[The eradication of Helicobacter pylori and the prevention of ulcer recurrence. The certainties and the open problems].

Maintenance treatment with antisecretory agents, and above all with H2-RA, is a therapeutic option still largely favoured by physicians. However, in the last decades the pathogenetic role of Helicobacter pylori (Hp) in duodenal and gastric ulcer has met with increasingly convincing confirmation. Actually, Hp eradication brings about a dramatic and persistent decrease in ulcer relapse rate. At present, there is a general agreement that Hp-positive patients, with ulcer whether ab initio or recurrent, need to be treated with anti-Hp regimens. The first choice therapy, according to some clinicians, should be the classic triple therapy (colloidal bismuth, metronidazole and tetracicline or amoxicillin) associated or not with a proton pomp inhibitors (PPI) or H2-RA. Though supported by other gastroenterologists, dual therapy with a PPI plus amoxicillin raises some perplexity due to the unpredictable variability of the results. Non-bismuth triple therapy, consisting in 2 antimicrobial and 1 antisecretory agent, for which a duration of only 1 week would seem sufficient even at low dosage, is currently meeting with greater favour. The FDA approval is probably imminent for 2 anti-Hp regimens consisting in clarithromycin plus a PPI or the complex salt ranitidine-bismuth citrate.