60% of gastric cancer is from Hp
Who should be tested – PUD, MALT lymphoma, unexplained dyspepsia, long term NSAID, family history of gastric cancer
All consider treatment in unexplained iron def, chronic ITP, and atrophic gastritis
False neg with recent GI bleeding and PPI use.
Different stains besides H and E include giemsa, immunohistologic, warthin starry stain
Urea C 13 and C 14 breath test.
ELISA test is good for pt in heavily infected population
Stool antigen detection – monocloconal better than polyclonal Ab
UBT and stool should only be done 4 weeks after stopping PPI and 4 weeks after completing antibiotics
PPI suppresses Hp growth
Check out uptodate for different regimens.
Levaquin based triple therapy, quadruple therapy, sequential therapy
Peptobismol, tetracycline, flagyl for 14 days (Helidac)
Dual antibiotic metronidazole, clarithromycin or amoxicillin for 10 days. ( Clarithro or Amoxicillin) and PPI bid. Now cure rate is 70%
Quadruple therapy, tetracycline, BSS, flagyl and PPI bid. Can substitute tetra with doxycycline 100 bid and clarithromycin bid instead of tetracycline
Sequential therapy : PPI and amoxicillin for 5 days, then PPI tinidazole and clarithromycin for subsequent 5 days. Italian study 90% eradication
Tinidazole based triple therapy is better
Quadruple can use levaquin instead of clarithromycin
LOAD ( levaquin, omeprazole, alinia (nitaxoxinide), doxycline) ( 250 mg levaquin, 40 ome, alinia 500 bid, doxy 100 bid
If patient has HP, persistent dyspepsia, MALT lymphoma and gastric cancer MUST confirm eradication.
Antimicrobial resistance – amoxicillin less than 1 tetrac 1 %, flagyl 35% resistance and biaxin resistance is 10%.
Prevpac do not use it. High Biaxin resistance
Consider using Saccharomyces boulardi might promotie eradication and decrease side effect rate of treatment
Or give yogurt 3 weeks before starting treatment (Japan study). (lactobacillus gasstri)
For treatment of NUD, NNT is 14 so it is low yield. (Hp treatment)