In this section : Gastrointestinal
Dysphagia
Coeliac diagnosis pathway (Adults)
Sengstaken/Minnesota Tube for Bleeding Varices
Eradication of Helicobacter pylori
Acute Severe Ulcerative Colitis
Acute Upper GI Bleeding (AUGIB)
Iron Deficiency Anaemia
Dyspepsia
Nutritional Support in Adults
Refeeding Syndrome
Parenteral Nutrition
Crohn’s Disease
Acute Pancreatitis
Suspected Variceal Bleeding
Lower Gastrointestinal Bleeding
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Eradication of Helicobacter pylori
Last updated 11th January 2022
H. pylori is a bacterium colonising the gastric mucosa and may be the causative agent in a number of gastrointestinal pathologies.
Which Patients?
- All patients with proven duodenal ulcer.
- Patients with gastric ulcer.
- Patients with H. pylori and a strong family history of gastric cancer.
- Patients with epigastric pain in the absence of an ulcer.
Assessment
- The most common test for detecting H Pylori is the stool antigen test.
- If already taking PPI then this should be stopped for at least one week before testing.
- Sample should go to Microbiology in a blue topped container
- H. pylori can also be detected by a breath test and by examination of tissue biopsy taken at endoscopy
Drug Therapy
- One week therapy with a proton pump inhibitor (PPI) and two antibiotics is recommended.
- Rx Omeprazole oral 20mg twice daily (or lansoprazole oral 30mg twice daily) together with Clarithromycin oral 500mg twice daily and Amoxicillin oral 1g twice daily.
- If penicillin allergy, then prescribe PPI as above together with Clarithromycin oral 500mg twice daily and Metronidazole oral 400mg twice daily.
- Patients should be counselled on the importance of compliance before starting treatment and in those patients taking metronidazole on the avoidance of alcohol because of the risk of a disulfiram-like reaction.
- After 1 week’s treatment all medication can be stopped, except where ulcers have bled or perforated, when a PPI will be continued.
- For gastric ulcers, continue therapeutic dose of PPI for 6-8 weeks before repeating the endoscopy.