Helicobacter pylori-related peptic ulcer disease

Helicobacter pylori-related peptic ulcer disease

Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population. Chronic infection with H. pylori causes atrophic and metaplastic changes in the stomach and is strongly associated with peptic ulcer disease. The most common routes of transmission are oral-to-oral and faecal-to-oral contact.

Clinical presentation

• As described in Section 10.2.1.1 (Peptic Ulcer Disease).

Investigations

Non-invasive tests

• Positive stool antigen test

  • Stop proton pump inhibitors (PPIs) 2 weeks before testing.

• Positive urea breath test

Invasive tests

• Positive urease test on an endoscopic biopsy specimen

• Identification of H. pylori by histopathological examination

Pharmacological treatment

Triple therapy

Triple therapy is indicated for complete eradication of the organism.

Regimen 1

• Omeprazole (PO) 20 mg every 12 hours for 10–14 days

AND

• Amoxicillin (PO) 1000 mg every 12 hours for 10–14 days

AND

• Metronidazole (PO) 400 mg every 12 hours for 10–14 days

Alternative regimen

• Lansoprazole (PO) 30 mg every 12 hours for 10–14 days

AND

• Clarithromycin (PO) 500 mg every 12 hours for 10–14 days

AND

• Tinidazole (PO) 500 mg every 12 hours for 14 days

Concomitant therapy

All medications are given for 7 days.

• Omeprazole (PO) 20 mg every 12 hours

AND

• Amoxicillin (PO) 1000 mg every 12 hours

AND

• Metronidazole (PO) 400 mg every 12 hours

AND

• Clarithromycin (PO) 500 mg every 12 hours

Management of H. pylori treatment failure

Bismuth-based quadruple therapy

• Pantoprazole (PO) 40 mg every 12 hours for 10–14 days

OR

• Esomeprazole (PO) 40 mg every 12 hours for 10–14 days

AND

• Bismuth subsalicylate (PO) 525 mg every 6 hours for 10–14 days

AND

• Metronidazole (PO) 250 mg every 6 hours

OR

• Metronidazole (PO) 500 mg every 8 hours

For 10–14 days

AND

• Tetracycline (PO) 500 mg every 6 hours for 10–14 days