Helicobacter pylori in Japan: Epidemiology, Diagnosis and Treatment

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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.