17th July 2023

Helicobacter Pylori Infection

H.pylori is a gram-negative bacterium that has been implicated in a number of gastrointestinal pathologies.

Table 9: Sequelae of chronic Helicobacter pylori infection.

Investigations (BSG guidelines)

• 1st line: Urea breath test/stool antigen testing
  • Requires a 2-week PPI washout period and 4 weeks for antibiotics
  • Urea breath test is the preferred investigation to test for eradication post treatment
• 2nd line: Serology (does not differentiate between active and past infection, so cannot be used for retesting)

If a patient is undergoing OGD, the endoscopist can take biopsies to perform a rapid urease test (also known as the CLO test – Campylobacter-Like Organism) to test for H. pylori.

Treatment

7 days high-dose PPI + amoxicillin + metronidazole/clarithromycin

• If the patient is penicillin allergic, use high-dose PPI + metronidazole + clarithromycin (7 days).

Antiulcer medication

Reduction/neutralisation of stomach acid:

• Proton pump inhibitors (antisecretory)
• Histamine-2 receptor antagonists (antisecretory)
• Antacids (neutralising)

Other mechanisms:

• Sucralfate (forms a protective barrier over the ulcer)