GIT Lec 2 Pt 3 - Eradication Of H.pylori Infection

Question 1

What is the most common cause of peptic ulcers?

Answer 1

It has been seen that up to 70-90% of patients presenting with peptic ulcers also have antral gastritis (caused by H.pylori) and eradication of the infection protects from relapse episodes.

Question 2

How do we treat patients with H.pylori infection?

Answer 2

There are two drug regimens we can use:
A. First line regimen: PPI’s + 2 antibiotics (triple therapy) Course: 7 days
a. PPI’s: one of the following
i. Omeprazole (20mg) 2x B.I.D
ii. Lansoprazole (30mg) 2x B.I.D
iii. Pantoprazole (40mg) 2x B.I.D
b. Antibiotics: one of the following combinations:
i. Clarithromycin (500mg) B.I.D + Amoxicillin (1 gm) B.I.D
ii. Clarithromycin (500mg) B.I.D + Metronidazole (400mg) B.I.D
B. Second line regiment: 2 antibiotics + 2 adjunctive drugs (quadruple therapy) Course: 10-14 days
a. Antibiotics: one of the following combination:
i. Tetracyclines (500mg) Q.I.D + Amoxicillin (1 gm) B.I.D
ii. Tetracyclines (500mg) Q.I.D + Metronidazole (400mg) B.I.D
b. One of the following combinations:
i. Bismuth subsalicylate (220mg) B.I.D + PPI’s
ii. Bismuth subsalicylate (220mg) B.I.D + long term maintenance therapy with acid suppression
(Select retreatment regime after consideration of previous therapy and /or microbial sensitivities)

Question 3

What is the management for patients with G.E.R.D?

Answer 3

1- General (life style modification):

a- Weight reduction, stop smoking.
b- Raising the head of the bed by 15-20cm, don’t sleep after meal.
c- Avoid drug relax gastroesophageal sphincter as antimuscarinic, antihistaminic, antidepressant, muscle relaxant.

2- Drug therapy:
a- Antacids.
b-Acid suppression as H 2-receptor antagonist, PPI.
c- Prokinetic drugs: as metoclopramide and domperidone.