- Adam Harris,
- 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.
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.
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 …