Is compliance a problem in patients receiving the recommended Helicobacter pylori eradication regimens?
Paul Moayyedi: It is a great question. I do not have a clear answer for you because up until recently we just recommended proton pump inhibitor (PPI) triple therapy, which was easier and shorter.
Certainly the trials would suggest these have much higher eradication rates, but how that translates into clinical practice is less clear. Of course there are observational studies that are reassuring, but again, they are usually from centers with an interest in H pylori, which may not translate to the general community setting, where complex regimens—particularly in the case of metronidazole you are not allowed to drink alcohol as well. That can be an issue with some of my patients.
There certainly could be an issue with compliance and it may not be as great as we think, but this is the point about evidence-based medicine: You go on the best evidence you have, but you should check. Almost like postmarketing surveillance, just look and make sure that what seems to work in studies seems to work in clinical practice. As all of these guidelines are new, we do not have that data yet. It is certainly an important point to be concerned about, and we need to keep an eye on what our eradication rates are.