H. pylori infection Flashcards
H pylori infection is one of the most common causes of…
peptic ulcer disease
Use of NSAIDs with co-existent H pylori infection
May have additive effect if there is co-existent H pylori infection, further increasing risk of peptic ulceration and bleeding
H pylori is also associated with
- acute and chronic gastritis
- gastric cancer
- gastric mucosa associated lymphoid tissue (MALT) lymphoma
Do you need to test before treating H pylori
- Yes, presence needs to be confirmed before starting eradication therapy
- Test and treat strategy
Who to test for for H pylori in line with PHE guidance
- Pt with uncomplicated dyspepsia and no alarm symptoms who are unresponsive to lifestyle changes and antacids, following a single 1 month treatment with a PPI
- pt considered to be at high risk of infection should be tested for infection first, or in parallel with course of PPI (NA ethnicity, older people, living in known high risk area)
- previously untested pt with history of peptic ulcers or bleeds
- prior to initiating NSAIDs in pt with a prior Hx of peptic ulcers or bleeds
- pt with unexplained iron deficiency anaemia after endoscopic investigation has excluded malignancy, and other causes have been investigated
3 tests recommended for diagnosis of gastro-duodenal infection with H pylori
- Urea (13C) breath test but no not perform this within 2 weeks of treatment with PPI or within 4 weeks of abx as this can lead to false negatives
- Stool Helicobacter Antigen Test (SAT), but do not perform this within 2 weeks of PPI or within 4 weeks of abx as this can lead to false negatives
- Lab based serology where performance can be locally validated
Are office based serological tests for H pylori recommended
No due to inadequate performance
When does PHE recommend to retest for H pylori?
- poor compliance or high local resistance rates
- persistent symptoms and initial test was performed within 2 weeks of treatment with PPI, or within 4 weeks of abx treatment
- in pt with associated peptic ulcer, MALT lymphoma, or after resection of an early gastric carcinoma
- pt taking aspirin without concomitant treatment with PPI
- pt with severe persistent or recurrent symptoms, esp if not typical of GORD
How many weeks after does retesting need to be performed
at least 4 weeks (ideally 8 weeks) after treatment
What to do if a pt needs to be retested but needs gastric acid suppression
use H2RA instead of PPI
which test is used for retesting
urea 13C breath test
Triple therapy regimen for H pylori eradication
2 abx and PPI for 7 days (sometimes 10 days, but this is 3rd line)
Choice of abx in H pylori eradication
- take into consideration pt abx treatment history - each additional course of clarity, metro or quinolone increases risk of resistance
What to do if pt remains positive after 2nd line eradication therapy
- consider referral to specialist
- PHE also advises to refer for endoscopy, culture and susceptibility testing if choice of abx treatment is reduced due to hypersensitivity, there are known high local resistance rates, or if pt have previously received treatment with clarith, metro or quinolone
What to do if diarrhoea develops
consider CDI and review need for treatment
