Helicobacter pylori in Israel: Epidemiology, Pathophysiology, Diagnosis, Management and Resistance to Therapy

In Israel, there is a 60% prevalence of H. pylori infection in the adult population. The annual incidence of gastric cancer is approximately 15 per 100,000 population. The male/female ratio for a positive 13C urea breath test (UBT) in diagnosing H. pylori infection is 1:1.77. Women have significantly higher UBT results than men. H. pylori infection is associated with a more severe inflammatory reaction, decreased gastric acid secretion and increased mucin secretion in relatives of patients with gastric cancer. Primary resistance to clarithromycin and metronidazole has been reported as 8.2% and 38.2%, respectively. Secondary resistance of clinical isolates from previously treated adults to clarithromycin, metronidazole, and levofloxacin is 65.7%, 57.1%, and 18.6%, respectively. Resistance to both clarithromycin and metronidazole is 32.8%, and to clarithromycin, metronidazole, and levofloxacin, 12.8%. All isolates are sensitive both to amoxicillin and tetracycline. In untreated children, the rate of resistance to metronidazole is 19%, and to clarithromycin, 25%. Corresponding rates among the isolates from children previously treated for H. pylori are 52% and 42%. No resistance is found to amoxicillin, tetracycline or levofloxacin in either group. Sequential regimen, used as primary therapy, attained significantly higher eradication rates than the standard triple therapy. The addition of cranberry to triple therapy improves the rate of H. pylori eradication in females. Susceptibility-guided retreatment is associated with better eradication rates than empiric treatment. The annual recurrence rate of H. pylori after successful eradication in Israel is 0.37% to 0.55%.

Keywords: Helicobacter, Israel, recurrence, recrudescence, reinfection, developed countries, developing countries, clarithromycin, metronidazole, amoxicillin, tetracycline, sequential therapy, concomitant therapy, urea breath test, rapid urease test, stool antigen test, gastroscopy, gastric cancer, peptic ulcer, maltoma.