Helicobacter pylori Eradication Protocols for Peptic Ulcers and Gastritis
Helicobacter pylori (H. pylori) is a bacterium that infects the stomach and can lead to peptic ulcers, gastritis, and gastric cancer. Treatment protocols for H. pylori eradication aim to not only provide temporary relief of symptoms but also eliminate the bacterial infection entirely.
Who should be tested for H. pylori?
If you have active gastric or duodenal ulcers or a prior history of ulcers, you should be tested for H. pylori. Patients diagnosed with gastric adenocarcinoma, atrophic gastritis, intestinal metaplasia, or MALT lymphoma should also be tested and treated for H. pylori.
MALT lymphoma is a type of cancer that affects the lymphatic tissue in the stomach lining. Eradication of H. pylori can induce remission in many patients when the tumor only affects the stomach.
Limited evidence suggests that testing and treatment for H. pylori may also benefit patients with early-stage gastric adenocarcinoma or first-degree relatives of patients with gastric adenocarcinoma who are at increased risk of developing the disease.
Controversies in testing and treating for H. pylori
There is no clear consensus as to whether patients with functional dyspepsia, gastroesophageal reflux disease, or other non-GI disorders should be tested and treated for H. pylori. Additionally, whether asymptomatic individuals should be tested and treated for H. pylori remains controversial.
Eradicating H. pylori
H. pylori eradication typically involves a combination of antibiotics and acid suppressants. The antibiotic therapy lasts between one and two weeks, depending on the regimen used. The antibiotic regimen may include clarithromycin, amoxicillin, metronidazole, tetracycline, or a combination of these.
The acid suppressant therapy aims to decrease acid production in the stomach, making it easier for antibiotics to reach the bacteria. Acid suppressants include proton pump inhibitors (PPIs), H2-blockers, and antacids.
Follow-up testing after H. pylori eradication
Following eradication therapy, patients should undergo follow-up testing to ensure the complete elimination of H. pylori bacteria. Appropriate testing methods include breath tests or stool tests; these tests can detect the presence of H. pylori using bacterial antigens or DNA.
In conclusion, H. pylori eradication protocols aim to eliminate bacterial infection to provide long-term relief of symptoms and prevent more severe complications. Patients with active gastric or duodenal ulcers, a prior history of ulcers, MALT lymphoma, atrophic gastritis, intestinal metaplasia, gastric adenocarcinoma, or first-degree relatives of patients with gastric adenocarcinoma should be tested and treated for H. pylori. It remains controversial whether testing and treatment for H. pylori benefits patients with functional dyspepsia, gastroesophageal reflux disease, or other non-GI disorders, as well as asymptomatic individuals. Appropriate testing methods are necessary to ensure the complete eradication of H. pylori bacteria.