Experiences with Helicobacter Pylori Treatment in Iran

Helicobacter pylori (H. Pylori) infection is currently recognized as the major cause of chronic active gastritis, peptic ulcer disease and mucosa associated lymphoid tissue (MALT) lymphoma and carcinoma of the stomach. Eradication of the infection will prevent the recurrence of the majority of such diseases. Different combined treatments have been tried in Iran for eradication of H. Pylori, but the optimal eradication needs further evaluation. Herein, we have reviewed the eradication regimens of H. Pylori used by Iranian scientists during a 16 year period from 1990 to 2006, regarding the number, the type of drugs used, the duration, eradication rate, and their side effects. From 26 articles retrieved, 22 drug regimens were evaluated. Triple drug therapy was favored in our country, as it consisted of 63% of the regimens. But it could not achieve an optimal eradication rate. Of eight quadruple drug regimens, two led to an optimal eradication rate, with the highest eradication rate being 92% based on furazolidone quadruple regimen. But this regimen had significant side effects in more than 62% of the patients. The best first line treatment regimen for eradication of H. Pylori in Iran seems to be a type of furazolidone or clarithromycin based quadruple therapy for a minimum duration of two weeks. However, the patients should be monitored for furazolidone side effects. Furthermore, in metronidazole based quadruple therapy drug resistance is a major problem, even with doses of more than 1 gm/day. In patients with treatment failure, medication should be adjusted according to antibiotic sensitivity and newer antibiotic therapies, which is designed as clinical trials.