7 responses to “Management of Helicobacter pylori in 2023: who should be tested, treated, and how”

  1. In Ontario h.pylori breath test and fecal testing is private pay rendering it inaccessible to the majority of newcomers especially the refugee population.
    We are left with serology which as pointed out will always remain positive.
    The proposed strategy of retesting for cure after treatment renders this even more challenging to use this approach.
    Otherwise a good overview and review.

  2. Thank you for this excellent TCMP! You specify that the PPI should not be stopped in patients with H Pylori confirmed PUD (and especially bleeding ulcers) until the infection is confirmed eradicated – but I presume one must stop the PPI for 14 days in order to completed a UBT or HpSAT to confirm successful treatment? i.e. continue a PPI for 8-12 weeks after the 14 day eradication period, and then stop it for 2 weeks prior to testing the patient again?

  3. I agree with the change to quad therapy as first line treatment.
    In Sask as well I believe it is not easy access to get the urea breath test, however, stool antigen is much more accessible.

    I am curious about the need to hold a PPI prior to the stool antigen or endoscopy as to what the percentage of equivocal results would be?

    For Joanne in Ontario, I do hope the province moves to cover at least stool antigen as a much less invasive way than endoscopy for getting results that are not private pay.

    If someone has ulcers confirmed by endoscopy my referral centre will treat empirically and after treatment will continue minimum 3 months of PPI

    I think as well telling patients the pill burden before they pick up the prescription is important to increase compliance as it is a lot of medications for two weeks to take, and I have had some people say they didn’t finish the course as it was to many pills!

    Very relevant TCMP, thank you!

  4. While I was practicing as a GP Anesthetist, and taking an NSAID for shoulder pain, I had a GI bleed. I was H Pylori positive on gastroscopy. I had the multi pill regime.

    Since then, if I have spicy pizza and/or a beer, I get some indigestion, and will take a PPI for a few days. Likely about 7 tablets per month, on average.
    Is being an anesthetist still considered a risk factor for IPylori infections?
    Begs the question of whether I should be worked up again.? Gastroduodenosopy. Or, whatever.

    KP born 1945.
    BSc (Hons. Chem) MD CCFP FCFP LM
    Clinical Associate Professor, Retired
    Department of Family Practice,
    Faculty of Medicine, University of BC

  5. Thank you- good update for current treatment approach – also should mention diet and eliminating caffeine – esp the AM caffeine – on empty stomachs

  6. Great presentation on current approach to treatment of H.pylori ; still dispense a lot of HP-PAC combos and occasionally get the Bi-QUAD therapy dispensed.

  7. Thanks for a great review of H Pylori testing and treatment. Will use the blister packs! I anticipate it will still be a challenge for me to differentiate patients with dyspepsia vs GERD. Any further tips on this?

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