H. pylori

Question 1

Name two malignancies associated with H. pylori infection.

Answer 1

Gastric cancer and MALT lymphoma

Question 2

What is the effect of combining NSAIDs with H. pylori infection?

Answer 2

Additive effect → Increased risk of peptic ulceration and bleeding

Question 3

When should H. pylori testing be done?

Answer 3

Persistent dyspepsia after 1-month PPI

High-risk individuals (e.g., older age, certain ethnicities)

History of ulcers/bleeds

Before NSAIDs in those with ulcer history

Unexplained iron-deficiency anaemia

Question 4

What are the preferred tests for diagnosing H. pylori?

Answer 4

Urea (13C) breath test

Stool antigen test (SAT)

Validated lab-based serology

Question 5

Why should PPIs and antibiotics be withheld before testing for H. pylori?

Answer 5

To avoid false-negative results.

Withheld test if 2 weeks of PPI use or 4 weeks of antibiotic use – can cause false negatives

Question 6

What test is recommended for H. pylori retesting?

Answer 6

Urea (13C) breath test, at least 4 weeks (ideally 8 weeks) post-treatment

Question 7

Which acid-suppressing drugs should be used during retesting if needed?

Answer 7

H2-receptor antagonists (not PPIs)

Question 8

What is first-line H. pylori eradication therapy in patients without penicillin allergy?

Answer 8

1st Line (7 days)

A PPI twice-dailyandamoxicillin 1 g twice-daily and
Eitherclarithromycin 500mg twice-dailyor metronidazole 400 mg twice-daily.

Question 9

What is first-line therapy in patients with penicillin allergy?

Answer 9

1st Line (7 days)

A PPI twice-dailyandclarithromycin 500 mg twice-dailyandmetronidazole 400 mg twice-daily.