New recommendations for the diagnosis and the treatment of Helicobacter pylori infection

Management of Helicobacter pylori infection is evolving. New data concern the role of the bacterium in various clinical conditions, the indications of H. pylori testing, diagnosis procedures and eradication treatment regimens. H. pylori should be sought and eradicated before starting NSAIDs treatment, in aspirin users with a history of gastroduodenal ulcer, and in patients presenting with chronic dyspepsia, high risk factors of gastric cancer, unexplained iron deficiency anaemia, vitamin B12 deficiency, or immune (idiopathic) thrombocytopenic purpura. The Urea Breath Test remains the best test to diagnose H. pylori infection, whereas serology is the only test, which is not affected by local changes in the stomach. Molecular tests can be used to detect H. pylori and clarithromycin and/or fluoroquinolone resistance in gastric biopsies without necessitating culture. In regions of high clarithromycin resistance, such as France, sequential treatment or bismuth-containing quadruple therapies are replacing standard triple therapies for the first-line empirical treatment.