How H Pylori Makes You Sick
For decades, doctors thought people got ulcers from stress, spicy foods, smoking, or other lifestyle habits. But when scientists discovered H. pylori in 1982, they found that the germs were the cause of most stomach ulcers.
After H. pylori enters your body, it attacks the lining of your stomach, which usually protects you from the acid your body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.
You can get H. pylori from food, water, or utensils. Itâs more common in countries or communities that lack clean water or good sewage systems. You can also pick up the bacteria through contact with the saliva or other body fluids of infected people.
Many people get H. pylori during childhood, but adults can get it, too. The germs live in the body for years before symptoms start, but most people who have it will never get ulcers. Doctors arenât sure why only some people get ulcers after an infection.
Management Of Helicobacter Pylori Infection
Leena Myran, PharmD, BCPSUniversity of Wyoming School of PharmacyLaramie, Wyoming
University of Wyoming School of PharmacyLaramie, Wyoming
US Pharm. 2018 43:27-32.
ABSTRACT: Helicobacter pylori infection is prevalent in about one-half of the worlds population. Infection with H pylori is associated with the development of peptic ulcer disease, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. Significant scientific advances have been made in the management of H pylori infection in adults these advances are addressed in updated recommendations by the American College of Gastroenterology and the Toronto Consensus. The increasing prevalence of H pylori that is resistant to traditional clarithromycin-based therapies is a global problem requiring a review of the evidence to incorporate additional regimens.
Helicobacter pylori is a gram-negative bacterium that colonizes the human stomach. It is typically acquired during childhood and transmitted from human to human.1,2 Risk factors for H pylori infection include low socioeconomic status, increasing number of siblings, and having an infected parent.1
Pcr Detection Of Urea And Cyp2c19 Genotypes In Gastric Biopsies
For confirmation of the presence of H. pylori infection in gastric biopsies, UreA gene was detected by the conventional PCR method.19,20 Primers for PCR amplification of UreA 20 was designed according to published study and synthesized at the NewLife Inc. . Moreover, the effect of PPI in H. pylori eradication therapy treatment can be affected by the CYP2C19 gene polymorphisms.21 Three main alleles have been found, including CYP2C19*1 , CYP2C19*2 and CYP2C19*3 .21,22 The sequences of primers were designed and synthesized for CYP2C19*2 and CYP2C19*3 .21 They were detected by PCR amplification and the products were analyzed and sequenced at the NewLife Inc.
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Ideal Length Of Treatment For Helicobacter Pylori Eradication
The ideal duration of therapy for H. pylori eradication is controversial, with recommendations ranging from 7 to 14 days. A proton pump inhibitor plus two antibiotics is the most commonly used first treatment to remove H. pylori infection. Current data suggest that increasing the length of treatment to 14 days of a PPI plus amoxicillin and clarithromycin or amoxicillin and a nitroimidazole significantly increases the eradication rate, while increasing the adverse events by a small amount. Based on the overall evidence, the ideal length of treatment with a PPI plus amoxicillin and clarithromycin is at least 14 days.
Increasing the duration of PPI-based triple therapy increases H. pylori eradication rates. For PCA, prolonging treatment duration from 7 to 10 or from 10 to 14 days is associated with a significantly higher eradication rate. The optimal duration of therapy for PCA and PAN is at least 14 days. More data are needed to confirm if there is any benefit of increasing the duration of therapy for PCN therapy. Information is limited for regimens other than PPI triple therapy more studies are needed to draw meaningful conclusions for optimal duration of other H. pylori eradication regimens.
The primary objective was to assess the relative effectiveness of different durations of a variety of regimens for eradicating H. pylori. The primary outcome was H. pylori persistence. The secondary outcome was adverse events.
Treatment For H Pylori
If you have ulcers caused by H. pylori, youâll need treatment to kill the germs, heal your stomach lining, and keep the sores from coming back. It usually takes 1 to 2 weeks of treatment to get better.
Your doctor will probably tell you to take a few different types of drugs. The options include:
- Antibiotics to kill the bacteria in your body, such as amoxicillin, clarithromycin , metronidazole , tetracycline , or tinidazole . Youâll most likely take at least two from this group.
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Tailored Eradication Therapy For H Pylori Infection Based On Culture Test
Determining the antibiotic susceptibility using either culture or genetic testing or both is useful to increase the eradication rate, particularly in populations with a high rate of infection with drug-resistant strains. Tailored eradication therapies are promising for significantly increasing successful outcomes compared to standard therapies, particularly in areas with a high prevalence of CLR-resistant strains . A tailored treatment regimen based on susceptibility to CLR achieved a 94.3% eradication rate, which is significantly higher than that achieved with standard treatment . Currently, no study has examined the efficacy of VPZ-containing tailored eradication therapy based on susceptibility to CLR. Because the eradication rate of VPZ-containing triple regimen in patients infected with CLR -resistant strains is around 80%, tailored eradication is expected to improve the effectiveness of these therapies.
Helicobacter Pylori Infection And Eradication Outcomes Among Vietnamese Patients In The Same Households: Findings From A Non
Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Writing original draft, Writing review & editing
Affiliations Institute of Gastroenterology and Hepatology, Hanoi, Vietnam, Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
Roles Data curation, Investigation, Project administration, Writing original draft
Affiliation Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
Roles Conceptualization, Data curation, Investigation, Methodology, Project administration
Affiliation Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
Roles Data curation, Formal analysis, Writing review & editing
Affiliation Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
Roles Data curation, Methodology, Writing original draft
Affiliation Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
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Two Key Questions Guide H Pylori Treatment
The best and most cost-effective treatments for H. pylori infection are the ones that work.
As one of the most common chronic bacterial infections, Helicobacter pylori is a known enemy due to its potential to cause peptic ulcer disease and gastric cancer. But in today’s era of antibiotic resistance, the infection now requires more ammunition to be defeated.
For many years, standard treatment for H. pylori was clarithromycin triple therapy, a combination of clarithromycin, amoxicillin or metronidazole, and a proton-pump inhibitor for 14 days. But the three-part regimen has fallen out of favor, said gastroenterologist Colin W. Howden, MD, during his session on common upper GI problems at Internal Medicine Meeting 2018.
In large parts of the country, I would say that this should no longer be recommended and this treatment is largely obsolete, he said.
So what are the best and most cost-effective treatments for H. pylori infection? Simply put, the ones that work, said Dr. Howden, professor of medicine at the University of Tennessee Health Science Center in Memphis.
Irrespective of dollars and cents, the most expensive treatment is the one that doesn’t work, he said. And there are a heck of a lot of treatments out there for H. pylori that don’t work.
Sample Size And Statistical Analysis
We reviewed English medical literature for Helicobacter Pylori doxycycline-based therapy and found a systematic review authored by Niv .There arent new studies yet. We reviewed the studies within it and found that nine clinical trials excluded bismuth, two clinical trials replaced proton pump inhibitors with ranitidine, and two clinical trials used different doxycycline therapeutic protocol . The remaining two studies: Borody TJ et al. reported the eradication rate of doxycycline based therapy as first line treatment and it was 0.65 ,while Wang et al. reported the eradication rate of doxycycline based therapy as second-line treatment based on ITT, It was 0.6744 . Those results were close and we chose the highest eradication rate. Federico et al. found that the eradication rate based on ITT was 0.922% in concomitant levofloxacin-containing therapy . To find if concomitant levofloxacin-containing regimen was more effective than doxycycline-based regimen we conducted a clinical trial with superior study design. We used a power of 80%, two tails test and significance level equal to 5%, with a 1:1 allocation ratio. Each treatment arm required 37 patients . We added two patients to each group to compensate for the predicted dropout .
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Treatment Regimen Of H Pylori Eradication
For all the 261 patients, whether they were treated for the first time or re-treated, bismuth quadruple therapy was used and the two antibiotics were chosen based on the results of antibiotic resistance by molecular pathologic examinations. In our study, seven patients were not treated by any regimen because 6 patients were resistant to all available antibiotics and one patient was intractable . In the 254 patients who received H. pylori eradication therapy, four treatment regimens were used for more than 90% of them , including AMPC + CAM , AMPC + FLQ , AMPC + TET , and AMPC + FZD . Between first-treated and re-treated patients, significant differences were found for all these four regimens .
Table 3 Treatment Regimen of H. pylori Eradication
Eradication Therapy For Helicobacter Pylori
- Nimish VakilCorrespondenceAddress requests for reprints to: Nimish Vakil, MD, Aurora-Sinai Medical Center, 945 North 12th Street, Room 4040, Milwaukee, Wisconsin 53233. fax: 219-7108.Department of Medicine, University of Wisconsin School of Medicine and Public Health, MadisonMarquette University College of Health Sciences, Milwaukee, Wisconsin
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Can I Be Re
Once you have had successful treatment of H. pylori, the chance of being re-infected is very low because most infections occur in childhood. It is very rare to get it as an adult. If you have recurrent symptoms it is most likely because the medication to get rid of the bacteria has not worked, rather than you have been re-infected with the bacteria again.
Helicobacter Pylori Infection Treatment
Regimens for eradication of Helicobacter pylori infection are typically chosen empirically, on the basis of regional bacterial resistance patterns, local recommendations, and drug availability. Health care providers should ask their patients about any prior antibiotic use or exposure, and take that information into consideration before choosing a treatment regimen. The following regimens are described below :
- Triple therapy
- Concomitant bismuth and levofloxacin-containing therapy
- Second-line therapy
- Rescue or third-line therapy
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Should We Test For Treatment Success After H Pylori Eradication Therapy
Because of the declining success rate of H. pylori eradication therapy, persistent infection is not uncommon after treatment. A urea breath test, fecal antigen testing, or biopsy-based testing should be used to determine treatment success. Testing should be performed at least four weeks after completion of antibiotic therapy and after PPI therapy has been withheld for one to two weeks. Although the recommendation for posttesting is intuitive, the scientific evidence regarding the cost-effectiveness of such testing is lacking, except for the scenario of bleeding peptic ulcers.
Recent Insights Into Antibiotic Resistance In Helicobacter Pylori Eradication
1Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China
Antibiotics have been useful in the treatment of H. pylori-related benign and malignant gastroduodenal diseases. However, emergence of antibiotic resistance often decreases the eradication rates of H. pylori infections. Many factors have been implicated as causes of treatment failure, but the main antibiotic resistance mechanisms described to date are due to point mutations on the bacterial chromosome, a consequence of a significantly phenotypic variation in H. pylori. The prevalence of antibiotic resistance varies among different countries it appears to be partly determined by geographical factors. Since the worldwide increase in the rate of antibiotic resistance represents a problem of relevance, some studies have been performed in order to identify highly active and well-tolerated anti-H. pylori therapies including sequential, concomitant quadruple, hybrid, and quadruple therapy. These represent a promising alternatives in the effort to overcome the problem of resistance. The aim of this paper is to review the current status of antibiotic resistance in H. pylori eradication, highlighting the evolutionary processes in detail at alternative approaches to treatment in the past decade. The underlying resistance mechanisms will be also followed.
2. Nature of H. Pylori and Intragastric Environment
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What Factors Predict Successful Eradication When Treating H Pylori Infection
Determinants of success can be related to patient factors or to the infection. The main determinants are choice of regimen, patient adherence to a multidrug regimen with frequent adverse effects, and the sensitivity of the H. pylori strain to the combination of antibiotics used. The number of doses per day and the severity of adverse effects influence treatment adherence. It is important for physicians to discuss the benefits and challenges of therapy before beginning the regimen. Other patient factors, such as cigarette smoking, diabetes mellitus, and genetics, may also have a role in treatment failure.
Of the infection-related factors, antibiotic sensitivity was found to be the most important determinant of treatment success in clinical trials and population-based studies. Resistance to clarithromycin, metronidazole, and levofloxacin limits their effectiveness and increases the prevalence of H. pylori infection. Resistance to amoxicillin, tetracycline, and rifabutin is rare.
What Are The Indications For H Pylori Testing And Treatment
Testing for H. pylori is indicated in certain patients. Any patient who tests positive for H. pylori infection should be treated.
All patients with active or previous peptic ulcer disease should be tested for H. pylori infection unless there is documentation that the infection was previously cured. Patients with low-grade gastric mucosaassociated lymphoid tissue lymphoma or a history of endoscopic resection of early gastric cancer should also be tested. Testing in patients with gastroesophageal reflux disease is not recommended unless the patient has a history of peptic ulcer disease or dyspepsia. If a patient with gastroesophageal reflux disease is tested and found to have H. pylori infection, treatment should be offered with the acknowledgment that symptoms of gastroesophageal reflux disease are unlikely to improve.
Based on low-quality evidence, the ACG also recommends testing for those initiating long-term nonsteroidal anti-inflammatory drug therapy, those with unexplained iron deficiency anemia, and adults with idiopathic thrombocytopenic purpura.
There is insufficient evidence to make a recommendation about testing and treatment in asymptomatic patients with a family history of gastric cancer or in patients with lymphocytic gastritis, hyperplastic gastric polyps, or hyperemesis gravidarum.
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Side Effects Of Triple Therapy H Pylori Treatment
The side effects of triple therapy H pylori treatment vary widely and can be pretty nasty, if Im honest.
I didnt take triple therapy when I had H pylori I decided on a more natural, herb-based approach.
But weve received hundreds of emails from frustrated people having a really hard time on triple therapy.
As Ive said before: I dont necessarily disagree with triple therapy, but I want to raise awareness of its drawbacks so folk like you can make informed decisions on what to do.
Ill be a happy man if you can avoid feeling really bad during treatment, and minimize your chances of developing other symptoms as a result of triple therapy
This article emphasizes some of the main problems associated with taking triple therapy that you might not hear about from your doc.
As always, theres a video followed by some writing it wont take you long to consume .
H pylori treatment doesnt always work
One of the most frustrating things about H pylori treatment is that a lot of docs assume it works every time.
In fact, research shows clearly that triple therapy works about 70% of the time.
Some studies even show success rates as low as 50%.
I dont say this to seem cool or suggest that antibiotics shouldnt be used for H pylori treatment.
Im simply sharing the info with you so that you have a balance of data on which to base your treatment decisions.
For those of you whod like to see the research, its here.
H Pylori Eradication Therapy
Helicobacter pylori: triple therapy :
- offer people who test positive for H pylori a 7-day, twice-daily course of treatment with:
- a PPI and
- amoxicillin 1g and
- either clarithromycin 500mg or metronidazole 400mg
Second-line treatment in adults
- offer people who still have symptoms after first-line eradication treatment a 7-day, twice-daily course of treatment with:
- a PPI and
- amoxicillin 1g bd and
- either clarithromycin 500mg bd or metronidazole 400mg bd
Seek advice from a gastroenterologist if eradication of H pylori is not successful with second-line treatment
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