Helicobacter pylori - Revision history

Aidan at 18:12, 19 September 2024

2024-09-19T18:12:07Z

← Older revision		Revision as of 18:12, 19 September 2024
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	* Present worldwide		* Present worldwide
			* About half of the world's population is estimated to have chronic infection[[CiteRef::zamani2018sy]]
	* About half of the world's population is estimated to have chronic infection<ref>Zamani M, Ebrahimtabar F, Zamani V, Miller WH, Alizadeh-Navaei R, Shokri-Shirvani J, Derakhshan MH. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018 Apr;47(7):868-876. doi: [https://doi.org/10.1111/apt.14561 10.1111/apt.14561]. Epub 2018 Feb 12. PMID: [https://pubmed.ncbi.nlm.nih.gov/29430669/ 29430669].</ref>
	* Usually acquired during infancy or childhood		* Usually acquired during infancy or childhood
	* Transmission is likely fecal-oral or oral-oral		* Transmission is likely fecal-oral or oral-oral
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	* Non-invasive testing, and preferred to pediatric patients		* Non-invasive testing, and preferred to pediatric patients
	* Based on ELISA, immunochromatographic assay, and CLIA		* Based on ELISA, immunochromatographic assay, and CLIA
	* Affected by PPIs (should be held for 7-14 days)<ref>Manes G, Balzano A, Iaquinto G, Ricci C, Piccirillo MM, Giardullo N, Todisco A, Lioniello M, Vaira D. Accuracy of the stool antigen test in the diagnosis of Helicobacter pylori infection before treatment and in patients on omeprazole therapy. ''Aliment Pharmacol Ther''. 2001 Jan;15(1):~~73-9. doi~~: ~~[https://doi.org/10.1046/j.1365-2036.2001.00907.x 10.1046/j.1365-2036.2001.00907.x~~]~~. PMID: [https://pubmed.ncbi.nlm.nih.gov/11136280/ 11136280~~]~~.</ref>~~, antibiotics, bismuth-containing medications, and [[N-acetylcysteine]]		* Affected by PPIs (should be held for 7-14 days)[[CiteRef::manes2001ac]], antibiotics, bismuth-containing medications, and [[N-acetylcysteine]]
	* Sample is temperature sensitive: max 24 hours at room temperature, 72 hours at 4ºC, or long-term if frozen		* Sample is temperature sensitive: max 24 hours at room temperature, 72 hours at 4ºC, or long-term if frozen

Aidan at 14:44, 2 May 2024

2024-05-02T14:44:32Z

← Older revision		Revision as of 14:44, 2 May 2024
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	*Treatment is with combination therapy for 14 days followed by confirmation of eradication		*Treatment is with combination therapy for 14 days followed by confirmation of eradication
	*First-line:		*First-line:
	**[[PBMT]] (~~PPI,~~ bismuth, [[metronidazole]], [[tetracycline~~]])~~ ~~(BMT~~ ~~Quad)~~		**[[PBMT]] (BMT Quad): bismuth subsalicylate 524 mg p.o. four time daily, metronidazole 500 mg p.o. three to four times daily, tetracycline 500 mg p.o. four times daily for 14 days
	**[[PAMC]] (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]]) ~~(CLAMET~~ ~~Quad)~~		**[[PAMC]] (CLAMET Quad): PPI twice daily, [[amoxicillin]] 1 g p.o. twice daily, metronidazole 500 mg p.o. twice daily, and [[clarithromycin]] 500 mg p.o. twice daily for 14 days
	**[[PAC]] (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or [[PAM]] (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with [[clarithromycin]] resistance <15% or with proven high local eradication rates >85%		**[[PAC]] (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or [[PAM]] (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with [[clarithromycin]] resistance <15% or with proven high local eradication rates >85%
	*Prior treatment failure:		*Prior treatment failure:
	**[[PBMT]] (PPI, bismuth, [[metronidazole]], [[tetracycline]])		**[[PBMT]]: PPI twice daily, bismuth subsalicylate 524 mg p.o. four times daily, [[metronidazole]] 500 mg p.o. three to four times daily, [[tetracycline]] 500 mg p.o. four times daily
			**[[PAL]]: PPI twice daily, [[levofloxacin]] 500 mg p.o. once daily, and [[amoxicillin]] 750 mg p.o. three times daily for 14 days
	**[[PAL]] (PPI, [[amoxicillin]], [[levofloxacin]])
	**[[PAR]] (PPI, [[amoxicillin]], [[rifabutin~~]])~~ ~~for~~ 10 ~~days,~~ as ~~last~~-~~line~~		**[[PAR]]: PPI twice daily, amoxicillin 750 mg p.o. three times daily, and rifabutin 300 mg p.o. once daily for 10-14 days
		⚫	*Duration generally 14 days
	*Doses:
	**[[PBMT]]
	***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid
	***[[Metronidazole]] 500 mg PO tid or qid
	***PPI: [[esomeprazole]] 20 mg, [[lansoprazole]] 30 mg, [[omeprazole]] 20 mg, [[pantoprazole]] 40 mg, or [[rabeprazole]] 20 mg
	****Some areas use double dosing
	***[[Tetracycline]] 500 mg PO qid
	**Others
	***[[Amoxicillin]] 1000 mg PO bid
	***[[Clarithromycin]] 500 mg PO bid
	***[[Levofloxacin]] 500 mg PO daily
	***[[Metronidazole]] 500 mg PO bid
	***[[Rifabutin]] 150 mg PO bid
	***PPI as above
⚫	*Duration: 14 days
	*Confirmation of eradication should be done 4 weeks following treatment		*Confirmation of eradication should be done 4 weeks following treatment
	*Recommended order of treatment, if persistently positive:		*Recommended order of treatment, if persistently positive:
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	** [[Levofloxacin]] resistance is caused by point mutations in DNA gyrase (''gyrA'' or ''gyrB'')		** [[Levofloxacin]] resistance is caused by point mutations in DNA gyrase (''gyrA'' or ''gyrB'')
	** [[Tetracycline]] resistance is uncommon and not fully understood		** [[Tetracycline]] resistance is uncommon and not fully understood
	** [[Rifabutin]] resistance is uncommon caused by mutations in DNA-dependent RNA polymerase		** [[Rifabutin]] resistance is uncommon and caused by mutations in DNA-dependent RNA polymerase
	* The most important regional rates of resistance to pay attention to when choosing empiric treatment is to [[clarithromycin]] and [[metronidazole]], since they are most frequent		* The most important regional rates of resistance to pay attention to when choosing empiric treatment is to [[clarithromycin]] and [[metronidazole]], since they are most frequent

Aidan: /* Management */

2024-01-03T16:01:53Z

Management

← Older revision		Revision as of 16:01, 3 January 2024
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	**[[PBMT]]		**[[PBMT]]
	***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid		***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid
	***[[Metronidazole]] 500 MG PO tid or qid		***[[Metronidazole]] 500 mg PO tid or qid
	***PPI: [[esomeprazole]] 20 mg, [[lansoprazole]] 30 mg, [[omeprazole]] 20 mg, [[pantoprazole]] 40 mg, or [[rabeprazole]] 20 mg		***PPI: [[esomeprazole]] 20 mg, [[lansoprazole]] 30 mg, [[omeprazole]] 20 mg, [[pantoprazole]] 40 mg, or [[rabeprazole]] 20 mg
	****Some areas use double dosing		****Some areas use double dosing

Aidan at 15:15, 2 October 2022

2022-10-02T15:15:33Z

← Older revision		Revision as of 15:15, 2 October 2022
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	[[File:Prevalence of ''Helicobacter pylori'' infection across the world.jpg\|thumb\|Prevalence of Helicobacter pylori infection across the world. From: Zamani ''et al''. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. ''Aliment Pharmacol Ther''. 2018;47(7):868-876. doi: [https://doi.org/10.1111/apt.14561 10.1111/apt.14561].]]		[[File:Prevalence of ''Helicobacter pylori'' infection across the world.jpg\|thumb\|Prevalence of Helicobacter pylori infection across the world. From: Zamani ''et al''. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. ''Aliment Pharmacol Ther''. 2018;47(7):868-876. doi: [https://doi.org/10.1111/apt.14561 10.1111/apt.14561].]]

			== Clinical Manifestations ==

			* Mostly asymptomatic
			* Complications include:
			** Peptic ulcer disease in 1 to 10%
			** Gastric cancer in 0.1 to 3%
			** MALT lymphoma in 0.01%

			== Diagnosis ==

			* Gastroscopy with biopsy for histopathology is the gold standard
			* Culture is challenging but necessary for phenotyping susceptibility testing

			=== Urea Breath Test ===

			* Patient is fed urea labelled with <sup>13</sup>C or <sup>14</sup>C isotopes, which is hydrolyzed into ammonia and isotope-labelled CO<sub>2</sub>, which is detected in exhaled breath 30 minutes later and measured by mass spectrometry (or other method)
			** The delta over baseline (DOB) (i.e. increase in labelled CO<sub>2</sub>) is compared to a threshold
			** Cutoff DOB is usually 5%
			* False negatives may be seen with PPIs (which should be held for 7 days before test), recent antibiotics (should be off of them for 4 weeks before test), bleeding ulcers (should be resolved before test), and corpus-predominant gastritis
			* False positives may be seen with [[Helicobacter heilmannii]] and rarely with other [[urease-producing organisms]] such as [[Proteus mirabilis]], [[Citrobacter freundii]], [[Klebsiella pneumoniae]], [[Enterobacter cloacae]], [[Staphylococcus aureus]], [[Staphylococcus capitis]] subsp. ''urealyticus''

			=== Stool Antigen Test ===

			* Non-invasive testing, and preferred to pediatric patients
			* Based on ELISA, immunochromatographic assay, and CLIA
			* Affected by PPIs (should be held for 7-14 days)<ref>Manes G, Balzano A, Iaquinto G, Ricci C, Piccirillo MM, Giardullo N, Todisco A, Lioniello M, Vaira D. Accuracy of the stool antigen test in the diagnosis of Helicobacter pylori infection before treatment and in patients on omeprazole therapy. ''Aliment Pharmacol Ther''. 2001 Jan;15(1):73-9. doi: [https://doi.org/10.1046/j.1365-2036.2001.00907.x 10.1046/j.1365-2036.2001.00907.x]. PMID: [https://pubmed.ncbi.nlm.nih.gov/11136280/ 11136280].</ref>, antibiotics, bismuth-containing medications, and [[N-acetylcysteine]]
			* Sample is temperature sensitive: max 24 hours at room temperature, 72 hours at 4ºC, or long-term if frozen

			=== Serology ===

			* Includes IgM, IgA, and IgG antibodies
			* More false positives with IgA and IgM
			* Post-treatment IgG titres can take 6-12 months to fall below 50% compared to pre-treatment
			* Not affected by concurrent medications, unlike other non-invasive tests
			* Accuracy varies by strain, so ideally should use locally-validated tests

			=== Test of Cure ===

			* Urea breath test is preferred to stool antigen
			* Serology not helpful

	==Management==		==Management==
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	*Treatment is with combination therapy for 14 days followed by confirmation of eradication		*Treatment is with combination therapy for 14 days followed by confirmation of eradication
	*First-line:		*First-line:
	**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]]) (BMT Quad)		**[[PBMT]] (PPI, bismuth, [[metronidazole]], [[tetracycline]]) (BMT Quad)
	**PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]]) (CLAMET Quad)		**[[PAMC]] (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]]) (CLAMET Quad)
	**PAC (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or PAM (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%		**[[PAC]] (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or [[PAM]] (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with [[clarithromycin]] resistance <15% or with proven high local eradication rates >85%
	*Prior treatment failure:		*Prior treatment failure:
	**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])		**[[PBMT]] (PPI, bismuth, [[metronidazole]], [[tetracycline]])
	**PAL (PPI, [[amoxicillin]], [[levofloxacin]])		**[[PAL]] (PPI, [[amoxicillin]], [[levofloxacin]])
	**PAR (PPI, [[amoxicillin]], [[rifabutin]]) for 10 days, as last-line		**[[PAR]] (PPI, [[amoxicillin]], [[rifabutin]]) for 10 days, as last-line
	*Doses:		*Doses:
	**PBMT		**[[PBMT]]
	***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid		***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid
	***[[Metronidazole]] 500 MG PO tid or qid		***[[Metronidazole]] 500 MG PO tid or qid
	***PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg		***PPI: [[esomeprazole]] 20 mg, [[lansoprazole]] 30 mg, [[omeprazole]] 20 mg, [[pantoprazole]] 40 mg, or [[rabeprazole]] 20 mg
	****Some areas use double dosing		****Some areas use double dosing
	***Tetracycline 500 mg PO qid		***[[Tetracycline]] 500 mg PO qid
	**Others		**Others
	***Amoxicillin 1000 mg PO bid		***[[Amoxicillin]] 1000 mg PO bid
	***Clarithromycin 500 mg PO bid		***[[Clarithromycin]] 500 mg PO bid
	***Levofloxacin 500 mg PO daily		***[[Levofloxacin]] 500 mg PO daily
	***Metronidazole 500 mg PO bid		***[[Metronidazole]] 500 mg PO bid
	***Rifabutin 150 mg PO bid		***[[Rifabutin]] 150 mg PO bid
	***PPI as above		***PPI as above
	*Duration: 14 days		*Duration: 14 days
	*Confirmation of eradication should be done 4 weeks following treatment		*Confirmation of eradication should be done 4 weeks following treatment
	*Recommended order of treatment, if persistently positive:		*Recommended order of treatment, if persistently positive:
	**PBMT (or PAMC)		**[[PBMT]] (or [[PAMC]])
	**PAMC (or PBMT)		**[[PAMC]] (or [[PBMT]])
	**PAL		**[[PAL]]
	**PAR vs. repeat endoscopy for culture and susceptibility testing		**[[PAR]] vs. repeat endoscopy for culture and susceptibility testing

			=== Antibiotic Resistance ===

			* Mechanisms:
			** [[Amoxicillin]] resistance is caused by modified PBPs (rather than [[β-lactamases]])
			** [[Clarithromycin]] resistance is caused by point mutations in the 23S rRNA of 50S ribosomal subunit
			** [[Metronidazole]] resistance is caused by mutations in RdxA and FrxA enzymes
			** [[Levofloxacin]] resistance is caused by point mutations in DNA gyrase (''gyrA'' or ''gyrB'')
			** [[Tetracycline]] resistance is uncommon and not fully understood
			** [[Rifabutin]] resistance is uncommon caused by mutations in DNA-dependent RNA polymerase
			* The most important regional rates of resistance to pay attention to when choosing empiric treatment is to [[clarithromycin]] and [[metronidazole]], since they are most frequent

	==Further Reading==		==Further Reading==

Aidan: Added pathophys and epidemiology, including a map

2022-10-02T13:36:23Z

Added pathophys and epidemiology, including a map

@@ Line 3: / Line 3: @@
 *Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
 *Oxidase-[[Oxidase::positive]] and urease-[[Urease::positive]]
-*Major cause of peptic ulcer disease and gastric cancer
+*Major cause of peptic ulcer disease and gastric cancer worldwide
 ==Management==

Aidan: /* Management */

2021-04-14T14:35:29Z

Management

← Older revision		Revision as of 14:35, 14 April 2021
Line 15:		Line 15:
	**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])		**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
	**PAL (PPI, [[amoxicillin]], [[levofloxacin]])		**PAL (PPI, [[amoxicillin]], [[levofloxacin]])
	**PAR (PPI, [[amoxicillin]], [[rifabutin]]) as last-line		**PAR (PPI, [[amoxicillin]], [[rifabutin]]) for 10 days, as last-line
	*Doses:		*Doses:
	**PBMT		**PBMT
Line 32:		Line 32:
	*Duration: 14 days		*Duration: 14 days
	*Confirmation of eradication should be done 4 weeks following treatment		*Confirmation of eradication should be done 4 weeks following treatment
			*Recommended order of treatment, if persistently positive:
			**PBMT (or PAMC)
			**PAMC (or PBMT)
			**PAL
			**PAR vs. repeat endoscopy for culture and susceptibility testing

	== Further Reading ==		==Further Reading==

	* ''H. pylori'' Enhanced Primary Care Pathway: [[2016 version]], [https://divisionsbc.ca/sites/default/files/inline-files/HPYLORI%20Enhanced%20Primary%20Care%20Pathway%202019_0.pdf 2019 version], [https://www.specialistlink.ca/files/HPylori_PCPathway_April112020.pdf 2020 version]		*''H. pylori'' Enhanced Primary Care Pathway: [[2016 version]], [https://divisionsbc.ca/sites/default/files/inline-files/HPYLORI%20Enhanced%20Primary%20Care%20Pathway%202019_0.pdf 2019 version], [https://www.specialistlink.ca/files/HPylori_PCPathway_April112020.pdf 2020 version]
	* The Toronto Consensus for the Treatment of ''Helicobacter pylori'' Infection in Adults. ''Gastroenterol''. 2016;151:51–69. doi: [https://doi.org/10.1053/j.gastro.2016.04.006 10.1053/j.gastro.2016.04.006]		*The Toronto Consensus for the Treatment of ''Helicobacter pylori'' Infection in Adults. ''Gastroenterol''. 2016;151:51–69. doi: [https://doi.org/10.1053/j.gastro.2016.04.006 10.1053/j.gastro.2016.04.006]
	* Houston Consensus Conference on Testing for ''Helicobacter pylori'' Infection in the United States. ''Clin Gastroenterol Hepatol''. 2018;16(7):992-1002.e6. doi: [https://doi.org/10.1016/j.cgh.2018.03.013 10.1016/j.cgh.2018.03.013]		*Houston Consensus Conference on Testing for ''Helicobacter pylori'' Infection in the United States. ''Clin Gastroenterol Hepatol''. 2018;16(7):992-1002.e6. doi: [https://doi.org/10.1016/j.cgh.2018.03.013 10.1016/j.cgh.2018.03.013]
	{{DISPLAYTITLE:''Helicobacter pylori''}}		{{DISPLAYTITLE:''Helicobacter pylori''}}
	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

Aidan at 01:45, 8 March 2021

2021-03-08T01:45:53Z

← Older revision		Revision as of 01:45, 8 March 2021
Line 1:		Line 1:
	== Background ==		==Background==

	*Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance		*Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
Line 5:		Line 5:
	*Major cause of peptic ulcer disease and gastric cancer		*Major cause of peptic ulcer disease and gastric cancer

	== Management ==		==Management==

			*Treatment is with combination therapy for 14 days followed by confirmation of eradication
⚫	* Duration: 14 days
	* First-line:		*First-line:
	** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])		**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]]) (BMT Quad)
	** PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]])		**PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]]) (CLAMET Quad)
	** PAC (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or PAM (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%		**PAC (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or PAM (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%
	* Prior treatment failure:		*Prior treatment failure:
	** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])		**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
	** PAL (PPI, [[amoxicillin]], [[levofloxacin]])		**PAL (PPI, [[amoxicillin]], [[levofloxacin]])
	** PAR (PPI, [[amoxicillin]], [[rifabutin]]) as last-line		**PAR (PPI, [[amoxicillin]], [[rifabutin]]) as last-line
	* Doses:		*Doses:
	** PBMT		**PBMT
	*** Bismuth subsalicylate ~~262~~ mg 2 tablets PO qid		***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid
	*** [[Metronidazole]] 500 MG PO tid or qid		***[[Metronidazole]] 500 MG PO tid or qid
	*** PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg		***PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg
	**** Some areas use double dosing		****Some areas use double dosing
	*** Tetracycline 500 mg PO qid		***Tetracycline 500 mg PO qid
	** Others		**Others
	*** Amoxicillin 1000 mg PO bid		***Amoxicillin 1000 mg PO bid
	*** Clarithromycin 500 mg PO bid		***Clarithromycin 500 mg PO bid
	*** Levofloxacin 500 mg PO daily		***Levofloxacin 500 mg PO daily
	*** Metronidazole 500 mg PO bid		***Metronidazole 500 mg PO bid
	*** Rifabutin 150 mg PO bid		***Rifabutin 150 mg PO bid
	*** PPI as above		***PPI as above
		⚫	*Duration: 14 days
			*Confirmation of eradication should be done 4 weeks following treatment

			== Further Reading ==

			* ''H. pylori'' Enhanced Primary Care Pathway: [[2016 version]], [https://divisionsbc.ca/sites/default/files/inline-files/HPYLORI%20Enhanced%20Primary%20Care%20Pathway%202019_0.pdf 2019 version], [https://www.specialistlink.ca/files/HPylori_PCPathway_April112020.pdf 2020 version]
			* The Toronto Consensus for the Treatment of ''Helicobacter pylori'' Infection in Adults. ''Gastroenterol''. 2016;151:51–69. doi: [https://doi.org/10.1053/j.gastro.2016.04.006 10.1053/j.gastro.2016.04.006]
			* Houston Consensus Conference on Testing for ''Helicobacter pylori'' Infection in the United States. ''Clin Gastroenterol Hepatol''. 2018;16(7):992-1002.e6. doi: [https://doi.org/10.1016/j.cgh.2018.03.013 10.1016/j.cgh.2018.03.013]
	{{DISPLAYTITLE:''Helicobacter pylori''}}		{{DISPLAYTITLE:''Helicobacter pylori''}}
	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

Aidan at 01:37, 8 March 2021

2021-03-08T01:37:09Z

← Older revision		Revision as of 01:37, 8 March 2021
Line 1:		Line 1:
			== Background ==
⚫	* Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
⚫	* Oxidase-[[Oxidase::positive]] and urease-[[Urease::positive]]
⚫	* Major cause of peptic ulcer disease and gastric cancer

		⚫	*Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
		⚫	*Oxidase-[[Oxidase::positive]] and urease-[[Urease::positive]]
		⚫	*Major cause of peptic ulcer disease and gastric cancer

			== Management ==

			* Duration: 14 days
			* First-line:
			** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
			** PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]])
			** PAC (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or PAM (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%
			* Prior treatment failure:
			** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
			** PAL (PPI, [[amoxicillin]], [[levofloxacin]])
			** PAR (PPI, [[amoxicillin]], [[rifabutin]]) as last-line
			* Doses:
			** PBMT
			*** Bismuth subsalicylate 262 mg 2 tablets PO qid
			*** [[Metronidazole]] 500 MG PO tid or qid
			*** PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg
			**** Some areas use double dosing
			*** Tetracycline 500 mg PO qid
			** Others
			*** Amoxicillin 1000 mg PO bid
			*** Clarithromycin 500 mg PO bid
			*** Levofloxacin 500 mg PO daily
			*** Metronidazole 500 mg PO bid
			*** Rifabutin 150 mg PO bid
			*** PPI as above
	{{DISPLAYTITLE:''Helicobacter pylori''}}		{{DISPLAYTITLE:''Helicobacter pylori''}}
	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

Aidan at 01:24, 8 March 2021

2021-03-08T01:24:49Z

← Older revision		Revision as of 01:24, 8 March 2021
Line 1:		Line 1:
	* Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance		* Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
	* Oxidase-positive]] and [[Urease ~~test::urease [[Oxidase~~::positive]]		* Oxidase-[[Oxidase::positive]] and urease-[[Urease::positive]]
	* Major cause of peptic ulcer disease and gastric cancer		* Major cause of peptic ulcer disease and gastric cancer

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

2020-10-08T14:23:35Z

Text replacement - "[[Cellular shape::" to "[[Shape::"

← Older revision		Revision as of 14:23, 8 October 2020
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	* Slow-growing [[Stain::Gram-negative]] microaerophilic [[~~Cellular shape~~::bacillus]] with a curve, gull-wing, or spiral appearance		* Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
	* Oxidase-positive]] and [[Urease test::urease [[Oxidase::positive]]		* Oxidase-positive]] and [[Urease test::urease [[Oxidase::positive]]
	* Major cause of peptic ulcer disease and gastric cancer		* Major cause of peptic ulcer disease and gastric cancer