Helicobacter pylori

Background

  • H. pylori is a gram negative bacteria that causes gastritis, peptic ulcer disease, and gastric adenocarcinoma.

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

  • May have highest eradication rates as compared to classical triple therapy or concomitant therapy[2]
  • Bismuth quadruple therapy for 10 days:
    • Bismuth 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

  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.