H.pylori and PPIs

Question 1

H.pylori

Answer 1

Test and treat

Test: Treatment 13 C, SAT (stool antigen Test or blood test.
- Urea 13 C mostly used.
- 13 C have to be OFF PPI for 2 weeks and OFF antibiotics for 4 weeks
- 13 c RETEST after 4- 8 weeks of treatment.

Treat:
Triple therapy.
1st line - 1 PPI + 2 Antibiotics
2nd line - same as above but different antibiotics
3rd - SPECILAIST referral
(DRUGS ON PHONE PICS)

Question 2

H.pylori Treatment

Answer 2

PHONE PIC BETTER
Mnemonic for different 1st/2nd line regimens (non allergic to penicillin):
1st/ALT line - PAM or PAC
2nd line - PCM
ALT 2nd line - PAT or PAL
3rd line - PB + either 2 of CAMT or Rifabutin or Furazolidone.

Mnemonic regimens (ALLERGIC penicillin):
1st line - PCM
ALT 1st line IF already used clarithromycin recently - PBMT (4 drugs)
2nd line - PML

KEY:
P = PPI
A= Amoxicillin
C = Clarithromycin
M = Metronidazole
T = Tetracycline
L = Levofloxacin
B = Bismuth

NOTE: Bf any PPI is fine but for pregnancy omeprazole ONLY.

1st and 2nd line = 7 days treatment
3rd line = 10 days

• Bismuth can cause black faeces and black tongue.

Question 3

Proton Pump Inhibitors

Answer 3

Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole, Rabeprazole.

Gi Qs always expect 1 on PPIs.

Some Conditions they treat:
Gastric ulcers, Duodenal ulcers, H.pylori, Dyspepsia, GORD, NSAID ulcers, ZES.

GPHC EXAM Q:
Monitoring requirements:
PPI prolong use can cause hypomagnesaemia which can cause tetany (muscle cramps/spasms) and arrhythmias.

Low Magnesium/Potassium can cause digoxin toxicity.
- Low magnesium increase digoxin conc. so = digoxin toxicity which = arrhythmias, confusion, vision changes.

MHRA warning of PPI - LUPUS.
PPI CAUTIONs:
- Risk of fractures
- Risk of GI infections (C.diff - GI infection main symptom - watery diarrhoea - happens when antibiotics kill natural stomach bacteria causes imbalance.)
- Mask symptoms of gastric cancer
- Risk of osteoporosis

MNEUMONIC - GOLF MC(K) for PPI caution:
- GI infections
- Osteoporosis
- Lupus (autoimmune, looks like rash)
- Fractures
- Magnesium (Hypomagnesaemia)
- Cancer (mask symptoms)

Question 4

PPI MHRA advice

Answer 4

Low risk of LUPUS. subcutaneous lupus erythematous (ScLE)

• Lesions appear on the skin when exposed to the sun
• Consider stopping PPI
• Most cases resolve once stopped

Question 5

PPI Interactions

Answer 5

Only Omeprazole is safe during pregnancy.
- Can use PPI with breast feeding - small amount may come up in milk.

PPI Interactions
Clopidogrel - Omeprazole and esomeprazole - decrease efficacy of clopidogrel - AVOID together
- AVOID ClOE - mnemonic.
[Clopidogrel, Omep., esomep.]

Methotrexate: Omeprazole decreases clearance of methotrexate
(METHOTREXATE ALWAYS COMES IN EXAM LEARN EVERYTHING ON IT)
- Use with caution or AVOID.

Monitor magnesium with Digoxin.