H.pylori

Question 1

What can H.pylori cause if left untreated?

Answer 1

Peptic ulcer disease, gastritis, gastric malignancies

Question 2

How to diagnose H.pylori?

Answer 2

Urea (13C) breath test
Stool heliobacter antigen test (SAT)
Lab-based serology

Question 3

How long a gap should be left between the SAT test or UREA breath test and PPIs?

Answer 3

2 weeks- can give false negatives

Question 4

How long a gap should be left between the SAT test or UREA breath test and antibiotics?

Answer 4

4 weeks- can give false negatives

Question 5

Which drug can increase risk of ulceration when given in a patient with H.pylori?

Answer 5

NSAIDs

Question 6

Those at high risk of H.pylori include?

Answer 6

Those of north African ethnicity, in the elderly, those living in a known high risk area

Question 7

When is H.pylori testing recommended?

Answer 7

In uncomplicated dyspepsia with no red flags, with no response to antacids or lifestyle changes, following a single months PPI course

In those at high risk of H.pylori

Those with previous peptic ulcers that weren’t tested for H.pylori

Before NSAID use in patients with a history of bleeds/ ulceration

Patients with unexplained iron-deficiency anaemia where malignancy has been ruled out

Question 8

Which test method should be used for re-testing?

Answer 8

Urea (13C) breath test

Question 9

Which antibiotics increase the chance of resistance with every additional course when used in H.pylori treatment?

Answer 9

Metronidazole, Quinolones, Clarithromycin

Question 10

1st line therapy for H.pylori in those with no penicillin allergy and recent use of Clarithromycin?

Answer 10

Lansoprazole 30mg BD or Omeprazole 20-40mg BD
Amoxicillin 1g BD
Metronidazole 400mg BD
For 7 days

Question 11

Alternative 2nd line therapy for H.pylori in those with no penicillin allergy who cannot have Metronidazole or Clarithromycin?

Answer 11

Lansoprazole 30mg BD or Omeprazole 20-40mg BD
Amoxicillin 1g BD
Tetracycline (or Levofloxacin)
For 7 days

Question 12

3rd line therapy for H.pylori in those with no penicillin allergy?

Answer 12

Lansoprazole 30mg BD or Omeprazole 20-40mg BD
Bismuth subsalicylate + 2 antibacterials mentioned in 1st and 2nd line treatment.
Or furazolidone
rifabutin
For 10 days
(SPECIALIST ADVICE ONLY)

Question 13

1st line therapy for H.pylori in those with a penicillin allergy?

Answer 13

Lansoprazole 30mg BD or Omeprazole 20-40mg BD
Metronidazole 400mg BD
Clarithromycin 500mg BD
For 7 days

Question 14

2nd line therapy for H.pylori in those with a penicillin allergy who have had a recent course of clarithromycin?

Answer 14

Lansoprazole 30mg BD or Omeprazole 20-40mg BD
Metronidazole 400mg BD
Bismuth subsalicylate
Tetracycline