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 [[gastritis|gastritis]], [[peptic ulcer disease|peptic ulcer disease]], and gastric adenocarcinoma. | ||
==Clinical Features== | ==Clinical Features== | ||
*Epigastric abdominal pain | |||
*[[Gastroesophageal Reflux Disease]] | *[[Epigastric abdominal pain|Epigastric abdominal pain]] | ||
*[[Gastroesophageal Reflux Disease|Gastroesophageal Reflux Disease]] | |||
==Differential Diagnosis== | |||
{{Abdominal Pain DDX Epigastric}} | |||
== | ==Evaluation== | ||
*Non-invasive Testing | *Non-invasive Testing | ||
| Line 15: | Line 27: | ||
**Stool Antigen Assay | **Stool Antigen Assay | ||
*Invasive Testing - Endoscopy | *Invasive Testing - Endoscopy | ||
==Management== | ==Management== | ||
*Triple Therapy | *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 | ||
*PPI plus clarithromycin | *Beware of other causes of abdominal pain despite positive testing | ||
*If | |||
===Triple Therapy=== | |||
*[[PPI|PPI]] plus [[clarithromycin|clarithromycin]] 500mg twice daily, and [[amoxicillin|amoxicillin]] 1000mg twice daily for 10-14 days | |||
*If penicillin allergic: PPI plus [[clarithromycin|clarithromycin]] 500mg twice daily, [[metronidazole|metronidazole]] 500mg twice daily for 10-14 days | |||
*Concomitant therapy adds [[metronidazole|metronidazole]] 500 mg BID to triple therapy for 10-14 days | |||
===[[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> | |||
*Bismuth quadruple therapy for 10 days: | |||
**[[Bismuth subsalicylate|Bismuth subsalicylate]] 300 mg QID | |||
**[[Lansoprazole|Lansoprazole]] 30 mg BID | |||
**[[Tetracycline|Tetracycline]] 500 mg QID | |||
**[[Metronidazole|Metronidazole]] 500 mg TID | |||
===Antibiotic Dosing=== | |||
====Adult==== | |||
*{{AntibioticDose|drug=Metronidazole|dose=250-375mg PO q6h x 10-14 days (in combination)|context=H. pylori|disease=Helicobacter pylori|population=Adult}} | |||
*{{AntibioticDose|drug=Clarithromycin|dose=triple treatment: 500mg PO q12hr x 7-14d; dual treatment: 500mg PO q8h x 14d (give with Omeprazole 40mg QD x 14d)|context=H. pylori infection|disease=Helicobacter pylori|population=Adult}} | |||
====Pediatric==== | |||
*{{AntibioticDose|drug=Amoxicillin|dose=50mg/kg/day PO divided BID x 7-14 days; Max: 2000mg/day|context=H. pylori|disease=Helicobacter pylori|population=Pediatric}} | |||
*{{AntibioticDose|drug=Clarithromycin|dose=20mg/kg/day PO divided BID x 7-14d; max 1000mg/day|context=H. pylori infection|disease=Helicobacter pylori|population=Pediatric}} | |||
==Disposition== | ==Disposition== | ||
*Discharge with GI outpatient follow-up | *Discharge with GI outpatient follow-up | ||
==See Also== | ==See Also== | ||
*[[Peptic Ulcer Disease]] | |||
*[[Gastroesophageal Reflux Disease]] | *[[Peptic Ulcer Disease|Peptic Ulcer Disease]] | ||
*[[Gastroesophageal Reflux Disease|Gastroesophageal Reflux Disease]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | |||
[[Category:ID]] | |||
Latest revision as of 10:58, 20 March 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
Antibiotic Dosing
Adult
- Metronidazole 250-375mg PO q6h x 10-14 days (in combination)
- Clarithromycin triple treatment: 500mg PO q12hr x 7-14d; dual treatment: 500mg PO q8h x 14d (give with Omeprazole 40mg QD x 14d)
Pediatric
- Amoxicillin 50mg/kg/day PO divided BID x 7-14 days; Max: 2000mg/day
- Clarithromycin 20mg/kg/day PO divided BID x 7-14d; max 1000mg/day
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.