From the Guidelines
When explaining H. pylori to patients, it is crucial to use simple, clear language that focuses on what the infection is, how it affects them, and why treatment matters, as this approach has been shown to improve patient understanding and adherence to treatment 1. H. pylori (Helicobacter pylori) is a type of bacteria that can live in the digestive tract, specifically in the stomach lining. This bacteria can cause inflammation of the stomach lining, leading to symptoms like stomach pain, nausea, bloating, and sometimes loss of appetite. H. pylori is important because it can cause ulcers in the stomach or small intestine and, if left untreated, may increase the risk of stomach cancer in some people, with a lifetime risk of developing gastric cancer varying from approximately 0.6% to 22% 1. The infection spreads mainly through contaminated food, water, or direct contact with an infected person's saliva. Treatment typically involves taking two antibiotics (such as amoxicillin 1000mg twice daily and clarithromycin 500mg twice daily) along with a proton pump inhibitor (like omeprazole 20mg twice daily) for 7-14 days, which effectively eliminates the bacteria in most cases 1. Patients should complete the entire course of medication even if symptoms improve before finishing. After treatment, a breath test, stool test, or endoscopy may be performed to confirm the infection has been cleared. Explaining that H. pylori is common worldwide, with approximately half of the global population infected, and treatable helps reduce patient anxiety while emphasizing the importance of completing the prescribed treatment, as all major gastroenterological societies recommend that H. pylori be eradicated in individuals who test positive 1. Some key points to emphasize when explaining H. pylori to patients include:
- The bacteria can cause stomach inflammation, ulcers, and increase the risk of stomach cancer
- The infection is common worldwide and can be spread through contaminated food, water, or direct contact
- Treatment typically involves a combination of antibiotics and a proton pump inhibitor
- Completing the entire course of medication is crucial, even if symptoms improve before finishing
- Follow-up testing may be necessary to confirm the infection has been cleared.
From the Research
Explaining H. pylori to Patients
- H. pylori is a type of bacteria that can cause peptic ulcer disease and other gastrointestinal problems 2, 3.
- It is estimated that H. pylori infection is present in most cases of duodenal and gastric ulcers, and eradication of the bacteria can lead to "cure" of ulcer disease and prevention of ulcer complications 4.
- Patients can be tested for H. pylori using serologic tests or urea breath tests (UBT), but only UBTs can be used to confirm eradication 4.
Treatment Options
- The first-line recommended treatment for H. pylori eradication is a 1-week course of triple therapy with a proton pump inhibitor, clarithromycin, and amoxicillin, or metronidazole 4.
- Quadruple therapy, which adds amoxicillin to the triple regimen, has also been shown to be effective in eradicating H. pylori 5.
- Treatment choices may include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy, depending on the patient's specific situation and the presence of antibiotic resistance 2, 3.
Important Considerations
- Chronic use of NSAIDs in patients with H. pylori infection increases the risk of peptic ulcer disease, and recommended therapies for preventing PUD in these patients include misoprostol and proton pump inhibitors 2.
- Patients with gastric or duodenal ulcers associated with H. pylori should be treated with antibiotics to eradicate the infection and reduce the risk of complications and recurrence 3.
- Older persons are at higher risk of peptic ulcer disease due to high-risk medication use, including antiplatelet drugs, warfarin, selective serotonin reuptake inhibitors, and bisphosphonates 2.