Helicobacter pylori infection medical therapy
|
Helicobacter pylori infection Microchapters |
|
Differentiating Helicobacter pylori infection from other Diseases |
|---|
|
Diagnosis |
|
Guideline Recommendation |
|
Treatment |
|
Case Studies |
|
Helicobacter pylori infection medical therapy On the Web |
|
American Roentgen Ray Society Images of Helicobacter pylori infection medical therapy |
|
Directions to Hospitals Treating Helicobacter pylori infection |
|
Risk calculators and risk factors for Helicobacter pylori infection medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Persons with active gastric or duodenal ulcers or documented history of ulcers should be tested for H. pylori, and if found to be infected, they should be treated. To date, there has been no conclusive evidence that treatment of H. pylori infection in patients with non-ulcer dyspepsia is warranted. Testing for and treatment of H. pylori infection are recommended following resection of early gastric cancer and for low-grade gastric MALT lymphoma. Retesting after treatment may be prudent for patients with bleeding or otherwise complicated peptic ulcer disease. Treatment recommendations for children have not been formulated. Pediatric patients who require extensive diagnostic work-ups for abdominal symptoms should be evaluated by a specialist.
Medical Therapy
Acute Pharmacotherapy
Antibiotics are the new cure for ulcers; therapy is 1-2 weeks of one or two antibiotics and a proton pump inhibitor or H2 blocker. This treatment is a dramatic medical advance because eliminating H. pylori with antibiotics means that there is a greater than 90% chance that the ulcer can be cured for good. Remember, it is very important to continue taking all of this medicine until it is gone, even when you begin to feel better. If you are having side effects that make it hard to take your medicine, talk to your health care provider.
Therapy for H. pylori infection consists of 10 days to 2 weeks of one or two effective antibiotics, such as amoxicillin, tetracycline (not to be used for children <12 yrs.), metronidazole, or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. Acid suppression by the H2 blocker or proton pump inhibitor in conjunction with the antibiotics helps alleviate ulcer-related symptoms (i.e., abdominal pain, nausea), helps heal gastric mucosal inflammation, and may enhance efficacy of the antibiotics against H. pylori at the gastric mucosal surface. Currently, eight H. pylori treatment regimens are approved by the Food and Drug Administration (FDA) (Table 1); however, several other combinations have been used successfully. Antibiotic resistance and patient noncompliance are the two major reasons for treatment failure. Eradication rates of the eight FDA-approved regimens range from 61% to 94% depending on the regimen used. Overall, triple therapy regimens have shown better eradication rates than dual therapy. Longer length of treatment (14 days versus 10 days) results in better eradication rates.