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Treatment of H Pylori -Peptic Ulcer Disease By Prof. Hanan Hagar

Treatment of H Pylori -Peptic Ulcer Disease By Prof. Hanan Hagar Department of Physiology and Pharmacology. H Pylori Helicobacter pylori: is a spiral-shaped bacterium that accounts for more than 90% of duodenal ulcers and up to 80% of gastric ulcers.

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Treatment of H Pylori -Peptic Ulcer Disease By Prof. Hanan Hagar

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  1. Treatment of H Pylori -Peptic Ulcer Disease By Prof. Hanan Hagar Department of Physiology and Pharmacology

  2. H 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.

  3. Helicobacter pylori in association with gastric mucosa

  4. Helicobacter pylori is the major etiological factor in peptic ulcer disease (PUD). All individuals with PUD must be evaluated for H. pylori. Patients with H. pylori should be treated. Eradication is important to prevent recurrence of ulcer.

  5. 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).

  6. Triple therapy Is first-line therapy consisting of: • Proton pump inhibitors (PPIs) • Clarithromycin • Amoxicillin. N.B. Metronidazole is substituted to amoxicillin for patients allergic to penicillin.

  7. Quadruple therapy (Bismuth-based regimen) consisting of: Proton pump inhibitors (PPIs) Bismuth subcitrate Metronidazole Tetracycline

  8. Treatment should be initiated with a proton pump inhibitor–based three-drug regimen. • The selection of an HP eradication regimen should be based on efficacy, safety, antibiotic resistance and cost. • If a second course of HP therapy is required, the regimen should contain different antibiotics.

  9. Bismuth subsalicylate Mechanism of Action It enhances mucosal protection by forming a coat over irritated mucosal surfaces that prevent effect of HCl. Promote healing of ulcer. Bactericidal effect against H pylori.

  10. USES Eradication of H. pylori. Traveler's diarrhea Adverse Effects Black stool / Teeth discoloration. Encephalopathy (in renal dysfunction). Bismuth is radiopaque and may interfere with radiological examinations.

  11. 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

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