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 even metaplastic changes in the stomach, and it has a known association with peptic ulcer disease. The most common route of H pylori infection is either oral-to-oral or fecal-to-oral contact.

Clinical presentation

Heartburn and regurgitation are cardinal symptoms.
Odynophagia, dysphagia, weight loss and bleeding
Chronic cough, laryngitis, pharyngitis
Chronic bronchitis, asthma, COPD, pneumonia, chronic sinusitis and dental decay

Investigations

Positive stool antigen test (Stop PPI 2 weeks before testing)
Positive urease breath test
Positive urease test on endoscopic biopsy sample
Identification of the pathogen by histopathology examination

Pharmacological Treatment

Triple therapy is indicated for complete eradication of the organism

A: omeprazole (PO) 20mg 12hourly for 10-14days

AND

A: amoxycillin (PO) 1000mg 12hourly for 10-14days

AND

A: metronidazole (PO) 400mg 12hourly for 10–14days

Alternatively

C: lansoprazole (PO) 30mg 12hourly for 10-14days

AND

C: clarithromycin (PO) 500mg 12hourly 10-14days

AND

B: tinidazole (PO) 500mg 12hourly for 14days

Concomitant Therapy (all for 7 days)

A: omeprazole (PO) 20mg 12hourly

AND

A: amoxicillin (PO) 1000mg 12hourly

AND

A: metronidazole (PO) 400mg 12hourly

AND

C: clarithromycin (PO) 500mg 12hourly

Treat with Bismuth-based therapy for H. pylori treatment failure

C: pantoprazole (PO) 40mg 12 hourly 10-14days

S: esomeprazole (PO) 40mg 12hourly 10-14days

AND

S: bismuth subsalicylate (PO) 525 mg 6hourly 10-14days

AND

A: metronidazole (PO) 250 mg 6 hourly or 500 mg 8hourly 10-14days

AND

S: tetracycline (PO) 500 mg 6hourly for 10-14days.

Note: H.pylori diagnostic tests should be repeated 5 weeks after the last dose of eradication therapy, and the PPI should be stopped 2weeks before testing the H.pylori stool antigen test to confirm eradication.