Treatment of Helicobacter pylori in Korea: Past, present and future

Standard triple therapy consisting of a proton pump inhibitor, clarithromycin, and amoxicillin has been the most recommended and used first-line therapy for the eradication of H. pylori in many countries, including Korea. However, the efficacy of this triple therapy has decreased over the past decade. Attempts to overcome eradication failure have been made in Korea. Sequential therapy, quadruple therapy and various combinations of new and old antibiotics have been introduced.
We will introduce an overview on the trends of H. pylori eradication and new therapeutic strategies in Korea through the systematic review. The Cochrane Library, the PubMed, Medline, EMBASE database and Korean Medical Database (Koreamed, KISS, KMBASE) were searched. Epidemiological, observational and interventional reports studied in Korea from 2001 to March 2013 were reviewed.
Eighteen RCTs were eligible for systematic review. The results of the meta-analysis for six studies concerning sequential therapy suggest that sequential therapy is superior to 7-day standard triple therapy in terms of eradication rates. In the sub-analysis, however, there were no significant differences between sequential therapy and standard triple therapy with prolonged treatment duration. Bismuth based quadruple therapy is still effective second line treatment. There were not enough studies for levofloxacin-based therapy as new strategies. Levofloxacin-based therapy could not achieve enough eradication rate as the first-line treatment.
In addition, nationwide multi-center study by Korean College of Helicobacter and Upper Gastrointestinal Research will be presented. The retrospective nationwide study was conducted for adult subjects aged ≥20 years who were treated H .pylori infection in the twenty secondary or tertiary medical centers from January 2001 to December 2010. In this study, the eradication rates of clarithromycin-based triple therapy had been decreased tendency, where as those of bismuth-based quadruple therapy unchanged over the past 10 years in Korea, though these trends were different among the geographic areas.
Finally, we will introduce briefly "Interim analysis of online registry of current trend of H. pylori eradication in Korea for 5 years, from July 2010 to June 2015".

In conclusion, sequential therapy or bismuth based quadruple therapy may be promising alternative to standard triple therapy as a first-line treatment regimen for H. pylori eradication. However, 10-day standard triple therapy and 14-day standard triple therapy remain effective. In the future, well-designed randomized controlled studies should be conducted to choose proper treatment for H. pylori infection as the first-line treatment in Korea.