Clinical Review ABC of the upper gastrointestinal tract

Management of Helicobacter pylori infection

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7320.1047 (Published 03 November 2001) Cite this as: BMJ 2001;323:1047
  1. Adam Harris,
  2. J J Misiewicz

    This article discusses the current management of Helicobacter pylori infection in patients with dyspepsia with or without endoscopic abnormalities. We take an evidence based approach when possible and consider recent guidelines from national and international bodies pertaining to primary and secondary care.

    Microanatomy of gastric mucosa indicating the pH gradient

    Duodenal ulcer disease

    In patients who are not taking non-steroidal anti-inflammatory drugs (NSAIDs) duodenal ulcer will be due to H pylori infection in 95% of cases, and eradication treatment can be prescribed without testing for H pylori. If there is any doubt about the diagnosis, such as a possible ulcer crater on a barium meal, endoscopic confirmation of duodenal ulcer and H pylori infection should be sought before prescribing treatment.

    Management plan for uncomplicated duodenal ulcer in patients not taking NSAIDs

    H pylori eradication treatment, if successful, will be effective in curing the ulcer diathesis regardless of whether a patient is seen at the initial presentation of the disease or at a recurrence. Patients taking long term (maintenance) treatment with H2 receptor antagonists or proton pump inhibitors should also be offered H pylori eradication treatment regardless of whether they are free of symptoms or still experiencing indigestion. In most cases eradication of H pylori cures the duodenal ulcer disease, and maintenance treatment can be stopped.

    After eradication treatment

    Uncomplicated duodenal ulcers heal quickly and completely after eradication of H pylori. Further antisecretory treatment, repeat endoscopy, or formal assessment of eradication is not necessary, and one can await the clinical outcome.

    Recurrent symptoms indicate either eradication failure or the presence of some other disease. Subsequent management will not be clear unless the outcome of eradication treatment is known, and this is best assessed by a 13C-urea breath test performed more than four weeks after the antimicrobial treatment. Recurrent symptoms after documented H pylori eradication …

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