ERADICATION THERAPY FOR HELICOBACTER PYLORI

Abstract

Relevance. Helicobacter pylori is a bacterium that causes chronic active gastritis, peptic ulcer disease, gastric adenocarcinoma, MALT lymphoma, and atrophic gastritis. In recent years, antibiotic resistance of Helicobacter pylori has become widespread globally, necessitating further investigation and the development of new therapeutic regimens. Objective: To analyze current approaches to Helicobacter pylori eradication therapy based on modern literature. Search strategy. A literature search was conducted in the PubMed, Scopus, Web of Science, and Cochrane Library databases for the period from 2014 to 2024. The following keywords and combinations were used: "Helicobacter pylori", "eradication", "treatment strategies", "antibiotic resistance", "triple therapy", "quadruple therapy", "bismuth-based therapy", "sequential therapy", "vonoprazan", "probiotics and H. pylori", "guidelines for H. pylori eradication". Additionally, a manual search of the literature was performed. Preference was given to original studies, systematic reviews, clinical guidelines, and meta-analyses published in English and Russian. A total of 81 sources were selected for analysis.
Results and conclusions. Among non-invasive diagnostic methods, the ¹³C-urea breath test and stool antigen detection for Helicobacter pylori are considered the gold standards. These tests also help assess the effectiveness of eradication therapy. Triple and quadruple therapy regimens have been proposed for Helicobacter pylori eradication, typically involving high doses of proton pump inhibitors (PPIs), two antibiotics, and a bismuth compound. More recently, potassium-competitive acid blockers (P-CABs), the most potent acid-suppressing agents, have been incorporated into treatment regimens. Despite the variety of treatment protocols available, the success rate of H. pylori eradication remains suboptimal and continues to be a pressing challenge in gastroenterology, especially given the bacterium’s role in the pathogenesis of peptic ulcer disease, gastric cancer, and other conditions. The rise in antibiotic resistance necessitates an individualized approach to therapy selection, with a preference for more effective and locally adapted strategies such as bismuth-based quadruple therapy or vonoprazan-containing regimens. The future of H. pylori treatment lies in personalized medicine, the development of new molecules, and improved diagnostics for resistant strains. Continued international coordination is essential for monitoring resistance and optimizing clinical guidelines.