Development and Current State of Helicobacter pylori Research in Hungary

The discovery of H. pylori led to a paradigm shift in the Hungarian medical community about the pathogenesis and treatment of peptic ulcer disease. H. pylori is the most prevalent infection also in our country. Epidemiologic studies revealed an overall prevalence of 52-63% of the infection in healthy blood donors with an age-dependent increase and no geographic differences. Endoscopic studies found a 83-92% prevalence in duodenal and 63- 92% in gastric ulcer patients. All known diagnostic methods are available in Hungary: serology and endoscopic biopsy + histology are mainly used in practice, urea breath tests are reserved for eradication control. The test-and treat, search-and-treat and scope-and treat strategies are not, however, used systematically and their cost-benefit ratio has not been determined. Antimicrobial resistance testing encounters the same difficulties as in Western countries, while fluorescence in situ hybridisation and polymerase chain reaction-based methods are used in research centres. The first consensus meeting of the Helicobacter pylori Working Group of the Hungarian Society of Gastroentrerology was held in 2000 and the results updated in 2002, following the Maastricht I provisions. A meta-analysis of the Hungarian studies showed that between 1992-2002, the proton pump inhibitor- based triple therapies achieved an overall eradication rate of 82.9% (71.3-93.7%) on an intention-to-treat basis, and are the most extensively used regimens. The efficiency of second- and third-line therapies is, unfortunately, unacceptably low. Several groups of researchers participated in randomised controlled trials which were later incorporated in international guidelines. Resistance to chlarithromycin was low in the 1990’s, then increased to 18% between 2005- 2009 in Budapest, came it at 10% in towns around the country and remained low in rural areas. Basic research on H. pylori has been developed in university centres from Budapest, Pécs and Szeged and published in major journals of gastroenterology.

Keywords: Helicobacter pylori, epidemiology, eradication therapy, chlarithromycin resistance, extraintestinal manifestations.