Helicobacter pylori: Difference between revisions
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==Background== | ==Background== | ||
*''H. pylori'' is a gram negative bacteria that causes [[gastritis]], [[peptic ulcer disease]], and gastric adenocarcinoma. | |||
*''H. pylori'' is a gram negative bacteria that causes [[Special:MyLanguage/gastritis|gastritis]], [[Special:MyLanguage/peptic ulcer disease|peptic ulcer disease]], and gastric adenocarcinoma. | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Epigastric abdominal pain]] | |||
*[[Gastroesophageal Reflux Disease]] | *[[Special:MyLanguage/Epigastric abdominal pain|Epigastric abdominal pain]] | ||
*[[Special:MyLanguage/Gastroesophageal Reflux Disease|Gastroesophageal Reflux Disease]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Abdominal Pain DDX Epigastric}} | {{Abdominal Pain DDX Epigastric}} | ||
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==Evaluation== | ==Evaluation== | ||
*Non-invasive Testing | *Non-invasive Testing | ||
**Urea Breath Testing | **Urea Breath Testing | ||
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**Stool Antigen Assay | **Stool Antigen Assay | ||
*Invasive Testing - Endoscopy | *Invasive Testing - Endoscopy | ||
==Management== | ==Management== | ||
*Though feasible in the ED<ref>Meltzer AC, et al. Rapid (13) C urea breath test to identify Helicobacter pylori infection in emergency department patients with upper abdominal pain. WJ Emerg Med. 2013; 14:278-282.</ref>, antibiotic therapy is typically not offered | *Though feasible in the ED<ref>Meltzer AC, et al. Rapid (13) C urea breath test to identify Helicobacter pylori infection in emergency department patients with upper abdominal pain. WJ Emerg Med. 2013; 14:278-282.</ref>, antibiotic therapy is typically not offered | ||
*Beware of other causes of abdominal pain despite positive testing | *Beware of other causes of abdominal pain despite positive testing | ||
===Triple Therapy=== | ===Triple Therapy=== | ||
*[[PPI]] plus [[clarithromycin]] 500mg twice daily, and [[amoxicillin]] 1000mg twice daily for 10-14 days | |||
*If penicillin allergic: PPI plus [[clarithromycin]] 500mg twice daily, [[metronidazole]] 500mg twice daily for 10-14 days | *[[Special:MyLanguage/PPI|PPI]] plus [[Special:MyLanguage/clarithromycin|clarithromycin]] 500mg twice daily, and [[Special:MyLanguage/amoxicillin|amoxicillin]] 1000mg twice daily for 10-14 days | ||
*Concomitant therapy adds [[metronidazole]] 500 mg BID to triple therapy for 10-14 days | *If penicillin allergic: PPI plus [[Special:MyLanguage/clarithromycin|clarithromycin]] 500mg twice daily, [[Special:MyLanguage/metronidazole|metronidazole]] 500mg twice daily for 10-14 days | ||
===[[Bismuth subsalicylate|Bismuth]] Quadruple Therapy=== | *Concomitant therapy adds [[Special:MyLanguage/metronidazole|metronidazole]] 500 mg BID to triple therapy for 10-14 days | ||
===[[Special:MyLanguage/Bismuth subsalicylate|Bismuth]] Quadruple Therapy=== | |||
*May have highest eradication rates as compared to classical triple therapy or concomitant therapy<ref>Liou JM et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2016. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31409-X/fulltext?rss=yes.</ref> | *May have highest eradication rates as compared to classical triple therapy or concomitant therapy<ref>Liou JM et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2016. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31409-X/fulltext?rss=yes.</ref> | ||
*Bismuth quadruple therapy for 10 days: | *Bismuth quadruple therapy for 10 days: | ||
**[[Bismuth subsalicylate]] 300 mg QID | **[[Special:MyLanguage/Bismuth subsalicylate|Bismuth subsalicylate]] 300 mg QID | ||
**[[Lansoprazole]] 30 mg BID | **[[Special:MyLanguage/Lansoprazole|Lansoprazole]] 30 mg BID | ||
**[[Tetracycline]] 500 mg QID | **[[Special:MyLanguage/Tetracycline|Tetracycline]] 500 mg QID | ||
**[[Metronidazole]] 500 mg TID | **[[Special:MyLanguage/Metronidazole|Metronidazole]] 500 mg TID | ||
==Disposition== | ==Disposition== | ||
*Discharge with GI outpatient follow-up | *Discharge with GI outpatient follow-up | ||
==See Also== | ==See Also== | ||
*[[Peptic Ulcer Disease]] | |||
*[[Gastroesophageal Reflux Disease]] | *[[Special:MyLanguage/Peptic Ulcer Disease|Peptic Ulcer Disease]] | ||
*[[Special:MyLanguage/Gastroesophageal Reflux Disease|Gastroesophageal Reflux Disease]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
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Latest revision as of 22:57, 4 January 2026
Background
- H. pylori is a gram negative bacteria that causes gastritis, peptic ulcer disease, and gastric adenocarcinoma.
Clinical Features
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Evaluation
- Non-invasive Testing
- Urea Breath Testing
- Serology - ELISA
- Stool Antigen Assay
- Invasive Testing - Endoscopy
Management
- Though feasible in the ED[1], antibiotic therapy is typically not offered
- Beware of other causes of abdominal pain despite positive testing
Triple Therapy
- PPI plus clarithromycin 500mg twice daily, and amoxicillin 1000mg twice daily for 10-14 days
- If penicillin allergic: PPI plus clarithromycin 500mg twice daily, metronidazole 500mg twice daily for 10-14 days
- Concomitant therapy adds metronidazole 500 mg BID to triple therapy for 10-14 days
Bismuth Quadruple Therapy
- May have highest eradication rates as compared to classical triple therapy or concomitant therapy[2]
- Bismuth quadruple therapy for 10 days:
- Bismuth subsalicylate 300 mg QID
- Lansoprazole 30 mg BID
- Tetracycline 500 mg QID
- Metronidazole 500 mg TID
Disposition
- Discharge with GI outpatient follow-up
See Also
External Links
References
- ↑ Meltzer AC, et al. Rapid (13) C urea breath test to identify Helicobacter pylori infection in emergency department patients with upper abdominal pain. WJ Emerg Med. 2013; 14:278-282.
- ↑ Liou JM et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2016. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31409-X/fulltext?rss=yes.