H.PYLORI

Question 1

H pylori infection is one of the most common causes oF

Answer 1

Peptic ulcer disease

Question 2

Use of NSAIDs with co-existent H pylori infection

Answer 2

May have additive effect if there is co-existent H pylori infection, further increasing risk of peptic ulceration and bleeding

Question 3

H pylori is also associated with

Answer 3

acute and chronic gastritis
gastric cancer
gastric mucosa associated lymphoid tissue (MALT) lymphoma

Question 4

Diagnosis of H.Pylori

Answer 4

• Diagnosed by Urea (13C) Breath Test
• Stool Helicobacter Antigen Test (SAT),
• Lab based serology where performance can be locally validated

Question 5

When should the breath test and SAT test not be performed

Answer 5

within 2 weeks of taking PPls
within 4 weeks of taking antibiotic

can lead to false negatives

Question 6

When does PHE recommend to retest for H pylori?

Answer 6

• 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

Question 7

How many weeks after does retesting need to be performed

Answer 7

at least 4 weeks (ideally 8 weeks) after treatment

Question 8

Treatment

Answer 8

Triple Therapy: PPI + 2 antibitotics (amoxicillin + either clari or met)

1. PPI - omeprazole, esomeprazole +
2. Two of the following three antibiotics:
Amoxicillin (1000mg BD) OR Metronidazole (400mg BD) OR Clarithromycin (500mg BD)

for second line use amoxicillin + which ever abx was not used in first line

Question 9

oral alternative 2nd line for 7 days for pt who have received previous treatment with clarith and metro

Answer 9

PPI BD
+ amox 1g BD
+ tetracycline (unlicensed) or levofloxacin (unlicensed) if tetracycline can’t be used

Question 10

oral 1st line in penicillin allergic pt, 7 days

Answer 10

PPI BD
+ clarith 500mg BD
+ metro 400mg BD

Question 11

oral 1st line in penicillin allergic pt who have previously been treated with clarith - quadruple therapy regimen

Answer 11

PPI BD
+ metro 400mg BD
+ bismuth salicylate 525 QDS
+ tetracycline 500mg QDS

10 days

Question 12

what are the PPI doses recommended for H pylori eradication therapy

Answer 12

lansop 30mg BD
omeprazole 20-40mg BD
esomeprazole 20mg BD
pantoprazole 40mg BD
rabeprazole 20mg BD

Question 13

Omeprazole and clopidogrel

Answer 13

• NOTE: interaction between omeprazole and clopidogrel. instead prescribe lansoprazole