Helicobacter pylori – quick guide

Bacteriology: Gram-negative microaerophilic bacterium

Pathogenesis: H. pylori produces urease, an enzyme that converts urea into ammonia and carbon dioxide, which in turn increases gastric pH and allows for further colonization of the bacteria.

Epidemiology: Up to 90% are infected in developing countries.

Diagnosis: Blood (serum antibodies – used only in naive, untreated patients), endoscopy (biopsy, rapid urease test), stool (detects antigen in feces – used to check infection clearance after treatment), breath (urea breath test).

Signs&symptoms: Majority (80%) are asymptomatic. When symptomatic, patients have bloating, dyspepsia, abdominal pain, nausea, vomiting, upper GI bleed (from gastric/duodenal ulcer).

Disease: Gastritis, peptic Ulcer, gastric cancer (H pylori classified by WHO as class I carcinogen)

Endoscopy: Gastric ulcer, nodular/erythematous gastritis

Nodular gastritis in H pylori infected patient

Tratament: Triple/quadruple therapy, sequential therapy. First line is amoxicillin 1g po bid + clarithromycin 500mg  po bid + esomeprazole 40 mg po once a day  (or 20 mg po bid – morning and evening) for 7-14 days.

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