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Helicobacter pylori: A Review of Current Diagnostic and Management Strategies

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Abstract

As one of the most prevalent infections globally, Helicobacter pylori (H. pylori) continues to present diagnostic and therapeutic challenges for clinicians worldwide. Diagnostically, the “test-and-treat” strategy is the recommended approach for healthcare practitioners when managing this potentially curable disease. The choice of testing method should be based on several factors including patient age, presenting symptoms, and medication use, as well as test reliability, availability, and cost. With rising antibiotic resistance, particularly of macrolides, care must be taken to ensure that therapy is selected based on regional resistance patterns and prior antibiotic exposure. In the USA, macrolide antibiotic resistance rates in some areas have reached or exceeded a generally accepted threshold, such that clarithromycin triple therapy may no longer be an appropriate first-line empiric treatment. Instead, bismuth quadruple therapy should be considered, while levofloxacin-based or alternative macrolide-containing therapies are also options. Once treated, it is essential to test for eradication as untreated H. pylori is associated with serious complications including peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. This review article aims to consolidate current knowledge of H. pylori infection with a particular emphasis on diagnostic and treatment strategies.

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Acknowledgments

We would like to extend our sincere gratitude to Dr. Souvik Sarkar, M.D., Ph.D., at UC Davis Medical Center, who assisted with the final editing of our review and provided invaluable comments and suggestions to enhance this piece.

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  1. Department of Internal Medicine, University of California Davis School of Medicine, 4150 V Street, Suite 1100, Sacramento, CA, 95817, USA

    Bernardo Guevara

  2. Division of Gastroenterology and Hepatology, UC Davis Medical Center, University of California Davis School of Medicine, 4150 V Street, Suite 3500, Sacramento, CA, 95817, USA

    Asha Gupta Cogdill

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  1. Bernardo Guevara
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Guevara, B., Cogdill, A.G. Helicobacter pylori: A Review of Current Diagnostic and Management Strategies. Dig Dis Sci 65, 1917–1931 (2020). https://doi.org/10.1007/s10620-020-06193-7

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