Key features:
- H. pylori is a gram negative bacillus that has naturally colonised the human stomach for at least 50,000 years. Usually acquired in childhood, it colonises the gastric mucosa of about 50% of the world’s population at some time in their life.
- Infection with H. pylori induces a persistent immune response. Because the organism has numerous adaptions to prevent immune detection, clearance by the body is never complete. The resulting sustained inflammatory processes in the stomach cause a reduction in the population of somatostatin-producing D cells. This causes a subsequent rise in gastrin secretion followed by an increase in gastric acid release which may lead to peptic ulceration in some patients.
- Most patients colonised with H. Pylori do not develop peptic ulcers.
- It would not be appropriate to investigate for H. pylori initially in the presence of alarm symptoms such as weight loss, bleeding, dysphagia or symptoms in a patient above the age of 55 years. In this context, investigations should first be directed at excluding malignancy, for example with a gastroscopy.
- Current Therapeutic Guidelines in Australia, revised in July 2013, recommend PPI-based triple therapy as the first line measure for eradication of H.pylori. (Esomeprazole 20 mg twice daily, amoxicillin 1 g twice daily and clarithromycin 500 mg twice daily)
- The conclusion to be drawn from the Swedish study is that in all traditionally prescribed regimens, eradication is only partially successful.
Reference:
http://www.racgp.org.au/afp/2014/may/helicobacter-pylori-eradication/
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