ABC of the upper gastrointestinal tract Management of Helicobacter pylori infection

摘要

This article discusses the current management of Helicobacter pylori infection in patients with dyspepsia with or without endoscopic abnormalities. We take an evidence based approach when possible and consider recent guidelines from national and international bodies pertaining to primary and secondary care.Duodenal ulcer disease In patients who are not taking non-steroidal anti-inflammatory drugs (NSAIDs) duodenal ulcer will be due to H pylori infection in 95 of cases, and eradication treatment can be prescribed without testing for H pylori. If there is any doubt about the diagnosis, such as a possible ulcer crater on a barium meal, endoscopic confirmation of duodenal ulcer and H pylori infection should be sought before prescribing treatment.H pylori eradication treatment, if successful, will be effective in curing the ulcer diathesis regardless of whether a patient is seen at the initial presentation of the disease or at a recurrence. Patients taking long term (maintenance) treatment with H_2 receptor antagonists or proton pump inhibitors should also be offered H pylori eradication treatment regardless of whether they are free of symptoms or still experiencing indigestion. In most cases eradication of H pylori cures the duodenal ulcer disease, and maintenance treatment can be stopped.