In this post, I link to and excerpt from The Curbsiders‘ #322 H. Pylori Infection
FEBRUARY 21, 2022 By BETH GARBITELLI.*
*Garbitelli, B, Saffouri, G Williams PN, Watto MF. “#322 H. Pylori Infection”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list February 21, 2021.
All that follows is from the above outstanding resource.
Tips and tricks for healing up patients with helicobacter!
Say hi and bye to H. pylori infections! We review the basics of H. pylori screening, refresh your memory on testing basics, discuss treatment strategies, and talk through eradication testing with gastroenterologist Dr. George Saffouri (@gbsaff).
A special thanks to our listener Ana Maria Keilhauer Varona (@KeilhauerMa) of @UFMedu who pitched this episode. Her hard work formed the basis for our script!
H.Pylori Pearls
- Dr. Saffouri wants us to not use the term ‘gastritis’ off the bat for a symptomatic diagnosis! Gastritis is a histopathologic diagnosis that requires a biopsy showing inflammatory cell infiltrates (Shah 2021).
- Remember H. pylori is a carcinogen! It is a causative agent in gastric cancer and if found it needs to be treated, with confirmation of eradication.
- Approach screening with a mindset of global and cultural competence. While H. pylori is reported as ‘low prevalence’ in the United States, other global regions have higher prevalence. As such, some guidelines recommend screening in first-generation immigrants from high prevalence countries (El-Serag 2018).
- Avoid H. pylori serologies for identification of the organism; stick with stool antigen, urea breath test, or endoscopy with biopsy.
- Before testing, patients should be off of proton pump inhibitors (Crowe 2019), antibiotics, and probably H2 receptor antagonists for a month (per Dr Saffouri’s practice, the guidelines indicate 1-2 weeks off PPI and 4 weeks off antibiotics, Chey 2017).
- Do not use clarithromycin triple therapy! Given high rates of clarithromycin resistance, choose bismuth-based quadruple therapy.
