Helicobacter pylori infection

Question 1

What is H. pylori

Answer 1

Gram negative aerobic bacteria that lives in stomach causing epithelial damage in the stomach lining resulting in gastritis, ulcers and increased risk of stomach cancer

Question 2

H. pylori pathophysiology

Answer 2

Avoids acidic environment by forcing its way into gastric mucosa (chemotaxis) - exposes underlying epithelial cells to acid
Fix to gastric epithelia via adhesions to resist peristalsis - mainly located in antrum of stomach
Produce ammonia to neutralise stomach acid - directly damages epithelial cells

Question 3

H. pylori presentation

Answer 3

Majority asymptomatic
Dyspepsia
Stomach pain
Burning throat/acidic taste

Question 4

H. Pylori investigations

Answer 4

Offer to anyone with dyspepsia
2 weeks without PPI before testing

Urea breath test using carbon 13
Stool antigen test
Rapid urease test - CLO test (performed during endoscopy and involves taking biopsy)

Question 5

H. Pylori treatment

Answer 5

Triple therapy for 7 days:
PPI e.g. omeprazole
2 ABX - amoxicillin and clarithromycin

Can use urea breath test to test for eradication after treatment