[Current therapy of Helicobacter pylori-induced chronic gastritis and/or peptic ulcer].

Helicobacter pylori (H.p.) induced chronic gastritis cannot at present be considered as an absolute indication for eradication therapy of H.p. Clinical trials with antimicrobial compounds, mainly bismuth, have not convincingly demonstrated appreciable symptomatic benefit for patients with H.p.-positive gastritis and non-ulcer dyspepsia. However, new results indicate that possibly a longer follow-up period may be necessary to prove a symptomatic improvement after H.p. eradication in patients with chronic gastritis. In contrast, eradication of H.p. reduces the relapse rates of recurrent non-iatrogenic peptic ulcer to virtually zero. Antimicrobial treatment of H.p. infection is, therefore, clearly indicated in chronic duodenal and gastric ulcers. In the case of success, drug maintenance therapy or operation becomes superfluous. The combination of amoxicillin plus metronidazole with ranitidine or of omeprazole with amoxicillin or clarithromycin results in eradication rates of about 85%. Triple therapy with bismuth, metronidazole, and amoxicillin or tetracycline is successful in about 90% of patients but the incidence of side effects is higher.