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Gastroenterology Research and Practice
Volume 2016, Article ID 9086581, 7 pages
Review Article

Optimal First-Line Treatment for Helicobacter pylori Infection: Recent Strategies

Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea

Received 11 August 2016; Revised 15 October 2016; Accepted 3 November 2016

Academic Editor: Vikram Kate

Copyright © 2016 Ju Yup Lee and Kyung Sik Park. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A new treatment strategy is needed, as the efficacy of triple therapy containing clarithromycin—the current standard treatment for Helicobacter pylori infection—is declining. Increasing antibiotic resistance of H. pylori is the most significant factor contributing to eradication failure. Thus, selecting the most appropriate regimen depending on resistance is optimal, but identifying resistance to specific antibiotics is clinically challenging. In a region suspected to have high clarithromycin resistance, bismuth quadruple therapy and so-called nonbismuth quadruple therapies (sequential, concomitant, and sequential-concomitant hybrid) are some first-line regimen options. However, more research is needed regarding appropriate second-line treatments after first-line treatment failure. Tailored therapy, which is based on antibiotic sensitivity testing, would be optimal but has several limitations for clinical use, and an alternative technique is required. A novel potassium-competitive acid blocker-based eradication regimen could be a valuable eradication option in the near future.