Guideline 68: Dyspepsia

Dyspepsia
Annex 1

SIGN guideline number 7 produced in 1997 and the update to this published in 1999 each contained a table detailing the evidence for H. pylori eradication in duodenal ulcer, gastric ulcer and gastric lymphoma.^{1,
2} This evidence has been updated by the dyspepsia guideline development group (see below).

1.1 Which patients with H. pylori should receive eradication therapy?

	Eradicate?	Grade of Recommendation	Level of evidence
Duodenal ulcer¹¹¹	YES	A	1+
Gastric ulcer¹¹¹	YES	A	1+
Low grade gastric malt lymphoma^{112, 113}	YES	B	2+

1.2 H. pylori eradication options

The evidence base for H. pylori eradication options has also improved since the previous SIGN guidelines were published. An update of the numbers of medicines to use, the duration of treatment and the influence of known antimicrobial resistance are given below.

Dual therapies eradicate H. pylori from fewer people than triple therapies¹¹⁴

Triple therapies including PPIs and two antibiotics give consistently high eradication rates
Metronidazole or clarithyromycin resistance established by laboratory testing is associated with reduced eradication of H. pylori by regimens including these antibiotics
Two weeks of triple therapy versus a one week regimen does not increase the eradication rate.