H.PYLORI 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
Diagnosis of H.Pylori
- Diagnosed by Urea (13C) Breath Test
- Stool Helicobacter Antigen Test (SAT),
- Lab based serology where performance can be locally validated
When should the breath test and SAT test not be performed
within 2 weeks of taking PPls
within 4 weeks of taking antibiotic
can lead to false negatives
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
Treatment
Triple Therapy: PPI + 2 antibitotics (amoxicillin + either clari or met)
- PPI - omeprazole, esomeprazole +
- 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
oral alternative 2nd line for 7 days for pt who have received previous treatment with clarith and metro
PPI BD
+ amox 1g BD
+ tetracycline (unlicensed) or levofloxacin (unlicensed) if tetracycline can’t be used
oral 1st line in penicillin allergic pt, 7 days
PPI BD
+ clarith 500mg BD
+ metro 400mg BD
oral 1st line in penicillin allergic pt who have previously been treated with clarith - quadruple therapy regimen
PPI BD
+ metro 400mg BD
+ bismuth salicylate 525 QDS
+ tetracycline 500mg QDS
10 days
what are the PPI doses recommended for H pylori eradication therapy
lansop 30mg BD
omeprazole 20-40mg BD
esomeprazole 20mg BD
pantoprazole 40mg BD
rabeprazole 20mg BD
Omeprazole and clopidogrel
- NOTE: interaction between omeprazole and clopidogrel. instead prescribe lansoprazole
