H. Pylori Chalk Talk
Before an encounter:
HPI:
RF: H. pylori, NSAIDs, Zollinger ellison syndrome, smoking, alcohol, emotional stress
Clx: Epigastric pain, aching or gnawing, nocturnal symptoms and pain during food intake, weight loss
Meds
PSHx: Tobacco Alcohol, drugs
Labs / Imaging: Endoscopy + bx, Barium Swallow, Urea breath test, serology, fecal antigen test
A/P:
- H. Pylori cure: PPI, amoxicillin, clarithromycin 14 days, quadruple: ppi, bismuth, metronidazole, tetracycline)
- Supportive: discontinue NSAIDs, restrict alcohol, stop smoking, avoiding eating before bedtime
- Acid suppression: PPIs omeprazole, lansoprazole. H2 receptor blockers: cimetidine, ranitidine. Antacids: aluminum hydroxide, calcium carbonate, bismuth subsalicylate
Peptic ulcer disease (gastric, duodenal)
Most common causes NSAIDs H pylori
PH = 2 in stomach what protects against acidity: 1.) Bicarbonate Secretion 2.) Stomach epithelium 3.) Blood flow one.
Diagnoses: Hydrogen breath test, h. pylori stool antigen test, biopsy with endoscopy, h pylori serology
Peptic ulcer disease is diagnosed via from most sensitive to the least sensitive
Hydrogen breast test, h pylori stool antigen test, biopsy, h pylori serology
Hydrogen breast test has a lot of false negatives because 90% of individuals utilize proton pump inhibitors. You cannot use proton pump inhibitors within the last two to three weeks
Why is H pylori serology used in ICU setting. In the ICU setting if a patient if a patient is coming in with H pylori gastritis with peptic ulcer disease and a upper GI bleed, then most oftentimes they will already have been started on a proton pump inhibitor And so the breath test doesn’t work. The stool antigen test may not work if they are not having regular bowel movements. Biopsy may not work because going down with an EGD may harm the patient with suspected upper GI bleed. The H pylori serology has both IGG and IGM components the problem with the serology is once it is positive it will always be positive So you’re banking on the fact that for patients in the ICU they have never been diagnosed with h pylori gastritis.
Treatment for H pylori gastritis is with quadruple therapy now.
So the guidelines are you do a urea breast test if it is positive then you start with quadruple therapy. Then you do another urea breath test to assess efficacy. If it is positive then he would start another round of quadratic therapy, but you would switch the macrolide antibiotic to a different one. If it is positive again then now you would go in and do a biopsy culture and assess the sensitivities and pick an antibiotic that works.
Prescriber's letter TRC
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