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Helicobacter pylori
From WikEM
Contents
Background
- H. pylori is a gram negative bacteria that causes gastritis, peptic ulcer disease, and gastric adenocarcinoma.
Clinical Features
- Epigastric abdominal pain
- Gastroesophageal Reflux Disease
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
Evaluation
- Non-invasive Testing
- Urea Breath Testing
- Serology - ELISA
- Stool Antigen Assay
- Invasive Testing - Endoscopy
Management
- Though feasible in the ED[1], antibiotic therapy is typically not offered
- Beware of other causes of abdominal pain despite positive testing
Triple Therapy
- PPI plus clarithromycin 500mg twice daily, and amoxicillin 1000mg twice daily for 10-14 days
- If penicillin allergic: PPI plus clarithromycin 500mg twice daily, metronidazole 500mg twice daily for 10-14 days
- Concomitant therapy adds metronidazole 500 mg BID to triple therapy for 10-14 days
Bismuth Quadruple Therapy
- May have highest eradication rates as compared to classical triple therapy or concomitant therapy[2]
- Bismuth quadruple therapy for 10 days:
- Bismuth 300 mg QID
- Lansoprazole 30 mg BID
- Tetracycline 500 mg QID
- Metronidazole 500 mg TID
Disposition
- Discharge with GI outpatient follow-up
See Also
External Links
References
- ↑ Meltzer AC, et al. Rapid (13) C urea breath test to identify Helicobacter pylori infection in emergency department patients with upper abdominal pain. WJ Emerg Med. 2013; 14:278-282.
- ↑ Liou JM et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2016. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31409-X/fulltext?rss=yes.
