Treatment Goals

Success is defined by confirmed H. pylori eradication, verified by urea breath test at least six weeks after completing therapy, together with regression of macroscopic gastric lesions at control endoscopy and histological regression of lymphocytic infiltration of the gastric mucosa.

First-Line Approach (overview)

H. pylori eradication therapy is the universal first step, applied in all cases. The specific antibiotic regimen is determined by clarithromycin susceptibility and whether antimicrobial susceptibility testing is feasible — the complete protocol details each pathway and its conditions.

Full regimen, sequencing, and all clinical decision points are available in the structured protocol below.

References

DOI: 10.3390/cancers15153811

The first line of treatment in all cases, independently of H. pylori status and of the disease stage, is an H. pylori eradication therapy.
In particular, the detection of clarithromycin resistance by RT-PCR must be encouraged since, in case of a strain susceptible to clarithromycin, an optimized triple therapy (amoxicillin 3 × 1 g + clarithromycin 2 × 500 mg + esomeprazole 3 × 40 mg/day for 14 days) may be proposed.
If antimicrobial susceptibility testing is not feasible, or the bacterial strain is resistant to clarithromycin, the first-line empirical treatment by Pylera® should be proposed.
The optimal duration of treatment is now established at 14 days, with the exception of Pylera® (association of bismuth subcitrate + metronidazole + tetracycline), which is administered together with omeprazole for 10 days.
The efficacy of the eradication treatment must always be verified, the best by the urea breath test performed at least 6 weeks after cessation of treatment.
The response to treatment is evaluated endoscopically by showing a regression of macroscopic lesions (i.e., ulcers), if present initially, at control endoscopy, and histologically, showing a histological regression of lymphocytic infiltration of gastric mucosa, the best evaluated according to the GELA classification.

View source ↗

What Is the Treatment of MALT Lymphoma of the Stomach? First-Line Protocol

References