The future of Helicobacter pylori eradication: a personal perspective.

Future changes in the use of Helicobacter pylori eradication therapy first will involve a decision-making process to determine which individuals require testing. Clearly, only persons who require therapy need to be diagnosed and, at present, the indications for therapy are constantly expanding. The author takes the view that everyone with H. pylori would be better off without the bacterium, but accepts that in many countries resources are inadequate to achieve this goal. Where antibiotic therapy for H. pylori fails due to a resistant organism, second treatment must include a different class of antibiotic. When a third therapy is contemplated, antibiotic sensitivity studies are usually necessary. In developing counties where reinfection with H. pylori is common, lesser goals than permanent cure might be appropriate. Thus, selected patients could have H. pylori suppressive therapy to prevent full expression of H. pylori-associated disease, or to prevent reinfection after an initial eradicative therapy. After considering all these alternatives, one must conclude that a vaccination strategy, if safe and cost effective, is the ideal future therapy.