H pylori

Question 1

Pathogenesis of H pylori

Answer 1

1. Causes:
   ●Peptic, duodenal ulcers
   ●Grp 1 Carcinogen
   ●Related to low grade MALT lymphoma
   ●Iron deficiency anaemia refractory to iron supplementation
2. Urease enzyme +
   Urea … Ammonia… basic (neutalised acid)
3. Vac A, Cag A, adhesins - attach to epithelium …
   Inflammation, apoptosis`

Question 2

Tests for H pylori

Answer 2

1. Serology - Antibody (if positive, Hp maybe +ve, If negative, Hp IS negative)
2. *BEST - Urea Breath test
3. Stool - antigen - children
   4.Endoscopic biopsy… add to strips to check colour
   Yellow - neg for H pylori
   Red - positive for H pylori

Question 3

Pt on antibiotics/bismuth and PPIs. What is essential before performing urea breath test

Answer 3

1. Stop antibiotics/bismuth 4wks before test
2. Stop PPI 1wk before test

Question 4

Test for children where UBT cannot be performed?

Answer 4

Stool antigen test

Question 5

Rx of H pylori

Answer 5

1. PPI + Clarithromycin + Amoxicillin x7days (2 antibiotics required)
   (OR)
2. PPI + Clarithromycin + metronidazole x7days
3. PPI + Bismuth subcitrate + Tetracycline + Metronidazole x14days
4. PPI + Amoxicillin x5days
   AND PPI + Clarithromycin + Tinidazole x5days

Bismuth subcitrate darkens tongue, stool

Question 6

In which cases do you test for H pylori post Rx

Answer 6

1. Dyspepsia still present post rx
2. MALT lymphoma
3. Gastric CA resection h/o
4. Ulcers+