H.pylory:pros&cons

This guideline is in overall agreement with the recently published Toronto Consensus for the treatment of H pylori infection in adults, which had a narrower focus and was restricted only to treatment options (215). Both guidelines attempt to restrict the use of clarithromycin triple therapy and strengthen the role of bismuth quadruple therapy and concomitant therapy. Both guidelines advocate for a longer duration of treatment (14 days for almost all regimens in the Toronto Consensus; 10–14 for almost all regimens in the ACG guideline). There are only a few differences between the two guidelines, occurring in areas with limited, low-quality evidence. The Toronto Consensus recommends against the use of sequential treatment (neither as a first-line therapy nor as a rescue treatment), while the ACG guideline conditionally recommends it as first-line therapy. Hybrid therapy and high-dose dual therapy are not officially endorsed by the Toronto Consensus, whereas the ACG guideline conditionally recommends them as first-line and rescue therapy respectively.

Given the rising rates of antimicrobial resistance and growing complexity of H. pylori therapy (216), a preventive or therapeutic vaccine remains an attractive long-term solution for managing this infection. Although progress has been slow, recent results from a large phase 3 trial conducted in China provide proof of principle for H. pylori vaccination (Zeng et al. (217)). In that report, an oral H. pylori vaccine based upon recombinant urease B provided about 70% protection against H. pylori acquisition in children. Although the efficacy of the vaccine started to wane after a year, this landmark study will likely prompt further efforts to develop a clinically useful and much needed alternative to antibiotic regimens for the prevention of H. pylori-associated diseases rather for than the treatment of established H. pylori infection.