Helicobacter pylori (H. pylori) infection is the main cause of gastritis, gastroduodenal
ulcer and gastric cancer. Evidence for the prevention of metachronous gastric
cancer has been established in Japan. The committee of the Japanese Society for
Helicobacter Research has revised the guidelines for diagnosis and treatment of H.
pylori infection in 2009. H. pylori eradication therapy achieved a grade A
recommendation, being useful for the treatment of gastric or duodenal ulcer, for the
treatment and prevention of H. pylori-associated diseases such as gastric cancer, and for
inhibiting the spread of H. pylori infection. According to Japanese guidelines, first-line
therapy for treating H. pylori infection consists of proton pump inhibitor (PPI) with
amoxicillin and clarithromycin given for 7 days. Even with the recommended regimens,
eradication failure is still seen in more than 20% of the patients. The recommended
second-line therapy is PPI with amoxicillin and metronidazole for 7 days. In case of
second-line treatment failure, a PPI + amoxicillin + fluoroquinolone or high-dose
PPI/amoxicillin therapy is recommended in Japan.
Keywords: Helicobacter pylori, eradication, Japan
