Treatment after failure: the problem of "non-responders"

Abstract

It has been over 12 years since the first randomised, placebo controlled clinical trial for the eradication of H pylori infection was published.1 Treatment to eradicate the infection has evolved from single agents to multiple combination treatments consisting of an antisecretory agent and one or more antibiotics.2 3 Treatments that achieve an eradication rate of greater than 80%, on an intent to treat basis, have been recommended by most consensus conferences and authorities.4-7 These now include bismuth based triple therapy, triple therapy involving a PPI and two antibiotics, quadruple therapy, or more recently combinations with RBC and two antibiotics. Although these combination treatments are very effective for eradicating H pylori infection in most patients, a significant proportion of patients fail these treatments for a variety of different reasons such as bacterial resistance, poor compliance, or treatment related factors.8 9 Retreatment of these non-responders remains a challenging issue as some patients may need more than two attempts for eradication of the infection. This paper reviews the current literature on the possible causes forH pylori treatment failure, discusses several approaches to retreatment, and gives suggestions for future studies.