Helicobacter - Patient Information
40% carry in UK
Acquired mainly in childhood – risk factors: social deprivation; crowding; the number of siblings. <2% of adults acquire each year
Only 10-20-% children are infected today (peptic ulcer and gastric cancer reducing)
Urea breath test is the test of choice – sensitivity and specificity >95%
Benefits of treating
Peptic ulcer – benefit in terms of healing, less bleeding and prevention of recurrence
Uninvestigated dyspepsia – significant improvement in symptoms
One RCT shows reduced incidence of gastric cancer (?consider eradicating HP in first-degree relatives of pts with gastric cancer)
Failure of eradication
Strict adherence to current guidelines significantly reduces treatment failure
Mainly due to drug resistance. Clarithromycin resistance = strongest predictor of failure so in areas with >15-20% clarithromycin resistance avoid it (although in Hackney patient population has more resistance to metronidazole than clarithromycin)
Also, avoid clarithromycin if pt has previously received a macrolide
Only 5% of pts have side effects (diarrhoea/nausea/taste disturbance) but inform pts that success of their treatment depends on their adherence to it
Treatment
Standard treatment eradicates H.Pylori in about 85% of cases
Standard treatments (all 7 days)
PPI twice daily plus clarithromycin and amoxicillin
PPI twice daily plus metronidazole and amoxicillin
PPI twice daily plus clarithromycin and metronidazole (use if penicillin allergic)
Quadruple therapy (consider if clarithromycin resistant area or recent macrolide)
PPI twice daily plus metronidazole, tetracycline and bismuth
Third-line treatment (use only if 2 attempts at eradication have failed)
PPI twice daily and amoxicillin and levofloxacin for 10 days
Follow up
Confirm eradication at least 4 weeks after treatment ends
Recurrence of H.pylori once eradicated is infrequent as reinfection rates low (3.4% per year)