Enfermedades relacionadas con H. pylori: dispepsia, úlcera y cáncer gástrico

The present article summarizes the main conclusions drawn from the communications presented in Digestive Diseases Week 2006 related to Helicobacter pylori infection. The most cost-effective approach in uninvestigated dyspepsia is «test and treat». Although the prevalence of H. pylori in duodenal ulcer is very high in Spain, it is considerably lower in other countries. Hyperplasic gastric polyps can disappear after H. pylori eradication. Endoscopic follow-up of patients undergoing gastrectomy due to peptic ulcer does not seem justified. The prevalence of H. pylori in patients with low-grade gastric MALT lymphoma is nearly 90%. H. pylori eradication in stage EI achieves complete tumoral regression in 80% of patients with good medium- to long-term outcomes. The monoclonal antigen stool test is reliable in the detection of H. pylori and is more sensitive than the polyclonal method. It is still too early to recommend the rapid antigen stool test to confirm eradication. Magnification endoscopy and confocal microscopy are two promising techniques for the diagnosis of H. pylori infection and of associated histological lesions. In patients with gastrointestinal hemorrhage, methods based on gastric biopsy show poor sensitivity (although high specificity) in detecting the infection; the 13C-urea breath test is highly accurate, while the antigen stool test is less so. H. pylori eradication eliminates almost all hemorrhagic recurrences due to peptic ulcer, making maintenance therapy with antisecretory agents unnecessary. Rescue therapy with levofloxacin seems safer and more effective than the usually recommended quadruple therapy. Third line treatment with levofloxacin is also a promising alternative. At least in our environment, recurrence of infection after eradication is infrequent and occurs mainly during the first year.