H Pylori Infection

Helicobacter pylori is a bacteria that lives in human stomach. It was first discovered by Dr. Barry Marshall and Dr. Robin Warren in 1982. In honor their great discovery, they were awarded the 2005 Nobel Prize in Physiology/Medicine.

About 1 in 2 people in the world have H pylori in their stomach. Most believe it is acquired during childhood. Social status, certain geography area, residence in developing countries, living with a person who has H pylori, etc, are risk factors to contract H pylori infection.

Most people with H. pylori infection will never develop any signs or symptoms. However, some people will develop peptic ulcer disease (such as gastric ulcer, duodenum ulcer), gastritis, esophagitis, and even cancer. Symptoms of H pylori infection are nonspecific. They may present like: Nausea, vomiting, epigastric pain, bloating, belching, burping, decreased appetite, loss of weight, etc. Some patients may have dark stool, black stool or positive occult blood test, and blood test may show anemia and or low iron, etc.

Diagnosis and Treatment of H Pylori Infection:

There are several ways to diagnosis H pylori infection:

  1. Blood test
  2. Stool test
  3. Breath test
  4. EGD with biopsies

Treatment of H pylori infection is by medications. It can be difficult and requires three or more medications at the same time for 10 to 14 days. Treatment failure can happen, which is due to noncompliant or drug resistant. Re-treatment usually requires a different regimen. The commonly used methods for H pylori treatment are:

  1. Proton pump inhibitor (PPI) triple therapy: PPI (standard dose twice daily) + amoxicillin (1 g twice daily) + clarithromycin (500 mg twice daily) for 10 or 14 days.
  2. Quadruple therapy: PPI (standard dose twice daily) + metronidazole (500 mg 3 times daily) + tetracycline (500 mg 3 times daily) + bismuth (dose depends on preparation) for 10 or 14 days.
  3. Levofloxacin triple therapy: PPI (standard dose twice daily) + amoxicillin (1 g twice daily) + levofloxacin (500 mg twice daily) for 10 days.
  4. Rifabutin triple therapy: PPI (standard dose twice daily) + amoxicillin (1 g twice daily) + rifabutin (150-300 mg daily) for 10 days.
  5. Sequential therapy: PPI (standard dose twice daily) + amoxicillin (1 g twice daily) for 5 days, followed by PPI (standard dose twice daily) + clarithromycin (500 mg twice daily) + tinidazole (500 mg twice daily) for 5 days.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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