Helicobacter Pylori (cont.)
Why treat H. pylori?
Chronic infection with H. pylori weakens the natural
defenses of the lining of the stomach against the ulcerating action of acid.
Medications that neutralize stomach acid (antacids), and medications that
decrease the secretion of acid in the stomach (H2-blockers and proton pump
inhibitors or PPIs) have been used effectively for many years to treat ulcers.
H2-blockers, include ranitidine (Zantac), famotidine (Pepcid), cimetidine
(Tagamet), and nizatidine (Axid). PPIs include omeprazole (Prilosec),
lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and
esomeprazole (Nexium). Antacids, H2-blockers and PPIs, however, do not eradicate
H. pylori from the stomach, and ulcers frequently return promptly after these
medications are discontinued. Hence, antacids, H2-blockers or PPIs have to be
taken daily for many years to prevent the return of the ulcers and the
complications of ulcers such as bleeding, perforation, and obstruction of the
stomach. Eradication of H. pylori prevents the return of ulcers and ulcer
complications even after the medications are stopped. Eradication of H. pylori
also is important in the treatment of the rare condition known as MALT lymphoma of the
stomach. Treatment of H. pylori to prevent stomach cancer is controversial and discussed later.
How is H. pylori treated?
H. pylori is difficult to eradicate from the stomach because it is capable of
developing resistance to commonly used antibiotics. Therefore, two or more
antibiotics usually are given together with a PPI and/or bismuth containing
compounds to eradicate the bacterium. (Bismuth and PPIs have anti-H. pylori
effects.) Examples of combinations of medications that are effective are:
These combinations of medications can be expected to
cure 70%-90% of infections. However, studies have shown that resistance of H.
pylori (failure of antibiotics to eradicate the bacteria) to clarithromycin is
common among patients who have prior exposure to clarithromycin or other
chemically similar macrolide antibiotics (such as erythromycin). Similarly, H. pylori resistance to
metronidazole is common among patients who have had prior exposure to
metronidazole. In these patients, doctors have to find other combinations of
antibiotics to treat the H. pylori. Antibiotic resistance is another reason
why antibiotics should be used carefully and judiciously for the right reasons,
and indiscriminate use of antibiotics for improper reasons should be
discouraged.
Some doctors may want to confirm eradication of H.
pylori after treatment with a urea breath test or a stool antigen test,
particularly if there have been serious complications of the infection such as perforation or bleeding in the
stomach or duodenum. Endoscopic biopsies to determine eradication of the bacteria are not necessary, and
blood tests are not good for determining eradication since
it takes many months for the antibodies to H. pylori to decrease. The
best tests for determining eradication are the breath and stool tests discussed
previously. Patients who fail to eradicate H. pylori with treatment are retreated, often
with a different combination of medications.
Next: Who should receive treatment? »
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