HELICOBACTER PYLORI GUIAS 2024

The medicine we used just a few years ago is outdated. Today, we face a critical increase in resistance to clarithromycin (31.5%) and levofloxacin (almost 38%) in North America. Therefore, the empirical use of the classic blind "triple therapy" is no longer ethical or acceptable in daily clinical practice, as success rates plummet to less than 30% in resistant strains. In this talk, we address, from doctor to doctor, the new pillars of treatment based on the latest evidence: The New Empirical Gold Standard: We explore why Bismuth Quadruple Therapy (BQT), strictly optimized for 14 days (using tetracycline and full doses of metronidazole), is our best initial weapon. Therapeutic Innovation: The triumphant arrival of triple therapy with Rifabutin and the new era of acid suppression using potassium-competitive acid blockers (PCABs, such as Vonoprazan) for highly effective dual regimens. Refractory Management and Salvage Therapy: What to do when first-line therapies fail. We explain the clinical golden rule: NEVER repeat a regimen that has already failed (with one very specific exception). The Eradication Test is MANDATORY: We explain why we cannot rely on symptom relief and why absolutely every patient requires confirmation of eradication 4 weeks post-treatment (with a breath test or stool antigen test), remembering to discontinue proton pump inhibitors (PPIs) at least 2 weeks prior. - Precision Medicine and Antibiotic Susceptibility: When is the ideal time to order molecular tests (PCR and NGS sequencing) in patients who have undergone multiple treatments or are allergic to penicillin? Colleagues, treating H. pylori is not just about relieving dyspepsia; if we successfully eradicate the bacteria, we achieve a Number Needed to Treat (NNT) of 4.5 for symptom improvement and reduce the risk of developing gastric adenocarcinoma by up to 76%. We are literally practicing preventive oncology in the doctor's office! Target audience: General practitioners, internists, gastroenterologists, and residents seeking to update their clinical prescribing protocols. BIBLIOGRAPHY. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection (2024) https://journals.lww.com/ajg/fulltext...