Helicobacter Pylori (H. pylori) Infection - Diagnosis and Management - GrepMed Handbook

Presentation: Dyspepsia / Peptic Ulcer Disease

Epidemiology: Unusual in children, up to 50% of adults +serology in developed countries

Microbiology: 

 • spiral shaped, microaerophilic, gram negative bacterium

 • Urease (hydrolyze urea to create neutralizing NH4+), shape and flagella allow adaptation to gastric mucosa

 • Transmission unknown (presumed fecal-oral or oral-oral)

Diagnosis:

 • Endoscopic Biopsy (definitive)

 • Stool Ag, Urea Breath Testing (UBT) - ↑ false ⊖ on antacids, hold 2w before testing if possible

 • Serology (IgG) - cannot differentiate past infection

Management:

 • 1st Line - Quadruple Therapy (14d)

    - PPI bid, Bismuth 300mg qid, Tetracyline 500mg qid (or doxy 100mg bid), Metronidazole (250 qid or 500 tid)

    - PPI bid, Clarithromycin 500mg bid, Tetracyline 500mg qid (or doxy 100mg bid), Metronidazole (250 qid or 500 tid)

 • Triple Therapy (14d) - PPI BID, Clarithromycin 500mg bid, Amoxicillin 1g bid (or flagyl 500mg TID if PCN-allergy)

 • Confirm Eradication (due to increased ABx resistance): Stool Ag, Urea Breath Test or repeat EGD



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