H. Pylori Infection

Introduction

Helicobacter pylori infection is one of the most common causes of peptic ulcer disease, with 95% of duodenal and 70-80% of gastric ulcers associated with it.

• Helicobacter pylori is a spiral-shaped gram-negative bacterium transmitted through the oral to oral (more common) or faecal to oral route.
• Eradication of H. pylori infection reduces the possibility of developing gastric carcinomas.

Diagnosis

The presence of H. pylori should be confirmed before starting eradication treatment ("test and treat" strategy).

• Test for Helicobacter pylori infection in patients with a current or prior documented peptic ulcer or gastric malignancy, and
• Consider testing in patients with uninvestigated dyspepsia, patients on long-term low-dose aspirin, patients with unexplained iron deficiency anaemia and patients with idiopathic thrombocytopenic purpura.

Diagnosis may involve the

• ¹³C-urea breath test
• Most accurate non-invasive test
• Stool Helicobacter Antigen Test (SAT)
• Antibody testing (serology)
• May give false positive results because they indicate past and not necessarily current infection.
• Invasive testing via endoscopy

NOTE: Do not perform breath test or SAT within 2 weeks of proton pump inhibitor (PPI), or 4 weeks of antibiotics as these drugs supress bacteria and can lead to false negatives.

Treatment

Typically, triple therapy regimen comprises a proton pump inhibitor (PPI) and 2 antibacterial agents for 1-2 weeks.

After eradication, PPIs may be required for 4-8 weeks after triple therapy to promote further healing, especially if the ulcer was associated with bleeding or NSAID usage.

External Links

• Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review, 2013
  
• NICE Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, 2019
  
• Helicobacter pylori in dyspepsia: test and treat, 2019