The discovery of the etiologic role of Helicobacter pylori in multiple gastroduodenal diseases has revolutionized the management of peptic ulcer disease. Cure of this infection markedly reduces peptic ulcer recurrence, decreases complications, and leads to resolution of histologic gastritis and gastric lymphoid follicles. Five combination therapies have been approved by the US Food and Drug Administration with good cure rates. Antimicrobial therapy for H. pylori infection remains an evolving area because of the search for simpler, more effective treatment regimens. The role of H. pylori in dyspepsia is uncertain; routine treatment of these patients remains a controversial area. Antimicrobial resistance is a major concern because of the high prevalence of metronidazole resistance in H. pylori isolates. Standardization of H. pylori antimicrobial susceptibility testing and surveillance of H. pylori antimicrobial resistance in the United States are in progress.
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