has been associated with the colonization of gastro duodenal mucosa of humans from millions of years. The central burden of the disease is in the developing countries, due to overcrowding and poor hygiene. Wherever it is found, if left untreated, it leads to a number of consequences from minor to sinister diseases over time (these include including extra-gastric diseases like cerebrovascular, cardiovascular, idiopathic thrombocytopenia, sideroblastic anemia, mental diseases, and collagen vascular diseases).
The major challenges that remain are prevention of H. pylori-related diseases by effective treatment and screening procedures and development of a vaccine. It is also becoming increasingly difficult to eradicate and the main reason for this is growing primary antibiotic resistance rates in a world where antibiotics are frequently prescribed and readily available. Clinicians today must be prepared to face multiple treatment failures, and should be equipped to decide the appropriate salvage therapy when antibiotic resistance occurs. Established empiric second line treatment options include both bismuth based quadruple therapy and levofloxacin based triple therapy. Antibiotic testing is recommended prior to initiating third line treatment.
The prevention of cancer of the stomach, a worst sequel of H. pylori continues to be a significant challenge despite population screening and prevention underway in many countries. In contrast, the beneficial effects of H. pylori with respect to allergic diseases and obesity are now clear. Moreover, the problem of drug resistance for eradication of H. pylori has arisen for which novel treatments are being tried. Lactobacillus reuteri having anti H. pylori action is emerging as one of the promising treatment.
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