Are there geographical and regional differences in Helicobacter pylori eradication?

An important area of controversy in Helicobacter pylori eradication is the apparent difference in eradication rates seen in different countries and populations. A recent meta-analysis showed that several factors may affect the outcome of therapy. Individuals residing in northeast Asia had higher eradication rates than those residing in Europe or other areas of Asia. Triple and quadruple drug therapies had significantly higher eradication rates than did dual drug therapies. Treatment regimens that lasted longer than 14 days were better than those that lasted less than seven days, but there was no significant advantage for 10 day therapy over seven day therapy. A number of factors may play a role in determining the regional and geographical differences in H pylori eradication therapy. Included in these factors are genetic differences in the metabolism of the proton pump inhibitor, which can alter the availability of antimicrobials in the stomach. Regional differences in antimicrobial resistance also affect the outcome of therapy. Some studies suggest that the degree of gastritis and the nature of the underlying disease may affect the outcome of therapy, but the data are controversial. Understanding the regional and geographical differences in H pylori eradication can help physicians select the optimal treatment regimen in different regions.