Defeating Helicobacter pylori: Mission impossible?

H. pylori is considered the main cause of gastric cancer. If we eradicate it, other stomach-related diseases may become rarer. Are we close to achieving this?

Important facts about Helicobacter pylori therapy

Adherance to antibiotic stewardship recommendations

Eradication of H. pylori in infected individuals significantly reduces the risk of gastric cancer. Therefore, H. pylori infections should also be treated after diagnosis according to the current recommendations (Maastricht VI/Florence consensus report).

In most cases, modern H. pylori therapy is still empirical, i.e. a predefined response to the diagnosis. However, it is better to test the antibiotic sensitivity of the pathogen before starting therapy. This is because antibiotic resistance is increasing worldwide in many bacterial pathogens, and H.pylori is not exempt from this.

Furthermore, a sensitivity-based use of antibiotics for H. pylori not only fulfils the requirements of antibiotic stewardship, but may also better protect other gut microbiota. This prevents resistance genes from accumulating (the so-called resistome). Prof. em. Francis Mégraud, secretary of the EHMSG (European Helicobacter and Microbiota Study Group), addressed whether there could be a vaccine in the near future in conversation at the UEG Week 2022: 

"There is a lot of work being done on this, but it has not yet entered clinical practice and I don't think that will happen anytime soon."

The fight against H. pylori recently suffered a setback as a result of the COVID-19 pandemic. Lockdowns and contact restrictions as well as the fear of many patients influenced the management of H. pylori infections. For example, gastroscopy rates fell, which significantly increased the time it took to diagnose gastric cancers.

Should infected children also receive H. pylori therapy?

Against the background of treating the infection with H. pylori as early as possible, the question of whether children with H. pylori infection should also be treated in the same way as adults > 18 years of age or not is of particular interest.

The clear answer from the experts: Yes, but this should only be considered if there has been a detailed informational discussion with the parents beforehand. In the case of children, it is particularly important to carefully weigh up the therapeutic successes (e.g. prevention of gastric complications up to and including gastric carcinoma) and the long-term consequences of an untreated infection with H. pylori.

Therapy risks for children are primarily the effects of antibiotics on the intestinal microbiome. Likewise, reinfections are much more likely in some countries of the world. Also of particular interest is the loss of the potential "protective effect" of H. pylori infection against immune disorders and allergies. However, the latter is currently the subject of further controversial discussion.

UEG Week, 8–11 October 2022, Vienna