09/09/2025
❇️ Imagine a tiny spiral-shaped bacterium that can survive in one of the harshest environments of the human body, the acidic stomach. That’s Helicobacter pylori (H. pylori). Discovered in the 1980s, this microbe changed the way doctors understood stomach ulcers and gastritis. Instead of stress or spicy food being the main culprits, it turned out that this resilient bacterium was behind many cases.
Today, H. pylori is one of the most common chronic infections worldwide, quietly living in the stomach of more than half the global population, sometimes harmless, but in other cases, leading to ulcers, gastritis, and even gastric cancer.
✅ H. pylori Management:
▶️ Indications for Testing
1. Peptic ulcer disease (gastric or duodenal)
2. Gastric MALT lymphoma
3. Unexplained iron deficiency anemia
4. Dyspepsia: Testing is indicated for uncomplicated dyspepsia without alarm symptoms after a trial of PPI.
5. Family history of gastric cancer
▶️ Diagnostic Tests
1. Urea breath test (most accurate non-invasive)
2. Stool antigen test
3. Endoscopic biopsy with rapid urease test (gold standard if endoscopy done)
4 Serology: NOT useful for confirming eradication
5. PI washout: Stop PPIs for 2 weeks before urea breath or stool antigen testing to avoid false negatives.
▶️ First-Line Treatment (14 days)
Bismuth Quadruple Therapy
1. PPI (e.g., omeprazole)
2. Bismuth subsalicylate
3. Metronidazole
4. Tetracycline
OR
Clarithromycin Triple Therapy (if no macrolide resistance)
1. PPI
2. Clarithromycin
3. Amoxicillin (or metronidazole if penicillin allergy)
▶️ Second-Line/Rescue Therapy
1. Levofloxacin-based triple therapy
2. Tailor regimen based on antibiotic resistance or previous exposure
▶️ Confirm Eradication
1. Urea breath test or stool antigen test ≥ 4 weeks after therapy, and ≥ 2 weeks off PPI
2. Not serology (remains positive long-term)
Disclaimer: This content is intended for educational and informational purposes only. It should not be taken as medical advice. Please consult a qualified healthcare professional before starting any treatment or medication.