Treatment strategy for H pylori infected patients:-

Triple therapy consisted of a standard dose of a proton pump inhibitor 40 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for one week.

 10‐day sequential therapy consisted of esomeprazole 40 mg plus amoxicillin 1000 mg twice a day for 5 days followed by esomeprazole 40 mg, clarithromycin 500 mg and metronidazole 500 mg twice a day for the next 5 days.

 2 week quadruple regimen after failure of first eradiation :-

Eradication of H. pylori was evaluated by C‐urea breath test at 4 weeks after the eradication therapy was completed.  

  Bismuth containing   (esomeprazole 40 mg BD., tripotassium dicitrate bismuthate [Denol] 300 mg QID., metronidazole 500 mg TDS  and tetracycline 500 mg QID.) or a 14‐day of moxifloxacin containing triple regimen (moxifloxacin   400 mg q.d., esomeprazole 40 mg BD., and amoxicillin 1 g BD.)

Kim et al , 2017.said that with H. pylori infection, the gastric mucosa progresses through   stages of chronic gastritis, atrophic gastritis, and Intestinal metaplasia. These are risk factors for Gastric cancer.

As H. pylori infection is the most important cause of both, regression of atrophic gastritis, and Intestinal metaplasia is important to avoid intestinal‐type Gastric cancer.  

H. pylori eradication  decrease the incidense of intestinal‐type Gastric cancer by decrease atrophic gastritis, and Intestinal metaplasia. However, conflicting results have been presented concerning whether AG and IM are improved by H. pylori eradication.

H. pylori eradication improved AG and IM, n some studies. However, such result is not found in other studies. 

Sometimes mucosal damage of IM stage cannot improve to normal gastric mucosa due to “histological point of no return at these studies. So early and prompt eradication is warranted.

Reference:-

Kim N  , LEE H, PARK S,Yoon H 2017. Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication ‐ a prospective study for up to 10 years . Alimentary pharmacology and therapeutics. 29 November,  2017