H. Pylori & Proton pump inhibitors

Question 1

What are the symptoms of H.Pylori?

Answer 1

Burning pain in tummy

Question 2

What tests are done to diagnose Pylori?

Answer 2

• Urea 13C breath test
• SAT
• Blood tests

Do not test within 4 weeks of antibiotic treatment and within 2 weeks of treatment with PPI.

Re-testing should be done 4 weeks after treatment (ideally 8 weeks) - the U13C breath test should be used for retesting.

Question 3

What is the usual treatment plan for H. Pylori?

Answer 3

Triple therapy for 7 days, involving 1 PPI & 2 Antibiotics.
For 1st and 2nd line.

3rd line is for 10 days treatment.

If no improvement, refer to specialist.

Question 4

What drugs are used for H. Pylori?

Answer 4

• PPI
• Clarithromycin
• Amoxicillin / Metronidazole

Backup:
- Tetracycline/Levofloxacin
- Bismuth subsalicylate (if pencillin allergy)

• Rifabutin or furazolidone

Treatment is:
PCM
PAM
PAC
PAT
PAL

Question 5

Which PPIs are used in H. Pylori eradication and what are the doses?

Answer 5

1. Omeprazole
   - 20-40mg BD
2. Rabeprazole
   - 20mg BD
3. Lansoprazole
   - 30mg BD
4. Esomeprazole
   - 20mg BD
5. Pantoprazole
   - 40mg BD

Question 6

What are examples of some test for H. Pylori?

Answer 6

• Pylobactell (soluble tabs)
• Helicobacter test

Question 7

What are the two treatment options for H-Pylori?

Answer 7

1. Allergic to penicillin (7 days)
   - PPI + clarithromycin + Metronidazole (1st line)

• PPI + Bismuth + Metronidazole + Tetracycline (PBMT) (alternative 1st line, previously treated with clarithro)
• PPI + Metronidazole + Levofloxacin (PML) (2nd line)

2. NOT allergic to penicillin (7 days)

• PPI + Amoxicillin + Metro/Clarithro (1st line)
• PPI + Amox + Tetra (2nd line)
• PPI + Bismuth + 2 antibiotics not previously used OR rifabutin or furazolidone

Question 8

What is used to treat functional dyspepsia?

Answer 8

• Lifestyle
• Antacids
• H. Pylori test/treatment
• H2 receptor antagonist

Question 9

What is used to treat univestigated dyspepsia?

Answer 9

• PPI (4 weeks)
• H. Pylori test/treatment
• H2 receptor antagonist

Question 10

What is used to treat GORD?

Answer 10

• Antacids
• Alginates
• H2 receptor antagonists
• Proton pump inhibitors (PPI)

Question 11

What are the indications for Proton pump inhibitor?

Answer 11

• Gastric ulcers
• Duodenal ulcers
• H. Pylori
• Dyspepsia
• GORD
• NSAID associated ulcers
• Zollinger-Ellison syndrome

Question 12

What is the monitoring requirement for proton pump inhibitors?

Answer 12

Measure serum-magnesium concentrations especially when used with other drugs that cause hypomagnesemia or with digoxin.

Question 13

What is the MHRA warning with PPIs?

Answer 13

Lupus

Question 14

What is the caution with PPIs?

Answer 14

• Risk of fractures
• Risk of G.I infections
• Mask symptoms of gastric cancer
• Risk of osteoporosis (take ca2+ & Vit D)
• Lupus
• Can cause hypomagnesemia