Treatment of H Pylori -Peptic Ulcer DiseaseTreatment of H Pylori -Peptic Ulcer Disease

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Prof. Hanan HagarProf. Hanan HagarDepartment of Physiology and PharmacologyDepartment of Physiology and Pharmacology

H Pylori Helicobacter pylori: Helicobacter pylori: is a spiral-shaped bacterium that accounts for more than 90%

of duodenal ulcers and up to 80% of gastric ulcers. causes chronic mucosal inflammation. produces enzymes that causes tissue damage and ulcer.

Helicobacter pylori in association with gastric mucosa

Helicobacter pylori Helicobacter pylori is the major etiological factoris the major etiological factor in peptic ulcer disease (PUD). in peptic ulcer disease (PUD). All individuals with PUD All individuals with PUD must be evaluated formust be evaluated for H. pylori.H. pylori.

Patients with H. pyloriPatients with H. pylori should be treated. should be treated. Eradication is important to prevent recurrence of ulcer.

How is an H. pylori-induced ulcer treated?

A combination of antibiotics and acid-reducing medicines is the most effective treatment. PPIs or H2 receptor blockers Antibiotics

Clarithromycin Tetracycline or amoxicillin Metronidazole if patient allergic to

penicillin. Bismuth subsalicylate (Pepto-Bismol).

Triple therapy

Is first-line therapy consisting of:1. Proton pump inhibitors (PPIs) 2. Clarithromycin3. Amoxicillin.

N.B. Metronidazole is substituted to amoxicillin for patients allergic to penicillin.

Quadruple therapy

(Bismuth-based regimen)

consisting of:1. Proton pump inhibitors (PPIs) 2. Bismuth subcitrate3. Metronidazole4. Tetracycline

Treatment should be Treatment should be initiatedinitiated with a proton with a proton pump inhibitor–based three-drug regimen.pump inhibitor–based three-drug regimen.

The selection of an HP eradication regimen The selection of an HP eradication regimen should be based on efficacy, safety, antibiotic should be based on efficacy, safety, antibiotic resistance and cost. resistance and cost.

If a second course of HP therapy is required, the If a second course of HP therapy is required, the regimen should contain different antibiotics.regimen should contain different antibiotics.

REGIMENDOSEDURATION

OmeprazoleMetronidazole

Clarithromycin

20 mg bid500 mg bid500 mg bid

10 to 14 days Omeprazole

AmoxicillinClarithromycin

20 mg bid1g bid

500 mg bid

OmeprazoleBismuth subsalicylate

MetronidazoleTetracycline

20 mg bid525 mg qid250 mg qid

500 mg qid

14 days

Bismuth subsalicylate

Mechanism of Action

1. It enhances mucosal protection by forming a coat over irritated mucosal surfaces that prevent effect of HCl.

2. Promote healing of ulcer.

3. Bactericidal effect against H pylori.

USES

1. Eradication of H. pylori.

2. Traveler's diarrhea

Adverse Effects

1. Black stool / Teeth discoloration.

2. Encephalopathy (in renal dysfunction).

3. Bismuth is radiopaque and may interfere with radiological examinations.

Summary Test for H. pylori prior to beginning therapy. Complete H. pylori eradication is required to

prevent relapse. Acid-reducing medications are prescribed in case

of PUD without H pylori infections. PUD with H pylori infections can be treated with Triple therapy

PPI’s + clarithromycin + amoxicillin Quadraple therapy

PPI’s + Bismuth + Metronidazole + tetracycline