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GI-Disorders    |  See also Dyspepsia  

Helicobacter pylori-associated Peptic Ulcers

Infection with H. pylori ( a spiral-shaped bacterium) is a necessary cofactor for the overwhelming majority of duodenal and gastric ulcers not associated with NSAIDs; more than 90% of patients with duodenal ulcer have H. pylori chronic gastritis.

After standard therapy with H2-antagonists or sucralfate, 70% to 85% of affected patients per year have a recurrence. One half of these are asymptomatic.

Patients with active ulcers should have antral biopsies taken at endoscopy. If histologic examination shows normal mucosa, NSAIDs or hypersecretory states are more likely possibilities than H. pylori infection. However, because approximately one half of patients taking chronic NSAID therapy who develop ulcers also have chronic H. pylori gastritis, the cause of the ulcer may be unclear.

DX of H. pylori:


§ The ONE WEEK  3-drug regimen is recommended as first-line therapy for eradication of H.pylori in patients who test positive:

  1. Amoxicillin 1 gm BID , or Metronidazole (Flagyl) 500 mg BID plus
  2. Clarithromycin (Biaxin) 500 mg BID, plus
  3. Pantoprazole (Protonix) 40 mg BID or Omeprazole (Prilosec) 20 mg  BID

The 10-day regimen with

The regimen a 14-day regimen of

Other FDA-approved Rx options (as of July 1998):

ACP Library on Disk 2- (c) 1997 - American College of Physicians   
Cleveland Clinic J of Med  Supplent 2 to Vol 72, May 2005

CDC Fact Sheet on H.Pylori       

Surgery to Cure the Zollinger-Ellison Syndrome NEJM 8-26-1999  


The Stool Antigen Test for Detection of Helicobacter pylori after Eradication Therapy
Ann Intern Med. Feb. 19, 2002;136:280-287  
A positive result on the stool antigen test 7 days after completion of therapy identifies patients in whom eradication of H. pylori was unsuccessful.