Internal Medicine

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

668 Helicobacter Pylori

■Retreatment: A BID PPI along with Pepto-Bismol, clarithromycin

and either amoxicillin, tetracycline or metronidazole (if they haven’t

been used previously) for 14 days

■cure rates unknown in U.S.

Side Effects

■Dyspepsia, nausea, vomiting, metallic taste with all of the above

treatments (usually mild)

Contraindications

■Absolute

➣Allergy to drug in regimen

■Relative

➣H. pyloristatus unknown

➣Eradication of organism of little or no benefit in those with non-

ulcer dyspepsia and no benefit in those with GERD, or the asymp-

tomatic patient

follow-up

Routine

■Complicated peptic ulcer

■Worried patient

Optional

■All treated patients given failure rate of 20–30%

complications and prognosis

Complications

■Peptic ulcer

➣Bleeding

➣Perforation

➣Obstruction

➣Symptomatic ulcer

■Gastric neoplasm

➣Bleeding

➣Obstruction

➣Weight loss

➣Death

Prognosis

■80% of infected individuals will never developH. pylori-related dis-

ease