Proton Pump Inhibitors in H. pylori eradication ( Review )[Ruolo degli Inibitori di Pompa Protonica nell'eradicazione dell'infezione da Helicobacter pylori]

Helicobacter pylori (H. pylori) infection is the main etiological agent of inflammatory and neoplastic gastric disease. In the clinical setting we usually search for H. pylori infection in dyspeptic patients, patients with gastritis, first-degree relatives of gastric cancer patients, and during upper endoscopy. The therapeutic regimen currently available is characterized by two antibiotics (clarithromycin plus metronidazole or amoxicillin) and proton pump inhibitors (PPIs). PPIs are strong gastric acid secretion inhibitors which possess antibacterial activity. At present, there are 5 different PPIs on the market: omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. They share the same basic chemical structure, though they have different pharmacological properties. Rabeprazole shows a faster and stronger inhibition of gastric acid secretion, a more potent inhibitory effect on the proliferation and motility of H. pylori than other PPIs and a primarily non enzymatic metabolism. Therefore, it could be the most favourable drug to use in eradication regimens.