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Helicobacter pylori

Page 1 Helicobacter pyloriFact Sheet for health Care ProvidersUpdated: July 1998 What is H. pylori ? Helicobacter pylori (H. pylori ) is a spiral-shapedbacterium that is found in the gastric mucous layeror adherent to the epithelial lining of the pylori causes more than 90% of duodenal ulcersand up to 80% of gastric ulcers. Before 1982, when this bacterium was discovered,spicy food, acid, stress, and lifestyle wereconsidered the major causes of ulcers. Themajority of patients were given long-termmedications, such as H2 blockers, and morerecently, proton pump inhibitors, without a chancefor permanent cure. These medications relieveulcer-related symptoms, heal gastric mucosalinflammation, and may heal the ulcer, but they doNOT treat the infection.

Page 1 Helicobacter pylori Fact Sheet for Health Care Providers Updated: July 1998 What is H. pylori ? Helicobacter pylori (H. pylori ) is a spiral-shaped

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1 Page 1 Helicobacter pyloriFact Sheet for health Care ProvidersUpdated: July 1998 What is H. pylori ? Helicobacter pylori (H. pylori ) is a spiral-shapedbacterium that is found in the gastric mucous layeror adherent to the epithelial lining of the pylori causes more than 90% of duodenal ulcersand up to 80% of gastric ulcers. Before 1982, when this bacterium was discovered,spicy food, acid, stress, and lifestyle wereconsidered the major causes of ulcers. Themajority of patients were given long-termmedications, such as H2 blockers, and morerecently, proton pump inhibitors, without a chancefor permanent cure. These medications relieveulcer-related symptoms, heal gastric mucosalinflammation, and may heal the ulcer, but they doNOT treat the infection.

2 When acid suppression isremoved, the majority of ulcers, particularly thosecaused by H. pylori , recur. Since we now knowthat most ulcers are caused by H. pylori ,appropriate antibiotic regimens can successfullyeradicate the infection in most patients, withcomplete resolution of mucosal inflammation and aminimal chance for recurrence of common is H. pylori infection? Approximately two-thirds of the world spopulation is infected with H. pylori . In the UnitedStates, H. pylori is more prevalent among olderadults, African Americans, Hispanics, and lowersocioeconomic illnesses does H. pylori cause?Most persons who are infected with H. pylorinever suffer any symptoms related to the infection;however, H.

3 pylori causes chronic active, chronicpersistent, and atrophic gastritis in adults andchildren. Infection with H. pylori also causesduodenal and gastric ulcers. Infected persons have a 2- to 6-fold increased riskof developing gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphomacompared with their uninfected counterparts. Therole of H. pylori in non-ulcer dyspepsia remainsunclear. What are the symptoms of ulcers?Approximately 25 million Americans suffer frompeptic ulcer disease at some point in their year there are 500,000 to 850,000 new casesof peptic ulcer disease and more than one millionulcer-related hospitalizations. The most common ulcer symptom is gnawing orburning pain in the epigastrium.

4 This pain typicallyoccurs when the stomach is empty, between mealsand in the early morning hours, but it can alsooccur at other times. It may last from minutes tohours and may be relieved by eating or by takingantacids. Less common ulcer symptoms include nausea,vomiting, and loss of appetite. Bleeding can also occur; prolonged bleeding may cause anemiaPage 2leading to weakness and fatigue. If bleeding isheavy, hematemesis, hematochezia, or melena mayoccur. Who should be tested and treated for H. pylori ?Persons with active gastric or duodenal ulcers ordocumented history of ulcers should be tested forH. pylori , and if found to be infected, they shouldbe treated. To date, there has been no conclusiveevidence that treatment of H.

5 pylori infection inpatients with non-ulcer dyspepsia is warranted. Testing for and treatment of H. pylori infection arerecommended following resection of early gastriccancer and for low-grade gastric MALT after treatment may be prudent forpatients with bleeding or otherwise complicatedpeptic ulcer disease. Treatment recommendations for children have notbeen formulated. Pediatric patients who requireextensive diagnostic work-ups for abdominalsymptoms should be evaluated by a specialist. How is H. pylori infection diagnosed?Several methods may be used to diagnose H. pyloriinfection. Serological tests that measure specific H. pylori IgG antibodies can determine if a personhas been infected. The sensitivity and specificity ofthese assays range from 80% to 95% dependingupon the assay used.

6 Another diagnostic method is the breath test. In thistest, the patient is given either 13C- or 1 4C-labeledurea to drink. H. pylori metabolizes the urearapidly, and the labeled carbon is absorbed. Thislabeled carbon can then be measured as CO2 in thepatient s expired breath to determine whether H. pylori is present. The sensitivity and specificityof the breath test ranges from 94% to 98%.Upper esophagogastroduodenal endoscopy isconsidered the reference method of endoscopy, biopsy specimens of thestomach and duodenum are obtained and thediagnosis of H. pylori can be made by severalmethods: The biopsy urease test - a colorimetric testbased on the ability of H. pylori to produceurease; it provides rapid testing at the time ofbiopsy.

7 Histologic identification of organisms -considered the gold standard of diagnostictests. Culture of biopsy specimens for H. pylori ,which requires an experienced laboratory and isnecessary when antimicrobial susceptibilitytesting is are the treatment regimensused for H. pylori eradication?Therapy for H. pylori infection consists of 10 daysto 2 weeks of one or two effective antibiotics, suchas amoxicillin, tetracycline (not to be used forchildren <12 yrs.), metronidazole, orclarithromycin, plus either ranitidine bismuthcitrate, bismuth subsalicylate, or a proton pumpinhibitor. Acid suppression by the H2 blocker orproton pump inhibitor in conjunction with theantibiotics helps alleviate ulcer-related symptoms( , abdominal pain, nausea), helps heal gastricmucosal inflammation, and may enhance efficacy ofthe antibiotics against H.

8 pylori at the gastricmucosal , eight H. pylori treatment regimens areapproved by the Food and Drug Administration(FDA) (Table 1); however, several othercombinations have been used resistance and patient noncomplianceare the two major reasons for treatment rates of the eight FDA-approvedPage 3regimens range from 61% to 94% depending on theregimen used. Overall, triple therapy regimens haveshown better eradication rates than dual length of treatment (14 days versus 10days) results in better eradication there any long-term consequencesof H. pylori infection?Recent studies have shown an association betweenlong-term infection with H. pylori and thedevelopment of gastric cancer. Gastric cancer is thesecond most common cancer worldwide; it is mostcommon in countries such as Colombia and China,where H.

9 pylori infects over half the population inearly childhood. In the United States, where H. pylori is less common in young people, gastriccancer rates have decreased since the do people get infected with H. pylori ?It is not known how H. pylori is transmitted or whysome patients become symptomatic while others donot. The bacteria are most likely spread fromperson to person through fecal-oral or oral-oralroutes. Possible environmental reservoirs includecontaminated water sources. Iatrogenic spreadthrough contaminated endoscopes has beendocumented but can be prevented by propercleaning of equipment. What can people do to prevent H. pylori infection?Since the source of H. pylori is not yet known,recommendations for avoiding infection have notbeen made.

10 In general, it is always wise for personsto wash hands thoroughly, to eat food that has beenproperly prepared, and to drink water from a safe,clean 1. FDA-approved treatment options (as of July 98)Omeprazole 40 mg QD + clarithromycin 500 mgTID x 2 wks, then omeprazole 20 mg QD x 2 wks -OR-Ranitidine bismuth citrate (RBC) 400 mg BID +clarithromycin 500 mg TID x 2 wks, then RBC 400mg BID x 2 wks-OR-Bismuth subsalicylate (Pepto Bismol ) 525 mgQID + metronidazole 250 mg QID + tetracycline500 mg QID* x 2 wks + H2 receptor antagonisttherapy as directed x 4 wks-OR-Lansoprazole 30 mg BID + amoxicillin 1 g BID +clarithromycin 500 mg TID x 10 days-OR-Lansoprazole 30 mg TID + amoxicillin 1 g TID x 2wks** -OR-Rantidine bismuth citrate 400 mg BID +clarithromycin 500 mg BID x 2 wks, then RBC 400mg BID x 2 wks-OR-Omeprazole 20 mg BID + clarithromycin 500 mgBID + amoxicillin 1 g BID x 10 days-OR-Lansoprazole 30 mg BID + clarithromycin 500 mgBID + amoxicillin 1 g BID x 10 days*Although not FDA approved, amoxicillin has been substituted fortetracycline for patients for whom tetracycline is not recommended.


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