CPT2: GI 4 (Helicobater Pylori)

Question 1

What needs to be checked before choosing treatment for H.Pylori?

Answer 1

• Confirm H.Pylori positive
• Drug allergies e.g. penicilin
• Any recent AB use? - affects choice

Question 2

What is the first line treatment

What is the sucess rate?

Answer 2

7 day course of:

Proton pump inhibitor BD (e.g. omeprazole 20mg BD)

+

Amoxicillin 1g BD

+

Metronidazole 400mg BD/Clarithromycin 500mg BD

80% sucess rate

Question 3

What would be given as first line treatment if the patient has a peniciln allergy?

Answer 3

7 day course of:

Proton pump inhibitor BD (e.g. omeprazole 20mg BD)

+

Metronidazole 400mg BD

+

Clarithromycin 500mg BD

Question 4

What happens if the patient still has reccurent symptoms after first line erradication?

Answer 4

Alarm signs - weightloss, age over 55, blood in vommit etc

Regardless of symptoms, if a patient has had an endoscopy that has confirmed the presence of a gastric ulcer, then another endoscopy needs to be performed to determine if treatment is healing ulcer. Gastric more chance cancer than duodenum.

Question 5

What is the 2nd line treatmetent if 1st line has not worked? For both allergy and no allergy to penicillin?

Answer 5

Question 6

What is additional option for treatment if 1st and 2nd line don’t work?

How does it work?

What forms is there?

What are the probolems

Answer 6

Bismuth is added to some regimens – penicillin allergy and recent exposure to a quinolone antibiotic (ciprofloxacin/levofloxacin) – Quadruple therapy.

Bismuth is toxic to H.pylori, limits adhesion to gastric mucosa and aids in production of gastric mucous and bicarbonate.

• Tripotassium dicitratobismuthate (DeNol Tabs)
• Bismuth subsalicylate (Pepto Bismol)

•

DeNol Tabs are no longer available in UK – Import?

Pepto Bismol is unlicensed for H.pylori eradication

Question 7

Patient Cousnelling points

Answer 7

• Diarrhoea – 30-50% of patients, mild.
• Flushing and vomiting with alcohol (metronidazole) (avoid mouthwash as alcohol in too)
• Nausea & vomiting/Abdominal cramp
• Headache
• Rash (sign of allergy?) - See GP if rash. Also tell signs of reaction to penicilin (shortness of breath, swelling)
• Black tongue/faeces (bismuth)
• Importance of completing course! - Ways to remember to take all 3 tabs a day?