Helicobacter Pylori (H. pylori) Infection - Diagnosis and Management - GrepMed Handbook
Presentation: Dyspepsia / Peptic Ulcer Disease
Epidemiology: Unusual in children, up to 50% of adults +serology in developed countries
Microbiology:
• spiral shaped, microaerophilic, gram negative bacterium
• Urease (hydrolyze urea to create neutralizing NH4+), shape and flagella allow adaptation to gastric mucosa
• Transmission unknown (presumed fecal-oral or oral-oral)
Diagnosis:
• Endoscopic Biopsy (definitive)
• Stool Ag, Urea Breath Testing (UBT) - ↑ false ⊖ on antacids, hold 2w before testing if possible
• Serology (IgG) - cannot differentiate past infection
Management:
• 1st Line - Quadruple Therapy (14d)
- PPI bid, Bismuth 300mg qid, Tetracyline 500mg qid (or doxy 100mg bid), Metronidazole (250 qid or 500 tid)
- PPI bid, Clarithromycin 500mg bid, Tetracyline 500mg qid (or doxy 100mg bid), Metronidazole (250 qid or 500 tid)
• Triple Therapy (14d) - PPI BID, Clarithromycin 500mg bid, Amoxicillin 1g bid (or flagyl 500mg TID if PCN-allergy)
• Confirm Eradication (due to increased ABx resistance): Stool Ag, Urea Breath Test or repeat EGD
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