Helicobacter pylori

Question 1

Helicobacter pylori:

Why is it important?

Answer 1

Associated with 80% of duodenal ulcerations and 60% of gastric ulcers

Question 2

Helicobacter pylori:

Pathophysiology?

Answer 2

Immune response created by bacteria results in a loss of somatostatin secreting cells and up-regulation of gastrin production resulting in increase acid secretion. Acid plus inflammation results in ulceration.

Question 3

Helicobacter pylori:

Testing in general practice?

Answer 3

Stool antigen - most reliable means

Serology

• low titre = past exposure
• high titre = current colonisation

Urea breath test (bacteria converts labelled urea into ammonia and carbon dioxide; exhaled carbon dioxide is measured) - high positive and negative predictive value, good for test of cure

Question 4

Helicobacter pylori:

Indication for testing?

Answer 4

• Dyspepsia
• Reflux
• NSAID user
• Patients requiring long term acid suppression therapy
• Family history of gastric cancer

Question 5

Helicobacter pylori:

Initial therapy?

Answer 5

PPI BD
Amoxicillin 1g BD
Clarithromycin 500mg BD
for 7 days

• if penicillin allergy then use Metronidazole 400mg BD instead of amoxicillin