Helicobacter pylori: Difference between revisions
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===Triple Therapy=== | ===Triple Therapy=== | ||
*PPI plus clarithromycin 500mg twice daily, and [[amoxicillin]] 1000mg twice daily for 10-14 days | *PPI plus clarithromycin 500mg twice daily, and [[amoxicillin]] 1000mg twice daily for 10-14 days | ||
*If | *If penicillin allergic: PPI plus clarithromycin 500mg twice daily, [[metronidazole]] 500mg twice daily for 10-14 days | ||
==Disposition== | ==Disposition== | ||
Revision as of 15:14, 8 September 2016
Background
- H. pylori is a gram negative bacteria that causes gastritis, peptic ulcer disease, and gastric adenocarcinoma.
Clinical Features
- Epigastric abdominal pain
- Gastroesophageal Reflux Disease
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Evaluation
- Non-invasive Testing
- Urea Breath Testing
- Serology - ELISA
- Stool Antigen Assay
- Invasive Testing - Endoscopy
Management
- Though feasible in the ED[1], antibiotic therapy is typically not offered
- Beware of other causes of abdominal pain despite positive testing
Triple Therapy
- PPI plus clarithromycin 500mg twice daily, and amoxicillin 1000mg twice daily for 10-14 days
- If penicillin allergic: PPI plus clarithromycin 500mg twice daily, metronidazole 500mg twice daily for 10-14 days
Disposition
- Discharge with GI outpatient follow-up
See Also
External Links
References
- ↑ Meltzer AC, et al. Rapid (13) C urea breath test to identify Helicobacter pylori infection in emergency department patients with upper abdominal pain. WJ Emerg Med. 2013; 14:278-282.