^[22]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 "www.nature.com" (PDF).
↑ Federico A, Gravina AG, Miranda A, Loguercio C, Romano M (2014). "Eradication of Helicobacter pylori infection: which regimen first?". World J. Gastroenterol. 20 (3): 665–72. doi:10.3748/wjg.v20.i3.665. PMC 3921476. PMID 24574740.
↑ Zullo A, Rinaldi V, Winn S, Meddi P, Lionetti R, Hassan C, Ripani C, Tomaselli G, Attili AF (2000). "A new highly effective short-term therapy schedule for Helicobacter pylori eradication". Aliment. Pharmacol. Ther. 14 (6): 715–8. PMID 10848654.
↑ Maconi G, Parente F, Russo A, Vago L, Imbesi V, Bianchi Porro G (2001). "Do some patients with Helicobacter pylori infection benefit from an extension to 2 weeks of a proton pump inhibitor-based triple eradication therapy?". Am. J. Gastroenterol. 96 (2): 359–66. doi:10.1111/j.1572-0241.2001.03519.x. PMID 11232676.
↑ Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F (2007). "Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication". Ann. Intern. Med. 147 (8): 553–62. PMID 17938394.
↑ Vakil N, Lanza F, Schwartz H, Barth J (2004). "Seven-day therapy for Helicobacter pylori in the United States". Aliment. Pharmacol. Ther. 20 (1): 99–107. doi:10.1111/j.1365-2036.2004.02029.x. PMID 15225176.
↑ Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P (2013). Bismuthfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23880479 "Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection" Check |url= value (help). Digestion. 88 (1): 33–45. doi:10.1159/000350719. PMID 23880479.
↑ Wu DC, Hsu PI, Wu JY, Opekun AR, Kuo CH, Wu IC, Wang SS, Chen A, Hung WC, Graham DY (2010). "Sequential and concomitant therapy with four drugs is equally effective for eradication of H pylori infection". Clin. Gastroenterol. Hepatol. 8 (1): 36–41.e1. doi:10.1016/j.cgh.2009.09.030. PMC 2838430. PMID 19804842.
↑ Chuah SK, Tsay FW, Hsu PI, Wu DC (2011). "A new look at anti-Helicobacter pylori therapy". World J. Gastroenterol. 17 (35): 3971–5. doi:10.3748/wjg.v17.i35.3971. PMC 3199554. PMID 22046084.
↑ ^10.0 ^10.1 ^10.2 Gatta L, Vakil N, Leandro G, Di Mario F, Vaira D (2009). "Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children". Am. J. Gastroenterol. 104 (12): 3069–79, quiz 1080. doi:10.1038/ajg.2009.555. PMID 19844205.
↑ Vaira D, Zullo A, Vakil N, Gatta L, Ricci C, Perna F, Hassan C, Bernabucci V, Tampieri A, Morini S (2007). "Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a randomized trial". Ann. Intern. Med. 146 (8): 556–63. PMID 17438314.
↑ Gisbert JP, Calvet X, O'Connor A, Mégraud F, O'Morain CA (2010). "Sequential therapy for Helicobacter pylori eradication: a critical review". J. Clin. Gastroenterol. 44 (5): 313–25. doi:10.1097/MCG.0b013e3181c8a1a3. PMID 20054285.
↑ ^13.0 ^13.1 Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre G, Dueñas C, Mateos-Rodriguez JM, Gonzalez-Garcia G, Abadia EG, Gisbert JP (2010). "Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication". Aliment. Pharmacol. Ther. 31 (10): 1077–84. doi:10.1111/j.1365-2036.2010.04274.x. PMID 20180787.
↑ ^14.0 ^14.1 Caselli M, Zullo A, Maconi G, Parente F, Alvisi V, Casetti T, Sorrentino D, Gasbarrini G (2007). ""Cervia II Working Group Report 2006": guidelines on diagnosis and treatment of Helicobacter pylori infection in Italy". Dig Liver Dis. 39 (8): 782–9. doi:10.1016/j.dld.2007.05.016. PMID 17606419.
↑ ^15.0 ^15.1 Romano M, Cuomo A, Gravina AG, Miranda A, Iovene MR, Tiso A, Sica M, Rocco A, Salerno R, Marmo R, Federico A, Nardone G (2010). "Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial". Gut. 59 (11): 1465–70. doi:10.1136/gut.2010.215350. PMID 20947881.
↑ Malfertheiner, Peter; Megraud, Francis; O'Morain, Colm A.; Atherton, John; Axon, Anthony T. R.; Bazzoli, Franco; Gensini, Gian Franco; Gisbert, Javier P.; Graham, David Y.; Rokkas, Theodore; El-Omar, Emad M.; Kuipers, Ernst J.; European Helicobacter Study Group (2012-05). "Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report". Gut. 61 (5): 646–664. doi:10.1136/gutjnl-2012-302084. ISSN 1468-3288. PMID 22491499. Check date values in: |date= (help)
↑ Chey WD, Wong BC (2007). "American College of Gastroenterology guideline on the management of Helicobacter pylori infection". Am. J. Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.
↑ Talley, Nicholas J.; Vakil, Nimish; Practice Parameters Committee of the American College of Gastroenterology (2005-10). "Guidelines for the management of dyspepsia". The American Journal of Gastroenterology. 100 (10): 2324–2337. doi:10.1111/j.1572-0241.2005.00225.x. ISSN 0002-9270. PMID 16181387. Check date values in: |date= (help)
↑ Ikenberry, Steven O.; Harrison, M. Edwyn; Lichtenstein, David; Dominitz, Jason A.; Anderson, Michelle A.; Jagannath, Sanjay B.; Banerjee, Subhas; Cash, Brooks D.; Fanelli, Robert D.; Gan, Seng-Ian; Shen, Bo; Van Guilder, Trina; Lee, Kenneth K.; Baron, Todd H.; ASGE STANDARDS OF PRACTICE COMMITTEE (2007-12). "The role of endoscopy in dyspepsia". Gastrointestinal Endoscopy. 66 (6): 1071–1075. doi:10.1016/j.gie.2007.07.007. ISSN 0016-5107. PMID 18028927. Check date values in: |date= (help)
↑ ASGE Standards of Practice Committee; Fukami, Norio; Anderson, Michelle A.; Khan, Khalid; Harrison, M. Edwyn; Appalaneni, Vasudhara; Ben-Menachem, Tamir; Decker, G. Anton; Fanelli, Robert D.; Fisher, Laurel; Ikenberry, Steven O.; Jain, Rajeev; Jue, Terry L.; Krinsky, Mary Lee; Maple, John T.; Sharaf, Ravi N.; Dominitz, Jason A. (2011-07). "The role of endoscopy in gastroduodenal obstruction and gastroparesis". Gastrointestinal Endoscopy. 74 (1): 13–21. doi:10.1016/j.gie.2010.12.003. ISSN 1097-6779. PMID 21704805. Check date values in: |date= (help)
↑ Bhatt, Deepak L.; Scheiman, James; Abraham, Neena S.; Antman, Elliott M.; Chan, Francis K. L.; Furberg, Curt D.; Johnson, David A.; Mahaffey, Kenneth W.; Quigley, Eamonn M.; American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (2008-10-28). "ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents". Circulation. 118 (18): 1894–1909. doi:10.1161/CIRCULATIONAHA.108.191087. ISSN 1524-4539. PMID 18836135.
↑ Malfertheiner, Peter; Megraud, Francis; O'Morain, Colm A.; Atherton, John; Axon, Anthony T. R.; Bazzoli, Franco; Gensini, Gian Franco; Gisbert, Javier P.; Graham, David Y.; Rokkas, Theodore; El-Omar, Emad M.; Kuipers, Ernst J.; European Helicobacter Study Group (2012-05). "Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report". Gut. 61 (5): 646–664. doi:10.1136/gutjnl-2012-302084. ISSN 1468-3288. PMID 22491499. Check date values in: |date= (help)

[urlwww.nature.com-1] 1.0 ^1.1 ^1.2 ^1.3 "www.nature.com" (PDF).

[pmid24574740-2] Federico A, Gravina AG, Miranda A, Loguercio C, Romano M (2014). "Eradication of Helicobacter pylori infection: which regimen first?". World J. Gastroenterol. 20 (3): 665–72. doi:10.3748/wjg.v20.i3.665. PMC 3921476. PMID 24574740.

[pmid10848654-3] Zullo A, Rinaldi V, Winn S, Meddi P, Lionetti R, Hassan C, Ripani C, Tomaselli G, Attili AF (2000). "A new highly effective short-term therapy schedule for Helicobacter pylori eradication". Aliment. Pharmacol. Ther. 14 (6): 715–8. PMID 10848654.

[pmid11232676-4] Maconi G, Parente F, Russo A, Vago L, Imbesi V, Bianchi Porro G (2001). "Do some patients with Helicobacter pylori infection benefit from an extension to 2 weeks of a proton pump inhibitor-based triple eradication therapy?". Am. J. Gastroenterol. 96 (2): 359–66. doi:10.1111/j.1572-0241.2001.03519.x. PMID 11232676.

[pmid17938394-5] Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F (2007). "Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication". Ann. Intern. Med. 147 (8): 553–62. PMID 17938394.

[pmid15225176-6] Vakil N, Lanza F, Schwartz H, Barth J (2004). "Seven-day therapy for Helicobacter pylori in the United States". Aliment. Pharmacol. Ther. 20 (1): 99–107. doi:10.1111/j.1365-2036.2004.02029.x. PMID 15225176.

[pmid23880479-7] Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P (2013). Bismuthfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23880479 "Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection" Check |url= value (help). Digestion. 88 (1): 33–45. doi:10.1159/000350719. PMID 23880479.

[pmid19804842-8] Wu DC, Hsu PI, Wu JY, Opekun AR, Kuo CH, Wu IC, Wang SS, Chen A, Hung WC, Graham DY (2010). "Sequential and concomitant therapy with four drugs is equally effective for eradication of H pylori infection". Clin. Gastroenterol. Hepatol. 8 (1): 36–41.e1. doi:10.1016/j.cgh.2009.09.030. PMC 2838430. PMID 19804842.

[pmid22046084-9] Chuah SK, Tsay FW, Hsu PI, Wu DC (2011). "A new look at anti-Helicobacter pylori therapy". World J. Gastroenterol. 17 (35): 3971–5. doi:10.3748/wjg.v17.i35.3971. PMC 3199554. PMID 22046084.

[pmid19844205-10] 10.0 ^10.1 ^10.2 Gatta L, Vakil N, Leandro G, Di Mario F, Vaira D (2009). "Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children". Am. J. Gastroenterol. 104 (12): 3069–79, quiz 1080. doi:10.1038/ajg.2009.555. PMID 19844205.

[pmid17438314-11] Vaira D, Zullo A, Vakil N, Gatta L, Ricci C, Perna F, Hassan C, Bernabucci V, Tampieri A, Morini S (2007). "Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a randomized trial". Ann. Intern. Med. 146 (8): 556–63. PMID 17438314.

[pmid20054285-12] Gisbert JP, Calvet X, O'Connor A, Mégraud F, O'Morain CA (2010). "Sequential therapy for Helicobacter pylori eradication: a critical review". J. Clin. Gastroenterol. 44 (5): 313–25. doi:10.1097/MCG.0b013e3181c8a1a3. PMID 20054285.

[pmid20180787-13] 13.0 ^13.1 Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre G, Dueñas C, Mateos-Rodriguez JM, Gonzalez-Garcia G, Abadia EG, Gisbert JP (2010). "Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication". Aliment. Pharmacol. Ther. 31 (10): 1077–84. doi:10.1111/j.1365-2036.2010.04274.x. PMID 20180787.

[pmid17606419-14] 14.0 ^14.1 Caselli M, Zullo A, Maconi G, Parente F, Alvisi V, Casetti T, Sorrentino D, Gasbarrini G (2007). ""Cervia II Working Group Report 2006": guidelines on diagnosis and treatment of Helicobacter pylori infection in Italy". Dig Liver Dis. 39 (8): 782–9. doi:10.1016/j.dld.2007.05.016. PMID 17606419.

[pmid20947881-15] 15.0 ^15.1 Romano M, Cuomo A, Gravina AG, Miranda A, Iovene MR, Tiso A, Sica M, Rocco A, Salerno R, Marmo R, Federico A, Nardone G (2010). "Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial". Gut. 59 (11): 1465–70. doi:10.1136/gut.2010.215350. PMID 20947881.

[16] Malfertheiner, Peter; Megraud, Francis; O'Morain, Colm A.; Atherton, John; Axon, Anthony T. R.; Bazzoli, Franco; Gensini, Gian Franco; Gisbert, Javier P.; Graham, David Y.; Rokkas, Theodore; El-Omar, Emad M.; Kuipers, Ernst J.; European Helicobacter Study Group (2012-05). "Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report". Gut. 61 (5): 646–664. doi:10.1136/gutjnl-2012-302084. ISSN 1468-3288. PMID 22491499. Check date values in: |date= (help)

[pmid17608775-17] Chey WD, Wong BC (2007). "American College of Gastroenterology guideline on the management of Helicobacter pylori infection". Am. J. Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.

[18] Talley, Nicholas J.; Vakil, Nimish; Practice Parameters Committee of the American College of Gastroenterology (2005-10). "Guidelines for the management of dyspepsia". The American Journal of Gastroenterology. 100 (10): 2324–2337. doi:10.1111/j.1572-0241.2005.00225.x. ISSN 0002-9270. PMID 16181387. Check date values in: |date= (help)

[19] Ikenberry, Steven O.; Harrison, M. Edwyn; Lichtenstein, David; Dominitz, Jason A.; Anderson, Michelle A.; Jagannath, Sanjay B.; Banerjee, Subhas; Cash, Brooks D.; Fanelli, Robert D.; Gan, Seng-Ian; Shen, Bo; Van Guilder, Trina; Lee, Kenneth K.; Baron, Todd H.; ASGE STANDARDS OF PRACTICE COMMITTEE (2007-12). "The role of endoscopy in dyspepsia". Gastrointestinal Endoscopy. 66 (6): 1071–1075. doi:10.1016/j.gie.2007.07.007. ISSN 0016-5107. PMID 18028927. Check date values in: |date= (help)

[20] ASGE Standards of Practice Committee; Fukami, Norio; Anderson, Michelle A.; Khan, Khalid; Harrison, M. Edwyn; Appalaneni, Vasudhara; Ben-Menachem, Tamir; Decker, G. Anton; Fanelli, Robert D.; Fisher, Laurel; Ikenberry, Steven O.; Jain, Rajeev; Jue, Terry L.; Krinsky, Mary Lee; Maple, John T.; Sharaf, Ravi N.; Dominitz, Jason A. (2011-07). "The role of endoscopy in gastroduodenal obstruction and gastroparesis". Gastrointestinal Endoscopy. 74 (1): 13–21. doi:10.1016/j.gie.2010.12.003. ISSN 1097-6779. PMID 21704805. Check date values in: |date= (help)

[21] Bhatt, Deepak L.; Scheiman, James; Abraham, Neena S.; Antman, Elliott M.; Chan, Francis K. L.; Furberg, Curt D.; Johnson, David A.; Mahaffey, Kenneth W.; Quigley, Eamonn M.; American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (2008-10-28). "ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents". Circulation. 118 (18): 1894–1909. doi:10.1161/CIRCULATIONAHA.108.191087. ISSN 1524-4539. PMID 18836135.

[22] Malfertheiner, Peter; Megraud, Francis; O'Morain, Colm A.; Atherton, John; Axon, Anthony T. R.; Bazzoli, Franco; Gensini, Gian Franco; Gisbert, Javier P.; Graham, David Y.; Rokkas, Theodore; El-Omar, Emad M.; Kuipers, Ernst J.; European Helicobacter Study Group (2012-05). "Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report". Gut. 61 (5): 646–664. doi:10.1136/gutjnl-2012-302084. ISSN 1468-3288. PMID 22491499. Check date values in: |date= (help)

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@@ Line 18: / Line 18: @@
 ====Triple Therapy====
-*Clarithromycin triple therapy consisting of a PPI, clarithromycin, and amoxicillin or metronidazole for 14 days remains a recommended treatment in regions where H. pylori clarithromycin resistance is known to be <15% and in patients with no previous history of macrolide exposure for any reason<ref name="pmid11232676">{{cite journal |vauthors=Maconi G, Parente F, Russo A, Vago L, Imbesi V, Bianchi Porro G |title=Do some patients with Helicobacter pylori infection benefit from an extension to 2 weeks of a proton pump inhibitor-based triple eradication therapy? |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=359–66 |year=2001 |pmid=11232676 |doi=10.1111/j.1572-0241.2001.03519.x |url=}}</ref><ref name="pmid17938394">{{cite journal |vauthors=Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F |title=Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication |journal=Ann. Intern. Med. |volume=147 |issue=8 |pages=553–62 |year=2007 |pmid=17938394 |doi= |url=}}</ref><ref name="pmid15225176">{{cite journal |vauthors=Vakil N, Lanza F, Schwartz H, Barth J |title=Seven-day therapy for Helicobacter pylori in the United States |journal=Aliment. Pharmacol. Ther. |volume=20 |issue=1 |pages=99–107 |year=2004 |pmid=15225176 |doi=10.1111/j.1365-2036.2004.02029.x |url=}}</ref>.
+*Triple  therapy consisting of a PPI and 2 antibiotics  for 14 days remains a recommended treatment in regions where H. pylori clarithromycin resistance is known to be <15% and in patients with no previous history of macrolide exposure .<ref name="pmid11232676">{{cite journal |vauthors=Maconi G, Parente F, Russo A, Vago L, Imbesi V, Bianchi Porro G |title=Do some patients with Helicobacter pylori infection benefit from an extension to 2 weeks of a proton pump inhibitor-based triple eradication therapy? |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=359–66 |year=2001 |pmid=11232676 |doi=10.1111/j.1572-0241.2001.03519.x |url=}}</ref><ref name="pmid17938394">{{cite journal |vauthors=Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F |title=Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication |journal=Ann. Intern. Med. |volume=147 |issue=8 |pages=553–62 |year=2007 |pmid=17938394 |doi= |url=}}</ref><ref name="pmid15225176">{{cite journal |vauthors=Vakil N, Lanza F, Schwartz H, Barth J |title=Seven-day therapy for Helicobacter pylori in the United States |journal=Aliment. Pharmacol. Ther. |volume=20 |issue=1 |pages=99–107 |year=2004 |pmid=15225176 |doi=10.1111/j.1365-2036.2004.02029.x |url=}}</ref>
 * '''<u>PCA regimen</u>'''
 :* Preferred regimen (1):'''[[Proton pump inhibitor]]''' (standard dose twice daily) for 7–14 days {{and}}
@@ Line 51: / Line 51: @@
 ====Bismuth-Containing Quadruple Therapy====
-*Bismuth quadruple therapy particularly attractive in patients with any previous macrolide exposure or clarithromycin resistance is known to be high or who are allergic to penicillin <ref name="pmid23880479">{{cite journal| author=Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P| title=Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. | journal=Digestion | year= 2013 | volume= 88 | issue= 1 | pages= 33-45 | pmid=23880479 | doi=10.1159/000350719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?d.* Bismuthfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23880479  }} </ref>
+*Bismuth quadruple therapy particularly advised in patients with any previous macrolide exposure or clarithromycin resistance is known to be high or who are allergic to penicillin <ref name="pmid23880479">{{cite journal| author=Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P| title=Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. | journal=Digestion | year= 2013 | volume= 88 | issue= 1 | pages= 33-45 | pmid=23880479 | doi=10.1159/000350719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?d.* Bismuthfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23880479  }} </ref>
 :*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily) for 10–14 days {{and}}
 :*Preferred regimen (2): '''[[Metronidazole]]''' (250 mg four times daily) for 10–14 days {{and}}
@@ Line 71: / Line 71: @@
 *'''Hybrid therapy''':
 :*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily) for 7 days
-:*Preferred regimen (2): '''[[Amoxicillin]]''' (1 g twice times daily) for 7 days
+:*Preferred regimen (2): '''[[Amoxicillin]]''' (1 g twice times daily) for 7 days '''<u>AND</u>''' <u>'''FOLLOWED BY'''</u>
-<u>'''FOLLOWED BY'''</u>
-:*Preferred regimen (3): '''[[Proton pump inhibitor]]''' (standard dose twice daily) for 5-7 days
+:*Preferred regimen (3): '''[[Proton pump inhibitor]]''' (standard dose twice daily) for 5-7 days '''<u>AND</u>'''
-:*Preferred regimen (4): '''[[Amoxicillin]]''' (1 g twice times daily)for 7 days
+:*Preferred regimen (4): '''[[Amoxicillin]]''' (1 g twice times daily)for 7 days '''<u>AND</u>'''
-:*Preferred regimen (5): '''[[Clarithromycin]]''' (500 mg twice daily)for 7 days
+:*Preferred regimen (5): '''[[Clarithromycin]]''' (500 mg twice daily)for 7 days '''<u>AND</u>'''
 :*Preferred regimen (6): '''[[Nitroimidazole ]]''' (250 mg four times dailyfor 7 days
 *'''Levofloxacin triple therapy'''<ref name="pmid20180787">{{cite journal |vauthors=Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre G, Dueñas C, Mateos-Rodriguez JM, Gonzalez-Garcia G, Abadia EG, Gisbert JP |title=Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication |journal=Aliment. Pharmacol. Ther. |volume=31 |issue=10 |pages=1077–84 |year=2010 |pmid=20180787 |doi=10.1111/j.1365-2036.2010.04274.x |url=}}</ref><ref name="pmid19844205">{{cite journal |vauthors=Gatta L, Vakil N, Leandro G, Di Mario F, Vaira D |title=Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children |journal=Am. J. Gastroenterol. |volume=104 |issue=12 |pages=3069–79; quiz 1080 |year=2009 |pmid=19844205 |doi=10.1038/ajg.2009.555 |url=}}</ref><ref name="pmid17606419">{{cite journal |vauthors=Caselli M, Zullo A, Maconi G, Parente F, Alvisi V, Casetti T, Sorrentino D, Gasbarrini G |title="Cervia II Working Group Report 2006": guidelines on diagnosis and treatment of Helicobacter pylori infection in Italy |journal=Dig Liver Dis |volume=39 |issue=8 |pages=782–9 |year=2007 |pmid=17606419 |doi=10.1016/j.dld.2007.05.016 |url=}}</ref><ref name="pmid20947881">{{cite journal |vauthors=Romano M, Cuomo A, Gravina AG, Miranda A, Iovene MR, Tiso A, Sica M, Rocco A, Salerno R, Marmo R, Federico A, Nardone G |title=Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial |journal=Gut |volume=59 |issue=11 |pages=1465–70 |year=2010 |pmid=20947881 |doi=10.1136/gut.2010.215350 |url=}}</ref>:
-:*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily) for 10-14 days.
+:*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily) for 10-14 days '''<u>AND</u>'''
-:*Preferred regimen (2): '''[[levofloxacin]]''' for 10–14 days
+:*Preferred regimen (2): '''[[levofloxacin]]''' for 10–14 days '''<u>AND</u>'''
 :*Preferred regimen (3): '''[[Amoxicillin]]'''(1 g twice times daily)  for 10-14 days<ref name="pmid20180787">{{cite journal |vauthors=Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre G, Dueñas C, Mateos-Rodriguez JM, Gonzalez-Garcia G, Abadia EG, Gisbert JP |title=Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication |journal=Aliment. Pharmacol. Ther. |volume=31 |issue=10 |pages=1077–84 |year=2010 |pmid=20180787 |doi=10.1111/j.1365-2036.2010.04274.x |url=}}</ref><ref name="pmid19844205">{{cite journal |vauthors=Gatta L, Vakil N, Leandro G, Di Mario F, Vaira D |title=Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children |journal=Am. J. Gastroenterol. |volume=104 |issue=12 |pages=3069–79; quiz 1080 |year=2009 |pmid=19844205 |doi=10.1038/ajg.2009.555 |url=}}</ref><ref name="pmid17606419">{{cite journal |vauthors=Caselli M, Zullo A, Maconi G, Parente F, Alvisi V, Casetti T, Sorrentino D, Gasbarrini G |title="Cervia II Working Group Report 2006": guidelines on diagnosis and treatment of Helicobacter pylori infection in Italy |journal=Dig Liver Dis |volume=39 |issue=8 |pages=782–9 |year=2007 |pmid=17606419 |doi=10.1016/j.dld.2007.05.016 |url=}}</ref><ref name="pmid20947881">{{cite journal |vauthors=Romano M, Cuomo A, Gravina AG, Miranda A, Iovene MR, Tiso A, Sica M, Rocco A, Salerno R, Marmo R, Federico A, Nardone G |title=Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial |journal=Gut |volume=59 |issue=11 |pages=1465–70 |year=2010 |pmid=20947881 |doi=10.1136/gut.2010.215350 |url=}}</ref>
 *'''Fluoroquinolone sequential therapy'''
-:*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily)for 5 -7 days.
+:*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily)for 5 -7 days '''<u>AND</u>'''
-:*Preferred regimen (2): '''[[Amoxicillin]]'''(1 g twice times daily)
+:*Preferred regimen (2): '''[[Amoxicillin]]'''(1 g twice times daily) '''<u>AND</u>''' <u>'''FOLLOWED'''</u>
-<u>'''FOLLOWED BY'''</u>
-:*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily)for 5–7 days
+:*Preferred regimen (1): '''[[Proton pump inhibitor]]''' (standard dose twice daily)for 5–7 days '''<u>AND</u>'''
-:*Preferred regimen (1): '''[[Fluoroquinolone]]'''for 5–7 days
+:*Preferred regimen (1): '''[[Fluoroquinolone]]'''for 5–7 days '''<u>AND</u>'''
 :*Preferred regimen (1): '''[[Nitroimidazole]]'''for 5–7 days
-* After failure of second-line treatment, treatment should be guided by antimicrobial susceptibility testing whenever possible.
+* After failure of second-line treatment, treatment should be guided by antimicrobial susceptibility testing whenever possible.The urea breath test or a laboratory based validated monoclonal stool test are both recommended as non-invasive tests for determining the success of eradication treatment.<ref>{{Cite journal| doi = 10.1136/gutjnl-2012-302084| issn = 1468-3288| volume = 61| issue = 5| pages = 646–664| last1 = Malfertheiner| first1 = Peter| last2 = Megraud| first2 = Francis| last3 = O'Morain| first3 = Colm A.| last4 = Atherton| first4 = John| last5 = Axon| first5 = Anthony T. R.| last6 = Bazzoli| first6 = Franco| last7 = Gensini| first7 = Gian Franco| last8 = Gisbert| first8 = Javier P.| last9 = Graham| first9 = David Y.| last10 = Rokkas| first10 = Theodore| last11 = El-Omar| first11 = Emad M.| last12 = Kuipers| first12 = Ernst J.| last13 = European Helicobacter Study Group| title = Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report| journal = Gut| date = 2012-05| pmid = 22491499}}</ref>
-The urea breath test or a laboratory based validated monoclonal stool test are both recommended as non-invasive tests for determining the success of eradication treatment.<ref>{{Cite journal| doi = 10.1136/gutjnl-2012-302084| issn = 1468-3288| volume = 61| issue = 5| pages = 646–664| last1 = Malfertheiner| first1 = Peter| last2 = Megraud| first2 = Francis| last3 = O'Morain| first3 = Colm A.| last4 = Atherton| first4 = John| last5 = Axon| first5 = Anthony T. R.| last6 = Bazzoli| first6 = Franco| last7 = Gensini| first7 = Gian Franco| last8 = Gisbert| first8 = Javier P.| last9 = Graham| first9 = David Y.| last10 = Rokkas| first10 = Theodore| last11 = El-Omar| first11 = Emad M.| last12 = Kuipers| first12 = Ernst J.| last13 = European Helicobacter Study Group| title = Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report| journal = Gut| date = 2012-05| pmid = 22491499}}</ref>
 '''Selection of a first-line H. pylori treatment regimen.'''
 <br><br>

Peptic ulcer medical therapy: Difference between revisions

Revision as of 13:23, 6 November 2017

Overview

Medical Therapy

Eradication Therapy for Helicobacter pylori Infection

Indications[1]

Triple Therapy

Bismuth-Containing Quadruple Therapy

Non–Bismuth-Containing Quadruple Therapy

Persistent Helicobacter Pylori infection

Salvage treatment

Medical therapy for Non Helicobacter pylori-associated Peptic ulcer disease:

Contraindicated Medications

Guidelines and Resources

References

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Indications^[1]