St Thomas University Helicoba

Roodelyne Petit Homme

Pylori

This week during clinical the clinic seems much busier than usual; we have seen patients with suspected Covid Delta variant that were so critical that we had to examine them in the parking lot and refer to the hospital. However, I would like to talk about a 72-year-old lady Spanish speaking who came in for follow up visit and laboratory results after she was in the office two weeks prior. As per her chart she came in complaining of chronic abdominal pain, discomfort, low appetite, and nausea. The provider instructed her to have an H. pylori breath test and laboratory testing.

Infection with Helicobacter pylori (H. pylori) is a major pathogenic factor for gastroduodenal ulcer disease and gastric carcinoma, as well as for other types of gastric and extra gastric disease. As a result of changing epidemiologic conditions, changing resistance patterns with therapeutic implications, and new knowledge relating to the indications for pathogen eradication, the medical management of H. pylori is a dynamic process in need of periodic reassessment. (Fischbach & Malfertheiner, 2018) H. pylori (Helicobacter pylori) is a bacteria that infects your stomach or duodenum. H. pylori bacteria can increase your risk of developing: Gastritis (Links to an external site.), Peptic ulcer disease (Links to an external site.), Stomach (gastric) cancer (Links to an external site.). The H. pylori breath test involves breathing into a balloon-like bag. It’s a safe and easy way to detect H. pylori bacteria, diagnosis H. pylori infection, and determine if treatment cured the infection. H. pylori infection is a major cause of peptic ulcer disease. Its presence also increases your risk of gastritis and stomach cancer.

Treatment for H. pylori can be challenging because this infection is hard to get rid of and reoccurrence of the disease is high even after treatment. After reviewing all the labs and test, which confirmed that the patient is indeed suffering from H. pylori, my preceptor proceeded to explain to her how importance it is to adhere to the treatment for a better chance of eradicating this bacterium in her gastrointestinal track. She explained that she will use dual therapy approach, which involved an antibiotic and a steroid. It has been proposed that giving longer courses of less complex dual therapies, for example, PPI and amoxicillin four times a day, can also improve compliance and eradication rates. One study on a 14-day high-dose dual therapy in a region of high antibiotic resistance prevalence in China showed that it was both effective and safe for first-line treatment with an eradication rate of 92.5% and a low adverse event rate of 7.5%. (O’Connor et al., 2020)

The eradication of Helicobacter pylori usually prevents the recurrence of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. The eradication of Helicobacter pylori is important in the treatment of the conditions of the stomach, like MALT lymphoma. Helicobacter pylori is difficult to eradicate because it is capable of developing resistance. Therefore, two or more antibiotics are usually given together with a PPI and/ or bismuth containing compounds to eradicate. Studies have shown that the resistance of Helicobacter pylori to clarithromycin is common among patients who have a prior exposure to clarithromycin or other chemically similar macrolide antibiotics (such as erythromycin). The Helicobacter pylori resistance to metronidazole is common among patients who have had a prior exposure to metronidazole.

References

Fischbach, W., & Malfertheiner, P. (2018). Helicobacter Pylori Infection. Deutsches Aerzteblatt Online. Published. https://doi.org/10.3238/arztebl.2018.0429

O’Connor, A., Furuta, T., Gisbert, J. P., & O’Morain, C. (2020). Review – Treatment of Helicobacter pylori infection 2020. Helicobacter, 25(S1). https://doi.org/10.1111/hel.12743 (Links to an external site.)

Diaconu, S., Predescu, A., Moldoveanu, A., Pop, C. S., & Fierbințeanu-Braticevici, C. (2017). Helicobacter pylori infection: old and new. Journal of medicine and life, 10(2), 112–117.

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