Difference between revisions of "Helicobacter pylori"

(Text replacement - "metronidazole " to "metronidazole ")
 
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==Background==
 
==Background==
*''H. pylori'' is a gram negative bacteria that causes gastritis, peptic ulcer disease, and gastric adenocarcinoma.
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*''H. pylori'' is a gram negative bacteria that causes [[gastritis]], [[peptic ulcer disease]], and gastric adenocarcinoma.
  
 
==Clinical Features==
 
==Clinical Features==
*Epigastric abdominal pain
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*[[Epigastric abdominal pain]]
 
*[[Gastroesophageal Reflux Disease]]
 
*[[Gastroesophageal Reflux Disease]]
  
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*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
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*[[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
 
*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
 
*Concomitant therapy adds [[metronidazole]] 500 mg BID to triple therapy for 10-14 days
===Bismuth Quadruple Therapy===
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===[[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 300 mg QID
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**[[Bismuth subsalicylate]] 300 mg QID
**Lansoprazole 30 mg BID
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**[[Lansoprazole]] 30 mg BID
**Tetracycline 500 mg QID
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**[[Tetracycline]] 500 mg QID
**Metronidazole 500 mg TID
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**[[Metronidazole]] 500 mg TID
  
 
==Disposition==
 
==Disposition==

Latest revision as of 15:12, 14 September 2019

Background

Clinical Features

Differential Diagnosis

Epigastric Pain

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

Bismuth Quadruple Therapy

Disposition

  • Discharge with GI outpatient follow-up

See Also

External Links

References

  1. 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.
  2. 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.