Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Helicobacter Pylori 667

Imaging

■Necessary only to diagnoseH. pylori-related disease

■Endoscopy/barium studies used to diagnose peptic ulcer, gastric

neoplasia

differential diagnosis

■EstablishedH. pylori-associated diseases

➣Peptic ulcer

➣Gastric cancer

➣Gastric lymphoma

■Differential diagnosis of dyspepsia not strongly associated with

H. pylori

➣Non-ulcer dyspepsia

➣Gastroesophageal reflux

➣Cholelithiasis

➣Gastroparesis

management

What to Do First

■Decide whether to test for infection

➣H. pyloria class I carcinogen

➣Lifetime risk of ulcer disease 10–15% in those infected

➣thus, in those testing positive, treatment should be presumed;

otherwise, why test and how do you explain decision not to

treat?

■Testing should occur only if treatment will be beneficial (those with

ulcers, gastric MALT lymphoma, and possibly uninvestigated dys-

pepsia)

specific therapy

Indications

■Patients testing positive forH. pylori

Treatment Options

■First line: A proton pump inhibitor (PPI) twice daily plus two of the

following antibiotics for 7–14 days (clarithromycin, amoxicillin or

metronidazole D)

■cure rates 75–80% in U.S.

■Option: A BID PPI combined with Pepto-Bismol 2 tabs QID, metron-

idazole and tetracycline for 14 days

■cure rates 70–80% in U.S. studies