H. pylori (Hp) is closely related to various gastritis, peptic ulcer, gastric cancer and other diseases. hp gastritis is actually an infectious disease, regardless of the presence of symptoms and complications, can be transmitted through saliva between mothers to children, couples and other family members; currently the rate of Hp infection in China is as high as 50%. H. pylori infection I. Who needs to eradicate Hp? 1. Peptic ulcer, gastric MALT lymphoma, chronic gastritis with dyspepsia, chronic gastritis with atrophic erosion of gastric mucosa, family history of gastric cancer, early gastric cancer after endoscopic treatment or gastric subtotal resection and other gastric diseases. 2. Those who have confirmed HP infection, please see the following table for details: 2. What are the Hp eradication programs? 1. Hp eradication program Recommended program: Only “bismuth quadruple program” is recommended. The domestic Hp dual resistance rate to clarithromycin and metronidazole is >15%, and the triplet regimen and non-bismuth quadruplet therapy have been abandoned. 2. Bismuth quadruple therapy: PPI + bismuth + 2 kinds of antibacterial drugs; the course of treatment should be extended to 14d. The first combination, PPI (can choose any one): Esomeprazole 20mg, Rabeprazole 10-20mg, Omeprazole 20mg, Lansoprazole 30mg, Pantoprazole 40mg, Eprazole 5mg. 2 times/d, taken orally half an hour before meal. The second combination, bismuth (can choose any one): bismuth potassium citrate 220mg, colloidal bismuth 200mg. 2 times/d, taken orally half an hour before meal. Third and fourth combination, 2 antibacterial drugs (not optional): amoxicillin, tetracycline, furazolidone, clarithromycin, metronidazole, levofloxacin. Take orally with a meal. Oral after meal. 3. Initial treatment with antimicrobial drug combination regimens There are seven domestically recommended antimicrobial drug combination regimens (see table above), with eradication rates of 85-94%. The clinic should choose one of these regimens according to drug contraindications and history of antimicrobial drug application. 4. Remedial treatment After the initial treatment failure, remedial treatment can be chosen from one of the other regimens, and do not repeat the used regimen. Remedial treatment is recommended to interval of 2-3 months. Third, need to take probiotics at the same time? The regimen of Hp eradication treatment contains at least 2 antibacterial drugs. Not only eradicate Hp, but also may make changes to the gastrointestinal microbiota. Probiotics can reduce the adverse gastrointestinal reactions caused by Hp eradication therapy to some extent. If necessary, probiotics can be supplemented with Hp eradication treatment or after eradication treatment to reduce the adverse effects of antibacterial drugs on intestinal microecology. IV. Precautions for Hp eradication 1. Allergy history Ask about the history of drug allergy; use amoxicillin with caution if you have a history of allergic diseases such as asthma, hay fever, eczema and urticaria. 2.Individual differences Omeprazole is greatly affected by CYP2C19 genotype, rabeprazole is less affected; furazolidone can cause hemolytic anemia in G-6PD deficient individuals. 3, special account PPI, bismuth oral half an hour before meal, antibacterial drugs oral after meal; metronidazole, furazolidone during the use of drugs and 1 week after the discontinuation of drugs containing ethanol food and drugs are prohibited.