Short Communication
Volume 7 Issue 5
Waqar Ali*
April 29, 2026
Abstract
Helicobacter Pylori infection is very common worldwide. Almost half of the world’s population has been found to be infected. The highest prevalence is seen in developing regions like Africa, Latin America & Asia, where prevalence can reach to more than 80%, while much lower rates are seen in developed countries. The most likely source of spread is fecal-oral route, which explains its high prevalence in areas of low hygiene.
H. Pylori infection can have a wide spectrum of presentations, ranging from completely asymptomatic (being discovered incidentally, if tested), to gastritis, peptic ulcer disease and gastric malignancies. Almost 80% of infected people are actually asymptomatic. The most common cause of peptic ulcer disease, is H. Pylori infection. Two gastric malignancies are strongly linked to H. Pylori: gastric adenocarcinoma and gastric MALT lymphoma (Mucosa Associated Lymphoid Tissue lymphoma).
All symptomatic patients with H. Pylori (gastritis, peptic ulcer) should be treated. Opinion differs on approach towards asymptomatic people. One school of thought advocates H. Pylori treatment even for asymptomatic patients, in order to prevent against these malignancies, while another group advocates therapy, only if there is a family history of gastric malignancy.
Until recently, the standard preferred therapy for H. Pylori was a three drug regimen, so called TRIPLE THERAPY (one PPI plus two antibiotics) given for 10 days. However, as per the 2024 guidelines of the American College of Gastroenterology, a 4 drug regimen is strongly recommended while the triple therapy containing Clarithromycin is strongly discouraged. This is due to rapid development of resistance in H Pylori, specially against Clarithromycin, in many areas. It leads to eradication failure in most cases. Now, the first line regimen highly recommended by ACG is: PPI(bid), plus Bismuth tablets (4 times daily) plus Tetracycline(500mg four times daily) plus Metronidazole(500 mg tid), all for 2 weeks. Although difficult to comply with, but it achieves the highest eradication rates. ACG guidelines have other suggested regimens also, one being a dual drug therapy with VONOPRAZAN ( a stronger PPI) 20mg b.i.d plus AMOXICILLIN 1G tid.
Unfortunately, many physicians (mainly GPs and Primary care physicians) are not aware of the new guidelines. These physicians are at the forefront of treating patients, in that patients mostly come to them first. So, it is imperative that they be aware of new guidelines. In a recent research done by me and my team, majority of the physicians were using the old triple regimen (88% in govt sector, 55% in private sector) [1] This underscores the importance of continuous professional development and adoption of standardized treatment protocols in primary care practice.
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