DÄ internationalArchive27/2010Targeted Second-Line Treatment
LNSLNS

In their review article, specifically in the section on gastric diseases, Lübbers et al state that follow-up endoscopy is mandatory in patients having suffered from gastric ulcer or a complicated duodenal ulcer, and that treatment should be monitored with a combination of urease test and histological evidence, using special staining techniques where necessary. We would like to add that according to the S3 guidelines cited by the authors (1, 2), a Helicobacter pylori culture with an antibiotic susceptibility test should be requested immediately in case of first-line treatment failure (which would be the case if the urease test yielded a positive result) in order to enable a targeted second-line treatment. This is the only way to reduce the likelihood of development of antibiotic resistance and repeated therapeutic failure.

DOI: 10.3238/arztebl.2010.0492a

Dr. med. Jonathan Jantsch

Prof. Dr. med. Christian Bogdan

Mikrobiologisches Institut –

Klinische Mikrobiologie, Immunologie und Hygiene

Universitätsklinikum Erlangen

Wasserturmstr. 3/5

91054 Erlangen, Germany

jonathan.jantsch@uk-erlangen.de

1.
Fischbach W, Malfertheiner P, Hoffmann JC, Bolten W, Kist M, Koletzko S: Helicobacter pylori and gastroduodenal ulcer disease [Klinische Leitlinie „Helicobacter pylori und gastroduodenale Ulkuskrankheit“]. Dtsch Arztebl Int 2009; 106: 801–8. VOLLTEXT
2.
Fischbach W, Malfertheiner P, Hoffmann JC, et al.: S3-guideline „helicobacter pylori and gastroduodenal ulcer disease“ of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e.V., German society for rheumatology, AWMF-registration-no. 021 / 001. Z Gastroenterol 2009; 47: 1230–63. MEDLINE
3.
Lübbers H, Mahlke R, Lankisch PG, Stolte M: Follow-up endoscopy in gastroenterology: When is it helpful? [Kontrollendoskopie in der Gastroenterologie: Sinnvoll oder Ballast?]. Dtsch Arztebl Int 2010; 107(3): 30–6 VOLLTEXT
1. Fischbach W, Malfertheiner P, Hoffmann JC, Bolten W, Kist M, Koletzko S: Helicobacter pylori and gastroduodenal ulcer disease [Klinische Leitlinie „Helicobacter pylori und gastroduodenale Ulkuskrankheit“]. Dtsch Arztebl Int 2009; 106: 801–8. VOLLTEXT
2. Fischbach W, Malfertheiner P, Hoffmann JC, et al.: S3-guideline „helicobacter pylori and gastroduodenal ulcer disease“ of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e.V., German society for rheumatology, AWMF-registration-no. 021 / 001. Z Gastroenterol 2009; 47: 1230–63. MEDLINE
3.Lübbers H, Mahlke R, Lankisch PG, Stolte M: Follow-up endoscopy in gastroenterology: When is it helpful? [Kontrollendoskopie in der Gastroenterologie: Sinnvoll oder Ballast?]. Dtsch Arztebl Int 2010; 107(3): 30–6 VOLLTEXT