What is Helicobacter Pylori?

Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that lives in the stomach lining. It affects approximately half of the world's population, though most people never develop symptoms. However, when it does cause problems, H. pylori is responsible for:

• Gastritis (inflammation of the stomach lining)
• Peptic ulcers (stomach or duodenal ulcers)
• Gastric cancer (in a small percentage of chronic cases)
• MALT lymphoma (a rare type of stomach lymphoma)

The bacterium is usually acquired during childhood through person-to-person contact (saliva, feces) or contaminated food and water. Want to know more about transmission? Check out our article: I have Helicobacter pylori: can I infect my family?

Why is it Important to Treat H. Pylori?

Not everyone infected with H. pylori needs treatment. However, your doctor will recommend eradication therapy if:

1. You have active peptic ulcers (gastric or duodenal)
2. History of ulcers (to prevent recurrence)
3. MALT lymphoma (H. pylori-associated gastric lymphoma)
4. Chronic gastritis with atrophy or intestinal metaplasia (precancerous lesions)
5. Family history of gastric cancer
6. Planning long-term use of NSAIDs or aspirin (to reduce ulcer risk)
7. Persistent dyspepsia (chronic indigestion with confirmed H. pylori)

First-Line Treatment: Bismuth Quadruple Therapy

According to the ACG Clinical Guideline 2024 and the Maastricht VI/Florence Consensus, bismuth quadruple therapy is the preferred first-line treatment in most countries, including Spain and the United States.

Why is it the best option?

• • High efficacy: 90-95% cure rate
• • Less affected by antibiotic resistance: Unlike clarithromycin-based therapies, bismuth quadruple therapy maintains its effectiveness even in regions with high resistance
• • Recommended by major guidelines: ACG 2024, Maastricht VI/Florence, and Toronto Consensus

Pylera®: The Combined Capsule That Simplifies Treatment

Pylera® is a commercial medication that combines three of the four components of bismuth quadruple therapy in a single capsule:

• • Bismuth subcitrate potassium (140 mg)
• • Metronidazole (125 mg)
• • Tetracycline hydrochloride (125 mg)

Treatment Regimens with Pylera®

Advantages of Pylera®

• • Better adherence: Fewer pills to manage (3 capsules instead of 6-8 separate tablets)
• • Reduced errors: Lower risk of forgetting individual doses
• • High efficacy: Comparable to traditional bismuth quadruple therapy
• • Available in many countries: Increasingly accessible worldwide

Concomitant Therapy: Alternative in Select Cases

Concomitant therapy is an alternative treatment that combines four antibiotics simultaneously (hence "concomitant"). It's primarily recommended in regions with low clarithromycin resistance (<15%).

Probiotics: Do They Help in H. Pylori Treatment?

The use of probiotics as adjuvants in H. pylori eradication therapy has gained interest in recent years. However, their role remains controversial and is not yet officially recommended in major international guidelines.

Common Side Effects and How to Manage Them

H. pylori treatment can cause side effects in 30-50% of patients, though most are mild and resolve when treatment ends.

Post-Treatment Follow-up: How to Confirm Cure

Confirming eradication is essential to ensure the bacterium has been completely eliminated and prevent future complications.

Conclusions

H. pylori treatment has evolved significantly in recent years. Bismuth quadruple therapy (including Pylera®) is now the gold standard, achieving cure rates >90% when properly followed.

If you have any questions or need personalized guidance on H. pylori treatment, don't hesitate to contact me. As a specialist in digestive diseases at Hospital Universitario La Paz and INMEQ, I'm here to help.