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SOURCE : Siddique O, et al. Helicobacter pylori infection: An update for the internist in the age of increasing global antibiotic resistance. Am J Med 2018;131:473-479.
Like every other infection, Helicobacter pylori (HP) is increasingly drug resistant. Estimated failure rates are 5-10%, even after receipt of two different antimicrobial regimens. Failures most often are due to resistance to clarithromycin (which may be as high as 30% in some countries and in some parts of the United States) and levofloxacin (which also may be approaching resistance rates of 30% in some parts of the United States). Physicians need to keep pace with the consequences of this development and newer recommendations. Although the prevalence of HP seems to be decreasing in the United States, at least in higher socioeconomic strata, HP remains a problem for lower-income groups, travelers to developing countries, and the rest of the world. The prevalence of HP is believed to be > 50% in some parts of the world, especially in Central Asia, Central America, and Eastern Europe.
There are multiple barriers to appropriate testing and treatment. The first barrier is the promotion of testing for HP in patients at risk. HP screening is indicated for anyone with recurring epigastric discomfort, chronic use of nonsteroidal anti-inflammatory drugs, unexplained iron deficiency anemia, and ITP. Any of the “alarm symptoms,” such as recurrent vomiting, weight loss, and dysphagia, especially with a family history of gastric cancer, should prompt endoscopy with biopsy and examination for HP.
The second barrier is the type and timing of testing. Tests for active infection include stool antigen testing and the urea breath test (both ≥ 95% sensitive, ≥ 95% specific). But these tests must be performed more than four weeks after the use of...